bluuebunny/crossref_metadata_2025 huggingface dataset:
Subjective Vertical Conflict Theory and Space Motion Sickness
Authors: Chen Wei , Chao Jian-Gang , Wang Jin-Kun , Chen Xue-Wen , Tan Cheng
Published: January 2016

BACKGROUND: Space motion sickness (SMS) remains a troublesome problem during spaceflight. The subjective vertical (SV) conflict theory postulates that all motion sickness provoking situations are characterized by a condition in which the SV sensed from gravity and visual and
idiotropic cues differs from the expected vertical. This theory has been successfully used to predict motion sickness in different vehicles on Earth.METHOD: We have summarized the most outstanding and recent studies on the illusions and characteristics associated with spatial disorientation
and SMS during weightlessness, such as cognitive map and mental rotation, the visual reorientation and inversion illusions, and orientation preferences between visual scenes and the internal z-axis of the body.RESULTS: The relationships between the SV and the incidence of and susceptibility
to SMS as well as spatial disorientation were addressed.CONCLUSION: A consistent framework was presented to understand and explain SMS characteristics in more detail on the basis of the SV conflict theory, which is expected to be more advantageous in SMS prediction, prevention,
and training.Chen W, Chao J-G, Wang J-K, Chen X-W, Tan C. Subjective vertical conflict theory and space motion sickness. Aerosp Med Hum Perform. 2016; 87(2):128–136.
New records of Trichoceridae (Diptera) from the island of Mallorca ​
Authors: Petrašiūnas Andrius , Kvifte Gunnar
Published: January 2016

The Trichoceridae are a small family distributed mainly in the Holarctic Region, most of which are associated with cold seasons and even snow. From the Iberian peninsula, 5 species have been recorded; however only a single previous occurence record exists from the Balearic islands.

In this paper we present new records of two species from Mallorca, of which Trichocera (Saltrichocera) saltator (Harris, 1776) has not previously been recorded from the Balearic islands. Trichocera (Saltrichocera) annulata Meigen, 1818 is recorded for the first time from Mallorca. We furthermore discuss the species' distributions within the Mediterranean region and report new morphological data for the Mallorca island form of T. saltator.
A Gift to Self: Leadership Coaching
Authors: Bleich Michael R.
Published: January 2016

In this article, the distinction between mentoring, therapy, and coaching is made, with a focus on the value of leadership coaching. Seven attributes to consider when selecting a coach and a framework describing the value proposition for retaining a coach are presented.

J Contin Educ Nurs.
2016;47(1):11–13.
Protogrammus alboranensis n. sp. (Teleostei: Callionymidae), a new species of dragonet from the Alboran Sea, western Mediterranean Sea
Authors: Farias Carlos , Ordines Francesc , García-Ruiz Cristina , Fricke Ronald
Published: January 2016

Protogrammus alboranensis n. sp. is described on the basis of four specimens from the Alboran Sea, western Mediterranean Sea. It is characterized within the genus Protogrammus by a total of nine unbranched rays on the second dorsal fin, eight unbranched rays on the anal fin, a very small preopercular spine with an upcurved main tip and one point on the dorsal margin, which is lacking an antrorse spine at the base, the first and second spines of the first dorsal fin filamentous and much longer than the first ray of the second dorsal fin in males, the tip of the last ray of the second dorsal fin reaching beyond the caudal fin base in males, and the anal fin distally black in the males (translucent in females). A key to the species of Protogrammus is presented; the zoogeography of the species is discussed.
Assessing the impact of spear fishing by using competitions records and underwater visual censuses
Authors: Pita Pablo , Freire Juan
Published: January 2016

Recreational fishers are increasingly competing for space and resources with commercial fishers worldwide, but have been poorly studied. In particular, the impacts of spearfishing competitions on the temperate fish assemblages have seldom been analysed. In Galicia (NW Spain), there are currently 5000 spear fishers, and 500 of them participate in spearfishing competitions. An historic archive of spearfishing competitions was used to assess their influence on the subsequent competitions in the area and to analyse their effect on the fish abundances estimated by underwater visual censuses. The annual recreational catch of the spear fishers was also estimated and comparisons with the commercial landings were performed. The spear fishers targeted 29 species, although six accounted for 95% of the catch. Most of the species show low vulnerabilities to fishing pressure and only Dicentrarchus labrax, among frequently caught species, can be considered as moderately vulnerable. The overall impact of spearfishing competitions on fish populations was limited, although some competitions temporarily reduced the abundances of Labrus bergylta, the main target species, by up to 83%. Spear fishers caught a large proportion of the total catch of common species, with recreational catches of some species (e.g. L. bergylta) matching or exceeding the commercial catch. The inclusion of this fishery in the management models of the coastal ecosystems is strongly recommended.
Advances in the Treatment of Dilated Cardiomyopathy
Authors: Purcell Julia Ann
Published: January 2016

