Measuring and documenting accurate data from pulmonary artery and central venous pressure catheters is an important responsibility of critical care nurses. The American Association of Critical-Care Nurses Practice Alert titled Pulmonary Artery/Central Venous Pressure Monitoring in Adults provides evidence-based standards against which nurses can compare their practice related to obtaining valid hemodynamic data. Identifying and acting on improvement opportunities is also a nursing responsibility and helps to ensure that patients with pulmonary artery or central venous pressure catheters receive high-quality care. This article reviews various strategies to compare nursing practice to the Pulmonary Artery/Central Venous Pressure Monitoring in Adults Practice Alert and to close identified gaps in clinical practice.

Coagulopathy after traumatic injury has multiple etiologies. It may result from overwhelming activation of tissue factor, consumption of circulating coagulation proteins, massive transfusion, metabolic alterations, hypothermia, or any combination of these factors. Despite advances in trauma resuscitation, the problem of persistent, life-threatening coagulopathy continues to pose a significant challenge for the healthcare team, and sometimes is an insurmountable obstacle in the path to recovery of the patient with trauma. Development of a coagulopathy has a significant impact on the morbidity and mortality of the patient with trauma. This article describes the relevant pathophysiology as it relates to the development of a coagulopathy, prevention strategies, and management principles applied in caring for the patient with trauma and a coagulopathy.

This article provides an introduction to the definition of and rationale for outcomes management and includes a brief review of the outcomes management literature. A model for outcomes management, which links processes that can be changed in care delivery to outcomes that can be measured in a patient population, is reviewed. Guidelines for application of the outcomes management model and practical examples of application to two surgical patient populations are presented. Finally, issues important to outcomes management as a tool for performance improvement are discussed.

Immobility is associated with multisystem pathophysiologic sequelae, especially in the critically ill trauma patient. Pulmonary embolus from deep vein thrombosis and nosocomial pneumonia are causes of pulmonary dysfunction that are directly related to immobilization in this population. Because of the high incidence of these complications, early identification of those at risk and institution of aggressive interventions to prevent nosocomial pneumonia and pulmonary embolus are crucial responsibilities of nurses caring for severely injured patients.

A variety of technologies is available to noninvasively evaluate arterial oxygen saturation and partial pressure of serum oxygen (PaO 2 ) and carbon dioxide (PaCO 2 ) in the critically ill patient. These include pulse oximeters, transcutaneous monitoring devices, capnometry, and capnography. Understanding the technology, the clinical significance of the data, and the associated limitations is fundamental in optimizing patient assessment and management. Accordingly, critical care nurses have increasing responsibilities related to these aspects of patient care