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Cardiac Surgery Essentials For Critical Care Nursing 3rd Revised edition [Hardback]

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  • Formāts: Hardback, 602 pages, weight: 1049 g
  • Izdošanas datums: 13-May-2019
  • Izdevniecība: Jones and Bartlett Publishers, Inc
  • ISBN-10: 1284154211
  • ISBN-13: 9781284154214
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  • Formāts: Hardback, 602 pages, weight: 1049 g
  • Izdošanas datums: 13-May-2019
  • Izdevniecība: Jones and Bartlett Publishers, Inc
  • ISBN-10: 1284154211
  • ISBN-13: 9781284154214
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Patients who undergo cardiac surgery require specialized care. Critical care nurses are crucial to their postoperative recovery and health. Cardiac Surgery Essentials for Critical Care Nursing, Third Edition is an indispensable resource for new and experienced nurses caring for patients in critical care units immediately following cardiac surgery and in the transitioning to home. With an evidence-based foundation, the Third Edition addresses nursing knowledge to meet the needs of acutely ill patients and strategies to optimizing patient outcomes in this dynamic field. Vital information has been added and updated to reflect significant changes in cardiac surgery as well as four new chapters based on needs of patients, families, and readers. These new chapters address nutritional issues, post ICU-care, psychological and spiritual support, and rehabilitation care post cardiac surgery.

Published in partnership with the American Association of Critical-Care Nurses (AACN), Cardiac Surgery Essentials for Critical Care Nursing, Third Edition is a must-have reference for all nurses caring for acute and critically ill patients and an ideal resource to help prepare nurses who plan to take the Cardiac Surgery Certification (CSC®) subspecialty exam offered by the AACN.
Preface xiv
Contributors xvi
Chapter 1 Clinical Judgment in Critical Care 1(12)
Introduction
1(1)
Clinical Judgment Processes
2(2)
Information Processing
2(1)
Intuition
3(1)
Decision Analysis
4(1)
Relationship-Centered Caring in Critical Care
4(1)
Day-to-Day Practice
5(5)
Trending and Knowing the Patient
5(1)
Common Trajectories
6(4)
Summary
10(3)
Chapter 2 Cardiovascular Anatomy and Physiology 13(14)
Introduction
13(1)
Chambers and Valves of the Heart
14(1)
Blood Flow Through the Heart and Major Blood Vessels
15(2)
Coronary Arteries
17(1)
Cardiac Lymphatic System
17(1)
Pressure of Blood in Major Blood Vessels
18(1)
Electrical Control of Cardiac Muscle
18(2)
Cardiac Output, Preload, and Afterload
20(1)
External Control of the Heart
21(1)
Systemic Circulation
22(1)
Systemic Control of Blood Pressure
23(1)
Disorders of Major Blood Vessels
24(1)
Summary
24(3)
Chapter 3 Indications for Cardiac Surgery 27(26)
Introduction
27(1)
Surgery for Ischemic Heart Disease
27(3)
Medical Therapy Versus Surgical Revascularization
28(1)
Percutaneous Versus Surgical Revascularization
28(2)
Indications for Coronary Artery Bypass Grafting
30(7)
CABG in Diabetics
30(6)
CABG in Patients with Concomitant Carotid Disease
36(1)
Minimally Invasive Myocardial Revascularization
36(1)
Transmyocardial Laser Revascularization
37(1)
Surgery for Valve Disease
37(1)
Surgical Management of Arrhythmias
38(3)
Atrial Fibrillation
39(1)
Surgical Management of Ventricular Tachycardia
40(1)
Surgical Therapies for Heart Failure
41(1)
Cardiac Transplantation
41(1)
Heart-Lung Transplantation
41(1)
Surgery for Adult Congenital Heart Disease
41(1)
Hypertrophic Cardiomyopathy
42(2)
Other Cardiac Surgeries: Pericardial Surgery
44(1)
Cardiac Tumors
44(1)
Summary
44(9)
Chapter 4 Preoperative Cardiac Surgery Nursing Evaluation 53(18)
Introduction
53(1)