The nursing care of the patient with dilated cardiomyopathy focuses on (1) improving right and left heart function, i.e., titrating vasoactive drugs to maintain acceptable cardiac index with minimum side effects (and/or monitoring the operation of a left ventricular assist device when left heart function is refractory to vasoactive drugs), (2) reducing cardiac filling pressures with diuretics, vasodilators, and/or restriction of dietary sodium, oral and IV fluids, (3) maintaining optimum oxygenation, (4) preventing complications associated with either the disease or treatment, and (5) assisting the patient/family to maintain hope during the often lengthy and crisis-filled wait for a donor heart. The critical care nurse is challenged, often for weeks or months at a time, by the complexity of this patient’s physical and emotional needs and functions in a collaborative role with the entire health team in an attempt to maintain both cardiovascular and psychological stability until a donor heart is available.
Retrograde Coronary Sinus Perfusion: A New Approach to Cardioplegia Delivery
Authors: Monsein Sheri , Constancia Patria
Published: January 2016

Retrograde coronary sinus perfusion is a technique being used to deliver cardioplegia during cardiac surgery. This article reviews the history behind its use, the procedure for delivery, and the advantages and limitations that exist in comparison with the standard antegrade infusion of cardioplegia via the aortic root. The complications resulting from the technique of retrograde coronary sinus perfusion are rare. Nursing considerations specific to the potential complications of this patient population are discussed.
Techniques in Cardiac Care: Lasers, Stents, and Atherectomy Devices
Authors: Halfman-Franey Marsha , Coburn Cathy
Published: January 2016

Various new technologies are currently being investigated to treat cardiovascular disease less invasively than with conventional open heart surgery. Although lasers have been used in other health disciplines, their use in the cardiovascular field is relatively new. Even newer is the use of atherectomy devices and endovascular stents. It is important for the critical care nurse to be knowledgeable concerning these techniques in order to provide optimal patient care.
The Critical Care Nurse’s Role in the Noninvasive Assessment of Myocardial Reperfusion
Authors: Kleven Marlene R.
Published: January 2016

Thrombolytic therapy is rapidly becoming the standard of care for the treatment of acute myocardial infarction (AMI). The goal of thrombolytic therapy is clot dissolution in the infarct artery that results in re-establishing blood flow to affected ischemic myocardium. Confirmation of the occurrence of reperfusion can only be established by direct visualization of the coronary artery. Clinical reperfusion markers (dysrhythmias, chest pain relief, ST segment normalization, CK peak values) have also been associated with myocardial reperfusion. These markers are noninvasive and are routinely relied on in the clinical setting. However, a review of the literature reveals that the noninvasive reperfusion markers individually lack reliability in successfully predicting reperfusion status. Because of the importance of establishing the success of reperfusion therapy early in the treatment of AMI, it is critical that the nurse at the bedside be aware of the criteria that can be established to improve the reliability of the reperfusion markers and their limitations.
Limiting Care: Should Age Be a Criterion?
Authors: Reigle Juanita
Published: January 2016

The rising costs of health care coupled with the dramatic increase in the number of individuals over the age of 65 years presents the health care industry with the dilemma of an increased demand for services and goods, with limited resources. Physicians, economists, and ethicists have suggested various solutions to this problem, including the controversial proposal strongly advocated by Daniel Callahan, of age-based rationing. This article explores some of the issues that are woven into the allocation of health care resources based on age. Although there are no easy answers to this dilemma, the critical care nurse needs to be familiar with these issues to function effectively as a patient advocate. Some suggestions to enhance this aspect of critical care nursing will also be discussed.
Pulse Oximetry: Application in the Pediatric and Neonatal Critical Care Unit
Authors: Salyer John W. , Lewis David D.
Published: January 2016

The use of pulse oximetry in the pediatric and neonatal intensivc care units has grown tremendously in recent years. Opinions about this growth are divergent. Arriving at a generalized statement about the accuracy of pulse oximeters is difficult, but it has generally been found to be acceptably accurate in most patient populations under most conditions. However, there are limitations to its application. Pulse oximetry accuracy can be adversely affected by elevated levels of certain abnormal hemoglobin varieties as well as motion artifact and low peripheral perfusion. Some authors suggest a caveat against the use of pulse oximetry to prevent hyperoxemia in the neonatal population, whereas others suggest it is an important advancement. The affect of the use of pulse oximetry on respiratory morbidity and mortality has not been established, and suggestions that all mechanically ventilated patients should be continuously monitored are unsubstantiated
Extracorporeal Membrane Oxygenation: Current Use and Future Directions
Authors: McDermott Beth Kaplan , Curley Martha A. Q.
Published: January 2016

