Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Sep 1989
ReviewCardiac output: theory, technique, and troubleshooting.
Cardiac output is a hemodynamic parameter used by critical care nurses to guide and evaluate therapy. The thermodilution method of cardiac output measurement has allowed this parameter to be obtained at the bedside that is easily performed, timely, and reliable. ⋯ Potential physiologic and technical problems may yield erroneous cardiac output values. Critical care nurses must strive to maintain up-to-date knowledge and skill in performing thermodilution cardiac output measurements to ensure accurate and reliable values.
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Crit Care Nurs Clin North Am · Sep 1989
Review Case ReportsPhysiologic rationale of Sv-O2 monitoring.
Mixed venous oxygen saturation is a global indicator of the balance between oxygen transport and oxygen demand. In critically ill patients, the delivery of adequate quantities of oxygen to meet the cellular oxygen demands is paramount. While parameters such as SaO2, PaO2, and CO reveal important information about oxygen transport, the SvO2 indicates the adequacy of supply in relation to tissue oxygen demands.
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Triggering and timing of the intra-aortic balloon pump are becoming more sophisticated but more clinically manageable. The key to understanding the data currently available is to go beyond early instruction to "eyeball" waveform analysis. Conclusive assessment of the patient's response to therapy lies in a greater understanding of today's technology and clinical competency in evaluating the patient's total hemodynamic, clinical, and laboratory response to assure maximal therapeutic efficiency of counterpulsation therapy. ⋯ Since that time, we have gained a depth of knowledge and an increased capacity for measuring physiologic and hemodynamic responses at the bedside. Concurrently, the medical industry has designed faster, smarter, and more efficient equipment to complement patient care. The critical care nurse faces the challenge of synthesizing the newest information from both areas and developing a greater understanding of the ongoing care of the patient on the IABP.
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Crit Care Nurs Clin North Am · Sep 1989
Using hemodynamic waveforms to assess cardiopulmonary pathologies.
The pulmonary artery catheter brought measurement of hemodynamic parameters to the bedside in the early 1970s. The critical care clinician has been able to obtain direct and derived parameters that have proved useful in the diagnosis, management, and evaluation in various clinical conditions. The evaluation of the mechanical events in the heart, as evidenced through accurate interpretation of waveform configuration, has enhanced the diagnostic ability of the clinician. A wide variety of cardiopulmonary conditions can be recognized, including valvular defects, shunts, electrical disturbances and others, which allow the clinician to optimize hemodynamic function and impact patient survival.
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Crit Care Nurs Clin North Am · Sep 1989
ReviewBridging the gap between hemodynamics and monitoring.
Hurst states that "hemodynamic monitoring is a complement of, rather than a replacement for, clinical judgment." Holder explains that "hemodynamic parameters add sufficient clarity for physicians to a difficult patient management problem." However, it is nursing which must bring clarity to the parameters. It is the nurse who must be ever-vigilant and strive for excellence in invasive hemodynamic monitoring of critically ill patients--as the caregiver who is with the patient 24 hours a day, 7 days a week. ⋯ Lastly, an appreciation for the risks and benefits, together with patient responses to being monitored, helps the nurse evaluate the contribution invasive hemodynamic monitoring has on patient outcomes. Nurses who couple knowledge of cardiovascular physiology, technical expertise, and thorough assessment and diagnosis of patient responses to hemodynamic instability and invasive monitoring bring the essence of holistic nursing care to hemodynamic monitoring.