Medical advancements in oncology and critical care during the past 2 decades have led to more patients with cancer being admitted to intensive care units. This article discusses the most common reasons for intensive care unit admission and factors associated with mortality among patients with cancer. It also reviews the multiple benefits of palliative care services in caring for critically ill patients with cancer and opportunities for critical care nurses working with these patients.
Surgical oncology is cancer care that focuses on using surgery to diagnose, stage, and treat cancer and is one of the main treatments for malignancy. Patients older than 65 years are generally considered geriatric. The incidence of cancer in geriatric patients is increasing annually. Candidacy for surgical intervention depends on factors such as cancer type, size, location, grade and stage of the tumor, and the patient's overall health status and age. Despite increasing agreement that age should not limit treatment options, geriatric patients tend to be undertreated. Cancer in geriatric patients has different features than in younger patients. As such, treatment options may be dissimilar in these 2 cohorts. Here, care of the geriatric patient undergoing surgical oncology interventions is discussed.
Neurogenic stunned myocardium is a form of stress cardiomyopathy. The disorder is sometimes referred to as atypical Takotsubo cardiomyopathy. The pathophysiology of neurogenic stunned myocardium is hypothesized to involve significant overdrive of the sympathetic nervous system after a brain injury. Treatment options for a patient with a brain injury who has progressed to cardiogenic shock remain controversial, with no consistent guidelines. A patient with subarachnoid hemorrhage who progresses to cardiogenic shock with concurrent cerebral vasospasm presents a special treatment challenge. Neurogenic stunned myocardium is reversible; however, it must be recognized immediately to avoid or manage potential complications, such as cardiogenic shock and pulmonary edema. A multifaceted treatment approach is needed for the patient with cardiogenic shock and concurrent vasospasm.
Acute care nurse practitioners need specialized training to prepare for their advanced role. Limited research investigates acute care nurse practitioners' leadership skills related to team dynamics and evidence-based practices. This study explored students' perceptions of a simulation and debriefing experience and the effects of debriefing on their ability to transfer their leadership-related learning. A qualitative exploratory approach was used. Students (N = 28) were divided between a video-assisted debriefing group (n = 16) and a verbal debriefing group (n = 12). Focus group interviews were conducted in order to explore students' experience of acting as team leader when managing emergency dysrhythmias during high-fidelity simulation code scenarios. Three themes emerged: leadership training, video-assisted debriefing and verbal debriefing, and transferability. This study adds valuable information about how simulation technology could be used in leadership skills learning by and training for nurse practitioners.
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