Risk Factors of Morbidity and Mortality Following Cardiac Surgery
53(1)
Nursing Assessment
54(4)
Preoperative Patient Interview
54(2)
Discharge Planning
56(1)
Physical Assessment
56(2)
Preoperative Assessment of Heart Disease
58(6)
Cardiac History
58(1)
Serological Testing
59(1)
Diagnostic Studies
60(1)
Medications
61(3)
Management of High-Risk Patients
64(1)
Ventricular Dysfunction
64(1)
Summary
65(6)
Chapter 5 Heart Valve Surgery 71(20)
Introduction
71(1)
Valvular Heart DiSease
71(1)
Aortic Stenosis
72(2)
Aortic Regurgitation (Insufficiency)
74(1)
Indications for Aortic Valve Replacement in Aortic Regurgitation
75(1)
Mitral Stenosis
75(3)
Mitral Regurgitation
78(3)
Choice of Valve Prosthesis
81(1)
Tricuspid Valve Disease
81(1)
Tricuspid Regurgitation
81(1)
Tricuspid Stenosis
81(1)
Infective Valve Endocarditis
82(1)
Complications of Heart Valve Surgery
83(2)
Summary
85(6)
Chapter 6 Cardiopulmonary Bypass and Off-Pump Coronary Artery Bypass 91(14)
Introduction
91(1)
Potential Complications of Bypass Surgery
92(1)
Off-Pump Coronary Artery Bypass
92(1)
Complications of On-Pump Surgery Versus Off-Pump Surgery
93(2)
Hemodynamic Monitoring
95(1)
Risks of On-Pump Surgery Versus Off-Pump Surgery
95(2)
Cognitive Decline
96(1)
Graft Occlusion
96(1)
Compartment Syndrome
97(1)
Summary
97(8)
Chapter 7 Minimally Invasive Cardiac Surgery 105(32)
Introduction
105(1)
Minimally Invasive Coronary Revascularization
105(5)
Off-Pump Coronary Artery Bypass
108(1)
Minimally Invasive Direct Coronary Artery Bypass
108(2)
Robotic Assisted or Totally Endoscopic Coronary Artery Bypass Grafting
110(1)
Hybrid Coronary Revascularization
110(2)
Minimally Invasive Valve Surgery
112(10)
Minimally Invasive Mitral Valve Surgery (MIMVS)
112(2)
Minimally Invasive Tricuspid Valve Surgery
114(1)
Minimally Invasive Aortic Valve Replacement
115(1)
Transcatheter Aortic Valve Replacement
116(6)
Minimally Invasive Pulmonic Valve Replacement
122(1)
Minimally Invasive Atrial Fibrillation Ablation
122(1)
Left Atrial Appendage Procedure
123(1)
Nursing Care and Special Considerations for MICS
123(6)
Admission to the ICU: The First 15 Minutes
124(1)
Secondary Assessment: The Next 15 Minutes
125(1)
Hemodynamic Monitoring
126(1)
Postoperative Complications
126(1)
Postoperative Ventilatory Support
127(1)
Acute Kidney Injury
128(1)
Recovery from MICS
128(1)
Summary
129(8)
Chapter 8 Recovery from Anesthesia 137(18)
Introduction
137(1)
Hand-off Communication or Situation-Background-Assessment- Recommendation (SBAR)
137(2)
Immediate Postoperative Care
139(1)
Assessment
139(1)
Anesthetic Agents
140(2)
Induction Agents
140(1)
Inhalation Agents
141(1)
Neuromuscular Blocking Agents
142(1)
Opioids
142(1)
Postoperative Care
142(5)
Hemodynamic Management
142(1)
Alterations in Heart Rate and Rhythm
143(1)
Postoperative Nausea and Vomiting
144(1)
Thermoregulation (Hypothermia)
144(1)
Postoperative Respiratory Management
145(1)
Stir-up Regimen
145(1)
Complications Related to Extubation
146(1)
Potential Postoperative Corn plications
147(1)
Malignant Hyperthermia
147(1)
Pseudocholinesterase Deficiency
147(1)
Protamine Sulfate Allergic Reactions
148(1)
Summary
148(7)
Chapter 9 Hemodynamic Monitoring 155(22)
Introduction
155(1)
Essentials of Hemodynamic Monitoring
155(1)
Initial Postoperative Assessment
156(3)
Preparing Hemodynamic Equipment
156(1)
Vital Signs and Hemodynamic Assessment
157(1)
Patient Assessment
158(1)
Blood Pressure Monitoring
159(2)
Central Venous Pressure Monitoring
161(3)
Monitoring Using a Pulmonary Artery Catheter
164(1)
Cardiac Output Measurement
165(3)
Continuous Cardiac Output
165(1)
Alternative Methods to Determine Cardiac Output
166(2)
Assessment of Oxygenation Parameters
168(2)
Venous Oxygen Saturation
168(1)
Central Venous Oxygen Saturation
168(1)
Postoperative Hemodynamic Assessment
169(1)
Summary
170(7)
