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Critical Care Nursing Clinics of North America

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https://www.readbyqxmd.com/read/27484666/cardiac-arrhythmias
#1
EDITORIAL
Mary G Carey
No abstract text is available yet for this article.
September 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27484665/in-hospital-cardiac-arrest-an-update-on-pulseless-electrical-activity-and-asystole
#2
REVIEW
Mina Attin, Rebecca G Tucker, Mary G Carey
Nonshockable rhythms, including pulseless electrical activity (PEA) and asystole, precede more than 70% of in-hospital cardiac arrests (I-HCA). Compared with shockable rhythms (ventricular fibrillation and ventricular tachycardia), nonshockable rhythms have higher mortality and morbidity. Therefore, investigating the underlying mechanisms of these arrhythmias to improve the quality of care and outcome for patients who suffer cardiac arrest is a priority. As the first responders to I-HCA, nurses must have the proper knowledge and training to provide timely and efficient cardiopulmonary resuscitation therapy...
September 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27484664/arrhythmias-and-cardiac-bedside-monitoring-in-the-neonatal-intensive-care-unit
#3
REVIEW
Sherri L McMullen
Cardiac physiology is unique in neonates and infants; there are several physiologic changes that occur in the first weeks of life. Important changes can be captured on the bedside monitor and provide vital data in a noninvasive way to providers. The importance of diligent observation cannot be overstated. Bedside monitoring has improved in the last decade, which has enhanced the ability to detect changes in heart rates and rhythms. The purpose here is to review cardiac physiology, describe those arrhythmias able to be observed on bedside monitors, and highlight heart rate changes that can be early signs of sepsis...
September 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27484663/basic-cardiac-electrophysiology-and-common-drug-induced-arrhythmias
#4
REVIEW
Aimee Lee, David Pickham
Drugs can be a double-edged sword, providing the benefit of symptom alleviation and disease modification but potentially causing harm from adverse cardiac arrhythmic events. Proarrhythmia is the ability of a drug to cause an arrhythmia, the number one reason for drugs to be withdrawn from the patient. Drug-induced arrhythmias are defined as the production of de novo arrhythmias or aggravation of existing arrhythmias, as a result of previous or concomitant pharmacologic treatment. This review summarizes normal cardiac cell and tissue functioning and provides an overview of drugs that effect cardiac repolarization and the adverse effects of commonly administered antiarrhythmics...
September 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27484662/acute-coronary-syndrome-and-st-segment-monitoring
#5
REVIEW
Mary G Carey
Acute coronary syndrome (ACS) is caused by a critical obstruction of a coronary artery because of atherosclerotic coronary artery disease. Three specific conditions are included: ST elevation myocardial infarction, non-ST elevation myocardial infarction, and unstable angina. The ST segment on the electrocardiogram is a sensitive and specific marker of myocardial ischemia and infarction; however, ST segment deviation is regional not global, thus the ECG lead must be placed over the affected region of the myocardium...
September 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27484661/cardiac-monitoring-in-the-emergency-department
#6
REVIEW
Jessica K Z├Ęgre-Hemsey, J Lee Garvey, Mary G Carey
Patients present to the emergency department (ED) with a wide range of complaints and ED clinicians are responsible for identifying which conditions are life threatening. Cardiac monitoring strategies in the ED include, but are not limited to, 12-lead electrocardiography and bedside cardiac monitoring for arrhythmia and ischemia detection as well as QT-interval monitoring. ED nurses are in a unique position to incorporate cardiac monitoring into the early triage and risk stratification of patients with cardiovascular emergencies to optimize patient management and outcomes...
September 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27484660/ventricular-tachycardias-characteristics-and-management
#7
REVIEW
Aksana Baldzizhar, Ekaterina Manuylova, Roman Marchenko, Yury Kryvalap, Mary G Carey
Ventricular tachycardias include ventricular tachycardia, ventricular fibrillation, and torsades de pointes; although these rhythms may be benign and asymptomatic, others may be life threatening and lead to increased morbidity and mortality. To optimize patient outcomes, ventricular tachycardias need to be rapidly diagnosed and managed, and often the electrocardiogram (ECG) is the first and only manifestation of a cardiac defect. Understanding of the initial electrocardiographic pattern and subsequent changes can lead to early intervention and an improved outcome...
