This document provides information on various topics related to newer methods of cardiac output monitoring. It discusses cardiac output which is the amount of blood pumped by the heart and how it is an important indicator of oxygen delivery to tissues. Several newer non-invasive methods for monitoring cardiac output are mentioned, including techniques that use aortic impedance, aortic pressure, and capacitance based methods. The document also provides background on the importance of cardiac output and how monitoring it can help assess a patient's oxygenation status.

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BGS Global Hospital, Bangalore,
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College of Nursing, NIMHANS, Bangalore,
India.
Dr. Sukhwinder Kaur
National Institute of Nursing Education,
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Choithram College of Nursing, CH&RC Indore
(M.P.), India.
Dr. C. Kanniammal
Meenakshi College of Nursing, Chennai,
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Dr. Arnel Banaga Salgado
RAK Medical and Health Sciences University,
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Kawaljit Kaur
Medical surgical Nursing, Mai Bhago College of
Nursing, Tarn Taran (Punjab), India.
Regina D Satvekar
Bharati Vidyapeeth College of Nursing, Sangli
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Mr. N.J. Vasudevan
Chitra College of Nursing, Kerala,
India.
K. Priscilla
Matha College of Nursing, Tamil Nadu,
India.
AArvin Babu
Sree Abirami Hospital and College of Nursing,
Coimbatore, India
Mr. Sembian. N.
Government Nursing College, U.P. Rural
Institute of Medical Sciences & Research,
Saifai, Etawah
Dr. Parimala.K.Samuel
Principal, Chitra College of Nursing, Kerala,
India

7. From the Editor's Desk
Dear Readers,
We would like to present, with great pleasure, the Second Volume of a new scholarly
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Critical Care Networks, End of life care, Ethical and legal issues in critical care, Patient centered care,
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8. 1. A Study to Assess the Self-Concept Among Adolescents
T. Kochurani, S.J. Vayalil 1
2. Newer Methods of Cardiac Output Monitoring
Neha Sharma 5
3. Use of Inotropes in Critical Care
Brinder Bhangal 11
4. Immunosuppressant Drugs and Their Side Effects
Arminder Singh 15
5. Are Nurses Aware Regarding Danger Signs of Labor? A Cross-Sectional Screening in a
Tertiary Care Centre in North India
S. Kumbhakar, V.R. Vijay 19
Contents

9. IJNCC (2016) 1-4 © JournalsPub 2016. All Rights Reserved Page 1
International Journal of Nursing Critical Care
Vol. 2: Issue 2
www.journalspub.com
A Study to Assess the Self-Concept Among Adolescents
T. Kochurani, S.J. Vayalil*
Department of Community Health Nursing, Lourdes College of Nursing, Kerala, India
ABSTRACT
The present study was conducted to assess the self-concept among adolescents. The
objectives of the study were; to assess the self-concept among adolescent population using
self-concept inventory and find the association between the self-concepts with selected
demographic variable. Non-experimental quantitative approach was used and research
design adopted for the study is descriptive survey design. The study was carried out in Ward
34 of Thrikkakara municipality. A total of 33 adolescents were selected by convenience
sampling technique. The tools used for the study were demographic proforma to assess the
socio demographic characteristics and self-concept inventory to assess the level of self-
concept among adolescents. The result revealed that among 33 sample, 14 (42.4%) have
good self-concept 19 (57.6%) have excellent self-concept. Among demographic variables
gender had significant association to the self-concept of adolescents ( =0.024, P=0.037)
Keywords: adolescents, assess, self-concept
INTRODUCTION
Adolescence is a new birth, for the higher
and more completely human traits are
now born. Stanley Hall
Adolescence is a transitional stage of
physical and mental human
development.[1]
And it is characterized by
a number of cognitive, emotional, physical
and attitudinal changes, which can be
conflict on one hand and positive
personality development on the other. In
global population one in 5% is an
adolescent. In 2012, the world had 721
million were adolescents. In India
according to 2010 census 243 million are
adolescents and the proportion of
adolescent’s is 19%.[2]
Total population of
Kerala according to 2011 census is 33,
406061(3.34) crores. Adolescent
population of Kerala (‘000) was 5, 433,
and decadal growth rate is 9%.[3]
Adolescence is the bridge between
childhood and adult hood. It is a time of
rapid development of growing maturity,
discovering one’s real self, defining
personal values, etc.[4]
Every adolescent have a thrust to success
in all fields which they have engaged and
adjusted with these changes. Success and
failure in life largely depend on the
variables like emotions, academic abilities,
intellectual capacities, socialization, self-
awareness, etc. Self-awareness gained
increases feeling of worth, thus enabling
them to make healthy self-evaluations, in
spite of what others may think of them.
Self-understanding further allows showing
empathy and understanding others during
relational interactions.
In sum, biological, cognitive and affective
functions affect the development of self-
images, worth, esteems efficacies, wills,
control and awareness and shape self-
conceptions.[5]