Chapter 10 Intra-Aortic Balloon Pump 177(18)
Introduction
177(1)
Components of an IABP
177(1)
Physiology of Balloon Function
178(1)
Indications for IABP Therapy
178(2)
Contraindications to IABP Therapy
180(1)
Insertion of an IABP
180(1)
Timing
181(4)
Timing Errors
182(3)
Complications of IABP Therapy
185(1)
Weaning from IABP Therapy
185(1)
Troubleshooting the IABP
186(3)
Low Diastolic Augmentation
186(1)
Faulty Trigger
187(1)
Autofill Failure
187(2)
Monitoring for Complications of IABP Therapy
189(1)
Summary
189(6)
Chapter 11 Mechanical Ventilation After Cardiac Surgery 195(20)
Introduction
195(1)
Predictors of Prolonged Mechanical Ventilation
196(1)
Anesthesia and Postoperative Complications
196(1)
Delays Related to Bypass Complications
196(1)
Complications of Prolonged Ventilation
196(1)
Pathophysiology of the Lungs
197(1)
Assessment of Readiness for Weaning
197(7)
General Physiologic and Hemodynamic Stability
197(1)
Pulmonary Mechanics
198(1)
Respiratory Physiologic Issues
199(1)
Phrenic Nerve Injury
199(1)
Arterial Blood Gas
200(3)
Intrapulmonary Shunt
203(1)
Postoperative Mechanical Ventilation
204(2)
Initial Postoperative Ventilator Settings
204(2)
Patient Monitoring
206(1)
Weaning Criteria
206(2)
Weaning from Mechanical Ventilation
206(2)
Weaning from Prolonged Ventilation
208(1)
Postextubation Care
208(1)
Summary
209(6)
Chapter 12 Pharmacologic Support Following Cardiac Surgery 215(36)
Introduction
215(1)
Agents Used to Manage Postoperative Hypertension
215(9)
Vasodilators
218(2)
Beta-Adrenergic Antagonists
220(1)
Angiotensin-Converting Enzyme Inhibitors
221(1)
Angiotensin Receptor Blockers
222(1)
Calcium Channel Blockers
222(2)
Selective Dopamine-1 Receptor Agonists
224(1)
Agents Used to Manage Postoperative Low Cardiac Output and Hypotension
224(11)
Adrenergic Agonists
225(5)
Phosphodiesterase Inhibitors
230(1)
Other Agents Used to Control Postoperative Hypotension
231(4)
Agents Used to Prevent or Control Postoperative Dysrhythmias
235(4)
Agents Used to Manage Atrial Dysrhythmias
235(3)
Agents to Treat Electrolyte Imbalances
238(1)
Other Agents That May Be Required in Postoperative Cardiac Surgery Patients
239(1)
Naloxone (Narcans)
239(1)
Prophylactic Antibiotics
239(1)
Agents Used to Control Postoperative Bleeding
240(4)
Protamine Sulfate
240(1)
Desmopressin (DDAVP®)
241(1)
Recombinant Activated Factor VII (NovoSeven® RT)
241(1)
Epsilon-Aminocaproic Acid (Amicar®)
242(1)
Other Coagulation Factors
243(1)
Summary
244(7)
Chapter 13 Postoperative Complications of Cardiac Surgery and Nursing Interventions 251(34)
Introduction
251(2)
Systemic Inflammatory Response to Cardiac Surgery
253(1)
Cardiac Complications
253(10)
Low Cardiac Output Syndrome
254(1)
Preload Issues
255(1)
Cardiac Dysrhythmias
256(1)
Diastolic Dysfunction
257(1)
Right Ventricular Failure
257(1)
Decreased Myocardial Contractility
258(1)
Myocardial Stunning and Hibernation
259(1)
Increased Systemic Vascular Resistance (Afterload)
259(1)
Decreased Systemic Vascular Resistance
259(1)
Mechanical Issues
260(1)
Cardiac Tamponade
260(1)
Coronary Vasospasm
260(1)
Myocardial Ischemia and Infarction
261(1)
Cardiac Arrest
262(1)
Pulmonary Complications
263(5)
Postoperative Effects on Pulmonary Function
264(1)
Atelectasis
264(1)
Pleural Effusion
265(1)
Phrenic Nerve Injury
266(1)
Pneumothorax
266(1)
Prolonged Mechanical Ventilation
267(1)
Acute Respiratory Distress Syndrome
267(1)
Pneumonia
268(1)
Hematologic Complications
268(3)
Bleeding
268(2)
Thrombosis
270(1)
Heparin-Induced Thrombocytopenia (HIT)
270(1)
Renal Complications
271(2)
Gastrointestinal Complications
273(1)
Neurologic Complications
273(1)
Infectious Complications
274(1)
Prevention of Hospital-Acquired Pressure Injury
274(1)
Summary
275(10)
Chapter 14 Pain Management 285(24)
Introduction
285(1)
What Is Pain?