Extracorporeal membrane oxygenation (ECMO) is the process of using prolonged cardiopulmonary bypass to support patients with reversible respiratory and/or cardiac failure who are refractory to maximal conventional therapy. This process has been used extensively for critically ill neonates, with encouraging results. The use of ECMO in the pediatric population has been limited but is increasing. The history, mechanics, and current applications of ECMO are discussed in this article. Critical care nursing management of the pediatric or neonatal ECMO patient focuses on optimizing recovery of the pulmonary and/or cardiac system while preventing complications. A case study of a pediatric ECMO patient is presented which illustrates the complex nursing care issues related to use of this intervention. Future directions for ECMO are addressed
Wound Healing in the Surgical Patient: Influence of the Perioperative Stress Response on Perfusion
Authors: West Judith M.
Published: January 2016

The clinical effect of surgical stress created by pain, cutting, cold, fear, and hypovolemia is peripheral vasoconstriction which limits wound perfusion and oxygenation and impairs wound healing. Correction of all factors as simultaneously as possible is the goal
Occurrence Screening in Critical Care
Authors: Kapner Peggy
Published: January 2016

Occurrence screening is a system of quality assurance in which patient care is reviewed, both concurrently and retrospectively, against a set of general outcome screening criteria. It is a method for monitoring the quality of clinical practice more comprehensively that has been possible in the past. If implemented appropriately, occurrence screening eliminates the random efforts and audits of past quality assurance efforts with a systematic and comprehensive monitoring process aimed at identifying questionable quality of care practices. This article discusses the concept of occurrence screening as a useful tool in assessing quality of care in a special care unit
Patient Education as a Quality Indicator in Critical Care: Ischemic Heart Disease—Recognition and Response
Authors: Arnoldussen Barbara , Coppin Klm , Schott Laurel
Published: January 2016

Medical critical care unit (MCCU) nurses at a VA medical center designed a quality assurance monitor for educating cardiac patients. Patients with a diagnosis of rule-out myocardial infarction are interviewed about their preadmission use of nitroglycerin and entry into emergency treatment facilities. The MCCU nurses teach a five-point “ischemic heart disease—recognition and response” lesson, and ascertain the patient’s immediate level of understanding. If the patient returns to the MCCU at a later date, nurses record the appropriateness of his use of nitroglycerin and entry into emergency treatment facilities. Thus, both short- and long-term gains in patient knowledge are assessed. Solutions to problems encountered in the quality assurance monitor implementation process are discussed. Benefits of the project to patients, the nursing department, and other departments are identified. A sample monthly report and the monitor data collection tool illustrate the process. Future directions for patient education efforts in the MCCU are outlined
Implementing a Quality Assurance Program at the Unit Level in Intensive Care: Essential Elements for Successful Implementation
Authors: Stevens Bernice
Published: January 2016

Implementing a quality assurance program at the unit level in intensive care can be accomplished smoothly if certain key elements are included in the implementation process. For the program to be successful, all of these elements are essential
Strengthening Nurse-family Relationships in Critical Care
Authors: Artinian Nancy Trygar
Published: January 2016

Establishing relationships with families in critical care is an essential part of high quality care. Critical care nurse-family relationships are important to the patient and family and also benefit the nurse. Thus, nurse-family relationships should be started when families first enter the critical care environment. Cooperative and collaborative relationships require negotiation and must consider the needs of the family as well as the nurse. Barriers need to be overcome before critical care nurse-family relationships can develop. Possible barriers include limited time, perceptions that families are stressors, dysfunctional response styles, and premature judgments. Essential qualities of successful relationships include: trust, respect, empathy, warmth, sensitivity, and touching, when appropriate. Each of these qualities is dependent on the verbal and nonverbal skills of the critical care nurse. As with anything worthwhile, relationship skills take practice to develop, involving a commitment to the importance of nurse-family relationships in critical care
Different Perspectives: The Effect of Heart Disease on Patients and Spouses
Authors: Marsden Celine , Dracup Kathleen
Published: January 2016

Nurses working in critical care units play an important role in helping patients and their families cope with illness. In this article, heart disease is used as a paradigm for discussion of the coping processes of patients and families as they adapt to an acute event. Patients and spouses demonstrate different but equally important responses that may increase marital conflict and impede recovery. The denial frequently used by patients is in direct contrast to the oversolicitousness demonstrated by spouses. Early assessment of potential family dysfunction is essential in order to plan and implement interventions that promote family coping. In this article, the interventions available to nurses working with families in an acute care setting are reviewed. Interview data from one study of cardiac patients and their spouses is used to illustrate the family dynamics seen in the acute and chronic phase of recovery and to provide examples of the couples’ differing perspectives on the helpfulness of various interventions
“Take Heart …”—Developing Support Sessions for Families of Acutely Ill Cardiac Patients
Authors: Schigoda Mary G. , Hook Mary L.
Published: January 2016

The diagnosis of a cardiac illness and subsequent adjustment to a permanently altered lifestyle have profound impact on patient and family. Nurses are in a key position to support the cardiac family during crisis and assist them in recovery. Within the group environment, the nurse can clarify perceptions of the cardiac event, explore alternative coping strategies, and facilitate the development of new social supports. This article describes the development of “Take Heart…” cardiac family support sessions at St. Luke’s Medical Center, Milwaukee, Wisconsin. It focuses on assessment, planning, implementation, and evaluation strategies with recommendations for future research
Standardizing the Weaning Process
Authors: Calhoun Carolyn J. , Specht N. Lennard
Published: January 2016

