Certified Registered Nurse Anesthesia Critical Care Nursing In The Operating Room An Issue Of Critical Care Nursing Clinics

APRNs are essential to deliver healthcare in today’s complex environment. Certified Registered Nurse Anesthetists have met that challenge for over 150 years. Nurse Anesthetists have shifted from the intensive care unit as critical care nurses into the operating room arena. The operating room is an environment that is uniquely challenging. A critical care background is essential to meet these challenges, and all Certified Registered Nurse Anesthetists share that experience. The topic; "Certified Registered Nurse Anesthesia: Critical Care Nursing in the Operating Room", highlights critical care nursing as it is applied in the operating room setting. Critical care nurses will appreciate the knowledge base that is essential for the anesthetist. As healthcare reform demands greater efficiency, more and more procedures are performed outside the operating room. The line between the Operating Room, ICU and Interventional Radiology will become less defined. Critical care nurses are, and will be more involved in patient care while an anesthetic is administered. It is the goal of this proposed monograph to share knowledge and experience so that ICU nurses will learn more about caring for the anesthetized patient.

Intensive care units (ICUs) provide comprehensive, advanced care to patients with serious or life-threatening conditions and consequently, a significant amount of end-of-life care (EOLC). Indeed, approximately 20% of deaths in the U.S. are associated with an ICU stay, and nearly half of U.S. patients who die in hospitals experience an ICU stay during the last 3 days of life. Despite the commonality of the ICU experience, ICU patients typically suffer from a range of distressing symptoms such as pain, fatigue, anxiety, and dyspnea, causing families significant distress on their behalf. Thus, there is a growing imperative for better provision of palliative care (PC) in the ICU, which may prevent and relieve suffering for patients with life threatening illnesses. Effective palliative care is accomplished through aggressive symptom management, communication about the patient and family’s physical, psychosocial and spiritual concerns, and aligning treatments with each patient’s goals, values, and preferences. PC is also patient-centered and uses a multidisciplinary, team-based approach that can be provided in conjunction with other life-sustaining treatments, or as a primary treatment approach. Failure to align treatment goals with individual and family preferences can create distress for patients, families, and providers. If implemented appropriately, palliative care may significantly reduce the health care costs associated with intensive hospital care, and help patients avoid the common, non-person centered treatment that is wasteful, distressing, and potentially harmful. Due to the success of many PC programs, administrators, providers, and accrediting bodies are beginning to understand that palliative care in the ICU is vital to optimal patient outcomes.

Heart failure is the only cardiovascular disease that is increasing. The impact on the critical care environment and the health care system, as a whole, is significant from both a cost and burden to the system perspective. There are 6.5 million hospital days a year and nearly $40 billion dollars in yearly health care costs attributed to heart failure in the United States. There are more Medicare monies spent for diagnosing and treating heart failure than any other Diagnosis Related Group. There is a 24% hospital re-admission rate for this diagnosis which leads to financial implications for health care systems. The human cost is also significant. Less than half of Americans diagnosed with heart failure survive greater than 5 years. The ongoing health care needs and cost of this chronic disease takes a significant toll on patients’ finances, time and quality of life. Over $2.9 billion dollars is spent annually on the pharmaceutical management of heart failure in the United States. This diagnosis is the leading cause of hospitalization for patients who are 65 years of age and older. Few health care providers in the critical care environment are not affected by heart failure on a routine basis. Caring for these patients and their families is both a challenging and yet a rewarding experience. This edition will provide critical care nurses with a comprehensive heart failure review which is essential in caring for this challenging population given the dynamic health and critical care environments.

This issue contains a series of articles focused on various initiatives aimed at improving the quality of patient care delivery and promoting safe passage across the continuum of care. Exemplary, evidence-based nursing practice is the cornerstone of quality care, and this issue highlights many ways in which nurses have led changes to optimize patient outcomes. In addition, quality care enhances cost-effectiveness by reducing avoidable complications and diminishing avoidable hospital readmissions, a concept more important than ever due to value-based purchasing and the Affordable Care Act. Articles are specifically devoted to prevention of delirium in critical care patients, palliative care in the intensive care unit, prevention of pressure ulcers, fall prevention in high-risk patients, prevention readmissions, preventing sepsis mortality, and nursing interventions in the elderly critical care patient, to name a few.

Critical care clinicians must be knowledgeable about the anatomic, physiologic, and biochemical processes that are critical to the restoration of a functioning microvascular affecting organ perfusion. These basic physiologic processes critical to tissue perfusion and cellular oxygenation are presented in this issue on Monitoring Tissue Perfusion and Oxygenation. A working knowledge of oxygen delivery and oxygen consumption at the microvascular level will provide critical information needed for clinicians to continuously question the adequacy of tissue perfusion given our current lack of microvascular bedside monitoring.

Special considerations arise as critical care nurses care for victims of trauma and violence. This issue highlights the recent advances in the care of these patients, including victims of street crime and domestic violence. As a result of the wars in Afganistan and Iraq, changes in the echelons of care have been brought to U.S. trauma centers in order to better triage, manage, and provide post-surgical care to trauma patients. Articles in this issue address the advances in this field.

Encompassing all anesthesia topics from basic to advanced, Miller’s Anesthesia Review, 3rd Edition, by Drs. Lorraine M. Sdrales and Ronald D. Miller, is an ideal study guide to assess your knowledge and deepen your understanding. This easy-to-use resource is conveniently cross-referenced to the newest edition of Miller & Pardo: Basics of Anesthesia. Hundreds of questions cover everything from physiologic and pharmacologic principles through anesthetic machine systems, anesthetic delivery in a variety of settings, and anesthesia administration for a full range of disease states. Corresponds to Miller & Pardo’s Basics of Anesthesia to help you make the most of your study time and learn more efficiently. Provides immediate feedback with detailed answers to each question at the end of every chapter, cross-referenced to specific pages in Basics of Anesthesia. Includes new chapters on Neurotoxicity of Anesthesia, Palliative Care, Sleep Medicine, and Perioperative Surgical Home. Brings you fully up to date with revised questions throughout, progressing logically from basic to advanced topics. Covers hot topics such as Implantable Cardiac Pulse Generators, Anesthesia for Robotic Surgery, Perioperative Blindness, Human Performance and Patient Safety, and Civil, Chemical, and Biological Warfare.

Dr. O'Malley is a well-known nurse researcer in the area of Hemaotology, and she has assembled top experts to write about the most important hemtaologic issues in critical care. The issue has articles devoted to the following topics: Cord blood banking; Leukemia and Lymphomas; Sickle Cell; Anticoagulants; Aplastic anemia & MDS; Hereditary Hemochromatosis and Pernicious Anemia; Hemophilia; Blood book: cells, products, transfusion; Anemia; Multiple Myeloma; DIC; and The lived experience of anemia without a cause. Nurses will come away with the clinical information they need to improve patient outcomes in the critical care setting.