acute
[ah-kūt´] 1. sharp.
2. having severe symptoms and a short course. Some serious illnesses that were formerly considered acute (such as myocardial infarction) are now recognized to be acute episodes of chronic conditions.
acute respiratory distress syndrome (ARDS) a group of symptoms accompanying fulminant pulmonary edema and resulting in acute respiratory failure; called also
shock lung, wet lung, and many other names descriptive of etiology or clinical manifestations. Many etiologic factors have been associated with ARDS, including shock, fat embolism, fluid overload, oxygen toxicity, fluid aspiration, narcotic overdose, disseminated intravascular coagulation, multiple transfusions, inhalation of toxic gases, diffuse pulmonary infection, and systemic reactions to sepsis, pancreatitis, and massive trauma or burns.
ARDS is characterized clinically by
dyspnea,
tachypnea,
tachycardia,
cyanosis, and
hypoxemia. Pa
O2/FI
O2 remains low (below 2 cc) even with oxygen therapy at high oxygen concentrations. The lung compliance is decreased so that the lung is stiffer and more difficult to ventilate. Chest radiographs show signs of bilateral interstitial and alveolar edema. Cardiac filling pressures are normal, and the pulmonary capillary wedge pressure is below 18 torr.
Most authorities consider that the syndrome has three phases or stages that characterize its progression: the
exudative stage, the
fibroproliferative or
proliferative stage, and the
resolution or
recovery stage. The exudative stage comes first, two to four days after onset of lung injury, and is distinguished by the accumulation of excessive fluid in the alveoli with entrance of protein and inflammatory cells from the alveolar capillaries into the air spaces. The fibroproliferative stage comes second and is characterized by an increase in connective tissue and other structural elements in the lungs in response to the initial injury. It begins between the first and third weeks after the initial injury and may last up to ten weeks. Microscopic examination reveals lung tissue that appears densely cellular. The patient is at risk for
pneumonia,
sepsis, and
pneumothorax at this time. The third stage is the resolution or recovery stage. During this stage the lung reorganizes and recovers, although it continues to show signs of
fibrosis. Lung function may continue to improve for as long as six to twelve months or even longer, depending on the precipitating condition and severity of the injury. It is important to remember that there are often different levels of pulmonary recovery in patients with ARDS.
Some authorities refer to a fourth phase or stage of ARDS, the period after the resolution or recovery stage. Some patients continue to experience health problems caused by the acute illness, such as coughing, limited exercise tolerance, and fatigue. Anxiety, depression, and flashback memories of the critical illness may also occur and be similar to
posttraumatic stress disorder.
Treatment and Patient Care. Mechanical
ventilation must be begun at the first signs of
hyperventilation and
hypoxemia, before obvious signs of respiratory distress develop. A cuffed
endotracheal tube or
tracheostomy tube is used to maintain an airway. The patient is ventilated at the lowest oxygen concentration that maintains the arterial oxygen saturation (Sa
O2) at 90 per cent.
positive end-expiratory pressure (PEEP) or
continuous positive airway pressure (CPAP) may be used to increase the number of alveoli that remain open at the end of exhalation and thus decrease pulmonary shunt.
hemodynamic monitoring, using a
swan-ganz catheter, is done to measure cardiac output, pulmonary capillary wedge pressure, and right atrial wedge pressure. An arterial line is placed to continuously monitor
blood pressure and measure arterial
blood gases. A diuretic such as
furosemide (Lasix) may be administered to reduce fluid volume overload and pulmonary edema. If infection develops, antibiotics are administered. Hemodynamic parameters, arterial blood gas levels, intake and output, breath sounds, vital signs, inspiratory pressure, tidal volume, inspired oxygen concentration, and end-expiratory pressure are all continuously monitored.
acute stress disorder an
anxiety disorder characterized by development of
anxiety,
dissociation, and other symptoms within one month following exposure to an extremely traumatic event, the symptoms including reexperiencing the event, avoidance of trauma-related stimuli, anxiety or increased arousal, and some or all of the following: a subjective sense of diminished emotional responsiveness, numbing, or detachment, derealization, depersonalization, and amnesia for aspects of the event. If persistent, it may become
posttraumatic stress disorder.
