Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Dec 2015
ReviewHemodynamics of Acute Right Heart Failure in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome.
In critically ill patients with circulatory shock, the role of the left ventricle has long been appreciated and the object of measurement and therapeutic targeting. The right ventricle is often under appreciated and dysfunction may be overlooked. ⋯ Traditional right heart filling indices may increase because of decreasing compliance, further complicating the picture. The pathophysiology of pulmonary vascular dysfunction in acute respiratory distress syndrome combined with the effects of a mean airway pressure strategy may create an acute cor pulmonale.
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The number of patients with heart failure is growing; the associated morbidity and mortality remains dismal. Advance care planning, end-of-life conversations, and palliative care referrals are appropriate, but do not occur regularly. ⋯ Nurses are well-positioned to provide basic. Nurses are also instrumental in initiating referrals to the specialized palliative care team as the patient's needs become too complex or the disease progresses and the patient approaches the end of life.
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Crit Care Nurs Clin North Am · Dec 2015
ReviewHigh-Output Heart Failure Caused by Thyrotoxicosis and Beriberi.
High-output heart failure is not seen as commonly as low-output heart failure and some of the typical guideline recommendations may not benefit patients with high-output failure. High-output failure is caused by several diseases, including thyrotoxicosis and beriberi, highlighted in this article. ⋯ Prompt recognition of these infrequently seen syndromes is essential. This article outlines the medical treatment and nursing care needed to return these patients to a normal state.
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Crit Care Nurs Clin North Am · Sep 2015
ReviewImplementing Palliative Care Interdisciplinary Teams: Consultative Versus Integrative Models.
Interdisciplinary teams are at the core of intensive care unit palliative care consultation. They allow health professionals of different disciplines to collaborate in a synergistic fashion to achieve the goals of patients and their families. ⋯ There are multiple benefits to highly functioning teams, as well as challenges that may be faced when trying to provide patient care in a team-based setting. Interdisciplinary teams of different structures may provide the ideal support for complex cases in critical care settings.
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Crit Care Nurs Clin North Am · Sep 2015
ReviewPriorities for Evaluating Palliative Care Outcomes in Intensive Care Units.
Defining the quality of intensive care unit (ICU) care when patients are dying is challenging. Palliative care has been recommended to improve outcomes of dying ICU patients; however, traditional ICU quality indicators do not always align with palliative care. Evidence suggests that some aspects of ICU care improve when palliative care is integrated; however, consensus is lacking concerning the outcomes that should be measured. Overcoming challenges to measuring palliative care will require consensus development and rigorous research on the best way to evaluate ICU palliative care services.