286(1)
Pain Pathways and Processes
287(2)
Types of Pain
289(1)
Pain Assessment
290(3)
Pain Assessment in Patients Who Are Unable to Communicate
291(1)
Preoperative Baseline Assessment
291(1)
Reassessment of Pain
292(1)
Phases of Pain
293(1)
Preemptive Analgesia
293(1)
Management of Pain
294(3)
Multimodal Analgesia
296(1)
Pain Sequelae
297(1)
Nonpharmacologic Pain Management
298(1)
Special Considerations
298(4)
Gender
299(1)
Race, Ethnicity, and Culture
300(1)
The Elderly Population
300(2)
Summary
302(7)
Chapter 15 Postoperative Dysrhythmias 309(16)
Introduction
309(1)
Incidence
309(1)
Etiology
310(1)
Atrial Dysrhythmias
310(6)
Postoperative Atrial Fibrillation
311(1)
Risk Factors for POAF
311(1)
Complications of POAF
312(1)
Prevention of POAF
313(1)
Pharmacotherapy
313(1)
Electrical Therapy: Atrial Pacing
314(1)
Atrial Dysrhythmias Following Cardiac Transplant
314(1)
Treatment of POAF
314(2)
Ventricular Dysrhythmias
316(2)
Premature Ventricular Contractions
317(1)
Ventricular Tachycardia and Ventricular Fibrillation
317(1)
Management of Postoperative Ventricular Dysrhythmias
317(1)
Bradyarrhythmias
318(2)
Management of Bradyarrhythmias
319(1)
Management of Bradyarrhythmias Following Cardiac Transplant
319(1)
Epicardial Pacemakers
320(1)
Summary
320(5)
Chapter 16 Neurologic Complications 325(24)
Introduction
325(1)
Risk Factors for Neurologic Complications
325(1)
Underlying Pathophysiology
326(1)
Avoiding Injury
326(13)
Description and Incidence of Neurologic Complications
326(13)
Other Neurologic Injuries
339(3)
Peripheral Nerve Injury
339(1)
Phrenic Nerve Neuropathy
340(1)
Brachial Plexus Injury
340(1)
Recurrent Laryngeal Nerve Neuropathy
341(1)
Intercostal Nerve Injury
342(1)
Other Peripheral Neuropathies
342(1)
Summary
342(7)
Chapter 17 Fluid and Electrolyte Imbalances Following Cardiac Surgery 349(26)
Introduction
349(1)
Fluid and Electrolyte Distribution
349(1)
Factors Affecting Fluid Volume Distribution
350(1)
Acid-Base Imbalances
350(4)
Acidosis
351(2)
Alkalosis
353(1)
Electrolyte Imbalances
354(7)
Potassium
354(2)
Sodium
356(1)
Magnesium
357(2)
Calcium
359(1)
Phosphorus
360(1)
Fluid Balance and Volume Management
361(5)
Hypovolemia
362(3)
Hypervolemia
365(1)
Glycemic Issues
365(1)
Acute Kidney Injury and Renal Insufficiency
366(3)
Azotemia
366(1)
Acute Kidney Injury
366(3)
Summary
369(6)
Chapter 18 Wound Care 375(26)
Introduction
375(1)
Incision Sites
375(1)
Conduits
376(1)
Risk Factors for Wound Complications
377(3)
Preoperative Risk Factors
377(1)
Intraoperative Risk Factors
378(1)
Postoperative Risk Factors
379(1)
Wound Infections Classification
380(2)
Superficial Wound Infections
381(1)
Sternal Wound Dehiscence
381(1)
Mediastinitis
382(1)
Septicemia
382(1)
Prevention of Surgical Site Infection
382(5)
Local collagen-Gentamicin
382(1)
Hair Removal
383(1)
Preoperativ-Skin Cleansing
383(1)
MRSA Prophylaxis
383(1)
Preoperative Antibiotic Administration
384(1)
Glycemic Control
384(1)
Avoiding Potentially Contaminated Sources
385(1)
Postoperative Dressings
386(1)
Evaluation of the Incision Site: Phases of Incision Healing
386(1)
Nursing Responsibilities to Enhance Wound Healing
387(1)
Wound Infection Sequelae
387(1)
Impact of Postoperative Infection
388(1)
Wound Infection Prediction
388(1)
Management of Wound Infections
389(2)
Sternal Wound Infections
389(1)
Mediastinitis
389(2)
Summary
391(10)
Chapter 19 Bridge to Transplant and Cardiac Transplantation 401(50)