care
[kār] the services rendered by members of the health professions for the benefit of a patient. See also
treatment.
admission care in the
nursing interventions classification, a
nursing intervention defined as facilitating entry of a patient into a health care facility.
adult day care a health care service provided for adults with a disability or illness who need partial or supplemental care and companionship during the day, when family members are working or otherwise unable to stay at home with a disabled relative. Among the services that may be offered at an adult day care center are nursing services (e.g., medication administration and health monitoring); nutritional and health education, health counseling; physical, speech, and occupational therapy; and socialization.
ambulatory care health services or acute care services that are provided on an outpatient basis.
amputation care in the
nursing interventions classification, a
nursing intervention defined as the promotion of physical and psychological healing after
amputation of a body part.
bed rest care in the
nursing interventions classification, a
nursing intervention defined as promotion of comfort and safety and prevention of complications for a patient unable to get out of bed. See also
bed rest.
bladder care activities and interventions designed to maintain urinary
bladder function, including bladder retraining,
catheter change, and catheter irrigation.
bowel care activities and interventions designed to maintain
bowel function, including
enema, bowel training, diet, and medication.
bowel incontinence care in the
nursing interventions classification, a
nursing intervention defined as promotion of bowel continence and maintenance of
perianal skin integrity.
bowel incontinence care: encopresis in the
nursing interventions classification, a
nursing intervention defined as promotion of bowel continence in children.
cardiac care in the
nursing interventions classification, a
nursing intervention defined as the limitation of complications resulting from an imbalance between myocardial oxygen supply and demand for a patient with symptoms of impaired cardiac function.
cardiac care: acute in the
nursing interventions classification, a
nursing intervention defined as the limitation of complications for a patient recently experiencing an episode of an imbalance between myocardial oxygen supply and demand resulting in impaired cardiac function.
cardiac care: rehabilitative in the
nursing interventions classification, a
nursing intervention defined as the promotion of maximal functional activity level for a patient who has suffered an episode of impaired cardiac functon which resulted from an imbalance between myocardial oxygen supply and demand.
cast care activities and interventions designed to protect and maintain an immobilized body part, including relief of pain, pressure or constriction of circulation. See also
hazards of immobility.
cast care: maintenance in the
nursing interventions classification, a
nursing intervention defined as care of a cast after the drying period.
cast care: wet in the
nursing interventions classification, a
nursing intervention defined as care of a new cast during the drying period.
cesarean section care in the
nursing interventions classification, a
nursing intervention defined as the preparation and support of a patient delivering a baby by
cesarean section.
circulatory care: arterial insuficiency in the
nursing interventions classification, a
nursing intervention defined as promotion of arterial circulation.
circulatory care: mechanical assist device in the
nursing interventions classification, a
nursing intervention defined as temporary support of the circulation through the use of mechanical devices or pumps.
circulatory care: venous insufficiency in the
nursing interventions classification, a
nursing intervention defined as promotion of venous circulation.
contact lens care in the
nursing interventions classification, a
nursing intervention defined as the prevention of eye injury and lens damage by proper use of contact lenses.
continuing care the level of care in the
health care system that consists of ongoing care of the physically handicapped, mentally retarded, emotionally retarded, and those suffering from chronic incapacitating illness.
cord care specialized care of the remnants of a newborn's
umbilical cord until it falls off, consisting of cleaning and precautions to prevent infection. Cleansing protocols continue until the site is completely healed.
culture-specific care those assistive, supportive, or facilitative acts toward or for an individual or group with evident or anticipated needs that are congruent with the values and lifestyles of an individual, family, or group of a specific culture, as used in the
cultural care diversity and universality theory.
day care/respite in the
omaha system, the providing by an individual or institution of supervision for a dependent child or adult in the abscence of the usual caregiver or parent.
developmental care in the
nursing interventions classification, a
nursing intervention defined as structuring the environment and providing care in response to the behavioral cues and states of the preterm infant.
