RESUMO
This narrative describes the experiences of an inner city respiratory unit that was transformed to treat COVID-19 patients with continuous positive airway pressure (CPAP) ventilation who were not scheduled for any further escalation in treatment. The high mortality rate and unconventional way of dying led to the creation of local guidance for removing assisted ventilation when the treatment ceased to be effective. We reflect on the specific challenges that caring for these patients holistically has presented and how we have learnt to deliver good palliative care in a unique set of circumstances. We also consider the impact of the pandemic on our team and how the development of a multidisciplinary support system has improved team dynamics and ultimately patient care.
Assuntos
Betacoronavirus/isolamento & purificação , Pressão Positiva Contínua nas Vias Aéreas , Infecções por Coronavirus/terapia , Máscaras , Cuidados Paliativos , Pneumonia Viral/terapia , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/enfermagem , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/enfermagem , Pneumonia Viral/fisiopatologia , SARS-CoV-2RESUMO
BACKGROUND: Although it is widely acknowledged that spiritual care is an important component of good palliative care, there remains a lack of confidence about it among healthcare providers. This paper analyses the benefits and drawbacks of using spiritual history-taking tools to address the problem, considering four of the most widely used tools-FICA, FAITH, SPIRITual and HOPE. METHOD: The authors conducted a literature review to establish the main themes identified as important to spirituality at the end of life. They then applied these findings to the spiritual history-taking tools to determine the extent to which they may be of assistance in identifying the spiritual needs of patients receiving palliative care. CONCLUSION: The authors conclude that spiritual history-taking tools do have an important role in identifying the spiritual needs of patients at the end of life, with the 'HOPE' tool most comprehensively addressing the spirituality themes identified as important within the healthcare literature.
Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Papel do Profissional de Enfermagem , Relações Enfermeiro-Paciente , Espiritualidade , Inquéritos e Questionários , Comunicação , HumanosRESUMO
BACKGROUND: Tricyclic antidepressant (TCA) toxicity results predominantly from myocardial sodium-channel blockade. Subsequent ventricular dysrhythmias, myocardial depression, and hypotension cause cardiovascular collapse. Animal studies have demonstrated the effectiveness of intravenous lipid-emulsion in treating TCA cardiotoxicity. CASE REPORT: We report a case of dothiepin (tricyclic antidepressant) overdose causing refractory cardiovascular collapse, which seemed to be successfully reversed with lipid-emulsion therapy (Intralipid(®); Fresenius, Cheshire, UK). CONCLUSIONS: Lipid emulsions are a potentially novel therapy for reversing cardiotoxicity seen in TCA overdose. Research is required into the role of lipid emulsion in the management of poisoning by oral lipophilic agents.