10. IJNCC (2016) 5-10 © JournalsPub 2016. All Rights Reserved Page 5
International Journal of Nursing Critical Care
Vol. 2: Issue 2
www.journalspub.com
Newer Methods of Cardiac Output Monitoring
Neha Sharma*
Department of Nursing, Khalsa College of Nursing, Amritsar, India
ABSTRACT
Vertebrate circulatory frameworks comprise of blood, which transports materials to and from
cells by means of veins, and a heart to pump the blood. One vital part of the circulatory
framework is to give oxygen to cells. When in doubt, little creatures have a higher rate of
oxygen utilization per unit body mass than expansive creatures. In this manner, the heart of a
little creature must supply oxygen at a higher rate than the heart of a huge creature. Since
the oxygen limit of blood is comparable amongst little and huge creatures, little creatures
must have hearts that pump blood at a higher rate, or as it were, have a higher
cardiovascular yield.
Keywords: aortic impedance, aortic pressure, capacitor, cardiac output
INTRODUCTION
Cardiovascular output (CO) is the essential
compensatory system that reacts to an
oxygenation challenge. Despite the fact
that Harvey found the flow of blood over
300 years prior, routine estimation of CO
is accessible just since 1970's, when Swan,
Ganz and associates reported that
aspiratory course catheter (PAC) inclusion
could be performed at the bedside by the
utilization of exceptionally composed
inflatable tipped catheter.
Preferably, the innovation which gives CO
estimation ought to be noninvasive,
precise, solid, ceaseless, and good in
grown-ups and pediatric patients. At
present, no single system meets every one
of these criteria. Late advances in
innovation have prompted to the
improvement of insignificantly obtrusive
and non-intrusive strategies. The
improvement of impedance cardiography
and advances in gadgets and flag preparing
has prompted to the improvement of
absolutely non-obtrusive screens, which
can give constant estimation of
haemodynamic parameters. A few audits
distributed in the later past report clinical
approval and confinements of the different
negligibly obtrusive and absolutely non-
intrusive strategies and also their
constraints.[1]
A late survey by the creators
clarifies the utilization of PAC in
hemodynamic observing.
INVASIVE METHODS
Thermodilution Technique
Aside from its weight observing
capacities, without a doubt the most vital
element of PAC is its capacity to quantify
CO utilizing the thermodilution strategy.
The thermodilution procedure has turned
into the defacto clinical standard for CO
assurance.
This strategy depends on standard like
pointer weakening however utilizes warm
rather than shading as a marker. Heart
yield is figured utilizing the changed
Stewart-Hamilton pointer weakening
condition. The system has as of late been
adjusted to figure the ceaseless CO and
also checking of right ventricular

