AACN clinical issues in critical care nursing

Publisher: American Association of Critical-Care Nurses


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    AACN clinical issues in critical care nursing, American Association of Critical Care Nurses clinical issues in critical care nursing, American Association of Critical-Care Nurses clinical issues in critical care nursing, Clinical issues in critical care nursing
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: In this article, the author explores the issue of violence in the inpatient and outpatient hospital setting. Only recently recognized as a significant occupational hazard to nurses, violence can lead not only to physical injury but also to prolonged and debilitating emotional, social, biophysiologic, and cognitive symptoms. The prevalence of the problem is presented, followed by a discussion of contributory factors and the effects violent incidents may have on victims. Strategies for prevention and topics for future research are identified.
    AACN clinical issues in critical care nursing 12/1994; 5(4):516-22; quiz 542-4.
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    ABSTRACT: The gastrointestinal tract is a major immunologic organ that must be maximally supported during critical illness. Gastrointestinal tissues require direct contact with nutrients to support their own rapid cellular turnover rate and carry out the multitude of metabolic and immunologic functions needed for successful adaptation to stress. Disruption in the ecologic equilibrium of the gastrointestinal tract often occurs during critical illness and the therapies provided. Problems encountered include stress ulcers, intestinal ischemia, bacterial overgrowth, aspiration pneumonia, bacterial translocation, sepsis, and the systemic inflammatory response syndrome. Early enteral nutrition has been shown to be a viable, economic, and physiologically beneficial way to support the gastrointestinal tract during critical illness. The fortification of enteral formulas with glutamine, arginine, or fiber is being studied to determine each one's unique role in the gut and immunologic changes that occur with severe stress.
    AACN clinical issues in critical care nursing 12/1994; 5(4):450-8.
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    ABSTRACT: The increasing maturation of our population and the economic hardships in our nation have forced numerous elders to become dependent upon family members for survival. The tremendous strain of providing care for a dependent elder along with societal demands has caused the problem of elder abuse to flourish. Frequently, emergency rooms and intensive care units are the primary points of entry for the elderly victim of abuse. It is within these settings that abuse is detected initially and in which successful intervention should begin. In this article, the author presents a review of the basic theories that have been proposed to explain why abuse occurs. This is followed by a detailed description of the common characteristics of both the abuser and the abused. The article is concluded by an overview of the medical personnel's responsibilities for reporting cases of suspected abuse.
    AACN clinical issues in critical care nursing 12/1994; 5(4):507-15.
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    ABSTRACT: As the incidence of HIV infection rises, so will cases of HIV positive intensive care unit admissions. Factors affecting nurses' care of these patients include fear of contagion, homophobia, and lack of knowledge. A multidimensional approach must be taken by the advanced practice nurse to decrease stigmatization by changing knowledge and attitudes of intensive care unit nurses.
    AACN clinical issues in critical care nursing 12/1994; 5(4):495-500.
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    ABSTRACT: Critical illness frequently leads to organ dysfunction. Nutritional support of individual organ function is an evolving area of nutritional support. Within the past several years, there was an increase in the number of nutritional products reported to improve organ function. In this article, the authors review disease/organ-specific nutritional support, including the theory behind therapy and the empiric data supporting or refuting these theories. It is hoped that this article will aid practitioners in their nutritional management of patients with organ dysfunction.
    AACN clinical issues in critical care nursing 12/1994; 5(4):421-35; quiz 536-8.
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    ABSTRACT: The metabolic response to critical illness and injury increases the metabolic rate and increases mobilization of amino acids from the peripheral tissues. This is done through a neuroendocrine response with elevated levels of catecholamines, glucocorticoids, inflammatory cytokines, and other products of inflammation. Control of the injury, restoration of hemodynamic stability, and early nutrition can minimize the drain on the lean body mass and improve the chance of survival. In this article, the authors summarize the metabolic response to stress and injury.
    AACN clinical issues in critical care nursing 12/1994; 5(4):443-9.
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    ABSTRACT: Liver transplantation has been an acceptable treatment for end-stage liver disease for many years. The greatest number of patients needing transplantation for survival are those suffering from alcohol-related end-stage liver disease. Throughout the years, many debates and much research have been completed looking at the medical and ethical responsibility to give transplants to these patients. In this article, the author looks at some of the arguments facing transplantation in patients with alcoholism and some of the related research published.
    AACN clinical issues in critical care nursing 12/1994; 5(4):501-6.
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    ABSTRACT: The recognition and treatment of malnutrition has been shown to improve the survival of patients. Current research to prevent and improve patient outcome with nutritional interventions in the critically ill is promising. Nurses are responsible for identifying the signs and symptoms of malnutrition, administering nutritional therapy while assessing for complications and side effects associated with these treatments, and monitoring the effectiveness of nutritional interventions. Enteral nutrition in the intensive care unit is addressed specifically in this article, whereas nutritional assessment and the recognition of malnutrition are discussed briefly. Salient points of providing enteral nutrition to intensive care unit patients are presented. Various feeding devices, products, and complications related to enteral nutrition are explained in detail. Comprehensive nursing care as related to the delivery of feeding products through various feeding devices is reviewed. Nursing research applicable to the practice of enteral nutrition in the intensive care unit is presented.
    AACN clinical issues in critical care nursing 12/1994; 5(4):459-75.