September 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27484659/paroxysmal-supraventricular-tachycardia-pathophysiology-diagnosis-and-management
#8
REVIEW
Salah S Al-Zaiti, Kathy S Magdic
Paroxysmal supraventricular tachycardia (PSVT) is a well-known and thoroughly studied clinical syndrome, characterized by regular tachycardia rhythm with sudden onset and abrupt termination. Most patients present with palpitations and dizziness, and their electrocardiogram demonstrates a narrow QRS complex and regular tachycardia with hidden or inverted P waves. PSVT is caused by re-entry due to the presence of inhomogeneous, accessory, or concealed conducting pathways. Hemodynamically stable patients are treated by vagal maneuvers, intravenous adenosine, diltiazem, or verapamil, hemodynamically unstable patients are treated by cardioversion...
September 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27484658/bradyarrhythmias-clinical-presentation-diagnosis-and-management
#9
REVIEW
Shu-Fen Wung
Bradyarrhythmias are common clinical findings consisting of physiologic and pathologic conditions (sinus node dysfunction and atrioventricular [AV] conduction disturbances). Bradyarrhythmias can be benign, requiring no treatment; however, acute unstable bradycardia can lead to cardiac arrest. In patients with confirmed or suspected bradycardia, a thorough history and physical examination should include possible causes of sinoatrial node dysfunction or AV block. Management of bradycardia is based on the severity of symptoms, the underlying causes, presence of potentially reversible causes, presence of adverse signs, and risk of progression to asystole...
September 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27484657/the-normal-electrocardiogram-resting-12-lead-and-electrocardiogram-monitoring-in-the-hospital
#10
REVIEW
Patricia R E Harris
The electrocardiogram (ECG) is a well-established diagnostic tool extensively used in clinical settings. Knowledge of cardiac rhythm and mastery of cardiac waveform interpretation are fundamental for intensive care nurses. Recognition of the normal findings for the 12-lead ECG and understanding the significance of changes from baseline in continuous cardiac monitoring are essential steps toward ensuring safe patient care. This article highlights historical developments in electrocardiography, describes the normal resting 12-lead ECG, and discusses the need for continuous cardiac monitoring...
September 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27484656/the-cardiac-conduction-system-generation-and-conduction-of-the-cardiac-impulse
#11
REVIEW
Alan Kennedy, Dewar D Finlay, Daniel Guldenring, Raymond Bond, Kieran Moran, James McLaughlin
In this article, the authors outline the key components behind the automated generation of the cardiac impulses and the effect these impulses have on cardiac myocytes. Also, a description of the key components of the normal cardiac conduction system is provided, including the sinoatrial node, the atrioventricular node, the His bundle, the bundle branches, and the Purkinje network. Finally, an outline of how each stage of the cardiac conduction system is represented on the electrocardiogram is described, allowing the reader of the electrocardiogram to translate background information about the normal cardiac conduction system to everyday clinical practice...
September 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27215363/an-update-on-sleep-and-sedation-issues-in-critical-care
#12
EDITORIAL
Jan Foster
No abstract text is available yet for this article.
June 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27215362/sleep-disturbances-in-acutely-ill-patients-with-cancer
#13
REVIEW
Ellyn E Matthews, J Mark Tanner, Natalie A Dumont
Intensive care units may place acutely ill patients with cancer at additional risk for sleep loss and associated negative effects. Research suggests that communication about sleep in patients with cancer is suboptimal and sleep problems are not regularly assessed or adequately treated throughout the cancer trajectory. However, many sleep problems and fatigue can be managed effectively. This article synthesizes the current literature regarding the prevalence, cause, and risk factors that contribute to sleep disturbance in the context of acute cancer care...
