Critical care nurse
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Although the incidence of acute pancreatitis among children is less than that in adults, the physical and psychosocial impact on children and their families can be overwhelming. Pancreatitis is manifested as pain accompanied by a host of other complex issues. ⋯ Management after discharge from the hospital is often an ongoing stress for these patients and families, and multiple admissions to the intensive care unit may be necessary for feeding and pain complications. Presented in the context of an actual clinical case at a 500-bed tertiary care pediatric hospital, this patient's scenario illustrates the importance of ensuring adequate nutrition, maintaining hydration, providing appropriate pain management, and preventing infection and thromboembolic events.
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Critical care nurse · Aug 2014
ReviewInterruptions in enteral nutrition delivery in critically ill patients and recommendations for clinical practice.
Malnutrition is common in critically ill patients and is associated with poor outcomes for patients and increased health care spending. Enteral nutrition is the method of choice for nutrition delivery. ⋯ Interruptions in enteral nutrition due to performance of procedures, positioning, technical issues with feeding accesses, and gastrointestinal intolerance contribute to underfeeding. Strategies such as head-of-bed positioning, use of prokinetic agents, tolerance of higher gastric residual volumes, consideration of postpyloric feeding access, and use of a nutrition support protocol may decrease time spent without nutrition.
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Critical care nurse · Aug 2014
Case ReportsSeparating fact from factitious hemoptysis: a case report.
A 61-year-old man with a history of testicular carcinoma and more recently diagnosed metastatic renal cell carcinoma was admitted because of recurrent submassive hemoptysis as evidenced by bright red blood in his bedside basin. Despite an exhaustive workup, including multiple invasive procedures, no cause of the bleeding was found. The diagnosis was Münchausen syndrome manifested as factitious hemoptysis via unusual and modern means. The case is a reminder to all members of the critical care team, from nurses to physicians: When dealing with the frustration of a recurrent problem with no clear answer, remain vigilant and remember the age-old advice to look at the patient… and trust your gut.
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The health of critical care nurse work environments has been shown to affect patient care outcomes as well as the job satisfaction and retention of registered nurses. The American Association of Critical-Care Nurses (AACN) Critical Care Nurse Work Environment Survey was first conducted in 2006 following the release of the AACN Standards for Establishing and Sustaining a Healthy Work Environment and was conducted again in 2008. This article reports the results of the third AACN Critical Care Nurse Work Environment Survey conducted in 2013. ⋯ An increasing body of evidence has shown relationships between healthy nurse work environments and patient outcomes. The results of this 2013 survey identified areas in which the health of critical care nurse work environments needs attention and care, requiring the relentless true collaboration of everyone involved.
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Connie Paine, RN, CCRN, is a staff nurse in the intensive care unit at UCSD/Thornton Hospital in La Jolla, California.