Reviewer: Patricia Gonce Morton, PhD, RN, ACNP-BC, FAAN (University of Utah College of Nursing) Description: This 173-page, soft cover book provides an excellent and concise discussion of hemodynamic monitoring in patients. Authored by 11 expert contributors, this fourth edition contains 10 chapters and a helpful index. The strength of the book is its superb use of colored photos, diagrams, and charts that enhance the step-by-step explanations of how to use technology for gathering hemodynamic data from patients. In addition, cartoon illustrations help maintain readers' interest and serve to emphasize key facts.Purpose: The objectives of the book are to teach readers the purposes of hemodynamic monitoring, the invasive and minimally invasive techniques used to gather hemodynamic monitoring data, the interpretation of the data, and the nursing care of patients undergoing hemodynamic monitoring. The author and contributors do an excellent job of meeting these important objectives.Audience: The book is ideal for nursing students and nurses who are new to critical care. Although the book is targeted to nursing, the information is also valuable for physician assistants who work in critical care units and for physicians who are starting their critical care training.Features: The book opens with a chapter that reviews key pulmonary and cardiac anatomical and physiological concepts fundamental to understanding hemodynamic monitoring. These concepts include diffusion, ventilation, perfusion, preload, afterload, contractility, and systemic vascular resistance. The book contains chapters addressing invasive monitoring of blood pressure, central venous pressure, pulmonary artery pressure, and cardiac output. The next two chapters cover tissue oxygenation monitoring and minimally invasive hemodynamic monitoring. The final chapter focuses on care of patients with circulatory assist devices. Through the use of excellent color illustrations, readers are taught in each chapter the step-by-step process of setting up monitoring systems, how to interpret the data generated by the systems, techniques for troubleshooting the systems, and the associated patient care. A short list of references appears at the end of each chapter. A major strength of the book is that complex information is presented clearly using a simplistic writing style. Special chapter features are employed throughout the book to focus readers' attention on key issues. These features include "On the level," which helps readers learn normal and abnormal pressure readings for a variety of patient conditions; questions and answers at the end of each chapter to help readers test their understanding of important information; memory boards, which are learning aids and memory cues that assist readers in learning vital definitions and processes in hemodynamic monitoring; "Ride the wave," which explains how to interpret waveforms including the ability to distinguish normal from abnormal waveforms; and "Nurse Joy and Jake," which offers expert insights and encouraging advice for readers.Assessment: No other book offers such an excellent visual approach to understanding hemodynamic monitoring in such a clear and concise way. Critical care nursing textbooks may have a chapter or a section of a chapter addressing hemodynamic monitoring, but none do it is as well as this text. The book will be very useful for the intended audience as they care for patients undergoing hemodynamic monitoring. The fourth edition of the book is needed since the technology used for hemodynamic monitoring is constantly being developed and improved.
hemodynamic monitoring made incredibly visual ebook 75
Doody's 5 Star! Review"No other book offers such an excellent visual approach to understanding hemodynamic monitoring in such a clear and concise way. Critical care nursing textbooks may have a chapter or a section of a chapter addressing hemodynamic monitoring, but none do it is as well as this text. The book will be very useful for the intended audience as they care for patients undergoing hemodynamic monitoring. The fourth edition of the book is needed since the technology used for hemodynamic monitoring is constantly being developed and improved." - Patricia Morton, PhD, RN, ACNP-BC, FAAN for Doody's Book Review Service
Laboratory tests in intestinal ischemia are nonspecific. In the early stage of the disease, complete blood cell count can be normal, but with the progression of the ischemia, leukocytosis with the leftward shift, elevated amylase, and lactate dehydrogenase levels may be observed.[43] Based on underlying risk factors, laboratory studies can be abnormal. In MVT, patients need to evaluate for hypercoagulopathy states such as examined for protein C and S and antithrombin III deficiency, lupus anticoagulant, and platelet aggregation.[15][44] In CMI, abnormal laboratory tests, including leukopenia, hypoalbuminemia, and electrolyte abnormalities, may be observed secondary to malnourishment.