ABSTRACT
BACKGROUND: Patients with decompensated chronic heart failure (CHF) are frequently evaluated in emergency departments (ED). The outcomes of such patients after discharge to the outpatient setting from the ED are not well known. Risk factors for return ED visits or subsequent hospital admission after ED discharge for CHF also are not known. METHODS: Charts were reviewed from all 112 patients discharged from the Parkland Memorial Hospital ED with a primary diagnosis of CHF from October to December 1998. A composite end point ("failure of outpatient therapy") was prespecified to be a recurrent ED visit for CHF, hospitalization for CHF, or death at 3 months after the index ED discharge. RESULTS: Within 3 months of the index ED visit, 61% of the study population met the composite end point. The median time to failure of outpatient therapy was 30 days. Univariate analysis of 27 clinical and demographic variables demonstrated the respiratory rate at presentation as the only predictor of failure of outpatient therapy (P =.02). Multivariate analysis of a model with 8 prespecified variables also demonstrated respiratory rate to be the only variable independently associated with an increased risk for the composite end point (odds ratio 1.6, 95% confidence interval 1.1-2.6, for each increase of 5 breaths/min). CONCLUSION: There is a high rate of failure of outpatient therapy (61%) in patients discharged with a primary diagnosis of CHF from an urban county hospital ED. Increased respiratory rate on presentation to the ED may be associated with adverse outcomes after ED discharge for CHF.
Subject(s)
Emergency Service, Hospital/statistics & numerical data , Heart Failure/diagnosis , Patient Discharge/statistics & numerical data , Ambulatory Care , Heart Failure/therapy , Hospitalization , Humans , Patient Readmission , Respiration , Treatment Failure , Treatment OutcomeABSTRACT
Fluid balance assessment is a fundamental aspect of caring for critically ill patients who often have volume disturbances. Since the introduction of hemodynamic monitoring in the critical care setting decades ago, we have become more dependent on technology to assist us in evaluating a patient's fluid status and less skilled in basic physical examination and interpretation of common blood and urine values. Information obtained from these basic clinical skills is equally as, if not more, important as numbers derived by invasive means.
Subject(s)
Nursing Assessment/methods , Water-Electrolyte Balance , Water-Electrolyte Imbalance/nursing , Adult , Aged , Algorithms , Body Fluids/physiology , Decision Trees , Humans , Kidney/physiology , Male , Water-Electrolyte Balance/physiology , Water-Electrolyte Imbalance/diagnosis , Water-Electrolyte Imbalance/metabolismABSTRACT
This article provides the critical care nurse with a comprehensive, up-to-date overview of endocrine physiology. Classic endocrine function is discussed including the hypothalamus, pituitary gland, thyroid, parathyroid, adrenal glands, and pancreas. Nonclassic endocrine organs including the heart, liver, and kidney are also reviewed. Recent advances in the field of endocrinology, including the role of local hormones and their physiologic and pathologic roles, are described.
Subject(s)
Endocrine Glands/physiology , Endocrine Glands/anatomy & histology , Humans , NeuroimmunomodulationABSTRACT
Sudden changes in plasma osmolality may have lethal consequences, because of abrupt changes in the volume of cells in the central nervous system. Acute osmotic disequilibrium can result in brain shrinkage or brain swelling. This article explores how the integrated responses of vasopressin and thirst maintain osmotic equilibrium through regulation of body water balance. These two mechanisms provide almost insurmountable barriers to excessive dilution or concentration of body fluids.
Subject(s)
Thirst/physiology , Vasopressins/physiology , Water-Electrolyte Balance/physiology , Humans , Osmolar ConcentrationABSTRACT
Derangements in plasma calcium and phosphorus concentrations can precipitate serious and life-threatening complications in critically ill patients. An understanding of the function and homeostasis of these ions is essential to fully comprehend the causes, clinical manifestations, and treatment of calcium and phosphorus imbalances. This article will help the critical care nurse to identify patients at risk, to recognize derangements early (while they are still mild), and to seek and monitor appropriate treatment.
Subject(s)
Calcium Metabolism Disorders , Phosphorus Metabolism Disorders , Calcium Metabolism Disorders/diagnosis , Calcium Metabolism Disorders/etiology , Calcium Metabolism Disorders/therapy , Humans , Phosphorus Metabolism Disorders/diagnosis , Phosphorus Metabolism Disorders/etiology , Phosphorus Metabolism Disorders/therapyABSTRACT
Magnesium plays a critical role in numerous metabolic functions, including all reactions involving adenosine triphosphate, and is thus essential for the production and use of energy. Magnesium imbalances are common in hospitalized patients, with magnesium deficiency occurring in 20% to 65% of critically ill patients. This article details the homeostatic mechanisms regulating magnesium, the functions of magnesium, and the causes, manifestations, and treatment of both hyper- and hypomagnesemia. Indications and guidelines for the therapeutic uses of magnesium are also reviewed.
