Critical care nursing clinics of North America
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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
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.
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Crit Care Nurs Clin North Am · Jun 1989
ReviewTranscutaneous cardiac pacing: expanding clinical applications.
Transcutaneous cardiac pacing is an exciting alternative to invasive endocardial pacing methods for the treatment of hemodynamically significant bradyarrhythmias. Prompt institution of a pacing support system is crucial for improving outcomes in this patient population. Recent advances in technology and microcircuitry have eliminated the problems of painful, musculoskeletal stimulation and excessive distortion of the ECG signal associated with earlier devices. ⋯ Prophylactic use of transcutaneous pacemakers in a variety of clinical situations, such as atrioventricular blocks, may eliminate the need for transvenous electrode insertion and its related complications. A transcutaneous pacing system with the capability of functioning in the demand mode should be readily available in emergency rooms, intensive care units, and telemetry floors. Although unlikely to replace transvenous methods, the growing popularity of this technique has many implications for the nurse in the critical care setting.
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Crit Care Nurs Clin North Am · Jun 1989
ReviewHemodynamic monitoring modalities in pediatric cardiac surgical patients.
Transthoracic monitoring lines yield vital information in the care of the pediatric postoperative cardiovascular surgical patient. It is the critical care nurse, in the holistic care of the patient, who integrates this data into the daily plan of care. ⋯ The care of these critically ill infants requires a multifactoral approach. Hemodynamic monitoring is one of many avenues that we follow in the intensive care unit.
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The severity of injury in a gunshot wound is dependent on many factors, including the type of firearm; the velocity, mass, and construction of the bullet; and the structural properties of the tissues that are wounded. Knowledge of ballistics and an appreciation of the wounding potential of certain firearms and their ammunition can help clinicians anticipate the severity of a wound and raise the index of suspicion for occult but severe internal trauma.