[45] The diagnostic approach in patients with intestinal ischemia depends on the severity of symptoms. In patients with peritonitis signs, the diagnosis will be made by abdominal exploration. Plain radiographs, computed tomography angiography (CTA) or magnetic resonance angiography (MRA), invasive angiography, and duplex ultrasound are common radiology studies in patients with suspicion of intestinal ischemia.[42] Plain abdominal radiography is nonspecific; however, the presence of ileus with bowel loops distention, bowel wall thickening, and pneumatosis intestinalis can be suggestive for mesenteric ischemia. Plain abdominal radiography commonly used in patients with signs of sepsis and unstable hemodynamics.[46] Generally, abdominal CT is used in hemodynamically stable patients who present with acute abdominal pain. In addition to, rule out other causes of abdominal pain, some findings including pneumatosis intestinalis, portal vein gas, mesenteric edema, streaking of the mesentery, focal edematous bowel wall, abdominal gas pattern, and solid organ infarction can be suggestive for acute mesenteric ischemia in abdominal CT scan.[10][11] In patients with high suspicious for intestinal ischemia, CT angiography, and MR angiography are the initial tests. However, the CTA is preferred over MRA due to lower cost, white availability, and speed.[12]The CT scans should be done without oral contrast due to oral contrast that can obscure the bowel wall enhancement and the mesenteric vessels, which both lead to a delay of definitive diagnosis.[47][48][49][50] Angiography usually reserved in patients with high suspicious of AMI with negative CTA or patients with NOMI. Diffuse stenosis in mesenteric vessels with the absence of occlusive lesions is the finding in NOMI patients by angiography.[51] The role of duplex ultrasound is just limited to the detection of clots in the proximal of the main vessels. In addition to that, peritoneal gas, previous abdominal surgical intervention, obesity can decrease the sensitivity of duplex ultrasound.[42] In hemodynamically stable patients with clinical features of acute colonic ischemia, including abdominal pain, urgent desire to defecation, diarrhea, and lower gastrointestinal bleeding in addition to common imaging studies (plain radiography, CTA) may require sigmoidoscopy or colonoscopy and biopsy for definitive diagnosis.[52] If colonic ischemia is suspected, colonoscopy preferred to be performed within 48 hours of initial symptoms rather than later.[53][54]
Due to high mortality rates in patients with AMI, it is essential for urgent medical treatment. Initial treatments include maintenance of adequate oxygen saturation, hemodynamic stability, and correction of electrolyte abnormalities. Typically, 2 to 4 units of blood products should be made available. Vasopressors should be avoided. Broad-spectrum antibiotic therapy with coverage of colonic flora is the recommended intervention to prevent and treat sepsis. Bladder catheterization, nasogastric tube decompression, correction of acid/base abnormalities, and intravenous fluid administration are implemented preoperatively. The patient's pain should be controlled, preferably by using parenteral opioids.[13][55][15] Based on intestinal ischemia subtypes, suggestions have included different treatment options.
Usually, the treatment of NOMI or colonic ischemia focuses on removing insulting factors (vasoconstrictive medications), hemodynamic support and monitoring, treating the underlying cause (sepsis, heart failure), and the administration of intra-arterial vasodilation medications. However, selected patients may require exploratory laparotomy. The colonic ischemia divided into three groups: mild, moderate, and severe ischemia according to the hemodynamic parameters, presence of risk factors, laboratory test results, radiological and colonoscopic findings to guide the treatment.[77] The mild ischemia is defined as a patient with typical symptoms of colonic ischemia but not isolated right colonic lesion and no identifiable risk factor. The moderate ischemia is defined when the patient has up to three of the following factors: male gender, tachycardia (heart rate greater than 100 beats/min), hypotension (systolic blood pressure less than 90 mm Hg), blood urea nitrogen greater than 20 mg/dl, Hgb less than 12 g/dl, LDH greater than 350 U/l, serum sodium less than 136 mEq/l, WBC greater than 1510/l, abdominal pain without rectal bleeding or colonoscopically identified mucosal ulceration.[78] The severe ischemia is defined by more than three of the previously listed criteria or any of the following: peritoneal signs on abdominal examination, gangrene on colonoscopy, pneumatosis on CT abdomen, and a pan-colonic distribution or isolated right colonic lesion on CT or colonoscopy.[79] The mild ischemia needs only conservative treatment. The moderate ischemia needs broad-spectrum antibiotics and surgical consultation. It is necessary to consider further investigation, such as CTA and colonoscopy, to assess the mesenteric circulation. Severe ischemia requires prompt surgical referral and intensive care unit monitoring.[78] 2ff7e9595c
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