AACN clinical issues
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AACN clinical issues · Feb 1999
ReviewRight heart volumetric monitoring: measuring preload in the critically injured patient.
Accurate assessment of preload status is a major concern in the resuscitation of the critically injured patient. Of the three physiologic determinants of stroke volume, preload is the variable that is most frequently influenced by an insult or intervention or both in the trauma patient. ⋯ Until recently, efforts to measure and optimize ventricular preload have focused on intracardiac filling pressures (central venous pressure and pulmonary artery occlusion pressure). The purpose of this review is to discuss the application of volumetric measurements that provide a more accurate means of determining recruitable ventricular preload in the critically injured patient.
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The critically injured trauma patient in severe hemorrhagic shock presents a complex and arduous challenge to even the most experienced trauma staff. Lives are at stake as trauma teams feverishly pour massive amounts of blood into severely injured patients attempting to replace entire blood volumes several times over. ⋯ Other treatments, such as autotransfusion and blood substitutes, are promising adjunctive therapies that may in the near future help to improve outcomes in patients who require massive blood transfusions. This article reviews the current standard of care for the trauma patient requiring massive transfusion.
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AACN clinical issues · Feb 1999
ReviewInitial resuscitation after burn injury: therapies, strategies, and controversies.
Thermal injury disrupts normal hemostasis and sets off a cascade of events: cellular alterations and release of inflammatory mediators cause hypovolemic and cellular shock. Fluid resuscitation in burn injuries has been in use for more than a century, and much research has been devoted to development of resuscitation formulas and appropriate choice of fluid. Parameters for adequate monitoring of resuscitation are greatly debated. Current research efforts focus on minimizing burn edema through mediator modulation and on development of definitive endpoints of resuscitation monitoring.
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Swallowing and respiration are well-coordinated and interdependent functions. When one of these processes is impaired, the ramifications may be negative for the other. This article describes the mechanics of normal swallowing, the disorders of swallowing, the effects of tracheotomy and mechanical ventilation on swallowing, and the procedures used to assess and treat swallowing. Combining a basic understanding of these concepts with practical management can increase safe and efficient oral intake in patients with artificial airways.
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Acute care nurse practitioners (ACNPs) entering the current job market or relocating must be able to sell their personal and professional attributes to potential employers. In many areas, health care providers may be unfamiliar with the scope of practice and competencies of an ACNP. As a result, ACNPs will be required to educate potential employers as they simultaneously negotiate for a position. ⋯ An attitude that projects an unwavering belief in the value and benefits of the ACNP can enhance the negotiator's position and improve the chances for success. Creating the proposal and developing attitudes for success can be accomplished through an organized process of preparing for negotiations. The purpose of this article is to describe the attitude needed for success, the steps in preparing for negotiation, and the development of an ACNP proposal.