Introduction
401(1)
Management of Heart Failure
402(2)
Mechanical Circulatory Support
404(14)
MCS Selection Criteria
406(1)
Short-Term Mechanical Circulatory Support
407(6)
Long-Term Mechanical Circulatory Support
413(1)
Mechanical Circulatory Support Postoperative Complications
414(3)
Postoperative Care of the LVAD Patient
417(1)
Requirements for Being Discharged with an LVAD
417(1)
Heart Transplantation
418(11)
Criteria for Heart Transplantation
418(1)
Heart Transplantation Procedure
419(1)
Care in the Immediate Postoperative Period
420(1)
Postoperative Complications
421(8)
Progression of Care
429(11)
Pain Management
430(1)
Nutrition
430(1)
Activity and Exercise
431(1)
Immunosuppression
431(4)
Rejection
435(1)
Complications of Immunosuppression
436(3)
Cardiac Allograft Vasculopathy
439(1)
Posttransplant Surveillance
440(1)
Outcomes After Heart Transplant
440(2)
Other Long-Term Complications
441(1)
Patient Teaching
442(2)
Infection Avoidance
442(1)
Sexual Activity
443(1)
Other Instructions
443(1)
Medications
443(1)
Summary
444(7)
Chapter 20 Post-ICU Care and Other Complications 451(36)
Introduction
451(1)
Cardiac Complications
451(9)
Dysrhythmias
452(1)
Bradycardia
453(1)
Atrial Fibrillation
454(3)
Ventricular Dysrhythmia
457(1)
Mechanical Complications
458(1)
Cardiac Tamponade
458(1)
Prosthetic Valve Endocarditis
458(1)
Postpericardiotomy Syndrome
458(1)
Sudden Cardiac Arrest and Sudden Cardiac Death
459(1)
Pulmonary Complications
460(2)
Pleural Effusions
461(1)
Pulmonary Hypertension
461(1)
Hematologic Complications
462(1)
Postoperative Bleeding
462(1)
Transfusion-Related Complications
463(2)
Transfusion-Associated Circulatory Overload
463(2)
Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism)
465(1)
Gastrointestinal Complications
466(1)
Postoperative Intestinal Ileus
467(1)
Hospital-Acquired Infections
467(4)
Catheter-Associated Urinary Tract Infections
467(1)
Sternal Complications and Mediastinitis
468(3)
Neurologic Complications
471(4)
Delirium
471(2)
Postoperative Cognitive Dysfunction
473(1)
Seizures
474(1)
Other Complications in Post-ICU Care
475(3)
Chest Tube-Related Complications
475(1)
Sleep
476(1)
Pain
477(1)
Post-Intensive Care Syndrome
477(1)
Summary
478(9)
Chapter 21 Implications of Obesity of the Cardiac Surgery Patient 487(10)
Introduction
487(1)
Physiologic Changes Associated with Obesity
488(1)
Cardiovascular Changes
488(1)
Respiratory Changes
488(1)
Gastrointestinal Changes
489(1)
Renal Changes
489(1)
Drug Pharmacokinetics and Pharmacodynamics
489(1)
The Preoperative Phase of Cardiac Surgery
489(1)
Preparation of the Operating Room and Staff
490(1)
Postoperative Care
490(1)
Summary
491(6)
Chapter 22 Cardiogenetics 497(22)
Introduction
497(1)
History
497(1)
Genetics Terminology
498(1)
Family History
498(2)
Clinical Screening
500(1)
Genetic Counseling/Testing
501(1)
Cardiac Generalizations
501(1)
Cardiomyopathies
501(5)
Dilated Cardiomyopathy
502(2)
Hypertrophic Cardiomyopathy
504(2)
Familial Hypercholesterolemia
506(1)
Genetics
506(1)
Screening
506(1)
Management
506(1)
Aortopathies
507(4)
Marfan Syndrome (MFS)
507(2)
Loeys-Dietz Syndrome (LDS)
509(1)
Ehlers-Danlos Syndromes (EDS)
510(1)
Bicuspid Aortic Valve Disease
511(2)
Pathogenesis
511(1)
BAV Genetics
512(1)
Screening
512(1)
BAV Diagnosis
512(1)
BAV Treatment
512(1)
Pharmacogenomics
513(1)
Drug Metabolism Pharmacogenetics
513(1)
Cardiogenetic Nursing Considerations
514(1)
Summary