June 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27215361/application-of-clinical-practice-guidelines-for-pain-agitation-and-delirium
#14
REVIEW
Anna Krupp, Michele C Balas
Critically ill patients experience several severe, distressing, and often life-altering symptoms during their intensive care unit stay. A clinical practice guideline released by the American College of Critical Care Medicine provides a template for improving the care and outcomes of the critically ill through evidence-based pain, agitation, and delirium assessment, prevention, and management. Key strategies include the use of valid and reliable assessment tools, setting a desired sedation level target, a focus on light sedation, choosing appropriate sedative medications, the use of nonpharmacologic symptom management strategies, and engaging and empowering patients and their family to play an active role in their intensive care unit care...
June 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27215360/complications-of-sedation-in-critical-illness-an-update
#15
REVIEW
Jan Foster
Sedation is a necessary component of care for the critically ill. Oversedation, however, is associated with immediate complications and long-term problems, termed post-intensive care unit syndrome. It also contributes to unnecessary costs of care. This article describes the physical, functional, psychiatric, and cognitive complications of oversedation, and multiple research-based strategies that minimize complications.
June 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27215359/obstructive-sleep-apnea-and-modifications-in-sedation-an-update
#16
REVIEW
Deborah Weatherspoon, Debra Sullivan, Christopher A Weatherspoon
One factor that may contribute to an increased risk for airway compromise is obstructive sleep apnea (OSA). Sedation in this population carries an increased risk for hypopnea. Critical care nurses must decide on the amount and type of sedation to administer at the point of care. It is important for them to understand OSA and the routinely prescribed sedatives that may affect this disorder. This article discusses the pathophysiology of OSA and traits that may help identify patients with undiagnosed OSA. The most commonly prescribed sedative pharmacologic agents and adjunctive airway support mechanisms are reviewed for use in this population...
June 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27215358/toward-solving-the-sedation-assessment-conundrum-neurofunction-monitoring
#17
REVIEW
DaiWai M Olson, Kyloni Phillips, Carmelo Graffagnino
The sedation-assessment conundrum is the struggle to balance the need for sedation against the need to awaken the patient and perform a neurologic examination. This article discusses the nuances of the sedation-assessment conundrum as well as approaches to resolve this and reduce the negative impact of abruptly stopping sedative infusions. Both oversedation and undersedation affect critically ill patients. This article discusses methods of assessing sedation and interpreting individualized patient responses to sedation...
June 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27215357/sleep-and-mechanical-ventilation-in-critical-care
#18
REVIEW
Patricia A Blissitt
Sleep disturbances in critically ill mechanically ventilated patients are common. Although many factors may potentially contribute to sleep loss in critical care, issues around mechanical ventilation are among the more complex. Sleep deprivation has systemic effects that may prolong the need for mechanical ventilation and length of stay in critical care and result in worse outcomes. This article provides a brief review of the physiology of sleep, physiologic changes in breathing associated with sleep, and the impact of mechanical ventilation on sleep...
June 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27215356/the-impact-of-liver-and-renal-dysfunction-on-the-pharmacokinetics-and-pharmacodynamics-of-sedative-and-analgesic-drugs-in-critically-ill-adult-patients
#19
REVIEW
Dinesh Yogaratnam, Kristen Ditch, Kristin Medeiros, Melissa A Miller, Brian S Smith
The use of sedative and analgesic drug therapy is often necessary for the care of critically ill patients. Renal and hepatic dysfunction, which occurs frequently in this patient population, can significantly alter drugs' pharmacokinetic and pharmacodynamics properties. By anticipating how these medications may be affected by liver or kidney dysfunction, health care practitioners may be able to provide tailored dosing regimens that ensure optimal comfort while minimizing the risk of adverse events.
June 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27215355/sleep-disturbances-and-critical-illness
#20
REVIEW
Roberta Kaplow
Sleep disturbances are common in the intensive care unit setting. This article describes the causal factors associated with alterations in sleep in the intensive care setting, effects of sleep disturbances for patients, and strategies to mitigate sleep disturbances. A review of normal sleep architecture is provided, as is a discussion of the methods of measuring sleep in the critical care setting.
June 2016: Critical Care Nursing Clinics of North America
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