Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Sep 2012
Current knowledge of acute lung injury and acute respiratory distress syndrome.
Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) continues to be a major cause of mortality in adult and pediatric critical care medicine. This article discusses the pulmonary sequelae associated with ALI and ARDS, the support of ARDS with mechanical ventilation, available adjunctive therapies, and experimental therapies currently being tested. It is hoped that further understanding of the fundamental biology, improved identification of the patient's inflammatory state, and application of therapies directed at multiple sites of action may ultimately prove beneficial for patients suffering from ALI/ARDS.
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Chronic obstructive pulmonary disease (COPD) is characterized by expiratory airflow limitation that is not fully reversible. Acute exacerbations in patients with moderate to severe COPD can cause severe hypoxia and persistent or severe respiratory acidosis, resulting in respiratory failure and the need for ventilator support. ⋯ Noninvasive and invasive ventilator support in conjunction with pharmacotherapy can be lifesaving, although mortality remains high. It is important also to consider pulmonary rehabilitation and palliative care.
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Patients undergoing critical illness and mechanical ventilation are at risk of developing neuromuscular and neurocognitive impairments that can impact physical function and quality of life. Mobilizing patients early in the course of critical illness may improve outcomes. Recent literature on early mobilization is reviewed, suggestions for implementation are discussed, and areas for future research are identified.
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Crit Care Nurs Clin North Am · Mar 2012
ReviewCritical care nursing and delirium management in the mentally ill client.
The critical care environment is an experience of stress for the patient and the practitioner. Turbulence can occur during the critical care course, which can cause exacerbation of chronic conditions. These exacerbations can lead to delirium and/or psychosis. ⋯ On the contrary, mental disorders are chronic conditions, not unlike diabetes mellitus or congestive heart failure. What the critical care nurse needs is a knowledge base in order to feel more comfortable in caring for these clients. Knowledge is empowerment.
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Crit Care Nurs Clin North Am · Mar 2012
Review Meta AnalysisHow professional nurses working in hospital environments experience moral distress: a systematic review.
The experience of moral distress for professional nurses working in hospital environments causes a myriad of biological, psychological, and stress-related reactions. There is an institutional culpability in producing an environment where moral distress is experienced. This is particularly true when nurses feel the need to advocate for patients' well-being while coping with institutional constraints. ⋯ Critical care nurses need to recognize moral distress and its adverse impact on providing optimal patient care. Critical care nurses should make a personal commitment that moral distress will not impact their nursing care and take a leadership role in their units to address this issue with their employing institution and develop strategies to lessen the impact of moral distress. These strategies should be based on the best available evidence such as this systematic review and other relevant appraised works.