Critical care nursing quarterly
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There are two major goals of critical care: (1) to save those with a chance to live and (2) to help patients who are dying have a peaceful and dignified death. If reversal of the disease process is not possible and the patient is experiencing substantial pain and suffering, goals need to be reviewed and potentially redefined. These new goals may be to remove unwanted or nonbeneficial therapy, to provide death with dignity, and to support the family. This article details aspects of the decision-making process regarding withdrawal of mechanical ventilation, including ethical principles; decision-making for autonomous patients and non-autonomous patients; advance directives; planning withdrawal of support; terminal weaning methods; patient comfort; family support; and future directions for research, practice, and education.
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One of the many challenges in the management of the patient with adult respiratory distress syndrome is optimal application of mechanical ventilation. Pressure controlled-inverse ratio ventilation has surfaced as a possible alternative to conventional ventilation for patients affected by this condition. In pressure controlled-inverse ratio ventilation, the conventional inspiratory-to-expiratory ratio is reversed, allowing the inspiratory phase to lengthen with an accompanying increase in mean airway pressure. When carefully applied, mean airway pressure adjustments can be manipulated without increases in positive end-expiratory pressure and peak airway pressure, thus minimizing the risk of alveolar rupture and worsening of lung injury.
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The critically ill older patient is at increased risk for developing an acute confusional state or delirium. Critical care nurses must be aware of the risk factors, the clinical manifestations, and potential complications associated with delirium. Nursing strategies focus on prevention, comprehensive assessments, and interventions to manage agitated behavior and provide environmental support.
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Changing demographics will increase the geriatric population in the intensive care unit. Geriatric clients are more likely to be malnourished than their younger counterparts, making the early initiation of appropriate nutritional support vital. The nutrition support process adapted for critical care nurses is outlined. Strategies for identification and management of common complications are presented.
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Review Case Reports
Assisted suicide: is there a future? Ethical and nursing considerations.
It is imperative that nurses take a personal and professional stand in the debate regarding physician-assisted suicide. Through case examples, this article defines and illustrates forms of euthanasia, including active and passive, voluntary and involuntary, double-effect, physician-assisted suicide, and physician aid-in-dying. ⋯ The anticipated negative effects that legalized physician-assisted death would pose to the health professions and society are discussed. Guidelines and nursing implications conclude the article.