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    ABSTRACT: Malnutrition in critically ill patients is caused by inadequate intake, absorption, and/or utilization of nutrients with a frequently compounding increased metabolic need. The nurse plays a pivotal role in the identification of patients at risk for nutritional deficits and collaborates with appropriate resources to obtain a comprehensive nutritional assessment and the required nutritional care. A five-step approach to nutritional support is presented and applied to three clinical situations. Through the use of a systematic decision-making process, the critical care practitioner ensures that patients receive adequate nutritional support for optimal organ function.
    AACN clinical issues in critical care nursing 12/1994; 5(4):436-42.
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    ABSTRACT: Critically ill patients experience a multitude of metabolic derangements in response to sepsis, shock, and severe injury. The result of extreme stress is characterized by alterations in carbohydrate and fat metabolism and persistent catabolism of lean body mass. Total parenteral nutrition is an important therapeutic modality in the care of critically ill patients. In this article, the author identifies the patient at risk, defines the appropriate time to initiate parenteral nutrition, and outlines current recommendations for energy and protein prescription. The author also briefly reviews administration issues, discusses possible complications of therapy, and defines effective strategies to monitor the response to therapy.
    AACN clinical issues in critical care nursing 12/1994; 5(4):476-84.
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    ABSTRACT: Terminal weaning is a clinical intervention for withdrawing mechanical ventilatory support when such support is an unacceptable outcome for a patient. Withdrawal of life support must be done in a humane manner for the patient, the family, and the patient's care providers. Research-based directions for clinical practice are limited because of the paucity of research in this area. Recommendations for future study are related to methods, facilitative therapy, patient, family, and caregiver responses, and care delivery models.
    AACN clinical issues in critical care nursing 12/1994; 5(4):523-33.
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    ABSTRACT: Nutritional needs and management of critically ill infants and children are complex and fundamentally different from adults. In addition to common physiologic issues of nutrition during acute illnesses, infants and children have nutritional needs related to growth and development of the whole child as well as individual organ systems. Critical care nurses play a key role in assuring that both physiologic and developmental needs related to nutrition are met, to prevent long-term complications.
    AACN clinical issues in critical care nursing 12/1994; 5(4):485-92; quiz 539-41.
  • AACN clinical issues in critical care nursing 09/1994; 5(3):308-12.
  • AACN clinical issues in critical care nursing 09/1994; 5(3):360-5.
  • AACN clinical issues in critical care nursing 09/1994; 5(3):324-8.
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    ABSTRACT: Numerous trends in the current health-care environment have converged to produce an increased emphasis on the role of the midlevel practitioner. Financial constraints head the list, including a mandate for the best care at the lowest rates and a resulting shift from costly specialists to primary care providers. The desire to conserve human and technologic resources requires a practitioner with advanced knowledge and skills to serve as gatekeeper in terms of facilitating access to health care, establishing efficient referral patterns, and developing a holistic care plan. The midlevel practitioner also is prepared to facilitate the transition from the intensive care unit to the less costly general care areas. In addition, the inevitable reduction in funds for graduate medical education and the dwindling number of first-year medical students choosing internal medicine as a specialty threaten the ability of academic medical centers in particular to provide adequate housestaff coverage to full-time and voluntary faculty members. Physicians eager to provide efficient, seamless care to patients in the acute care setting, while maintaining an office practice and caseloads at several hospitals, find the support provided by a midlevel practitioner an enhancement to their clinical practice and a solution to the continuous management of acute and chronically ill patients. In this article, the authors describe one medical center's experience in implementing the midlevel practitioner role.
    AACN clinical issues in critical care nursing 09/1994; 5(3):369-403.
  • AACN clinical issues in critical care nursing 09/1994; 5(3):299-307.
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    ABSTRACT: Congenital cardiac defects and the clinical symptoms they exhibit are affected intimately by the relation they have with pulmonary circulation. Cardiac lesions that increase pulmonary blood flow often occur clinically with signs and symptoms of congestive heart failure, including hepatomegaly, tachycardia, diaphoresis, and feeding difficulties. However, in the neonatal period, pulmonary vascular resistance often remains elevated, decreasing the pulmonary blood flow and, therefore, severity of symptoms. Cardiac lesions that reduce pulmonary blood flow often manifest early in life with clinical signs and symptoms of cyanosis, tachypnea, and acidosis. Finally, cardiac lesions that result in isolated pulmonary blood flow manifest immediately in the neonatal period, with profound cyanosis and acidosis. In all three groups of cardiac anomalies, critical care nurses play a key role in the control of pulmonary vascular resistance and blood flow by collaborating in therapies designed to increase, decrease, or promote mixing to reduce morbidity and mortality.
    AACN clinical issues in critical care nursing 09/1994; 5(3):255-62.
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    ABSTRACT: In this article, the experiences of two new acute care nurse practitioners working at the University of Pittsburgh Medical Center are described. Included are the experiences they encountered in initiating the role and some of the responsibilities they assumed.
    AACN clinical issues in critical care nursing 09/1994; 5(3):404-7.
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    ABSTRACT: It is not unusual for neonates to be born before the 24th week of gestation and weigh less than 1,000 g. These neonates are surviving to be transferred to a tertiary care center, and many are discharged eventually to home. When one considers that these infants are only "half developed" by the standard 40-week gestational period, it is understandable that the challenges for nurses caring for them are enormous. In this article, the authors review gestational development and the critical care needs of this special neonatal population.
    AACN clinical issues in critical care nursing 09/1994; 5(3):231-41.

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