AACN clinical issues in critical care nursing
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Critical care nurses frequently are involved in obtaining cardiac output measurements and in using these data to assess and to plan therapy. This article reviews the physiologic determinants of cardiac output and the clinical factors that influence these determinants. ⋯ Nursing management issues are discussed using relevant nursing research. Future considerations in cardiac output measurement are discussed, and suggestions of an ideal cardiac output system are provided.
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Intracranial pressure monitoring (ICP) is a technology that assists critical care nurses in the assessment, planning, intervention, and evaluation of care. The physiologic basis of intracranial hypertension (ICH) and ICP monitoring are reviewed. ⋯ Advantages, disadvantages, and complications of fluid-filled versus fiberoptic systems are explored. Priorities in nursing care of the patient with an ICP monitor are examined.
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AACN Clin Issues Crit Care Nurs · Aug 1992
Adrenocortical insufficiency in the critically ill patient.
The fluid and electrolyte imbalances associated with adrenocortical failure affect multiple physiologic systems in the critically ill patient. Because of its widespread effect, the objective signs of adrenocortical failure may escape recognition. ⋯ When effective patient assessment and management are standard components of care, adrenocortical dysfunction may be reversed, while failure to assess for signs of adrenal insufficiency may lead to irreversible patient outcomes. This paper describes phenomena of adrenocortical failure in critically ill patients and presents the problems of fluid and electrolyte imbalance that accompany them.
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AACN Clin Issues Crit Care Nurs · May 1992
ReviewEndocrine responses to the stress of critical illness.
The physiologic and psychologic stress of critical illness produces systemic endocrine responses that affect the body's ability to achieve and maintain homeostasis. Regardless of the nature of the stress or illness, specific hormonal changes occur in thyroid, adrenal, and posterior pituitary activity. This article describes the physiologic and pathophysiologic basis underlying endocrine responses to the stress of critical illness. The critical care nurse is challenged by the complexity of this patient and needs to be familiar with the endocrine responses to critical illness for assessment and clinical interventions to be meaningful.
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Hyperglycemic emergencies are the most common endocrinopathies that require intensive care. It is estimated that between 10% and 15% of patients admitted to intensive care units experience complications of acute hyperglycemia. The common denominator of hyperglycemic emergencies is diabetes mellitus, a group of diseases in which, either because of beta-cell destruction of the pancreas or insulin receptor-site defects, there is a relative or absolute deficiency of insulin that results in hyperglycemia. ⋯ The more lethal disorder of HHNK was "rediscovered" in the 1950s and is occurring with greater frequency as clinical awareness of the condition grows and the elderly (who are at greatest risk for the disorder) populate critical care units in increasing numbers. Prevention is instrumental in abating deadly hyperglycemic emergencies. A positive outcome can be realized but only with timely diagnosis and prompt hormonal and fluid replacement.