direct care the provision of services to a patient that require some degree of interaction between the patient and the health care provider. Examples include assessment, performing procedures, teaching, and implementation of a care plan.
dying care in the
nursing interventions classification, a
nursing intervention defined as promotion of physical comfort and psychological peace in the final phase of life. See also
dying.
ear care in the
nursing interventions classification, a
nursing intervention defined as prevention or minimization of threats to ear or hearing.
embolus care: peripheral in the
nursing interventions classification, a
nursing intervention defined as limitation of complications for a patient experiencing, or at risk for, occlusion of peripheral circulation. See also
embolus.
embolus care: pulmonary in the
nursing interventions classification, a
nursing intervention defined as limitation of complications for a patient experiencing, or at risk for, occlusion of pulmonary circulation. See also
embolus.
emergency care in the
nursing interventions classification, a
nursing intervention defined as providing life-saving measures in life-threatening situations. See also
emergency.
episodic care interventions aimed at patient cure or restoration to previous level of functioning.
eye care in the
nursing interventions classification, a
nursing intervention defined as the prevention or minimization of threats to eye or visual integrity.
family-centered maternity care a pattern of caring for infants and their families used by Health and Welfare Canada. It is characterized by a great deal of flexibility and parental choice, and health care professionals are encouraged to individualize care. Breast feeding and rooming in are encouraged and grandparent and sibling visits are permitted.
foot care see foot care.
hair care in the
nursing interventions classification, a
nursing intervention defined as the promotion of neat, clean, and attractive hair.
high-risk pregnancy care in the
nursing interventions classification, a
nursing intervention defined as identification and management of a high-risk pregnancy to promote healthy outcomes for mother and baby.
incision site care in the
nursing interventions classification, a
nursing intervention defined as cleansing, monitoring, and promotion of healing in a wound that is closed with sutures, clips, or staples.
indirect care services that are related to patient care but do not require interaction between the health care provider and the patient. Examples include charting and scheduling.
infant care in the
nursing interventions classification, a
nursing intervention defined as the provision of developmentally appropriate family-centered care to the child under one year of age.
intrapartal care in the
nursing interventions classification, a
nursing intervention defined as the monitoring and management of stages one and two of the birth process. See
labor.
intrapartal care: high-risk delivery in the
nursing interventions classification, a
nursing intervention defined as assisting vaginal birth of multiple or malpositioned fetuses.
kangaroo care in the
nursing interventions classification, a
nursing intervention defined as promoting closeness between parent and physiologically stable preterm infant by preparing the parent and providing the environment for skin-to-skin contact.
long-term care health care services required for an extended period of time by individuals unable to fully execute activities of daily living; it can be provided by a variety of agencies in outpatient settings as well as on an inpatient basis.
managed care a method of health care delivery that focuses on collaboration among and coordination of all services to avoid overlap, duplication, and delays and to reduce costs. There is an emphasis on efficacy and timeliness of interventions to prevent unnecessary delays in discharge from the hospital or agency.
medical/dental care in the
omaha system, diagnosis and treatment by a physician or dentist.
nail care in the
nursing interventions classification, a
nursing intervention defined as promotion of clean, neat, attractive nails and prevention of skin lesions related to improper care of nails.
newborn care in the
nursing interventions classification, a
nursing intervention defined as management of the
neonate during the transition to extrauterine life and the subsequent period of stabilization.
nursing care in the
omaha system, therapeutic activities in addition to intermittent service, including private duty nursing.
ostomy care in the
nursing interventions classification, a
nursing intervention defined as maintenance of elimination through a stoma and care of surrounding tissue. See also
ostomy.
ostomy care (omaha) in the omaha system, management of elimination through artificial openings, including colostomy and ileostomy.
perineal care in the
nursing interventions classification, a
nursing intervention defined as maintenance of
perianal skin integrity and relief of perineal discomfort.
peripherally inserted central catheter care in the
nursing interventions classification, a
nursing intervention defined as insertion and maintenance of a peripherally inserted central catheter.
personal care the management of hygiene, including bathing, shampooing, shaving, nail trimming, dressing, and so on.
point of care the location at which patient services are delivered.
postanesthesia care in the
nursing interventions classification, a
nursing intervention defined as monitoring and management of the patient who has recently undergone general or regional anesthesia.
postmortem care in the
nursing interventions classification, a
nursing intervention defined as providing physical care of the body of an expired patient and support for the family viewing the body.
postoperative care see postoperative care.
postpartal care in the
nursing interventions classification, a
nursing intervention defined as monitoring and management of the patient who has recently given birth.
prenatal care 1. care of the pregnant woman before delivery of the infant. See also
pregnancy.
