AACN clinical issues
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AACN clinical issues · May 1995
ReviewPulmonary dysfunction related to immobility in the trauma patient.
Immobility is associated with multisystem pathophysiologic sequelae, especially in the critically ill trauma patient. Pulmonary embolus from deep vein thrombosis and nosocomial pneumonia are causes of pulmonary dysfunction that are directly related to immobilization in this population. Because of the high incidence of these complications, early identification of those at risk and institution of aggressive interventions to prevent nosocomial pneumonia and pulmonary embolus are crucial responsibilities of nurses caring for severely injured patients.
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AACN clinical issues · May 1995
ReviewChronotherapy in acutely ill patients with respiratory disorders: Part I. Respiratory chronobiology and chronopathology.
Chronotherapy is a relatively new approach in patient care that is based on knowledge of the various biologic rhythms of the body. Treatment is aimed at supporting normal rhythms or altering therapies based on known variations in body rhythms. Application of chronotherapy concepts to the pathology of respiratory diseases is discussed to provide a basis for altering pharmacologic therapy in the care of critically ill patients with respiratory disorders.
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AACN clinical issues · Feb 1995
Case ReportsEvaluating cerebral oxygenation using jugular venous oximetry in head injuries.
When caring for the critically ill patient, a primary objective is to maintain an adequate delivery of oxygen to the tissues. Monitoring and ensuring satisfactory cerebral oxygen delivery in patients at risk for cerebral ischemia presents a significant challenge to the clinician. Cerebral oxygen content usually is determined using blood gas analysis, whereas blood flow to cerebral tissues is inferred from monitoring of the cerebral perfusion pressure. ⋯ The validity of the cerebral perfusion pressure as an index for cerebral oxygen delivery becomes questionable when the autoregulatory mechanisms of the brain are disturbed, as in severe head injuries. Jugular bulb oxygen monitoring provides a method of evaluating cerebral oxygenation status for early identification of impending ischemia by measuring oxygenation of the mixed cerebral venous blood. In this article, the authors review the physiology of cerebral oxygenation, describe a method of monitoring cerebral oxygenation using jugular bulb oximetry, and review a case study to show how these assessments can affect the nursing care of the head-injured patient.
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AACN clinical issues · Feb 1995
Redefining nursing according to patients' and families' needs: an evolving concept. AACN Certification Corporation.
Patients' and families' needs have been displaced from the core of today's health-care system. Nurses are positioned to serve a pivotal role during such a critical time, as health-care systems evolve. ⋯ Nurses must acknowledge that the historical conceptualization of nursing--delineating clinical practice dimensions according to a patient's diagnosis, a nurse's role, the clinical setting, and the patient's psychosocial and physiologic systems--is of limited value if we are to meet these future challenges. Redefining nursing practice according to patients' needs provides an organizing framework to examine, across all levels of nursing, the dimensions of practice most likely to meet patient needs and contribute to optimal outcomes, as well as enhance the linkages between practice, education, and research.
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AACN clinical issues · Feb 1995
Case ReportsStrategies to optimize the cardiorespiratory status of the critically ill.
The goal of cardiorespiratory monitoring is to evaluate the components of oxygen delivery and consumption. Parameters obtained from the physiologic profile are used to assess and optimize oxygen transport to meet the tissue needs of the critically ill patient. ⋯ Therapeutic interventions can be implemented to optimize the cardiorespiratory status of the critically ill patient. Intervention strategies are not directed at simply achieving normal values or even supranormal values but at identifying the relation of oxygen delivery to oxygen consumption to potentially eliminate the development of oxygen debt.