bluuebunny/crossref_metadata_2025 huggingface dataset:
Outbreak evaluation of highly pathogenic avian influenza in Bangladesh
Authors: Giasuddin M , Haque ME , Kamal AHM , Islam MR , Jahangir A , Chowdhury EH , Taimur MJFA , Rahman M Hafizur
Published: January 2016

Bangladesh first experienced outbreaks of highly pathogenic avian influenza (HPAI) subtype H5N1 in poultry 2007 and by December 2012 a total of five hundred fifty six (556) outbreaks have been reported of which four hundred ninety nine (499) outbreaks occur in commercial poultry farm as against only fifty seven (57) in backyard poultry chicken. The virus appeared to be a deadly pathogen causing a total of six hundred eight (608) human cases with three hundred fifty nine (359) deaths in the world. In Bangladesh seven (7) human cases have been reported with a singular mortality of a child acquiring the infection from household poultry. There had been six epidemic waves of AI outbreaks in Bangladesh since March 2007 and other new waves seem to have started. From the six years incidence analysis it was found that higher number of outbreaks occurred in the month of February followed by March. The outbreak started from the middle to late winter and continued up to summer. The phylogenetic analysis of viruses isolated till 2010 revealed only one clade 2.2 virus circulating in Bangladesh. But from 2011 two new clades 2.3.2 and 2.3.4 viruses have been introduced. In 2012, it was observed that Clade 2.2 viruses that was in circulation since 2007 were replaced by 2.3.2.1 viruses. Extensive backyard poultry including a large number of ducks, dense human population, and economic dependence of poor people on poultry with low awareness about risk of infection, live bird trading and poor bio-security were critical factors in the spread of avian influenza infection that posses key challenge in rapid containment. Because of the complex situation in poultry production and marketing system, attempts to control this disease through stamping out and bio-security measures have apparently failed in Bangladesh.Bangladesh J. of Livestock Res. 19(1-2): 44-49, Jan-Dec 2012
Selection responses for egg production of Fayoumi and Rhode Island Red breeds
Authors: Haque ME , Deb GK , Hasan MN , Ali MH
Published: January 2016

This experiment estimated the selection responses for egg production of Fayoumi (Fay) and Rhode Island Red (RIR) breeds. A total of 3000; belonging Fay 2000 & RIR 1000 day old chicks were collected from Egypt and Bangladesh Livestock Research Institute (BLRI), Savar, Dhaka respectively, considered as foundation stock. The chicks were brooded for 5 weeks and reared up to 14 weeks of age providing standard feeding and management. After brooding, 640 Fay and 504 RIR pullets were reared in 40 and 36 individual pens respectively, considering as a family. Finally, 30 and 24 best families of Fay and RIR respectively were selected with 420 Fay and 288 RIR pullets at 15 weeks of age, on the basis of age at 1st egg lay, egg production and fertility. Salmonella and mycoplasma free eggs were collected on the basis of blood test (agglutinate test) from the selected families of both the breeds and hatched out for next generation. The experiment was continued up to 40 weeks of age for each generation. The study revealed that hen day egg production of Fay and RIR was higher in Foundation stock (64.39% in Fay and 68.54% in RIR) than that of F1 generation (58.6% in Fay and 46.8% in RIR) but no significant difference (P > 0.05) was observed for livability between Foundation stock and F1 generation. Reasons for lower productivity in F1 generation may be the poor management practices during growing period. In F2 generation, egg production was higher in both the breeds (64.09% in Fay and 62.05% in RIR) than in F1 generation. Egg production of RIR was not recorded for F3 generation, as their ability to adopt under farmers condition was very poor. However, in F3 generation, egg production of Fay was higher (65.82%) than in F2 generation. Genetic gain in Fay was 0.06%, 0.11% and 0.12% for F1, F2 and F3 generation, respectively. In case of RIR genetic gain was 0.07% in F1 and 0.18% in F2 generation. Due to selection slight genetic gain for egg production was obtained in Fay and RIR but further research with larger stock is needed for better understanding of selection responses of these breeds.Bangladesh J. of Livestock Res. 19(1-2): 66-73, Jan-Dec 2012
Gastrointestinal Disease in Pilots, 2001–2013
Authors: Storms Patrick R. , Kinchen Mark J.
Published: January 2016