11. IJNCC (2016) 11-14 © JournalsPub 2016. All Rights Reserved Page 11
International Journal of Nursing Critical Care
Vol. 2: Issue 2
www.journalspub.com
Use of Inotropes in Critical Care
Brinder Bhangal
Phoenix Institute of Nursing, Punjab, India
BACKGROUND
Inotropes are a social occasion of
pharmaceuticals that modify the
contractility of the heart. Positive
inotropes invigorate the heart's
compressions, so it can pump more blood
with fewer heartbeats. This solution is for
the most part given to patients with
congestive heart disillusionment or
cardiomyopathy. These pharmaceuticals
may similarly be given to patients who
have had a late heart ambush. Now and
again, inotropes are given to patients
whose hearts have been crippled after
heart surgery (in examples of cardiogenic
daze).
Negative inotropes incapacitate the heart's
withdrawals and direct the heart rate.
These arrangements are used to treat
(hypertension), ceaseless heart
dissatisfaction, unpredictable heart
rhythms (arrhythmias), and midriff
torment (angina). They are here and there
used as a piece of heart ambush patients to
diminishing weight on the heart and
foresee future heart strikes.
The method of reasoning for inotrope
utilize Inotropes are demonstrated in
intense conditions where there is low
cardiovascular yield (CO, for example,
cardiogenic stun taking after myocardial
dead tissue, intense decompensated heart
disappointment and low CO states after
heart surgery.
Lessened CO prompts to tissue hypo
perfusion and consequent hypoxia.
Digestion system changes from oxygen
consuming to anaerobic, bringing about
the arrangement of lactic corrosive. On the
off chance that left untreated, this can
bring about multi-organ disappointment
and demise.
Mean Arterial Pressure
Tissue perfusion is liable to mean vein
circulatory strain (MAP), which is the
consequence of CO and systemic vascular
resistance (SVR):*
Layout CO × SVR
Diminishing CO or SVR cuts down the
MAP and along these lines reduce tissue
perfusion.
[* = central venous weight (CVP) can in
like manner be joined into the condition
(i.e., MAP - CVP = CO × SVR). Since
CVP is a far tinier regard than MAP, it has
no sober minded impact to fuse CVP in the
condition and it is frequently disregarded
for simplicity][1]
Systemic Vascular Resistance
SVR can be depicted basically as the
impenetrability to circulation system (CO).
It is frequently called the “afterload.”
Heart Yield
CO is dependent on the stroke volume
(SV) and heart rate (HR):
CO = HR × SV
The SV depends on upon the SVR
(afterload) and the "preload". Preload
(how much ventricles are stretched out
before contracting) compares with the end
diastolic volume (the volume of blood in a
ventricle toward the end of filling). It is
basic to streamline preload by amending
fluid change before starting inotropes,

12. IJNCC (2016) 15-18 © JournalsPub 2016. All Rights Reserved Page 15
International Journal of Nursing Critical Care
Vol. 2: Issue 2
www.journalspub.com
Immunosuppressant Drugs and Their Side Effects
Arminder Singh*
Phoenix Nursing Institute, Punjab, India
ABSTRACT
Immunosuppressive medications or immunosuppressive specialists or antirejection
prescriptions are medications that restrain or avoid movement of the insusceptible
framework. They are utilized as a part of immunosuppressive treatment to: Keep the
dismissal of transplanted organs and tissues (e.g., bone marrow, heart, kidney, liver) Treat
immune system infections or ailments that are no doubt of immune system root (e.g.,
rheumatoid joint inflammation, different sclerosis, myasthenia gravis, psoriasis, vitiligo,
systemic lupus erythematosus, sarcoidosis, central segmental glomerulosclerosis, Crohn's
illness, Behcet's Disease, pemphigus, and ulcerative colitis). Treat some other non-immune
system incendiary ailments (e.g., long haul hypersensitive asthma control).
Keywords: drugs, immunosuppressant, side-effect
INTRODUCTION
Immunosuppressant medications are a
class of medications that stifle or decrease
the quality of the body's insusceptible
framework. They are likewise called
hostile to dismissal drugs. One of the
essential employments of
immunosuppressant medications is to
bring down the body's capacity to dismiss
a transplanted organ, for example, a liver,
heart or kidney. There are 2 sorts of
Immunosuppressant:
(1) Induction medications: Powerful
antirejection drug utilized at the season
of transplant.
(2) Maintenance medications:
Antirejection medicines utilized for the
long haul.
The three primary immunosuppressants
medicates as of now utilized as a part of
organ transplantations are the
accompanying:
(a) Cyclosporins (Neoral, Sandimmune,
SangCya). These medications
demonstration by repressing T-cell
actuation, therefore keeping T-cells
from assaulting the transplanted organ.
(b) Azathioprines (Imuran). These
medications upset the union of DNA
and RNA and cell division.
(c) Corticosteroids, for example,
prednisolone (Deltasone, Orasone).
These medications smother the
irritation connected with transplant
dismissal.
Most patients are recommended a mix of
medications after their transplant, one
from each of the above principle bunches;
for instance cyclosporin, azathioprine and
prednisolone. Over a timeframe, the
measurements of every medication and the
quantity of medications taken might be
lessened as the dangers of dismissal
abatement. In any case, most patients need
to take no less than one
immunosuppressive for whatever is left of
their lives.
Think about a land home loan; the upfront
installment resemble the acceptance

