Ventilator Support Literature Review
Concerns over palliative withdrawal of ventilator support in patients causing undue suffering have been discussed in the literature. Certainly, terminal withdrawal of support should be treated with the same aggressive measures that we use to treat those patients that are better able to communicate their symptoms. However, to simply state that we need to treat symptoms aggressively is naïve in assuming that we know completely what the patient is experiencing. High quality evidence does not exist to describe the best methods for which palliative ventilator withdrawal should be performed under. That being said, withdrawal of ventilator support will continue and it is our responsibility to perform such procedures informed with the best available …show more content…
The Richmond Agitation-Sedation Scale and Critical-Care Pain Observation Tool are two of the more widely used scales for patient assessment in the ICU. Of particular difficulty is the assessment and quantification of dyspnea in the ventilated and sedated ICU patient. Dyspnea is well recognized as an area of under treatment in the ICU and the current state of medical science leaves us lacking in more complete understanding. The intensive care respiratory distress observation scale (IC-RDOS) was created to address this area of symptom management. It is a simple tool to use bedside with an online calculator and, to the best of our knowledge, the only scale available to evaluate dyspnea in the intubated patient.
We believe the use of a cyclical process with changes in ventilator support followed by frequent bedside reassessments is the most practical method to address patient distress short of more advanced and less practical neurophysiologic testing. In contrast to methods that address the patient’s symptoms prior to initiation of ventilator weaning and then quickly decrease ventilator settings sprinkling in medications as symptoms arise, a cyclical method with predefined intervals of reassessments utilizing validated scales seeks to maintain vigilance in addressing
Kelly Malone Case Summary
242 Words | 1 PagesJustin is the registered nurse that has been given the handover for Kelly Malone’s postoperative care in the surgical unit. Kelly Malone is a 49 female patient who has had a septoplasty and a right ethmoidectomy. Justin is working with Kelly to identify Kelly’s needs in order for Kelly to be discharged from the hospital. Kelly’s postoperative observations were a temperature of 36.2 degrees celsius; heart rate of 68 beats per minute; respiratory rate of 18 breaths per minute, blood pressure of 111 systolic over 73 diastolic millimetres of mercury; oxygen saturation at 93 percent of room air and a self-rated pain score of two out of ten. Kelly has a history of ‘not being able to breathe well through her nose’ and a history of disturbed sleep.
Impaired Gas Exchange Case Study
1218 Words | 5 PagesGoals & Interventions: 1. Nursing Diagnosis: Impaired gas exchange r/t exacerbation of COPD a.e.b. wheezing in patient’s throughout. Goals/outcomes: Patient will maintain adequate ventilation and have clear breath sounds within 24 hours upon auscultation. Goal met within 24 hours of initial respiratory assessment and maintained over a 24 hour period 10/26/2015.
Congestive Heart Failure Summary
172 Words | 1 PagesCalls were analyzed within the standard GRASP® MIStro® DataWorks analysis program (Staples & Earle, 2007). Unfortunately, the study did not capture patient outcomes, breathing statuses, vital signs, or clinical progress.
CAM-ICU Quantitative Analysis Paper
1431 Words | 6 PagesICU patients are at an increased risk of developing delirium, a significantly underdiagnosed neurologic condition (Gusmao-Flores, Salluh, Chalhub, & Quarantini, 2012). CAM-ICU is effectively incorporated into daily assessments by clinical staff. This process allows for clinicians to appropriately identify and treat delirium before there are adverse
Annette Nursing Case
1676 Words | 7 PagesAnnette’s reason for admittance at the hospital is an overall weakness, flu-like symptoms, and difficulty with breathing (Prizio, n.d.). She is diagnosed with diabetic acidosis, left upper lobe pneumonia, and a bacterial infection (Prizio, n.d.). Unfortunately, her condition becomes worse. Annette’s right lung collapses, her heart rate is irregular, and she has an episode of unresponsiveness that leads to mechanical ventilation (Prizio, n.d.). Annette has challenges weaning off the mechanical ventilation, which resulted in the placement of a tracheostomy and percutaneous endoscopic gastrostomy tube (Prizio, n.d.).