INTRODUCTION: The frequency and distribution of gastrointestinal (GI) disease in the population of active duty Air Force pilots is poorly understood, even though GI illness can temporarily or permanently lead to disqualification from flying duties. Better understanding of GI
disease within this population could yield considerable operational risk and human performance insight and provide data to use in assessing the effectiveness of current medical standards related to flight training and flying duties.METHODS: A dataset reflecting inpatient and outpatient
healthcare visits from 2001 through 2013 was developed and reviewed. Gastrointestinal illness was grouped into 18 subcategories of disease, and the frequency and distribution of visits for these categories were tallied. The total burden of GI illness over the target dates was compared between
pilots, nonpilot aircrew/special operational duty personnel, and nonaircrew/nonspecial duty personnel.RESULTS: Esophageal disease and dyspeptic conditions were the two most frequently encountered diagnoses among all three population groups, comprising almost 50% of the gastrointestinal
diagnoses in age and gender-matched samples of all three populations. The overall burden of disease over the total timeframe of the study was not statistically different in the three populations, with a median of four encounters per person for GI disease. Of interest, the total burden of disease
increased over the course of the study period in all populations, driven in large measure by increases in esophageal disease and dyspeptic conditions.DISCUSSION: The general distribution and overall burden of GI disease in populations of Air Force pilots, nonpilot aircrew/special
operational duty personnel, and nonaircrew/nonspecial duty personnel were similar. The increase in esophageal and dyspeptic conditions over time warrants further attention.Storms PR, Kinchen MJ. Gastrointestinal disease in pilots, 2001–2013. Aerosp Med Hum Perform. 2016; 87(2):122–127.
Missing Aircraft Crash Sites and Spatial Relationships to the Last Radar Fix
Authors: Koester Robert J. , Greatbatch Ian
Published: January 2016

BACKGROUND: Few studies have examined the spatial characteristics of missing aircraft in actual distress. No previous studies have looked at the distance from the last radar plot to the crash site. The purpose of this study was to characterize this distance and then identify
environmental and flight characteristics that might be used to predict the spatial relationship and, therefore, aid search and rescue planners.METHODS: Detailed records were obtained from the U.S. Air Force Rescue Coordination Center for missing aircraft in distress from 2002 to
2008. The data was combined with information from the National Transportation Safety Board (NTSB) Accident Database. The spatial relationship between the last radar plot and crash site was then determined using GIS analysis.RESULTS: A total of 260 missing aircraft incidents involving
509 people were examined, of which 216 (83%) contained radar information. Among the missing aircraft the mortality rate was 89%; most occurred in mountainous terrain (57%); Part 91 flight accounted for 95% of the incidents; and 50% of the aircraft were found within 0.8 nmi from the last radar
plot. Flight characteristics, descent rate, icing conditions, and instrument flight rule vs. visual flight rule flight could be used to predict spatial characteristics.CONCLUSIONS: In most circumstances, the last radar position is an excellent predictor of the crash site. However,
5% of aircraft are found further than 45.4 nmi. The flight and environmental conditions were identified and placed into an algorithm to aid search planners in determining how factors should be prioritized.Koester RJ, Greatbatch I. Missing aircraft crash sites and spatial relationships
to the last radar fix. Aerosp Med Hum Perform. 2016; 87(2):114–121.
Le livre de chevet au prisme du genre
Authors: Lévy Clara
Published: January 2016

Ce texte propose une analyse des modalités d’élection puis d’usages de leur livre de chevet par les lectrices et les lecteurs. Autour du livre préféré s’organise une série de pratiques genrées, d’abord dans le choix de l’ouvrage préféré, puis dans l’acceptation ou le contrôle des émotions dues à la lecture. Enfin, l’identification aux personnages principaux du livre de chevet concerne, pour un personnage du même genre que soi, à la fois des lectrices et des lecteurs – alors que la transgression identificatoire de genre concerne plutôt les lectrices que les lecteurs.
L’art des écuyères de haute école au xix e   siècle Transgression ou reproduction des stéréotypes de genre ?
Authors: Tourre-Malen Catherine
Published: January 2016

Sur les pistes de cirque, les écuyères furent libres de faire comme les hommes, de leur emprunter leur répertoire (l’équitation académique). L’article montre que cet emprunt pouvait s’opérer sans que la frontière entre le masculin et le féminin ne se brouillât. Elles respectèrent, en majorité, les stéréotypes genrés en vigueur au niveau technique (monte en amazone) et vestimentaire, même si la mode des écuyères travesties en hommes connut une certaine vogue. Les stéréotypes féminins furent également à l’œuvre dans la réception du public. L’art des écuyères manifeste ainsi à la fois une transgression genrée à travers ce qu’elles montraient et une reproduction des stéréotypes féminins à travers ce que le public voyait d’elles, imaginait d’elles, projetait sur elles.
Queering the Macho Grip Transgressing and Subverting Gender in Latino Music and Dance
Authors: Morad Moshe
Published: January 2016

Remettre en question la mainmise machiste. Transgression et subversion du genre dans la musique et les danses latino‑américaines Cet article décrit et analyse l’espace queer que créent la transgression et la subversion des normes de genre dans cinq types de danses latino populaires, depuis la passion du tango, qui s’est développée au tournant du xx e   siècle, en passant par la mélancolie du bolero, originaire du Cuba des années trente, jusqu’aux genres de danse plus récents, la salsa qui traverse la culture latino, le timba et le reggaeton cubains, actuellement dominants sur les parquets de danse. L’article est fondé sur un long travail de terrain que l’auteur a conduit sur les scènes homosexuelles de la Havane, de Buenos‑Aires, et au sein de la diaspora latino‑américiane de Londres.
Réforme foncière et endogamie de localité à l’île de La Réunion
Authors: Paillat-Jarousseau Hélène
Published: January 2016