The goal among critical care staff of discontinuing mechanical support in a prudent and expeditious manner emerges immediately after intubation. This goal, known as the weaning process, contains the three phases of optimizing the patient’s condition, assessing and evaluating the patient’s progress, and diagnostic testing. As a diagnostic test, the wean trial needs to be standardized for efficiency and safety. To maximize safe and efficient delivery of the trial, the primary nurse and respiratory therapist should be the responsible professional monitors. The standardized trial enhances staff confidence for safe extubation. A successful standardized weaning protocol eases the transition from mechanical ventilation to spontaneous breathing for the patient and improves the professional performance and confidence of critical care staff
Thermo Cardiosystems Left Ventricular Assist Device as a Bridge to Cardiac Transplant
Authors: Abou-Awdi Nancy L.
Published: January 2016

In 1986, clinical trials were initiated with a left ventricular assist device capable of supporting individuals in end-stage heart disease for extended periods of time (longer than 14 days). While supported by this device, patients were hemodynamically stabilized for future transplant and were afforded an opportunity to improve their overall health status. At initiation of support these patients were in New York Heart Association class IV, and within approximately 2 weeks, improved to class I. Their nutritional status improved, they were able to exercise regularly, and they became the “healthiest” candidates for cardiac transplant. Nursing care of a patient requiring the HeartMate provides the critical care nurse with new challenges
The ABIOMED BVS 5000 System
Authors: Dixon John F. , Farris Charlotte D.
Published: January 2016

The ABIOMED BVS 5000 system is an investigational pulsatile biventricular assist device. Positioned externally, pneumatically driven two-chambered blood pumps can support one or both sides of the heart. A single console automatically adjusts beat rate and systolic/diastolic ratio based on compressed air flow into and out of the external system. Transthoracic cannulae connect the external system with the patient. Two patient groups are currently approved for BVS investigational use: post-cardiotomy ventricular dysfunction and post-acute myocardial infarction with cardiogenic shock. Established research protocols are followed with regard to data collection. Potential adverse effects fall into three categories: patient related, device related, and cause unknown. Weaning is initiated during cardiac recovery, and if it is successful, the pump is removed. Nursing care is based on standards of care for cardiac surgery coupled with the ABIOMED BVS 5000 nursing protocol
The Cutting Edge: Neurotransmitters and Brain Tissue Transplant
Authors: Carroll V. Susan
Published: January 2016

Neural tissue transplant represents one of the most exciting and controversial areas of current basic neuroscience research. It offers enormous therapeutic promise for patients with degenerative and traumatic neurologic disorders. This article reviews the functions of several common neurotransmitters and examines the clinical applications of tissue transplant into the human nervous system
Adverse Psychologic Responses of the Elderly to Critical Illness
Authors: Foreman Marquis D.
Published: January 2016

Afflicting as many as 80% of critically ill elderly (older than 65 years) patients, adverse psychologic reactions (e.g., acute confusional states) to critical illness and its treatment present a unique challenge to medical and nursing intensive care practitioners. Additionally, the consequences of these adverse psychologic reactions financially strain health-care organizations, placing additional constraints on the delivery of health-care services. This article presents information regarding the origins of these adverse psychologic reactions and nursing strategies for the prevention, identification, and management of these clinical states. With such information, nurses who work in critical care units may be better equipped to identify and care for patients at risk of or experiencing an adverse psychologic reaction to critical illness
Care of the Elderly Mechanically Ventilated Patient: Preserving the Fragile Environment
Authors: Stiesmeyer Johanna K.
Published: January 2016

Caring for the elderly mechanically ventilated patient is a challenging and increasingly frequent clinical situation confronting critical nurses. The key complications and states to which the elderly patient is particularly susceptible are nosocomial pneumonia; congestive heart failure; malnutrition; reactions to medications, especially antibiotics, morphine sulfate, and Valium; changes in mental status, and pneumothorax. These can significantly contribute to multisystem deterioration. It is unclear which mode of ventilation is best for sustaining the patient during the course of illness or the weaning process. It is critical to recognize the assessment indicators of failed weaning. Paramount in this assessment are rapid shallow breaths, change in blood pressure of 20 mmHg, change in respiratory rate of more than 10 breaths per minute, tidal volume of less than 250 to 300 mL, a minute ventilation with an increase of 5 L/minute, and an oxygen saturation of less than 90% per pulse oximeter. Research in these areas is needed
Trauma and the Elderly: The Impact on Critical Care
Authors: Rauen Carol A.
Published: January 2016

