AACN advanced critical care
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Patients experiencing a dyspnea exacerbation will often report feeling smothered or suffocated. This highly distressing, prevalent, multidimensional symptom is the chief complaint signifying pulmonary dysregulation. Increasing dyspnea intensity heralds the onset of respiratory failure, leading to hospitalization and/or admission to the intensive care unit (ICU). ⋯ Opioids and benzodiazepines reduce dyspnea and the associated fear or anxiety and are most often used to maintain ventilator-patient synchrony, in terminal illness or during the withdrawal of mechanical ventilation. Inhaled furosemide is under investigation as an alternative to opioids. The focus of this article is to provide an evidence-based approach to nursing assessment and management of dyspnea.
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As the population continues to age, the specialized needs of older adult patients warrant the close attention of the critical care nurse. The combination of critical illness, age-related changes, multiple comorbidities, and the hospital environment can make the diagnosis and management of the older adult's critical illness challenging. ⋯ The Geriatric Resource Nurse model is the foundation of the program. The goals of NICHE are to support nursing departments to (1) bring evidence-based geriatric practice to the bedside; (2) build patient- and family-centered environments; (3) cultivate healthy and productive practice environments aligned with meeting the specialized needs of older adults and their families ("geriatric nursing practice environments"); and (4) conduct comprehensive measurement of geriatric initiatives.
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Increasing numbers of older adults are cared for in intensive care units (ICUs) across the country. These patients are disproportionately impacted by illnesses such as sepsis, ventilator-associated pneumonia, and infections. Their care and course of recovery are complicated by myriad factors, including their often-indistinct presentation of illness and issues related to pharmacotherapy. ⋯ However, these guidelines, protocols, or bundles, as they are known, generally have not been studied in an older population. This article describes the ventilator-associated pneumonia and sepsis bundles relative to the older critical care patient. Although an exhaustive discussion of every intervention within each bundle as it relates to older ICU patients is beyond the scope of this article, selected bundle parameters are presented, with examples of special considerations for the older ICU patient.