AACN clinical issues
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Credentialing and privileging are increasingly common administrative processes that advanced practice nurses must complete. With the intention of assuring the public of safe health care provided by qualified personnel, several federal and state organizations have developed criteria that licensed practitioners must meet. ⋯ This article explains the guidelines from federal, state, and institutional agencies and offers recommendations to practitioners as they prepare for the credentialing process. Also included are sample forms for establishing a practice agreement and a privilege-delineation request.
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Costs for hemodynamic monitoring can comprise a large segment of an institution's budget. Noninvasive monitoring with thoracic electrical bioimpedance is a cost-effective alternative to invasive monitoring. It can decrease not only materials costs but also costs related to patient complications.
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AACN clinical issues · Aug 1999
Review Case ReportsManaging congestive heart failure with thoracic electrical bioimpedance.
Because of clinical utility, immediate feedback, absence of risk to the patient, portability, and use in virtually any practice setting, facilities using thoracic electrical bioimpedance monitoring are increasing throughout the world. Specialized centers treating patients with heart failure have shown remarkable benefits, both in health care costs and patient morbidity, attributable to the careful monitoring and management of patients with heart failure. The ability of thoracic bioimpedance monitoring to provide objective data in the management of congestive heart failure provides practitioners with the clinical reassurance to optimize pharmacologic therapy safely.
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AACN clinical issues · May 1999
ReviewThe current status of lung transplantation: a nursing perspective.
Since the first lung transplantation was attempted in 1963, the use of the procedure has gradually increased. The first successful operation was performed in 1983, and during the past decade the number of lung transplantations and heart-lung transplantations has increased rapidly, with 75% of recipients surviving past the first year. ⋯ Recipient selection criteria are reviewed, together with the listing process and donor organ criteria. Recommendations for care of patients before and after lung transplantation are outlined, with a description of the postoperative course, including complications, pain control, rehabilitation, discharge procedures, and outpatient treatment.
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Shock is defined as inadequate perfusion of tissues with oxygen and nutrients to support cellular function. Resuscitation from shock can therefore only be complete when all evidence of oxygen debt, anaerobic metabolism, and tissue acidosis has been eliminated. All of the diagnostic and therapeutic maneuvers performed by trauma nurses today, whether basic or advanced, whether performed in the field, emergency department, operating room, or intensive care unit, can be traced directly or indirectly to this goal. ⋯ Resuscitation endpoints (i.e., variables or parameters) must be viewed across the continuum of shock because the effectiveness of endpoints varies with the phase of resuscitation. The optimal resuscitation endpoint in trauma is controversial, remains elusive, and is one of the most published topics in modern medical literature. This article presents the current understanding of the resuscitation endpoints in trauma.