The population older than age 65 is growing rapidly. This change in the demographics of our nation is impacting critical care in many ways. Most researchers have found that trauma patients older than 65 have a higher mortality rate, longer hospital stays, more complications, common mechanism of injuries, and poorer outcomes than their younger counterparts. These facts must be taken into consideration when planning care for the elderly trauma patient population. This paper will review the research literature on elderly trauma victims and the impact these patients are having on critical care practice
Atrioventricular Block
Authors: Cross Jean A.
Published: January 2016

The presentation of atrioventricular block in the critical care setting and the assessment parameters that the critical care nurse may use to aid in the determination of the severity of atrioventricular block are described. The underlying pathophysiology of atrioventricular block is examined to enhance the nurse’s understanding of the rationale for intervention versus observation
The Electrocardiogram during Myocardial Infarction
Authors: Menzel Linda K.
Published: January 2016

The electrocardiogram during myocardial ischemia, injury, and infarction produces classic changes in the QRS complex, ST segment, and T wave. These changes arc easily recognized and, with results of serum isoenzymes, physical assessment, and the patient’s history, aid in diagnosis. This article reviews the changes that occur on the electrocardiogram beginning with a brief review of normal depolarization and repolarization and ending with changes seen in various types of myocardial infarctions
The Use of Atrial Electrograms in the Diagnosis of Supraventricular Dysrhythmias
Authors: Dziadulewicz Laurel , Lang Rita
Published: January 2016

Temporary epicardial pacing wires are frequently used to perform atrial electrograms in patients after cardiac surgery. This article reviews Einthoven’s triangle and describes a method of obtaining and evaluating atrial electrograms. Examples of specific dysrhythmias and nursing diagnoses relating to atrial wires are also described
Nitrates
Authors: Kuhn Merrily
Published: January 2016

Nitrates have been used for the last 130 years to treat and control the symptoms of angina pectoris. Within the last 15 years, nitrates also have been shown to limit infarct size and to be beneficial in the treatment of patients with severe intractable heart failure, cardiogenic shock, severe mitral and aortic regurgitation, hypertensive episodes, and portal hypertension. The adequate use of nitrates to treat these disorders requires the ability to document a hemodynamic response and to closely monitor the adverse consequences of this therapy. Nitrates work by directly relaxing smooth muscle in resistance and capacitance vessels, thereby causing generalized dilation. Nitrates reduce preload and, at higher doses, reduce systemic vascular resistance and afterload. This chapter reviews the physiologic mechanisms that underlie nitrate therapy, the appropriate indications for nitrate use, the usefulness of specific agents, and their appropriate nursing implications
Calcium Channel Blockers
Authors: White Pamela
Published: January 2016

Calcium channel blockers are widely used in the treatment of ischemic heart disease, hypertension, and supraventricular tachycardia. The prototype agents, verapamil, nifedipine, and diltiazem, represent three classes of calcium channel blockers, each of which has different pharmacologic effects. Nifedipine and the other dihydropyridines primarily are vasodilators and have no clinical effects on cardiac conduction or contractility. Diltiazem and verapamil also are vasodilators, but they possess, to varying degrees, negative inotropic, chronotropic, and dromotropic effects. Side effects of these drugs are relatively rare and usually not serious, with the exception of potential conduction disturbances and heart failure in patients with underlying cardiac disease. To assess patients taking these medications and provide the necessary teaching, the nurse needs an understanding of the pharmacologic properties, clinical indications, and potential adverse effects of the various drugs
Lipid-lowering Drugs
Authors: Milander Melinda M. , Kuhn Merrily
Published: January 2016

Controlling hyperlipidemia is an important aspect in the treatment and prevention of coronary artery disease. This article provides the clinician with a general reference for currently used lipid-lowering agents. Lipoproteins present in the plasma are defined and a brief overview of their functions is presented. Normal lipid uptake from the intestine and normal lipid metabolism are discussed to provide a basis for an understanding of the pharmaceutical treatment of hyperlipidemia. Guidelines are reviewed for interpreting lipid profiles according to the National Cholesterol Education Program. An evaluation of the agents currently used to treat hyperlipidemia is included. Lipid-lowering agents cause alterations in liver function; therefore, patients taking these medications are monitored closely. Patient teaching, including adverse effects of the medications, diet therapy and other alterable risk factors, is also reviewed
Hypertension: Current Trends and Choices in Pharmacotherapeutics
Authors: Deglin Judith Hopfer , Deglin Stuart
Published: January 2016

Many new choices exist in the management of hypertension. Armed with a basic understanding of the definition and causes of hypertension, the pharmacotherapeutics, and special patient populations, health care professionals should be able to optimally educate, treat, and follow up patients with hypertension. In the step-care approach, four different classes of agents may be used as Step 1 choices. Selection is determined by concurrent illnesses, patient age, or concomitant drug therapy. In emergency situations, additional choices exist. Tailoring therapy in hypertensive crises may prevent or minimize end-organ damage. These areas are reviewed, and guidelines for patient assessment and education are presented
Acute Hemodialysis: Issues in the Critically Ill
Authors: Peschman Patricia
Published: January 2016