2. in the
nursing interventions classification, a
nursing intervention defined as monitoring and management of the patient during pregnancy to prevent complications of pregnancy and promote a healthy outcome for both mother and infant.
primary care the routine outpatient care that a patient receives at first contact with the
health care system.
prosthesis care in the
nursing interventions classification, a
nursing intervention defined as the care of a removable appliance worn by a patient and the prevention of complications associated with its use. See also
prosthesis.
respite care 1. services provided by a health care agency that permit a primary caregiver temporary relief from caring for an ill individual.
2. in the
nursing interventions classification, a
nursing intervention defined as the provision of short-term care to provide relief for a family
caregiver.
restorative care the level of care in the
health care system that consists of follow-up care and rehabilitation to an optimal functional level.
sickness/injury care in the
omaha system, the appropriate responses to illness or accidents, including first aid, taking temperature, and seeking medical care.
skilled nursing care the services provided by a registered nurse in a
skilled nursing facility. It currently includes observation during periods of acute or unstable illness; administration of intravenous fluids, enteral feedings, and intravenous or intramuscular medications; short-term bowel and bladder retraining; and changing of sterile dressings.
skin care activities and interventions designed to maintain integrity of integument, including care of
pressure ulcers and
massage.
skin care: topical treatments in the
nursing interventions classification, a
nursing intervention defined as the application of topical substances or manipulation of devices to promote skin integrity and minimize skin breakdown.
subacute care comprehensive goal-oriented inpatient care designed for a patient who has had an acute illness, injury, or exacerbation of a disease process; it is rendered either immediately after or instead of acute care hospitalization, to treat specific active or complex medical conditions or to administer any necessary technically complex medical treatments in the context of the person's underlying long-term condition.
supportive care interventions that help the patient achieve comfort but do not affect the course of a disease. Called also
palliative care or
treatment.
tertiary care the level of care in the
health care system that consists of complex procedures given in a health care center that has highly trained specialists and often advanced technology.
total patient care a method of organizing care of patients such that one practitioner carries out all care requirements.
traction/immobilization care in the
nursing interventions classification, a
nursing intervention defined as management of a patient who has
traction and/or a stabilizing device to immobilize and stabilize a body part.
tube care in the
nursing interventions classification, a
nursing intervention defined as management of a patient with an external drainage device exiting the body.
tube care: chest in the
nursing interventions classification, a
nursing intervention defined as management of a patient with an external water-seal drainage device exiting the chest cavity.
tube care: gastrointestinal in the
nursing interventions classification, a
nursing intervention defined as management of a patient with a gastrointestinal tube.
tube care: umbilical line in the
nursing interventions classification, a
nursing intervention defined as management of a newborn with an umbilical catheter.
tube care: urinary in the
nursing interventions classification, a
nursing intervention defined as management of a patient with urinary drainage equipment.
tube care: ventriculostomy/lumbar drain in the
nursing interventions classification, a
nursing intervention defined as management of a patient with an external cerebrospinal fluid drainage system. See also
ventriculostomy and
drain.
urinary incontinence care in the
nursing interventions classification, a
nursing intervention defined as assistance in promoting continence and maintaining perineal skin integrity. See also
urinary incontinence.
urinary incontinence care: enuresis in the
nursing interventions classification, a
nursing intervention defined as promotion of urinary continence in children.
wound care: closed drainage in the
nursing interventions classification, a
nursing intervention defined as maintenance of a pressure drainage system at the wound site.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.