AACN clinical issues
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AACN clinical issues · Nov 2000
Review Case ReportsUse of indirect calorimetry to optimize nutrition support and assess physiologic dead space in the mechanically ventilated ICU patient: a case study approach.
Indirect calorimetry (IC) is an accurate method of estimating a patient's energy expenditure, particularly the complex critically ill patient who benefits most from an individualized regimen of nutritional support. This bedside technique measures variables related to gas exchange and replaces assumptions about physiologic stress. When indirect calorimetry data are augmented by an arterial blood gas analysis of carbon dioxide (PaCO2), the dead space to tidal volume ratio (VD/VT) can be determined for an individual patient. ⋯ A case study approach to a 69-year-old man with acute respiratory distress syndrome and biliary sepsis will demonstrate the utility of this measurement. Attention to precise nutritional support and optimal gas exchange can influence the outcome of critically ill mechanically ventilated patients. This discussion highlights the potential benefits of indirect calorimetry for critical care nurses.
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AACN clinical issues · May 2000
ReviewPathophysiology and implications for treatment of acute respiratory distress syndrome.
Acute respiratory distress syndrome is a complex group of signs and symptoms caused by direct or indirect lung injury. In spite of decades of research, it is still associated with a high mortality rate. ⋯ However, novel therapies are in development, based on the knowledge of the pathologic processes of acute respiratory distress syndrome. In this article an overview of the disease process and mediator involvement is presented, followed by a review of pharmacologic and ventilation treatments currently in use or under study.
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As the climate of healthcare continues to change, critical care nurses are under increasing stress, which in turn puts them at risk for stress-related illnesses. Nurses can benefit from having a repertoire of healthy coping mechanisms, and one of the means available to them is humor. ⋯ Without considering the elements of bond, environment, and timing, however, humor can come across as offensive and hurtful. This article explores some of the precursors of stress for nurses, the use of humor to combat stress, how to keep humor constructive, and the importance of being active rather than passive in producing humor.
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AACN clinical issues · Feb 2000
ReviewMusic therapy as a nursing intervention for patients supported by mechanical ventilation.
Music therapy is a nonpharmacologic nursing intervention that can be used as a complementary adjunct in the care of patients supported by mechanical ventilation. This article details the theoretical basis of music therapy for relaxation and anxiety reduction, highlights the research testing the intervention in such patients, and discusses areas of needed research to extend further the implementation of music therapy in critical care nursing practice in an effort to promote a healing environment for patients.
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The number of elderly, both in society at large and in the critical care population, is increasing at an unprecedented rate. Critical care nurses must address how best to provide care to these elders. ⋯ The critical care environment may also be a factor in facilitating delirium, common in critically ill elders. Critical care nurses can proactively help to create a healing environment for these elders by facilitating sleep, implementing strategies to reduce delirium, preventing or minimizing painful experiences, and liberalizing family visitations.