Hemodialysis is a commonly used therapy for renal failure in critically ill patients. This article reviews components of the hemodialysis system, including vascular access, and provides an explanation of principles underlying the hemodialysis process. Expected patient responses and potential complications of hemodialysis therapy are emphasized. Critical care nursing interventions for the care of patients before, during, and after dialysis also are outlined
Hepatorenal Syndrome
Authors: Mudge Christine , Carlson Laurie
Published: January 2016

The exact physiologic mechanism of the hepatorenal syndrome remains unclear; however, it always develops in the presence of liver failure. A number of theories have been postulated to explain the syndrome, which are discussed in this review. None of the proposed theories is able to explain the syndrome completely, and continued research is necessary. Management of hepatorenal syndrome is directed at supporting the patient and maintaining/ restoring hepatic function to prevent further renal damage. Liver transplantation has been considered an effective method of treatment for this patient population. Nursing care is supportive and focuses on maintaining the patients’ internal environment and psychologic well-being
Fluid and Electrolyte Imbalances After Cardiac Surgery
Authors: Vaska Patricia L.
Published: January 2016

Patients having cardiac surgery experience a myriad of fluid and electrolyte disorders. Cardiopulmonary bypass (CPB) can cause multiple physiologic alterations, including electrolyte disturbances, acid-base imbalances, atelectasis, diminished pulmonary compliance, hemolysis, and thromboembolism. Cardioplegic solutions and induced hypothermia impose alterations in potassium metabolism and pH. The stress of surgery increases catecholamine circulation and augments antidiuretic hormone release, both of which affect fluid and electrolyte equilibrium. Dilution of the circulating blood volume from pump perfusate and volume resuscitation with crystalloid and colloid solutions produce fluid, electrolyte, and hemostatic disorders. Nonpulsatile flow produced by CPB can alter renal function. This article describes the metabolic alterations that are iatrogenically produced by cardiac surgery and the nursing and medical therapies aimed at correcting such alterations
Adrenocortical Insufficiency in the Critically Ill Patient
Authors: Epstein Carol Diane
Published: January 2016

The fluid and electrolyte imbalances associated with adrenocortical failure affect multiple physiologic systems in the critically ill patient. Because of its widespread effect, the objective signs of adrenocortical failure may escape recognition. In the context of shock states affecting the function of multiple organs that have been previously diagnosed, empirical evidence suggesting the presence of adrenal insufficiency may be attributed to the primary diagnosis and illness. However, it is most important that critical care nurses question whether adequate adrenal function is present. When effective patient assessment and management are standard components of care, adrenocortical dysfunction may be reversed, while failure to assess for signs of adrenal insufficiency may lead to irreversible patient outcomes. This paper describes phenomena of adrenocortical failure in critically ill patients and presents the problems of fluid and electrolyte imbalance that accompany them
Implementing Managed Care in a Pediatric Setting
Authors: Barnsteiner Jane H. , Mohan Anne , Milberger Pam
Published: January 2016

A challenge in the current nursing environment is the ability to provide care cost-effectively and yet achieve desired patient outcomes. The managed care delivery system facilitates achievement of these goals. The system incorporates management of time, resources, and personnel so that patient outcomes are achieved within appropriate time frames. This article describes the design and implementation of a managed care delivery system in a children’s hospital
Use of Patient Care Extenders in Critical Care Nursing
Authors: Cardin Suzette , Kane Sandra , Koch Kathleen
Published: January 2016

This article explores the implementation and use of patient care extenders in two critical care units. Experimentation and diversity in changing the care-delivery system were the forces motivating the management team to redesign the existing nursing care-delivery system. The impetuses for the change process were the use of the role of the registered nurse and cost containment. Two case studies will illustrate from a practical perspective how the change occurred. Although the same nurse manager was responsible administratively for the two units, the patient care extender models were implemented differently. This was based on the conviction that each unit is unique with regard to patients and staff needs. The first case study occurred in an 18-bed cardiac telemetry unit in which the patient extender care model was integrated with direct patient care activities of the unit. In the second case study, which occurred in a ten-bed cardiac care unit, the patient care extender was integrated with indirect patient care activities. The approach to this article is practical, and it is intended for units that may be dealing with these issues in these changing times in health care
Bedside Electrocardiogram Monitoring
Authors: Drew Barbara J.
Published: January 2016

A recent national survey of critical care nurses reveals that the leads many nurses select to monitor their patients are diagnostically inferior to other available leads, and that lead placement often is inaccurate. This article reviews the best leads for electrocardiographic (ECG) monitoring, illustrates their accurate placement, and explains reasons for the dilemma in current practice. Questions relevant to practicing nurses are addressed, including 1) Is lead MCL1 as good as V1? 2) When is it appropriate to substitute lead MCL1 for V1? and 3) How important is it for electrodes to be placed exactly in specific anatomic locations? Finally, a case study is provided to illustrate how accurate monitoring can prevent misdiagnosis and resultant inappropriate therapy
Monitoring Body Temperature
Authors: Holtzclaw Barbara J.
Published: January 2016

