End-of-Life Care and Decisions About Life Sustaining Treatments

Older adults who are dying in the critical care setting need the same quality care as is given to any patient who is facing his or her final days in critical care. Where the care of older adults differs is often in decision making, the consequences of care decisions, and in modifications to symptom management to account for the physiologic changes seen with aging. Good end-of-life care in any setting requires effective communication with the patient and the family, facilitation of decision making, management of complications of the treatment and the disease, symptom control, psychosocial– spiritual care of the patient and the family, and holistic care at the time of death (Foley & Gelband, 2001).

Criical Nursing Care Plan For Cerebrovascular Accident (CVA)

A cerebrovascular accident, or stroke, occurs when a sudden decrease in cerebral blood circulation as a result of thrombosis, embolus, or hemorrhage leads to hypoxia of brain tissues, causing swelling and death. When circulation is impaired or interrupted the small area of the brain becomes infarcted and this changes membrane permeability resulting in increased edema and intracranial pressure (ICP). The clinical symptoms may vary depending on the area and extent of the injury.

Disseminated intravascular coagulation

Disseminated intravascular coagulation, also known as consumptive coagulopathy, defibrinogenation syndrome, or DIC, is an acute disorder that accelerates the activation of the intrinsic and/or extrinsic cascade clotting mechanism and depletes both clotting factors and platelets. DIC is usually a complication of another disease process in which excessive thrombin is produced, converting fibrinogen to fibrin, and the fibrin creates damaging thrombi in the microcirculation. Fibrin blocks the capillary flow to the organs and results in ischemic tissue damage, and as the clotting factors, platelets, and fibrin split products (FSP) are consumed, hemorrhage and shock results. As the fibrin and FSP repolymerize, a secondary fibrin mesh forms in the microcirculation and when blood travels through this, the red blood cells become damaged and a hemolytic anemia can occur.

Upper Airway Infections

Upper airway infections are common conditions that affect most people on occasion. Some infections are acute, with symptoms that last several days; others are chronic, with symptoms that last a long time or recur. Patients with these conditions seldom require hospitalization. However, nurses working in community settings or long-term care facilities may encounter patients who have these infections. Thus, it is important for the nurse to recognize the signs and symptoms and to provide appropriate care.

The Conduction System in the Heart

The conduction system in the heart is an intrinsic system whereby the cardiac muscle is automatically stimulated to contract, without the need for external stimulation (Waugh & Grant, 2007). It comprises specialised cardiac cells, which initiate and conduct impulses, providing a stimulus for myocardial contraction. It is controlled by the autonomic nervous system; the sympathetic nerves increase heart rate, contractility, automaticity and atrioventricular (AV) conduction, while the parasympathetic nerves have an opposite effect.

Blood Transfusion and Its Components

E. Celis-Rodriguez, K. Reinhart, Y. Sakr

Transfusion of blood products in the critical care setting is a common practice that has been performed for many years. Since the 19th century, when James Blundell reported the clinical application of the treatment of hemorrhage for the first time in the Lancet [1], blood transfusion has been the cornerstone in the treatment of severe hemorrhage, not only as a means of improving oxygen transport capacity, but also to maintain homeostasis and reduce mortality rates [1]. The 10/30 rule was the standard of care for decades [2], but the first report of this appeared in the 1940s, when Lundy et al. [3] stated that “It is a clever idea to provide blood before surgery,” referring to patients whose hemoglobin levels were between 8 and 10 g/dL. With the more restrictive use of blood transfusion since the 1980s, there have been attempts to define specific indications for transfusion, minimal hemoglobin levels for critically ill patients, and the benefits and potential risks of transfusion [4].

The Neuroendocrine Response to Sepsis

Acute response to LPS includes the release of a number of proinflammatory mediators that reach the brain in areas free of blood-brain barrier, or via specific transport systems. The hypothalamic-pituitary axis is also activated via neural routes. Then, infection is characterized by high circulating levels of adrenocorticotrope hormone (ACTH), and cortisol which remain in plateau as long as the stressful condition is maintained. Circulating vasopressin levels follow a biphasic response with high concentrations, followed by relative vasopressin insufficiency in about one third of cases.


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