AACN clinical issues
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AACN clinical issues · Jan 2004
ReviewInactivity and inflammation: selected cytokines as biologic mediators in muscle dysfunction during critical illness.
Muscle dysfunction leads to activity intolerance, prolonged hospitalization, and additional days of mechanical ventilation. The etiology of muscle dysfunction in the critically ill patient is multifactoral. ⋯ Cytokines are small biological active molecules that regulate inflammation and have a direct effect on muscle wasting. The purpose of this article is to describe selected cytokines (ie, interleukin-1, interleukin-6, interleukin-10, and tumor necrosis factor), explain their role in muscle dysfunction, and explore the role of therapeutic activity as a moderator of muscle dysfunction and cytokine-mediated muscle damage.
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AACN clinical issues · Aug 2003
ReviewPrivacy and confidentiality: the Health Insurance Portability and Accountability Act in critical care nursing.
Nurses are responsible to protect the confidentiality and security of patients' health information. In the critical care setting, these privacy and confidentiality issues may be even more poignant. ⋯ This article reviews the current literature, presents a discussion of confidentiality and security as it applies to uniquely identifiable health information, and offers some "best practices" that can be used in daily practice. Furthermore, the author discusses the Health Insurance Portability and Accountability Act of 1996 and details some reasons why the act is not fully implemented a full 6 years after it was signed into law.
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The resuscitation of critically ill patients frequently requires the administration of fluids for the purpose of increasing cardiac output and oxygen delivery to the tissues. The assessment of the patient's preload status during this process is vital. Traditionally, preload assessment has been through the use of right atrial pressure and pulmonary artery occlusion pressure, which are often referred to as the "filling pressures." The use of these filling pressures is based upon the assumption that ventricular compliance does not change. ⋯ The volumetric parameters are presented followed by a discussion of research supporting the use of the volumetric parameters in lieu of pressure measurements for preload assessment in a variety of patient populations. The technology providing continuous RVEDV measurements is presented followed by a discussion of a case study demonstrating the value of continuous measurements. Specific implications for the advanced practice nurse are addressed.
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AACN clinical issues · May 2003
Review Case ReportsContinuous nervous system monitoring, EEG, the bispectral index, and neuromuscular transmission.
In critically ill patients, the central nervous system remains vulnerable to multiple insults including ischemia, hemorrhagic events, and encephalopathy. The peripheral nervous system is vulnerable in the setting of neuro-muscular blockade (NMB), related drug-drug interactions, and drug-clinical state interactions. Optimal assessment of the nervous system is done by means of the clinical neurological examination. ⋯ Neuromuscular transmission (NMT) monitoring by means of peripheral nerve stimulation and assessment of the evoked response may be utilized, within the context of clinical assessment, to determine level of chemical paralysis and minimize dosing of NMB agents. This article explores utilization and differentiates technologies such as EEG, BIS, and NMT monitoring. Monitoring parameters are illustrated using a case study approach.
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AACN clinical issues · May 2003
ReviewSublingual capnometry: an alternative to gastric tonometry for the management of shock resuscitation.
Normal vital signs do not reflect the physiologic aberrations after blood loss. Recognition of hypoperfusion during resuscitation can avoid the development of multiple organ failure. ⋯ Gastric tonometry can be quite helpful in the intensive care unit in identifying gastric hypoperfusion, but has considerable drawbacks. The ability to monitor P(SI)CO(2) via sublingual capnometers overcomes some limitations of gastric tonometry and may be a valuable aid in the prehospital phase, the emergency department, and the intensive care unit in identifying end points of resuscitation.