AACN clinical issues in critical care nursing
-
Initial management of minor and moderate, uncomplicated burn injury focuses on wound management and patient comfort. Initial management of patients with major burn injury requires airway support, fluid resuscitation for burn shock, treatment for associated trauma and preexisting medical conditions, management of adynamic ileus, and initial wound treatment. Fluid resuscitation, based on assessment of the extent and depth of burn injury, requires administration of intravenous fluids using resuscitation formula guidelines for the initial 24 hours after injury. ⋯ Circumferential torso burns compromise air exchange and cardiac return. Loss of skin function places patients at risk for hypothermia, fluid and electrolyte imbalances, and systemic sepsis. The first 24 hours after burn injury require aggressive medical management to assure survival and minimize complications.
-
AACN Clin Issues Crit Care Nurs · Feb 1993
Using continuous SVO2 to assess oxygen supply/demand balance in the critically ill patient.
To ensure that tissues are well oxygenated, oxygen supply and demand are now targets of therapy for the critically ill patient. This chapter reviews the physiologic determinants of oxygen supply, how it is threatened by respiratory or cardiac dysfunction or by hemorrhaged or anemic states, and how it can be assessed in individual patients. ⋯ Failure of tissues to consume enough oxygen is explained in patients with critically low delivery or with the maldistributed blood flow state seen in sepsis. The monitoring of mixed venous oxygen saturation is examined as a method of tracking the threats to supply/demand balance and of guiding treatment that can support the adequate oxygenation of tissue.
-
The goal of invasive hemodynamic monitoring is to evaluate the components of oxygen delivery and consumption. Parameters obtained from the physiologic profile are used to assess and optimize oxygen delivery to meet the tissue needs of the critically ill patient. Oxygen delivery is defined as cardiac output multiplied by the arterial oxygen content. ⋯ Current clinical issues are directed toward assessment of the patient's status in relation to the oxygen supply-and-demand balance. Identification of therapeutic interventions to achieve the goal of increasing oxygen delivery are paramount. Evaluation of the role of the right ventricle (RV) in biventricular performance and incorporation of volumetric measurements to assess the critically ill patient are presented.
-
A recent national survey of critical care nurses reveals that the leads many nurses select to monitor their patients are diagnostically inferior to other available leads, and that lead placement often is inaccurate. This article reviews the best leads for electrocardiographic (ECG) monitoring, illustrates their accurate placement, and explains reasons for the dilemma in current practice. Questions relevant to practicing nurses are addressed, including 1) Is lead MCL1 as good as V1? 2) When is it appropriate to substitute lead MCL1 for V1? and 3) How important is it for electrodes to be placed exactly in specific anatomic locations? Finally, a case study is provided to illustrate how accurate monitoring can prevent misdiagnosis and resultant inappropriate therapy.
-
Many patients in the critical care unit (CCU) are at risk for myocardial ischemia and acute coronary artery reocclusion. The use of continuous ST segment monitoring detects transient and sustained ischemia, despite the absence of symptoms, more completely than rate and rhythm monitoring alone. ⋯ Thus, when using ST segment monitoring for detection of ischemia, one of the most important decisions for the nurse to make is lead selection. In addition, both ischemic and nonischemic ST segment changes must be considered.