While the specific target organ that is affected may dictate some specifics of treatment, rapid lowering of blood pressure is the mainstay of therapy for hypertensive emergencies. The goal would be to lower the mean arterial pressure by 20% to 25% within the first 1 to 2 hours. Several agents can be used, but the unifying characteristics are that they are rapidly acting and easily titratable. For this reason, oral medications, such as clonidine and nifedipine, play no role in the immediate management of a hypertensive emergency. Intravenous vasoactive drips such as labetalol, esmolol, nicardipine, and nitroglycerin are typically effective options.[5][8]

Preeclampsia is a particularly troubling and difficult to manage hypertensive emergency since there are two patients to consider. The first-line therapy is magnesium sulfate, administered as a 4 g to 6 g loading dose followed by 1 g to 2 g/hour infusion. Care must be taken to monitor urine output, deep tendon reflexes, and respiratory status. If further antihypertensives are needed, beta-blockers can be used, but only to treat SBP higher than 160 mmHg. Hydralazine was once touted as the preferred agent in pregnant patients; however, its delayed onset of action, prolonged duration, and unpredictable hypotensive effects make it a less than ideal choice. Regardless of the agent, the patient is likely to need close monitoring in a critical care setting.


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Since the first edition of Textbook of Adult Emergency Medicine was published twenty years ago, there has been enormous change in the way emergency care is delivered. This has occurred both in countries where emergency medicine was originally developed and in those where its application was limited because of cost. Emergency medicine is now perceived as the cornerstone of response to acute illness regardless of resources.

"This is an excellent evidence based textbook suitable for exam preparation or for reference, which takes you through the complete management of all emergency medicine conditions. I would strongly recommend it to all emergency medicine trainees."

Associate Clinical Professor and Doctor of Nursing Practice (DNP) Program Director Nicole Martinez has published a textbook chapter in the first edition of Emergency Nurse Practitioner Core Curriculum.

Elsevier, a global publisher of textbooks, peer-reviewed research journals, and analytics that focus on the science, technology and healthcare professions, just released the 10th edition of the Medical-Surgical Nursing textbook that Wittenberg nursing majors use in their classes.

Manual: The manual provides fundamental pediatric emergency nursing content with expanded information including dermatologic and environmental emergencies, human trafficking, food allergies and more. A valuable resource for future reference!

The text provides nursing and paramedicine students and clinicians with the opportunity to understand the best available evidence behind the treatment that is provided throughout the emergency care trajectory. This unique approach ultimately seeks to strengthen multidisciplinary care and equip readers with the knowledge and skills to provide safe, quality, emergency care.

When an RN becomes interested in a particular specialty, such as adult or pediatric emergency nursing or trauma nursing or flight nursing, they can become board certified in their specialty, similar to what physicians do. To earn a specialty credential, RNs must pass a national specialty certification exam.

Before the foundation of modern nursing, members of religious orders such as nuns and monks often provided nursing-like care.[11] Examples exist in Christian,[12] Islamic,[13] and Buddhist[14] traditions amongst others. Phoebe, mentioned in Romans 16 has been described in many sources as "the first visiting nurse".[15][16] These traditions were influential in the development of the ethos of modern nursing. The religious roots of modern nursing remain in evidence today in many countries. One example in the United Kingdom is the use of the historical title "sister" to refer to a senior nurse in the past.[17]

Florence Nightingale laid the foundations of professional nursing after the Crimean War.[22] Nightingale believed that nursing was a social freedom and mission for women. She believed that any educated woman can help improve the care of the medically sick.[23] Her Notes on Nursing (1859) became popular. The Nightingale model of professional education, having set up one of the first schools of nursing that is connected to a continuously operating hospital and medical school, spread widely in Europe and North America after 1870.[24] Nightingale was also a pioneer of the graphical presentation of statistical data.[25]

Nurses with higher degrees allow for specialization within the medical field. There are many specific nursing professions that can be separated into categories of care type, age, gender, certain age group, practice setting, etc. Nurses are able to specialize with a combination of these categories as well.[1] There are also specialist areas such as cardiac nursing, orthopedic nursing, palliative care, perioperative nursing, obstetrical nursing, oncology nursing, nursing informatics, telenursing, radiology, and emergency nursing.

Another pathway into the profession, or a higher level of education for other nurses, is obtaining a Bachelor of Science in Nursing (BSN), a four-year degree that also prepares nurses for graduate-level education. For the first two years in a BSN program, students usually obtain general education requirements and spend the remaining time in nursing courses. In some new programs the first two years can be substituted for an active LPN license along with the required general studies. Advocates for the ADN and diploma programs state that such programs have an on the job training approach to educating students, while the BSN is an academic degree that emphasizes research and nursing theory. Some states require a specific amount of clinical experience that is the same for both BSN and ADN students. A BSN degree qualifies its holder for administrative, research, consulting and teaching positions that would not usually be available to those with an ADN, but is not necessary for most patient care functions. Nursing schools may be accredited by either the Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE).

Areas of advanced nursing practice include that of a nurse practitioner (NP), a certified nurse midwife (CNM), a certified registered nurse anesthetist (CRNA), or a clinical nurse specialist (CNS). Nurse practitioners and CNSs work assessing, diagnosing and treating patients in fields as diverse as family practice, women's health care, emergency nursing, acute/critical care, psychiatry, geriatrics, or pediatrics, additionally, a CNS usually works for a facility to improve patient care, do research, or as a staff educator.

Canadian nursing dates back to 1639 in Quebec with the Augustine nuns.[101] These nuns were trying to open a mission that cared for the spiritual and physical needs of patients. The establishment of this mission created the first nursing apprenticeship training in North America.[101] In the nineteenth century, some Catholic orders of nursing were trying to spread their message across Canada. Most nurses were female and only had an occasional consultation with a physician. Towards the end of the nineteenth century, hospital care and medical services had been improved and expanded. Much of this was due to Nightingale's influence. In 1874 the first formal nursing training program was started at the General and Marine Hospital in St. Catharines in Ontario.[101]

These courses are three (occasionally four) years' long. The first year is known as the common foundation program (CFP), and teaches the basic knowledge and skills required of all nurses. Skills included in the CFP may include communication, taking observations, administering medication and providing personal care to patients. The remainder of the program consists of training specific to the student's chosen branch of nursing. These are:

In 1952 Japan established the first nursing university in the country.[101] An associate degree was the only level of certification for years. Soon people began to want nursing degrees at a higher level of education. Soon the Bachelor's Degree in Nursing (BSN) was established. Currently, Japan offers doctorate-level degrees of nursing in a good number of its universities.

There are organizations that unite Japanese nurses like the Japanese Nursing Association (JNA); the JNA is a professional organization and not a union. Members of the JNA lobby politicians and produces publications about nursing. According to the American Nurses Association's article on Japan, the JNA "works toward the improvement in nursing practice through many activities including the development of a policy research group to influence policy development, a code of ethics for nurses, and standards of nursing practice." The JNA also provides certification for specialists in mental health, oncology and community health.[101] There are other organizations, including some that categorize nurses by specialty, like emergency nursing or disaster nursing. One of the older unions that relates to nursing is the Japanese Federation of Medical Workers Union, which was created in 1957.[101] It is a union that includes physicians as well as nurses. This organization was involved with the Nursing Human Resource Law.[101] ff782bc1db

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