Critical care nursing quarterly
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Critical care nurses learn early in their careers that patient confidentiality is to be respected. Challenges to this belief come when public safety or justice seems to outweigh any individual's privacy. The resolution of the problem caused by such competing values may not be easy for a nurse and will necessarily demand examination of legal, ethical, and professional responsibilities.
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Currently, more than 1,200 advanced practice nurses have sought certification as acute care nurse practitioners (ACNPs). Surveys of practicing ACNPs have shown that the role is expanding in terms of practice settings and role components. This article reports on the results of ongoing survey with ACNPs that portray the role of the ACNP as an evolving career opportunity for advanced practice nurses.
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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.