À la fin des années 1960, une réforme foncière est mise en œuvre au cœur des grands domaines de canne à sucre à La Réunion. L’auteur montre que, en dépit de la promotion d’un modèle destiné à privilégier un successeur unique, le nombre des exploitations agricoles ainsi que le nombre d’habitants n’ont pas diminué en raison du maintien de pratiques d’endogamie qui préexistaient du temps de la plantation.
Les villages ont‑ils des mentalités ?Une approche comparative dans les Hautes‑Corbières viticoles
Authors: Guille‑Escuret Georges
Published: January 2016

Envisagée sur de vastes ensembles sociaux, la contestation de la notion de mentalité par Geoffrey Lloyd s’acheva sur une ouverture méthodologique qu’il revient à une sociologie comparative de tester à petite échelle. Cette tentative est esquissée ici à travers l’examen de « mentalités villageoises » vivement ressenties voici trente‑cinq ans dans trois communes des Hautes‑Corbières audoises. L’objectif n’est pas de se rapprocher d’une définition théorique de la notion, mais de chercher à quelles conditions son utilisation cesserait d’autoriser toutes sortes de confusions pour devenir contrôlable de différents points de vue scientifiques, dans la mesure où renoncer totalement à son emploi équivaut souvent à abandonner des thèmes de recherche importants.
Breaking Down the Silos: An Interprofessional Approach to Education
Authors: Glossenger Audrey , Bennett Doris , Ferren Melora , Sageser Paul E.
Published: January 2016

An interprofessional practice gap was identified in relation to discharge care provided to patients with tracheostomies or laryngectomies. Using a case study method, this article presents an approach that administrators of educational programs can take to develop an instructive strategy to address the practice gap and improve patient care.

J Contin Educ Nurs
. 2016;47(1):5–7.
Learning Theory Support of Simulation to Improve Nurses' Care of Critically Ill Patients
Authors: Walker Mandi , Stevenson Gina
Published: January 2016

Simulation, as a conduit to apply both adult and constructivist learning theory, is an important educational modality in nursing professional development. The use of simulation is well studied in the academic setting, but evidence supporting its use in the practice environment is lacking. This educational quality improvement project provides a road map for designing and implementing simulation to meet the educational needs of practicing nurses.

J Contin Educ Nurs
. 2016;47(1):27–31.
Development of an Interfacility Transport Program for Critically Ill Cardiovascular Patients
Authors: Greco Adrienne
Published: January 2016

The expanding use of newer coronary artery intervention modalities in the treatment of critically ill cardiac patients has produced a profound change in the manner in which acute care is rendered to these patients. To meet the needs of community hospitals and to improve the safety of interfacility transport to tertiary care centers, a transport program was developed at The Hospital of the Good Samaritan, Los Angeles, California. Rapid transport by helicopter, fixed-wing aircraft or specialized ground ambulance services has been used to improve patient transit time and safety of transfer between the community hospital and tertiary care facility. Experience at The Hospital of the Good Samaritan (1,012 consecutive patients) compares favorably with other programs and proves to be safe and beneficial.
The Child Following the Fontan Procedure: Nursing Strategies
Authors: O’brien Patricia , Elixson E. Marsha
Published: January 2016

The underlying principle of the Fontan procedure, perfusing the lungs without benefit of a ventricular pump, has been reinforced by its successful application in many children with complex cardiac anomalies involving only one functional ventricle. Several different techniques that direct systemic venous return through the right atrium directly to the pulmonary arteries can be used. By separating the pulmonary and systemic circulations, reducing ventricular volume overload, and relieving cyanosis, improved cardiac function and hemodynamics can be achieved. This article reviews the surgical techniques, perioperative nursing care with particular attention to the assessment, and management of systemic venous hypertension and the long-term outlook for these children. The collaboration of physicians and critical care nurses in the postoperative care of these children and their families is vital to a successful outcome.
Using Inotropic and Vasodilating Agents in Pediatric Patients with Cardiac Disease
Authors: Delgizzi Linda J. , Ueda Julia N.
Published: January 2016

Inotropic and vasodilating agents are traditionally used with diuretics to manage heart failure in children with congenital heart disease. This article reviews the developmental aspects of cardiovascular physiology and the rational use of therapeutic agents for acutely ill surgical and medical pediatric patients with cardiac disease. By understanding the actions and indications for inotropic support and afterload reduction, the critical care nurse can intelligently administer these agents and evaluate their effects.
Alternate Modes of Mechanical Ventilation
Authors: St. John Robert E. , Lefrak Stephen S.
Published: January 2016

As a result of technological progress and a better understanding of respiratory disease processes, new modes of mechanical ventilation for the critically ill patient have been developed. These new methods may offer specific advantages over traditional techniques by avoiding or reducing complications commonly associated with positive pressure ventilation. A thorough understanding of anticipated benefits and potential problems is carefully considered for each mode of mechanical ventilation. Several alternate approaches to ventilatory assistance are discussed. Clinical applications of nursing care are also discussed
Nursing Diagnoses and Interventions in Bronchopulmonary Dysplasia: A Case Study
Authors: Cavender Barbara Sechrist
Published: January 2016

