Dimensions of critical care nursing : DCCN
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Dimens Crit Care Nurs · Sep 2003
ReviewStrategies to improve end-of-life care in the intensive care unit.
Death is a frequent occurrence in the intensive care unit (ICU). Critical care nurses often feel unprepared to deliver expert end-of-life care. This article proposes specific strategies for critical care nurses to improve the delivery of end-of-life care in the ICU. Critical care nurses can examine beliefs about death; recognize that cure and palliative care coexist; create an environment that supports dying as well as curing; improve communication among providers, patients, and families; provide "small things that make a big difference" at the end-of-life; and locate and utilize support for improving end-of-life care.
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Dimens Crit Care Nurs · Jul 2003
ReviewManagement of pharmacologically induced neuromuscular blockade using peripheral nerve stimulation.
Currently, many critically ill patients are treated with neuromuscular blocking agents to facilitate endotracheal intubation, mechanical ventilation, and manage confused, combative, head injured, and status epileptus patients. To prevent persistent pharmacologically induced paralysis, the aide of a peripheral nerve stimulator and clinical indicators may help determine the minimal effective drug dose to facilitate safe neuromuscular blockade. The purpose of this article is to provide nursing clinicians the essential knowledge to manage patients with neuromuscular blockade effectively using peripheral nerve stimulation monitoring.
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Dimens Crit Care Nurs · Mar 2003
The use of propofol in the mechanically ventilated medical/surgical intensive care patient: is it the right choice?
This article provides a review of the use of propofol in the mechanically ventilated patient. The indications for the administration of propofol are presented as well as the contraindications, adverse effects, and nursing care.
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Dimens Crit Care Nurs · Mar 2003
An algorithm for train-of-four monitoring in patients receiving continuous neuromuscular blocking agents.
Neuromuscular blocking agents (NMBA) are increasingly being used in the management of critically ill patients. These medications are used to facilitate mechanical ventilation. ⋯ Although unwilling to go so far as to establish this as a standard of care, the American College of Critical Care Medicine of the Society of Critical Care Medicine released an executive summary recommending train-of-four monitoring for patients receiving continuous or sustained NMBAs. This protocol and algorithm was developed to facilitate the objective monitoring of patients receiving continuous NMBAs.