515(4)
Chapter 23 Nutritional Issues of the Patient Undergoing Cardiac Surgery 519(16)
Introduction
519(1)
Cardiac Surgery Patients' Need for Nutrition
520(1)
Assessment of Nutrition
520(2)
Physical Exam
520(1)
Lab Data
521(1)
Nutrition Risk Scoring Systems
521(1)
Challenges to Attaining an Adequate Nutritional Status
522(1)
Patients at Risk
523(1)
Evidence-Based Recommendations
524(3)
Nutritional Support
524(1)
Enteral Nutrition
525(1)
Parenteral Nutrition
526(1)
Nursing Interventions
527(1)
Summary
528(7)
Chapter 24 Depression, Anxiety, and Spirituality Among Patients Undergoing Cardiac Surgery 535(12)
Introduction
535(1)
Depression
535(1)
Anxiety
536(1)
Potential Mechanisms Linking Depression and Cardiac Events
536(2)
Behavioral Factors
536(1)
Biologic Mechanisms
536(2)
Identifying Depression in Patients Undergoing CABG Surgery
538(1)
Treatment
538(2)
Pharmacological Treatment
538(1)
Psychotherapy
539(1)
Educational Programs
540(1)
Spirituality
540(1)
Coping with Spirituality
540(1)
Summary
541(6)
Chapter 25 Rehabilitation and Care of the Cardiac Surgery Patient 547(22)
Introduction
547(1)
Definition
548(1)
Cardiac Rehabilitation Phases
549(10)
Phase I
549(2)
Phase II
551(8)
Phases III/IV
559(1)
Rehabilitation Challenges of the Cardiac Surgery Patient
559(3)
Immediate In-Hospital Postoperative Rehabilitation
559(1)
Cognitive Impairment
560(1)
Discharge from Hospital
561(1)
Symptom Management
561(1)
Resuming Driving and Regular Physical Activities
561(1)
Complications and Comorbidities After Discharge
562(1)
Summary
562(7)
Glossary 569(10)
Index 579
Dr. Sonya Renae Hardin is a Professor and Dean in the School of Nursing at University of Texas Health, San Antonio, TX. She has provided academic leadership for nursing administration, nursing education and nurse practitioner programs. Dr. Hardin has co-authored books and numerous book chapters and articles in critical care, cardiovascular disease and geriatrics. She serves on several editorial boards and reviews for many journals focused on critical care and geriatrics. Her PhD is from the University of Colorado Health Sciences Center. She is certified as a Critical Care Nurse and an Adult Nurse Practitioner with experience teaching in undergraduate, graduate and doctoral programs. Her scholarship includes serving as PI on a HRSA funded Geriatric Workforce Enhance Program grant focused on improving care in rural eastern North Carolina through interprofessional education. She has served on expert panels to develop geriatric competencies and standards of care.

Dr. Roberta Kaplow is a clinical nurse specialist at Emory University Hospital in Atlanta, GA. She has co-authored books and numerous book chapters and articles in critical care and oncology. She has served on the AACN Board of Directors and AACN Certification Corporation Board of Directors. She has served on the editorial board of Applied Nursing Research and reviews for many journal focused on critical care, oncology, research, and medical/surgical nursing. Her Ph.D. is from New York University. She is certified as a Critical Care Nurse, Critical Care Clinical Nurse Specialist, and Adult Oncology Clinical Nurse Specialist. She has taught in undergraduate and graduate nursing programs. She has also Director of the Oncology/Immunology Master's Nurse Practitioner/Clinical Nurse Specialist program at the Nell Hodgson Woodruff School of Nursing of Emory University.'