Bronchopulmonary dysplasia (BPD) requires collaborative management in the pediatric health care setting. Because of the nature of the medical diagnoses, BPD can be viewed by nurses using selected nursing diagnoses. With the pediatric client, nursing diagnoses can assist the nurse to identify system alterations, and thereby address nursing interventions most appropriate for the child. Nursing interventions are based on collaborative decision making using both medical and nursing diagnoses. This case study will identify selected nursing diagnoses useful in the care of the child with BPD and nursing interventions used to treat frequently occurring health problems
Preparing the Family for Home Tracheotomy Care
Authors: Ronczy Nancy M. , Beddome Mary Anne Lichtenstein
Published: January 2016

Children with tracheotomy tubes are frequently cared for by nurses in critical care settings, as well as on general patient care units. These children require tracheotomies for a variety of reasons and often are ready to be discharged before they are ready to be decannulated. As a result, many children are cared for at home by their parents, other family members, or other care givers. Discharging a child home with a tracheotomy is a process that involves many people. The staff nurse plays a valuable role in providing education and support to the child and family. After discharge, otolaryngology nurse-clinicians provide some of the support and continuing education the families may need, while parents and school personnel assist the families with support in normalizing their lives and meeting the developmental needs of the child
Noninvasive Monitoring of the Neonatal Respiratory System
Authors: Paige Patti L.
Published: January 2016

The development and use of a large variety of nonivasive respiratory monitors have provided the neonatal intensive care unit clinician with invaluable tools for continuous monitoring. Thorough understanding of how each monitor functions, what it measures, and factors that contribute to monitor errors and injuries is vital for appropriate use of this technology and for proper interpretation of monitor values. On-going patient assessment and a good understanding of physiologic principles affecting respiratory status and monitoring also are imperative to interpreting monitor values. Noninvasive monitors have raised a controversy about home use of monitors to prevent sudden infant death syndrome—a review of National Institute of Health recommendations is helpful when cardiorespiratory monitoring is an issue. Family teaching and support are beneficial for discharge planning
On the Horizon: Surfactant Replacement Therapy
Authors: Renaud Michelle T.
Published: January 2016

During the past decade, significant advances in the treatment of neonatal respiratory distress syndrome (RDS) have been directly attributable to the emergence of surfactant replacement therapy. Using a variety of surfactant preparations, clinical trials have been accomplished in a number of centers on large numbers of infants. These clinical trials showed that there were applications of surfactant replacement both in the prevention mode, early in life, and in the rescue mode, once RDS is diagnosed. There were no evident adverse effects on the infants, and there was significant reduction in mortality and severity of disease in the treated infants. Currently, a large number of neonatal intensive care units are enrolling infants in treatment investigational drug (IND) protocols as defined by the Food and Drug Administration (FDA) while the new drug applications are pending. Surfactant replacement therapy has numerous implications for neonatal nurses and will be part of all neonatal nursing skills in the near future
High-Frequency Ventilation and Extracorporeal Membrane Oxygenation
Authors: White Charmaine , Richardson Cliff , Raibstein Libertad
Published: January 2016

Dramatic improvement in morbidity and mortality associated with neonatal respiratory failure has evolved over the last 30 years. Favorable survival statistics can be directly related to the institution and refinement of assisted ventilation techniques. Short-and long-term pulmonary complications continue to be of major concern. New ways to support the neonate in respiratory failure are being investigated. Concentrated efforts are being undertaken to find ways to safely and effectively treat these infants while decreasing the morbidity associated with therapy. Two such therapies, both experimental and controversial, which are gaining widespread recognition, are high-frequency ventilation (HFV) and extracorporeal membrane oxygenation (ECMO)
Pressure Ulcer Prevention in Critical Care: State of the Art
Authors: Glavis Connie , Barbour Susan
Published: January 2016

Prevention of pressure ulcers in the critically ill patient is a major responsibility of the critical care nurse. The authors review the causes of pressure ulcer development and the methods of identifying the patient at increased risk. Pressure relief strategies for use in critical care are presented, and currently available pressure reduction and relief devices are discussed. Because few research studies address pressure ulcer prevention in the critical care setting, future research in this area is needed to develop a reliable predictive tool for use with the critically ill patient. Level of risk needs to be linked with intervention to assist the nurse in managing the pressure relief options available in today’s market. In the meantime, prevention of pressure ulcers in critical care patients requires vigilance and the best use of available knowledge in the field
Quality Assurance: Monitors in Special Care
Authors: Hall Irene Jonell
Published: January 2016

Special care units need to establish economically feasible and meaningful monitors to evaluate patient care needs. High-cost areas, such as special care, monitor appropriate use of resources in high-risk, high-volume, and problem-prone areas. The monitoring process needs to provide information regarding the quality of care in the special care unit without greatly decreasing time spent by staff in direct patient care. This chapter discusses development of efficient monitoring tools for quality assurance indicators in the special care unit
Standards of Care: Integrating Nursing Care Plans and Quality Assurance Activities
Authors: Mize Carolyn P. , Bentley Gail , Hubbard Susie
Published: January 2016

