Focus on critical care / American Association of Critical-Care Nurses

Publications
Research and development in parenteral nutrition delivery systems, infection control, and new therapeutic agents promise to optimize the use of parenteral nutrition for the 1990s. Nurses must integrate these new technologies into patient care and apply research findings to clinical practice. Critical care nurses are at the forefront of these changes because of their unique position as expert clinicians at the bedside of the patients most in need of nutritional interventions.
 
ECG abnormalities are a frequent, potentially life-threatening complication of subarachnoid hemorrhage. Yet, the mechanism behind these ECG abnormalities is poorly understood. Nursing literature has given this phenomenon little attention. However, neurogenic ECG abnormalities have implications for critical care nursing practice and research. In this article the most frequently documented neurogenic ECG abnormalities occurring in patients with subarachnoid hemorrhage have been discussed. The proposed pathophysiologic mechanisms and nursing implications were also discussed. Patients with neurogenic ECG abnormalities require complex, multifaceted nursing assessment and intervention. Only with a better understanding of the phenomenon will the critical care nurse be able to meet the needs of these patients.
 
Acute pancreatitis affects one per 10,000 people annually. Among the alcoholic population this number rises to one per 100. Etiologic factors are numerous, but the main causative agents are biliary tract disease and excessive alcohol intake. The exact mechanism of injury is unknown, but is believed to be either bile reflux into the pancreatic duct or stricture of the sphincter of Oddi. Through either of these pathways the pancreatic enzymes, normally inactive within the gland, are activated and begin digesting pancreatic tissue. Using the knowledge of major collaborative problems, nursing diagnoses, pathophysiology, appropriate assessment parameters, and nursing interventions discussed above, the nurse can develop an effective plan of care for managing the patient with acute pancreatitis.
 
The survival of a patient with acute crack intoxication requires the dynamic and ongoing collaboration of the nurse and physician to facilitate aggressive treatment. The prevention of ominous complications in the patient exhibiting multisystem failure requires advanced physical assessment skills. It is the integration of these physical findings along with the interpretation of laboratory data and invasive monitoring techniques that enables the critical care nurse to constantly evaluate the patient's response. This ongoing evaluation further directs care planning to potentiate optimum patient outcomes.
 
The nature and severity of an acute myocardial infarction may be related to the region of myocardial involvement. Four possible sites of infarction are inferior, anterior, posterior, and lateral. Knowledge of ECG tracings common to each of these areas, the coronary artery source of each, clinical complications, and signs and symptoms is vital to subsequent nursing management.
 
The patient with ARDS presents a particular challenge to critical care nurses and other members of the health care team. The key to effective nursing management of the patient with ARDS is astute observation of the high-risk patient, particularly the trauma patient who has had chest trauma or cardiac or pulmonary contusion. Continual monitoring of arterial blood gas values and chest x-ray examinations aid in the early recognition of the clinical manifestations of ARDS. Although the trauma patient in whom ARDS develops faces a long and frequently difficult recovery, with astute, aggressive nursing intervention, patients with ARDS today face a much lower mortality rate than they did even 10 years ago. The overview of primary nursing diagnoses, goals, and interventions presented applies to most patients with ARDS. Individualized care plans can be formulated as an extension of the basic plan, thus ensuring optimum nursing care to the patient with ARDS.
 
ECMO is an aggressive treatment for selected patients who are unresponsive to conventional therapy for respiratory failure. Although its use in neonates is well documented, the number of successful reports in adults is limited. Venovenous ECMO represents a therapeutic option for adult patients with severe respiratory failure that has not responded to diuresis, high oxygen flows, and positive end-expiratory pressure. As medical centers obtain more experience with and resources for adult ECMO, critical care nurses will need to develop more familiarity with this technology.
 
Top-cited authors
Kathy Dracup
  • University of California, San Francisco
Deborah Chyun
  • New York University
Esther Helen Bay
  • University of Michigan
Sue Wingate
  • National Institutes of Health
Margaret Auld Bruya
  • Washington State University