13. IJNCC (2016) 19-23 © JournalsPub 2016. All Rights Reserved Page 19
International Journal of Nursing Critical Care
Vol. 2: Issue 2
www.journalspub.com
Are Nurses Aware Regarding Danger Signs of Labor? A Cross-
Sectional Screening in a Tertiary Care Centre in North India
S. Kumbhakar*, V.R. Vijay
College of Nursing, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, UP, India
ABSTRACT
Awareness of danger signs during labor is one of the essential aspects of maternal well-being
that enhances early diagnosis and treatment as it augments reduction in maternal and infant
mortality. The objective of the study was to assess the knowledge regarding danger signs of
labor among the nurses and to find out the association between the selected demographic
variables and their knowledge score. A cross sectional descriptive research approach was
employed. Three hundred and twenty two subjects are included in the study. Subjects were
prearranged on the basis of purposive sampling. Interview schedule was used to collect socio
demographic and clinical data of the subjects. Knowledge was assessed by a questionnaire
related to danger signs. The result showed that a large group (44%) belongs to moderately
adequate category and 38% were in inadequate group whereas only 18% had adequate
knowledge.
Keywords: awareness, danger signs of labor, nurses
INTRODUCTION
The labor and childbirth are special
proceedings in women life. It is a time of
great hope and pleasurable anticipation
whereas it can also be a time of panic,
distress and even death. UNICEF report
reveals India’s maternal mortality rate
reduced from 212 deaths per 100,000 live
births in 2007 to 178 deaths in 2012.[1]
Labor may be linked with certain risks for
both women and fetus. Appropriate
midwifery care such as adequate fetal and
maternal monitoring, judicious medical
intervention, reducing prolonged labor and
apt referral throughout and immediately
after childbirth can help out to avoid
intrapartum complications.[2–5]
The key obstetric danger signs comprises
of early or premature rupture of
membrane, profuse vaginal bleeding,
prolonged labor (more than 24 hrs of labor
pain or pushing pain more than 2 hours),
tearing abdominal pain, hyperpyrexia,
oliguria or dysuria , toxemia of pregnancy
(frontal or occipital severe headache,
blurred or double vision, sudden epigastric
pain, overactive reflexes, protein in urine,
raised BP), increased pulse rate or reduced
BP, convulsions, decreased or absence of
fetal movement, diminished or raised or
absence FHR, Meconium or blood or
golden yellow stained liquor, retained
placenta, inversion of uterus(sense of
something coming out) , and fruity smell
breath.[6–8]
A study pointed out that timely and
necessary obstetric intervention was
delayed by midwives’ due to the lack of
proper monitoring of warning signs
throughout labor. Several studies noted
that midwives’ had critically low
knowledge to recollect the danger signs of

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Architecture
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Nanotechnology
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Chemistry
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Nursing
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« International Journal of Oncological Nursing
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Care
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