Traditionally, standards are used to define the level of care that a patient can expect to receive in a given institution or on a given nursing unit. These standards are the foundation of quality assurance programs. Unfortunately, with the increased emphasis on monitoring care, many standards are being written after the quality assurance activities have been developed and are in place. Often, standards are placed neatly in a book that is dusted off and brought out when the Joint Commission for Accreditation of Healthcare Organizations representative (JCAHO) visits. The nursing staff at the unit level has no real knowledge or understanding of the standards. This may result in a nonfunctioning quality assurance program
Quality Assurance to Quality Improvement: The Impact of the Agenda for Changes
Authors: Moreland Joanne
Published: January 2016

Health care professionals are committed to the continual improvement of the quality of patient care. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has launched a major research and development project intended to improve its ability to evaluate health care organizations and encourage greater attention to the quality of daily patient care. This chapter describes JCAHO’s challenge to evaluate capability and performance of health care organizations and practitioners. The intent of JCAHO’s agenda for change is to focus on patient outcomes and quality improvement through a more precise and objective evaluation of both clinical and managerial performance. Through the agenda for change, JCAHO and the health care organization will participate in a continuous-flow monitoring system in which clinical and organizational data are transmitted from the field to JCAHO, analyzed, and fed back to the health care organization
Temporary Cardiac Pacing
Authors: Hickey Cheryl Schneider , Baas Linda S.
Published: January 2016

The use of temporary cardiac pacing in critical care and stepdown units has grown tremendously over the past 10 years. While the concept of artificial pacing is simple, improvements in generator technology and lead design, along with broader clinical applications, have made temporary cardiac pacing more complex. Consequently, the critical care nurse is required to maintain an advanced level of knowledge regarding modes and complications of temporary pacing, and assessment skills related to recognizing pacemaker hemodynamic effects and pacemaker problems
Transcutaneous Cardiac Pacing
Authors: Waggoner Pamela C.
Published: January 2016

Pacemaker technology has experienced many advances. Today temporary pacing can be provided in several ways. This chapter examines one of these modalities, transcutaneous noninvasive pacing. In addition, this chapter reviews relevant historic milestones, describe transcutaneous pacing, state procedural aspects, and delineate important nursing aspects of care
Cardiac Pacing in Children
Authors: Lawrence Patricia A.
Published: January 2016

Advances in pacemaker technology over the last 25 years have made cardiac pacing in infants and children a safe and practical therapy. Some of the technical challenges encountered with the first permanent pacemaker implantation in children during the early 1960s have been solved with miniaturized generators, lithium batteries, noninvasive programmability, and improved placement techniques.1–3 This chapter reports common causes of bradydysrhythmias in children, reviews the indications for permanent pacemaker implantation in children, describes current pacing systems appropriate for children, and identifies nursing implications and potential pacemaker complications unique to children
Electrocardiographic Interpretation of Pacemaker Rhythms
Authors: Feeney Mary Kay
Published: January 2016

The interpretation of electronic pacemaker rhythm strips requires attention to detail to determine the appropriate function of a pacemaker. Often the clinician is faced with the admission of a patient who is either unknown to have a pacemaker, or the type of pacemaker is not immediately available to the practitioner. In such a situation, the practitioner must be able to use pre-existing skills to determine the proper function of the pacemaker as well as any abnormalities in its pattern. This evaluation requires review of the inherent or underlying patient rhythm, the presenting pacemaker rhythm, and the relationship of the two. Additionally, in more sophisticated pacemakers, the relationship between the functions of the pacemaker also must be assessed. A variety of pacemaker rhythm examples are used to delineate the process involved in the determination of proper pacemaker function.
A Family-centered Critical Care Unit
Authors: Smith Kim , Kupferschmid Barbara J. , Dawson Carrie , Briones Tess I.
Published: January 2016

Although care of the family has long been a focus of nursing, there has been an increased emphasis in recent years to provide opportunities for families to be an integral part of the hospitalization experience. This has been difficult for many nurses who perceive themselves as competent to care for a patient in “medical crisis” but feel unqualified to provide family care. This article will address issues related to implementing a family-centered philosophy of care in a critical care unit. Implementation strategies that will be discussed include: formulating a staff-led family support group and family committee, instituting a family visitation contract within open visitation parameters, and developing clinicians with expertise in family care. Tools such as a performance plan for a Clinical Nurse II specializing in family care and the family visitation contract will be shared
Family Needs and Coping Strategies during Illness Crisis
Authors: Kolier Patricia Ann
Published: January 2016

This descriptive study was conducted to explore family needs and coping behaviors when faced with the stress of a family member’s critical illness. Family systems, crisis, and coping theories provided the conceptual frameworks for this study. A convenience sample of 30 family members of 22 critically ill patients completed the Critical Care Family Needs Inventory and the Jalowiec Coping Scale and responded to a seven-item semi-structured questionnaire. The need to know the patient’s prognosis was identified as most important on the basis of item mean scores. The top ten identified needs centered around the need for assurance, information, and proximity. Hope was the most frequently used method of coping. Seven of the top ten coping methods most frequently used were also identified by family members as being most effective. Coping styles labeled confronting and optimistic were found to be most useful and effective overall. Nursing interventions described by family members as helpful included: the provision of information, emotional support, and competence and manner of the nurse
Nutrition and the Use of Metabolic Assessment in the Ventilator-dependent Patient
Authors: ST. John Robert E. , Eisenberg Patti
Published: January 2016