Terminally Informed Consent Case Study
1384 Words | 6 PagesHowever, the responsible and trusted caregiver team must take an action through multiple processes in order to favor the patient. Although the physicians have known earlier when the terminally ill patient near to die, they are not comfortable with withdrawing of life-sustaining treatments. The intention is not to kill the patient, but using the available technology and creating a moral obligation to use what ethical principle prescribes. Underlining the disease process cannot be reversed, life-sustaining treatment can be withdrawn acknowledging that the treatment limitation (Reynolds, Coper, & McKneally, 2005). Ethics committee is a helpful source of advice that can provide consultation about ethical issues in treatment limitation.
Icu Failure
2234 Words | 9 PagesTogether, the two systems were devised to establish a means to extend intensivist expertise to a greater number of ICU patients and potentially maximize both effectiveness and efficiency of critical care treatment. The eICU program comprises of a suite of information technology tools that monitor and support the remote team and the on-site team. The core information system collects data from various sources and reorganizes it to optimize data presentation and facilitate physician work flow.
Arguments Against Physician Assisted Suicide
1322 Words | 6 PagesAccording to Karaim in 2013 “Decisions about sustaining life, allowing it to end or even hastening death are among the most difficult choices terminally ill patients and their families can face” (para 1). Patients going through this have a bountiful number of things going
Opioid Case Study
1301 Words | 6 PagesThis helps provide more patient centered care. Guidelines to follow after opioid administration will vary by hospital but it is still necessary to use sedation scales with acceptable measures of reliability and validity for pain management. The use of sedation scales should be used with consistent monitoring of respirations. Pasero (2009) emphasizes that a comprehensive evaluation of respiratory status that includes depth, regularity, rate, and noisiness of respiration in addition to sedation assessment is essential to decision making during opioid administration for pain management. Respirations should be counted for a full minute while the patient is at rest in a quiet and relaxed environment.
Do Not Resuscitate Orders
1867 Words | 8 PagesDo Not Resuscitate Orders “DNR” “A DNAR form is a document issued and signed by a doctor, telling your medical team not to attempt cardiopulmonary resuscitation (CPR).” (“ATTEMPT” 1). I will be covering the Definition of what a do not resuscitate order is. Why you would need a do not resuscitate order. Also How to get a do not resuscitate order from your doctor.
Dyssynchrony Case Summary
1209 Words | 5 PagesMr. A is admitted to the critical care unit post bowel resection, splenectomy, acute respiratory distress syndrome (ARDS) and patient-ventilator dyssynchrony (PVD). He is an eighteen-year-old African American man who is placed on an IV infusion of Norcuron and Ativan. The major outcomes expected for Mr. A would be for him to be able to wean of the ventilator, be hemodynamically stable, heal adequately, tolerate his diet, have adequate bowel elimination, and be able to adjust to his life with optimal functioning. The problems that are to be manage include, being on the ventilator, being sedated, having an elevated temperature, having a low hemoglobin, post surgical bowel resection, splenectomy, hypoxia and diet intolerance.
CIWA-A Case Study
429 Words | 2 PagesThe CIWA evaluation tool is sometimes replaced with the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method (CAM) assessment tools when patients reside in the ICU.24 These are well validated tools that evaluate the level of a patient’s agitation versus sedation and presence or absence of
Nursing Care Plan
440 Words | 2 PagesLabs such as Arterial blood gas gives information about a patient oxygenation, ventilation, and acid-base balance. Assess collaboration of client with healthcare team such as the physician, respiratory therapist. Last, you would interpret and summarize finding you would match evaluative measure with expected outcome to determine if client status improving or not improving. If goals have been met discontinue the portion of the care
End Of Life Care Essay
1610 Words | 7 PagesHowever, as more people are living longer with chronic illnesses, the need for effective palliative care has become increasingly clear. Palliative care is an approach that focuses on improving the quality of life for patients with serious illnesses, by addressing their physical, emotional, and spiritual needs. According to a report by the World Health Organization (WHO), palliative care should be considered an essential component of healthcare for all patients with serious illnesses, not just those who are nearing the end of life (WHO,
Examples Of Observation In Nursing
913 Words | 4 PagesAssessment is a fundamental component of any nurse’s role. However, from what I observed today it seems particularly vital to the PACU nurse. While they do provide interventions, the majority of PACU nurses’ time is spent assessing their patients and documenting their findings. Patients in the PACU have undergone the significant stressor of surgery under general anesthesia and they have the potential for very serious complications. It is up to the PACU nurse to observe if the patient is declining and act quickly and appropriately.
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