The Journal of cardiovascular nursing
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Excellence in bedside monitoring is achievable when attention to detail is practiced. The cardiovascular nurse must choose a monitoring lead to best identify dysrhythmias and a lead to best identify myocardial ischemia with ST segment monitoring. ⋯ A quality assurance approach that involves all levels of nursing can help to integrate current research into practice. Nursing practice can be improved when changes are linked to science.
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Pediatric resuscitation is most frequently required for respiratory arrest. Cardiac arrest is a rare and ominous event and usually develops as a complication of shock or respiratory failure. Once asystolic cardiac arrest occurs, the outcome of any resuscitation is dismal; if cardiopulmonary arrest persists longer than 15 minutes in the normothermic child, further efforts are unlikely to result in patient recovery. For this reason, attention must focus on prevention of arrest and prompt restoration of oxygenation and ventilation, heart rate, and systemic perfusion.
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This article reviews the chemical nature of cocaine, an increasingly abused stimulant. Following a description of the clinical manifestations of drug use, cardiovascular effects as well as routes of administration are described. ⋯ Clinical manifestations and assessment protocols are summarized. Treatment protocols remain focused on symptom presentation at this time, as there is no known antidote for cocaine toxicity or overdose.
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A new catheter developed by Edwards Critical-Care Division measures right ventricular ejection fraction and calculates right ventricular stroke volume, end-systolic volume, and end-diastolic volume. The nurse can thus assess a patient's right ventricular function curves using the relationship between stroke volume and end-diastolic volume. This article critiques a study that used this new technology and discusses implications for clinical practice and nursing research.
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Alterations in right ventricular (RV) performance are critical to the cardiac dysfunction witnessed in adult respiratory distress syndrome (ARDS), septic shock (SS), and as a consequence of positive end-expiratory pressure (PEEP) administration during mechanical ventilation. The authors review evidence for right heart dysfunction in these circumstances. In ARDS, an increase in RV afterload with the onset of pulmonary artery hypertension is the predominant factor promoting RV dysfunction. ⋯ The application of PEEP during mechanical ventilation can potentiate alterations in RV preload, afterload, and/or contractility, all of which promote RV dysfunction and compromise left ventricular filling. As RV dysfunction may seriously affect global myocardial performance in all of these settings, the clinician must identify that RV function is impaired, discern the contributing mechanism, and select an appropriate therapeutic regimen targeted at addressing this predominant mechanism. Assessment and management strategies are described.