Nutritional support is an important aspect of care in hospitalized patients, especially those receiving mechanical ventilation. While nutritional assessments can help guide the clinician in determining appropriate caloric intake requirements and refeeding schedules, few tools exist to evaluate the consequences of over- or underfeeding. Metabolic assessment using indirect calorimetry is a new method of nutritional assessment for use at the bedside of the weaning patient. The data obtained from a metabolic assessment can be used to adjust formulas and total caloric intake as well as differentiate between dead space and elevated carbon dioxide production as reasons for persistent hypercarbia
Nursing Considerations for Patients Requiring Cardiopulmonary Support
Authors: Bavin Terry K.
Published: January 2016

The number of patients receiving cardiopulmonary support (CPS) is increasing, requiring critical care nurses to be better prepared to care for these complex patients. Background information on CPS along with considerations for nursing management are presented. A case study of a patient requiring CPS and a suggested nursing care plan are included to assist in providing quality nursing care
Preventing Secondary Brain Injury
Authors: Walleck Connie A.
Published: January 2016

Traumatic brain injury affects approximately 500,000 persons each year. For those patients who survive until they reach the hospital, the major goal of the health care team is to prevent secondary injuries or insults that may follow the initial event and worsen the brain injury. Factors that can cause secondary insults to the brain include hypoxia, hypercapnia, hypotension, and intracranial hypertension. Prevention of these factors begins in the pre-hospital care phase and continues into the critical care unit. Early recognition of these factors and prompt intervention can improve the neurologic outcome of the patient with severe head injury. An understanding of the causes and effects of these secondary insults is critical to the appropriate medical and nursing management of these patients
Elderly Patients in the Emergency Department
Authors: Fulmer Terry , Degutis Linda C.
Published: January 2016

Emergency department nursing care of the older individual requires a specific knowledge base to ensure optimal outcomes. Health-care resource utilization specific to elderly patients in the emergency department and selected common health problems that bring older people to the emergency department are described. Distinctions between normal age-related changes and disease signs and symptoms are explained to provide emergency department nurses with the requisite information to care for the elderly appropriately
Elderly Patients in Critical Care: An Overview
Authors: Stanley Mickey
Published: January 2016

Elderly patients who enter the critical care setting have special nursing care needs based on the physiologic changes of aging. An overview of the changes of aging associated with the immunologic, cardiovascular, integumentary, musculoskeletal, and renal systems provides the basis for care planning to meet the needs of older adults in the intensive care unit
The Maze Procedure: A New Treatment for Atrial Fibrillation
Authors: Sorenson Lisa M. , Vulich Claudia M. , McErlean Ellen Strauss , McCarthy Patrick M.
Published: January 2016

Atrial fibrillation is a dysrhythmia with lethal complications afflicting thousands of people each year. Unfortunately, atrial fibrillation is frequently resistant to medical therapy and other nonsurgical treatments, such as cardioversion and catheter ablation. Past surgical procedures to correct the dysrhythmia have also proved ineffective. A surgical procedure has been developed in which multiple incisions are made in the atrium, creating an electrical maze. The maze procedure restores atrioventricular synchrony while simultaneously preventing macroreentry within the atria. It thereby eliminates the clinical sequelae often associated with atrial fibrillation and improves the quality of life for those patients refractory to current methods of treatment
Ventricular Dysrhythmia Secondary to Select Environmental Hazards
Authors: Cox Amy
Published: January 2016

Ventricular fibrillation is the mechanism of death in a number of catastrophic events related to the environment. In particular, electrical shock, organophosphate poisoning, and hypothermia are known to give rise to ventricular fibrillation either directly or by causing unstable situations in which fibrillation may be readily provoked. This article reviews these mechanisms of ventricular fibrillation and aspects of treatment unique to environmental hazards
Complex Dysrhythmias in Infants and Children
Authors: Hanisch Debra G. , Perron Linda
Published: January 2016

Dysrhythmias in infants and children are, in many ways, similar to those in adults, yet several important differences exist in their presentation and management. Complex dysrhythmias most frequently encountered in pediatrics include sinus node dysfunction, chaotic atrial rhythm, atrial flutter, supraventricular tachycardia (including Wolff-Parkinson-White syndrome and junctional ectopic tachycardia), complete atrioventricular block (congenital and acquired), and ventricular dysrhythmias (premature ventricular contractions and ventricular tachycardia). Newer approaches to the diagnosis and management of these dysrhythmias are addressed in this paper
Endocrinopathies of Hyperfunction: Cushing’s Syndrome and Aldosteronism
Authors: Gumowski Julie , Proch Marcella , Kessler Christine Ashley
Published: January 2016

