The Nursing clinics of North America
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Nurs. Clin. North Am. · Sep 2016
ReviewPain Assessment in Noncommunicative Adult Palliative Care Patients.
Palliative care patients who have pain are often unable to self-report their pain, placing them at increased risk for underrecognized and undertreated pain. Use of appropriate pain assessment tools significantly enhances the likelihood of effective pain management and improved pain-related outcomes. This paper reviews selected tools and provides palliative care clinicians with a practical approach to selecting a pain assessment tool for noncommunicative adult patients.
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Nurs. Clin. North Am. · Sep 2016
Review Case ReportsSeeing the Light: End-of-Life Experiences-Visions, Energy Surges, and Other Death Bed Phenomena.
Spiritual care is an integral part of multidimensional palliative care and a major domain of care identified in definitions and guidelines. Death bed phenomena include visions, dreams, hallucinations, and premortem energy surges, which can be deeply spiritual experiences. ⋯ The last hours of life are sacred; as holistic, multidimensional practitioners, nurses should remain open to experiences not easily explained within a traditional medical model. As the most consistent caregivers, nurses assess, recognize, and validate such experiences to assist patients in finding meaning, comfort, and a peaceful end-of-life.
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Understanding the significance of rituals at the end-of-life enables health care professionals to offer meaningful and compassionate interventions that enhance quality of life and support those dying and those who grieve. Rituals contribute to the strength, capacity, and health of providers who cope with death events. Rituals help the living create continuing bonds with those dying, help with coping skills, and allow healthy growth through opportunities for naming, honoring, and memorializing. The display of respect and a nonjudgmental attitude create a space for support, trust, sharing of emotion, empowerment, and quality of care during end-of-life events.
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Antithrombotic medications have become standard of care for management of acute coronary syndrome. Platelet adhesion, activation, and aggregation are essential components of platelet function; platelet-inhibiting medications interfere with these components and reduce incidence of thrombosis. Active bleeding is a contraindication for administration of platelet inhibitors. There is currently no reversal agent for platelet inhibitors, although platelet transfusion may be used to correct active bleeding after administration of platelet inhibitors.
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Nurs. Clin. North Am. · Mar 2016
ReviewBlood Transfusion Strategies for Hemostatic Resuscitation in Massive Trauma.
Massive transfusion practices were transformed during the 1970s without solid evidence supporting the use of component therapy. A manual literature search was performed for all references to the lethal triad, acute or early coagulopathy of trauma, fresh whole blood, and component transfusion therapy in massive trauma, and damage control resuscitation. Data from recent wars suggest traditional component therapy causes a nonhemostatic resuscitation worsening the propagation of the lethal triad hastening death. These same studies also indicate the advantage of fresh whole blood over component therapy even when administered in a 1:1:1 replacement ratio.