Vigilant and accurate assessment of thermal balance is imperative with the critically ill. Disease, injury, or pharmacologic activity can impair thermoregulation, leaving patients vulnerable to uncontrolled gain or loss of heat. Body temperature provides cues to onset of infection, inflammation, and antigenic responses, as well as indicating efficacy of treatment. With knowledge of heat transfer principles, physiologic processes that distribute body heat, and principles of thermometry, the nurse is better equipped to make reasoned clinical judgment about this important vital sign. Choices of instruments or measurement sites are influenced by needs to estimate either hypothalamic temperature or shifts in body heat. Need for continuous versus episodic assessment, availability or intrusiveness of equipment, and stability of the patient also influence choices. Monitoring devices, measurement sites and techniques, equipment limitations and precautions are discussed. Interpretation and application of assessment findings are presented as they relate to abnormally high or low temperatures, patterns of fever, and temperature gradients
Physiologic Monitoring of Infants and Children
Authors: Webster Holly , Chellis Mary Jo
Published: January 2016

Accurate and safe monitoring of infants and children requires knowledge of their unique physiology, especially cardiovascular function, pulmonary physiology, and metabolic function. These individual features influence the equipment selection, as well as data interpretation. Although some adult equipment is adaptable for pediatric use, many specifications must be tailored to pediatric needs. Vascular monitoring in pediatric patients requires specific knowledge of insertion procedures and complications, fluid maintenance, and hemodynamic norms, indexed to body surface area. Valid data interpretation requires an understanding of the distinctive clinical responses intrinsic to the pediatric patient. Likewise, maintenance care for pediatric patients always includes attention to precise fluid balance, thermoregulation, and metabolic needs. Finally, all pediatric patients require constant vigilance to protect the integrity of their monitoring systems and, ultimately, the safety of these patients. Failure to address these concerns may result in complications or invalid data
Current Perspectives on Prosthetic Heart Valves and Valve Repair
Authors: Fitzgerald Carmel A.
Published: January 2016

The quest for the ideal cardiac valve substitute represents a highly categorized goal for the cardiac surgical community. Ongoing research has resulted in the development and creation of multiple newer heart valves and techniques for valve repair. Each of the many valves commercially available possesses a wide array of features. With the expansion of research investigations, improvement in long-term management can be translated and incorporated directly into patient care. As valvular replacement and repair/reconstruction surgery become more commonplace, it is paramount for nurses to be knowledgeable regarding the critical components of care
The Economics of Cardiac Surgery
Authors: Evans S. Ann
Published: January 2016

The coronary artery bypass graft (CABG) is the most costly single surgical procedure in the United States, making bypass surgery a key target for cost containment in the current health care reform environment. This article highlights the relationship between risk factors and costs and describes some of the current initiatives aimed at cost containment and quality enhancement
The Midlevel Practitioner Role: One Medical Center’s Experience
Authors: Burkholder Judith S. , Dudjak Linda A.
Published: January 2016

Numerous trends in the current health-care environment have converged to produce an increased emphasis on the role of the midlevel practitioner. Financial constraints head the list, including a mandate for the best care at the lowest rates and a resulting shift from costly specialists to primary care providers. The desire to conserve human and technologic resources requires a practitioner with advanced knowledge and skills to serve as gatekeeper in terms of facilitating access to health care, establishing efficient referral patterns, and developing a holistic care plan. The midlevel practitioner also is prepared to facilitate the transition from the intensive care unit to the less costly general care areas. In addition, the inevitable reduction in funds for graduate medical education and the dwindling number of first-year medical students choosing internal medicine as a specialty threaten the ability of academic medical centers in particular to provide adequate housestaff coverage to full-time and voluntary faculty members. Physicians eager to provide efficient, seamless care to patients in the acute care setting, while maintaining an office practice and caseloads at several hospitals, find the support provided by a midlevel practitioner an enhancement to their clinical practice and a solution to the continuous management of acute and chronically ill patients. In this article, the authors describe one medical center’s experience in implementing the midlevel practitioner role.
Geropharmacology
Authors: Ferrario Catherine G.
Published: January 2016

In the first part of this 2-part continuing education series, sources of medication errors were discussed. A predominant source of errors was the prescribing of potentially inappropriate medications for older adults. In this second part, drug classifications and drugs posing problems for older adults and cautions for advanced practice acute care and critical care nurses in their medication therapy management are highlighted. Cautions are advanced for anticholinergics, antihypertensives, analgesics, and psychotropics because of the severity of adverse reactions, including anticholinergic symptoms; mental status changes (especially confusion, sedation, delirium, and cognitive impairment); orthostatic hypotension; gastrointestinal tract problems (especially hemorrhage); depression; and neurobehavioral disturbances (agitation and aggressiveness). Risks of life-threatening outcomes associated with medications and adverse reactions are highlighted.
Challenges in Conducting End-of-Life Research in Critical Care
Authors: Wiegand Debra Lynn-McHale , Norton Sally A. , Baggs Judith Gedney
Published: January 2016