Increased function of the adrenal cortex is a normal response in times of physiologic and psychologic stress. Adrenal cortical secretions (e.g., glucocorticoids, aldosterone) orchestrate a multitude of internal processes aimed at maintaining homeostasis and psychologic integrity. Many patients admitted to a critical care unit will manifest some increase, even minor, in adrenal function. However, excessive secretions of these hormones can have a lethal effect of fluid and electrolyte balance, energy metabolism, and immune function. Cushing’s syndrome denotes a disorder characterized by increased circulating levels of glucocorticoids (primarily Cortisol). An easily recognizable disorder, it may arise from pathology of the adrenal cortex or the anterior pituitary glands, ectopic secretions from a nonendocrine tumor, or from excessive doses of exogenously administered glucocorticoids. Cushing’s syndrome is rarely an admitting diagnosis to critical care but is a disorder that can seriously affect recovery from coexisting illnesses if not treated. Aldosteronism, although rare, will often be diagnosed after admission to a critical care unit for management of troublesome hypertension, hypokalemia, congestive heart failure, and various dysrhythmias. Suspicion of the diagnosis should always arise when these manifestations occur, particularly when hypokalemia is refractory to potassium supplementation. Without timely diagnosis and treatment, these patients will succumb to lethal dysrhythmias
Hyperglycemic Emergencies
Authors: Sauve Deborah Orange , Kessler Christine Ashley
Published: January 2016

Hyperglycemic emergencies are the most common endocrinopathies that require intensive care. It is estimated that between 10% and 15% of patients admitted to intensive care units experience complications of acute hyperglycemia. The common denominator of hyperglycemic emergencies is diabetes mellitus, a group of diseases in which, either because of beta-cell destruction of the pancreas or insulin receptor-site defects, there is a relative or absolute deficiency of insulin that results in hyperglycemia. In response to various precipitating factors, staggering hyperglycemia may develop in the form of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNK). The existence of DKA has been known since ancient times, and critical care nurses are familiar with the diagnosis. The more lethal disorder of HHNK was “rediscovered” in the 1950s and is occurring with greater frequency as clinical awareness of the condition grows and the elderly (who are at greatest risk for the disorder) populate critical care units in increasing numbers. Prevention is instrumental in abating deadly hyperglycemic emergencies. A positive outcome can be realized but only with timely diagnosis and prompt hormonal and fluid replacement
Hypoglycemic Emergencies
Authors: Mulcahy Kathryn
Published: January 2016

Optimal control of blood glucose requires a balance of diet, exercise, and in some cases, medications. Many factors can cause a state of imbalance, resulting in extremes of glucose control. Hypoglycemia is defined generally as a blood glucose level lower than 50 mg/dL. Although the causes of hypoglycemic episodes are diverse, the management is always aimed at normalizing the plasma glucose concentration. Treatment ranges from simple carbohydrate ingestion in mild to moderate cases to intravenous administration of glucose when the reaction is severe and loss of consciousness occurs. Recognition of warning signs and prompt treatment is essential in all cases
Diuretics
Authors: Kellick Kenneth A.
Published: January 2016

Diuretics are the mainstay of therapies for many diseases, including hypertension congestive heart failure. While their use can be beneficial, many side effects and interactions are attributed to diuretic therapy. This chapter reviews the mechanism of action for the various diuretics and elucidates differences between classes. Major drug-drug and drug-nutrient interactions are examined with information on intervention and patient teaching. Several therapeutic dilemmas in the treatment of hypertension, renal failure, congestive heart failure, and pulmonary edemas are reviewed. With proper nursing assessment and intervention, the diuretics can have beneficial effects in hypertension therapies and the treatment of edema and cause a minimum of adverse drug experiences
Dialysis Therapies in Critically Ill Children
Authors: Hendrix Will
Published: January 2016

Technologic advances provide renal replacement therapies to critically ill pediatric patients. Having multiplied rapidly, the options for intervention and treatment of acute renal failure in infants and small children are numerous. Thus, the need for the dialysis nurse and the critical care nurse to maintain, expand, and develop a new baseline of knowledge is a constant challenge. This article explores the management and treatment options for acute renal failure in infants and children
Monitoring and Prevention of Renal Dysfunction in Cardiac Transplant Recipients
Authors: Dressler Diane K.
Published: January 2016

Renal dysfunction is a common problem in cardiac transplant recipients who receive the immunosuppressive agent cyclosporine. Elevation in serum creatinine levels and other indicators of renal dysfunction often appear during the first year after transplant. Related problems of hypertension and gout also arc common. Specific strategies to minimize the nephrotoxic effects of cyclosporine and other potential insults to renal function can be used by nurses, physicians, and other health team members. Preservation of renal function enhances a patient’s overall functional status and improves survival and quality of life for cardiac transplant recipients
Fluid and Electrolyte Problems of Infants of Very Low Birth Weight
Authors: Shiao Shyang-Yun Pamela
Published: January 2016

