Critical care nurse
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Critical care nurse · Aug 2011
ReviewHow low should you go? The limbo of glycemic control in intensive care units.
Hyperglycemia, a common finding in critically ill patients, is linked to poor outcomes in multiple conditions. The Leuven I study published in 2001 was the first evaluation of intensive insulin therapy, and the 3.4% absolute reduction in mortality in a single-center surgical intensive care unit led to widespread endorsement of the therapy. In a subsequent study in a medical intensive care unit, reduction in mortality was not significant. ⋯ In the largest prospective study conducted to date, mortality was significantly higher (P = .02) in patients who had intensive therapy (27.5%) than in control patients (24.9%). Thus, after years of research, intensive insulin therapy does not appear to convey the original benefit in all critically ill patients. Several organizations have proposed alternative blood glucose targets, such as 140 to 180 mg/dL, to both provide glycemic control and reduce the opportunity for hypoglycemic episodes.
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Critical care nurse · Aug 2011
Risk profile characteristics associated with outcomes of hospital-acquired pressure ulcers: a retrospective review.
Hospital-acquired pressure ulcers are a common problem. Although a number of risk factors have been identified, relationships among risk profile characteristics and pressure ulcer outcomes have not been described in hospitalized patients. ⋯ Identification of characteristics and risk factors associated with development of nonhealing hospital-acquired pressure ulcers will allow nurses to recognize patients at risk for nonhealing and to take aggressive preventative measures.
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Critical care nurse · Aug 2011
Case ReportsCoordination of multiple services for a patient with severe lymphedema of the right lower extremity.
Surgical resection of the right lower extremity in an adult with severe lymph-edema of the extremity required intensive coordination of multiple services and specialists because of the medical and surgical complexity of the patient's condition, massive limb size, and surgical location in a children's hospital. Early and prolonged planning was necessary to anticipate problems and provide optimal care. The patient had a successful surgical outcome, improvement in medical comorbid conditions postoperatively, and improvement in the quality of life upon discharge. This coordinated effort will be used in the future as a template for patients with complex conditions whose care requires lengthy planning and involves multiple services and specialists.
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Critical care nurse · Aug 2011
Case ReportsCare of the lower extremities in patients with acute decompensated heart failure.
Patients with heart failure and pulmonary edema are often admitted to the critical care unit. Many of these patients have severe peripheral edema, which may be associated with exudates and wounds of the lower extremities and which present a challenge to critical care nurses. Little information is available on treatment of peripheral edema in the intensive care unit or in patients with unstable hemodynamic status. ⋯ An appropriate mattress surface with an underpad that promotes wicking away of moisture should be selected. The patient's lower extremities should be elevated according to his or her current pulmonary status, and skin-protective interventions should be instituted. Multilayer compression wraps should be avoided until the patient's hemodynamic status is stable and the patient can get out of bed.