Critical care nursing quarterly
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Perfusion status of the critically ill and injured has, in the past, been assessed by indices such as blood pressure (BP), heart rate, and urine output. These indices represent global perfusion and may not reflect regional blood-flow abnormalities. ⋯ The gastrointestinal (GI) tract remains one of these tissue beds that is extremely sensitive to low-flow states. Gastric tonometry is a noninvasive means in which these early symptoms of low flow may be monitored with early interventions to optimize tissue perfusion and patient outcome.
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Modern engineering and space-age technology introduce innovations in thermometry at a crucial time in critical care history. Today's assessment and care decisions are based, in part, on emerging scientific evidence about thermoregulatory responses. ⋯ Confusion exists as to which instrument or site is "ideal." Interpretation of temperature correlations, between temperature sites or without consideration of linearity, has little meaning outside the clinical context. This article discusses hemodynamic and thermal conditions influencing regional body temperatures along with instrument accuracy, reliability, linearity, precision, safety, comfort, and need for staff training.
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While structure of the central nervous system (CNS) is evaluated through diagnostic tests such as computed tomography or magnetic resonance imaging, CNS function requires special monitoring techniques. These techniques are particularly useful adjuncts to the clinical examination, especially in the critically ill patient. ⋯ Rationale and specific applications are unique to each technique. Nursing considerations focus on knowledge of rationale for monitoring, providing safe patient care, validating appropriateness of interventions based on monitoring, and investigating the relationship of monitoring to outcome.
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Critical care practice has greatly changed over the last three decades. This is partly due to the advent of the pulmonary artery catheter and subsequent advances in technologies associated with it. ⋯ Parameters that were once only available on an intermittent basis can now be obtained continuously. Addition of mixed venous oxygen saturation to the cardiorespiratory profile and other derived parameters provides the bedside clinician with important variables to assess the cardiorespiratory status of the critically ill.
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Nutritional assessment can be incorporated into the assessments performed daily by the critical care nurse for every patient. Identification of nutritional deficits will lead to timely interventions and will facilitate recovery and early discharge. The metabolic responses to starvation and stress are reviewed, and bedside techniques for nutritional assessment are outlined. General guidelines for nutritional support and parameters for monitoring the effectiveness of nutritional therapies are defined.