Advances in providing care for infants of very low birth weight have improved their survival status. Because the fundamental problem for these infants is physical immaturity, the balance of fluids and electrolytes is a complex phenomenon to assess and manage. In managing the major problems of fluid and electrolyte balance for these infants, the controversy of fluid restriction versus fluid replenishment has persisted to the present. Thus, the challenge of managing fluid and electrolyte therapy remains to be conquered in the next decade, providing chances for nurses’ to expand their role in neonatal intensive care units. They will become more involved and will take on supervisory roles in managing the fluid and electrolyte balance of these infants
Case Management in the Neonatal Intensive Care Unit
Authors: Gunderson Laurie , Kenner Carole
Published: January 2016

This article will provide the reader with an overview of the concept of case management as it is used by the neonatal nurse practitioner in a neonatal intensive care unit. The role of the neonatal nurse practitioner as a case manager will be compared and contrasted to the roles of the primary nurse and staff nurse. The collaborative role with physicians will be described. Future directions for neonatal case management also will be addressed
On the Essential Integration of Nursing and Informatics
Authors: Brennan Patricia Flatley , Fitzpatrick Joyce J.
Published: January 2016

This paper asserts that nursing knowledge is fundamentally inseparable from the strategies and structures that represent it. Nursing informatics comprises a new disciplinary focus that results from a blend of nursing and informatics. The technologies of informatics, communications, computer science, decision science, human information processing, and knowledge engineering, provide critical care nurses with the support necessary for contemporary nursing practice. Informatics technologies enable nurses to communicate, process knowledge in new and more efficient ways, and better understand the nature of nursing thinking
Right Ventricular Volumetric Monitoring
Authors: Headley Jan M. , Diethorn Marcy L.
Published: January 2016

The goal of invasive hemodynamic monitoring is to evaluate the components of oxygen delivery and consumption. Parameters obtained from the physiologic profile are used to assess and optimize oxygen delivery to meet the tissue needs of the critically ill patient. Oxygen delivery is defined as cardiac output multiplied by the arterial oxygen content. Research has demonstrated that adequate increases in oxygen delivery improve survival. The primary intervention for optimizing oxygen delivery is appropriate fluid resuscitation. Classic endpoints of adequate fluid resuscitation have been pressure-based parameters, which possess many inherent assumptions. Current clinical issues are directed toward assessment of the patient’s status in relation to the oxygen supply-and-demand balance. Identification of therapeutic interventions to achieve the goal of increasing oxygen delivery are paramount. Evaluation of the role of the right ventricle (RV) in biventricular performance and incorporation of volumetric measurements to assess the critically ill patient are presented
Managing Low Cardiac Output States: Maintaining Volume after Cardiac Surgery
Authors: Norris Susan O’brien
Published: January 2016

Low cardiac output after cardiac surgery may be caused by hypovolemia, myocardial depression, vasoconstriction, and dysrhythmias. Postoperative hypovalemia occurs because of blood volume loss and decreased diastolic filling. Diuresis, intravascular fluid shift into the interstitium, hormonal influences, and bleeding deplete blood volume. Diastolic filling may be compromised by positive end-expiratory pressure, vasodilation, dysrhythmias, and venous return obstruction. The primary indicator of intravascular volume is ventricular preload, which may be measured indirectly with central venous pressure, left atrial pressure, or pulmonary capillary wedge pressure. Recognition of hypovolemia is aided through the use of cardiac pressure trend monitoring and evaluation of noninvasive indicators of hypovolemia. Nursing goals, in response to hypovolemia, are to increase the circulating volume, optimize oxygen delivery, stabilize hemodynamics, improve tissue perfusion, and prevent shock
Burn Wound Management
Authors: Walter Pamela H.
Published: January 2016

Management of a burn wound is interrelated with many patient care protocols. After the patient has received initial care, is in stable condition, and has been transported to the appropriate medical facility, the selection of burn wound treatment protocols is based on patient population. Hydrotherapy, debridement, topical antimicrobial agents, and dressings reduce bacterial colonization until the wound closes. Supportive care is essential to the preservation of viable tissue. Excision and autografting are the primary method of wound management. The practical application of cultured autograft and growth factors is under study
Metabolic Alterations and Nutritional Management
Authors: Rieg Linda S.
Published: January 2016

Major burn trauma is one of the greatest insults the body can sustain. Complex responses to this injury greatly increase the body’s energy and nutritional requirements. This article presents the metabolic responses and associated nutritional requirements that occur with a thermal injury. Nursing standards of care for the nutritional management of the patient with thermal injury are presented, since nurses have a primary role in managing the patient’s care in a manner that will provide adequate nutrients, reduce energy demands, and prevent potential complications associated with the injury, healing process, and therapeutic interventions
When Is the Burn Injury Healed?: Psychosocial Implications of Care
Authors: Molter Nancy C.
Published: January 2016

The psychosocial and economic effects of burn trauma are profound, not only for the patients, their families, and the burn unit staff members, but also for society as a whole. Understanding the perception of stresses experienced by patients, families, and staff is discussed, and related strategies to assist in reducing the stress are presented. A comprehensive psychosocial support system can assist the nurse in reducing the psychosocial morbidity of severe burn trauma