Critical care units present some unique challenges to the researcher, especially when the research topic of interest is related to end-of-life care. The purpose of this article is to address some of the methodological and practical issues related to conducting end-of-life research in the critical care setting. Recruitment barriers include gaining access to a clinical site, gaining access to patients, and prognostic uncertainty. Additional barriers include challenges related to informed consent, data collection, the research team, and ethical considerations. Strategies are described that can be used to guide researchers to conduct end-of-life research successfully in critical care.
Design, Analysis, and Interpretation of Method-Comparison Studies
Authors: Hanneman Sandra K.
Published: January 2016

Clinicians often need to know whether a new method of measurement is equivalent to an established one already in clinical use. This article reviews the methodology of a method-comparison study to assist the clinician with the conduct and evaluation of such studies. Temperature data from 1 subject are used to illustrate the procedures. Although one would not make decisions on the basis of the findings from 1 subject, the large number of paired measurements in the data set permits its use for illustrative purposes. Currently available software eliminates the need for tedious statistical computation but does not reduce the burden of understanding the concepts underlying a method-comparison study and accurate interpretation of the findings.
Selecting a Model for Evidence-Based Practice Changes
Authors: Gawlinski Anna , Rutledge Dana
Published: January 2016

Evidence-based practice models have been developed to help nurses move evidence into practice. Use of these models leads to an organized approach to evidence-based practice, prevents incomplete implementation, and can maximize use of nursing time and resources. No one model of evidence-based practice is present that meets the needs of all nursing environments. This article outlines a systematic process that can be used by organizations to select an evidence-based practice model that best meets the needs of their institution.
A Comparative Analysis of the Information Resource Usage of the Agriculture Students
Authors: Wijetunge P.
Published: January 2016

The purpose of this paper is to illustrate the differences in information resource usage among the agriculture students in University of Peradeniya, so that remedial measured could be adopted to address the identified trends. A 10% sample was surveyed and the data were complimented by the information provided by published literature, statistics, faculty members and the library staff. Findings established that the Search Engines, Wikipedia, Classmates, Lecturers and Recommended Readings are used often by all but there is a variation in the usage across the academic years. Use of Recommended Readings, Library Collection, and Lecturers increased across the academic years while the use of their Personal Collections of material, and the use of Classmates, Friends and Family and the Librarians as an information resource decreased. There was no difference in the use of Search Engines across the years but the use of Wikipedia, and Government Websites decreased in the fourth year. The study proved that the students expect training from the library, and that there is a variation across the academic years in the topics they would like to learn about. The study recommends a well-planned information literacy programme for all the students of the faculty irrespective of their year of study. A limitation of the study was that it covered only what and how often aspects of the information resource usage but not why, due to time limitation, but elucidated the why of findings in the light of previous research. However, this paper is the first of its kind, which makes a comparative analysis of the information resource usage of the agriculture undergraduates in Sri Lanka.Journal of the University Librarians’Association of Sri Lanka, Vol. 19, Issue 1, October 2015, Page 6-31
The Publication Output and Impact of various Faculties in Sri Lankan Universities: a Scientometric Assessment and Policy Implications
Authors: Pratheepan Thuraiyappah , Weerasooriya W. A.
Published: January 2016

This paper aims to evaluate the faculty research performance on the basis of publication output, citations and h- index of professors working in Sri Lankan universities. Six hundred fifty professors from different universities of Sri Lanka served as respondents. Using scientometrics, publications of professors spanning 1980-2014 are analyzed. It found that based on the mean h-index used in this study, faculty of science is the best performer with the mean h-index of 5.55, followed by medicine (5.24), engineering (3.81), agriculture (3.76), management (2.74) and arts (2.62). This study further revealed that, the faculty of agriculture has the highest percentage (97.37 %.) of professors with published output; they have at least one research paper. Study also measured the universities’ position in the each disciplines on the basis of the mean h-index. The results showed that out of six faculties, which are grouped in this study, University of Peradeniya (PDN) is found to be the most predominant in agriculture, arts, science and engineering). In medicine, University of Kelaniya is the best on the basis of the mean h-index with 6.85. In the case of the faculty of management, University of Jaffna had the highest mean h-index of 7.75. On the other hand result indicates that the performance of arts among almost all of the universities except University of Colombo and PDN were very poor and similar. It is recommended that research output on arts, social sciences and management across the university faculty must be strengthened and mechanism should be introduced by the authorities.Journal of the University Librarians’ Association of Sri Lanka, Vol. 19, Issue 1, October 2015, Page 54-70
Monaldi Archives 2009-2011
Authors: Chieffo Carmine
Published: January 2016

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