AACN clinical issues in critical care nursing
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AACN Clin Issues Crit Care Nurs · Aug 1991
ReviewDyspnea in the weaning patient: assessment and intervention.
Dyspnea, the subjective sensation of uncomfortable breathing, is frequently experienced by patients during weaning from mechanical ventilation. As the clinical manifestation of increased work of breathing, dyspnea can be a valuable predictor and indicator of changes in patient respiratory status during the weaning process. ⋯ The most reliable physiologic variables that can be used to indirectly estimate dyspnea are discussed. Strategies such as positioning, coaching, "bagging," inspiratory muscle training, pressure support ventilation, oxygen, and relaxation/biofeedback techniques that can be used by the critical care nurse to decrease dyspnea are suggested.
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AACN Clin Issues Crit Care Nurs · Aug 1991
ReviewRespiratory muscle conditioning and the work of breathing: a critical balance in the weaning patient.
Normal ventilatory function depends on a balance between ventilatory demand and ventilatory capacity. The respiratory muscles play a critical role in achieving this balance. ⋯ Results of research show that muscle training may increase the ability of some patients to resume spontaneous ventilation. Continued research is needed to identify the appropriate training protocols for patients experiencing an acute imbalance between ventilatory demand and capacity.
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AACN Clin Issues Crit Care Nurs · Aug 1991
Case ReportsAuto-PEEP: an impediment to weaning in the chronically ventilated patient.
Auto-positive end expiratory pressure (auto-PEEP) is a physiologic event that is a recently recognized phenomenon common to mechanically ventilated patients. Auto-PEEP occurs when forces exist that limit expiration and the subsequent elimination of positive pressure from the lungs. If positive pressure is retained, a potential reduction in cardiac output and increase in complications from barotrauma arise. ⋯ Nursing measures that can reduce the effect of auto-PEEP during weaning are centered on improving the inspiratory/expiratory flow patterns. These efforts include manipulating mechanical ventilator settings and reducing causes of increased respiratory rates (e.g., pain and anxiety). Since auto-PEEP was only recently identified as a potential impediment to weaning from mechanical ventilation, the nurse must be aware of the need to assess for the presence of auto-PEEP in these patients.
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AACN Clin Issues Crit Care Nurs · May 1991
Family needs and coping strategies during illness crisis.
This descriptive study was conducted to explore family needs and coping behaviors when faced with the stress of a family member's critical illness. Family systems, crisis, and coping theories provided the conceptual frameworks for this study. A convenience sample of 30 family members of 22 critically ill patients completed the Critical Care Family Needs Inventory and the Jalowiec Coping Scale and responded to a seven-item semi-structured questionnaire. ⋯ Seven of the top ten coping methods most frequently used were also identified by family members as being most effective. Coping styles labeled confronting and optimistic were found to be most useful and effective overall. Nursing interventions described by family members as helpful included: the provision of information, emotional support, and competence and manner of the nurse.