AACN clinical issues
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AACN clinical issues · Jan 2004
ReviewInactivity and inflammation: selected cytokines as biologic mediators in muscle dysfunction during critical illness.
Muscle dysfunction leads to activity intolerance, prolonged hospitalization, and additional days of mechanical ventilation. The etiology of muscle dysfunction in the critically ill patient is multifactoral. ⋯ Cytokines are small biological active molecules that regulate inflammation and have a direct effect on muscle wasting. The purpose of this article is to describe selected cytokines (ie, interleukin-1, interleukin-6, interleukin-10, and tumor necrosis factor), explain their role in muscle dysfunction, and explore the role of therapeutic activity as a moderator of muscle dysfunction and cytokine-mediated muscle damage.
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AACN clinical issues · Aug 2003
ReviewPrivacy and confidentiality: the Health Insurance Portability and Accountability Act in critical care nursing.
Nurses are responsible to protect the confidentiality and security of patients' health information. In the critical care setting, these privacy and confidentiality issues may be even more poignant. ⋯ This article reviews the current literature, presents a discussion of confidentiality and security as it applies to uniquely identifiable health information, and offers some "best practices" that can be used in daily practice. Furthermore, the author discusses the Health Insurance Portability and Accountability Act of 1996 and details some reasons why the act is not fully implemented a full 6 years after it was signed into law.
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AACN clinical issues · May 2003
Review Case ReportsCapnography application in acute and critical care.
The use of capnography has expanded over recent years. Currently, capnography is used in a variety of acute care settings. This article describes what capnography is and how it is used. ⋯ The multiplicity of clinical indications include detection of pulmonary embolism as well as malpositioned endotracheal/tracheal, gastric, and small bowel tubes. Capnography also provides clinicians with information regarding expiratory breathing patterns and assists in perfusion assessments such as those for cardiopulmonary resuscitation. Finally, case studies are provided to help the reader apply the concepts of capnography to a variety of acute care settings.
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AACN clinical issues · May 2003
Case ReportsWorking with respiratory waveforms: how to use bedside graphics.
Respiratory waveform graphics packages are available on many ventilators. Despite the prevalence of the waveforms, accurate interpretation and clinical application are not widespread. In fact, many clinicians find the waveforms confusing and choose to ignore them. This article provides a straightforward description of how to interpret the waveforms and suggests ways that the information might be used to improve clinical outcomes.
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AACN clinical issues · May 2003
ReviewDoppler-based hemodynamic monitoring: a minimally invasive alternative.
Doppler-based hemodynamic assessment affords a magnitude of diagnostic applications including evaluation of blood flow from the left ventricle. Doppler echocardiography, in the form of transthoracic and transesophageal echocardiography, allows for intermittent evaluation of hemodynamic information including aortic blood flow, global and regional wall motion, and valvular integrity. In the hands of a skilled operator, transthoracic and transesophageal echocardiography provides reliable cardiac output determinations. ⋯ In contrast, esophageal Doppler monitoring, a minimally invasive hemodynamic assessment tool, provides the ability for ongoing real-time hemodynamic assessment of the critically ill or compromised patient. This simple-to-use technology requires that a probe, similar in size and shape to a gastric tube, be inserted into the esophagus to obtain measurement of blood flow in the descending aorta. Hemodynamic variables such as cardiac output, preload, afterload, and contractility are measured or derived from the esophageal Doppler monitoring waveform.