The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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This study was undertaken to determine differences between caloric intake and requirements of critically ill, enterally fed, neurosurgical and neurotrauma patients and to determine the nature and frequency of interruptions in enteral feedings in this same population. This descriptive, prospective study was conducted in a surgical intensive care unit (ICU) in a university teaching hospital. The sample consisted of 52 mechanically ventilated, critically ill patients with a mean age of 48.96 years who were receiving enteral nutrition for at least two days. ⋯ Underfeeding due to interruptions occurred in the majority of patients for the first eight days following initiation of enteral feeding. Reasons for underfeeding were interruptions of continuous tube feedings due to medication administration via the feeding tube (31%), feeding tube displacement (27%), surgery (12%), ileus (9%), radiologic studies (9%), airway management (8%), bedside procedures (3%) and agitation (1%). The frequency of these enteral feeding interruptions may indicate inadequate nutritional support, highlighting the importance of performing daily nutritional monitoring to prevent malnutrition.
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Review Comparative Study
Severe diffuse axonal injury in adults and children.
Diffuse axonal injury (DAI) occurs in 30% of all fatal head injuries. DAI is identified on autopsy as microscopic lesions that commonly appear in the splenium of the corpus callosum, rostral brainstem and frontal and temporal lobes of the cerebrum. ⋯ The most common mechanism for DAI is motor vehicle accidents. The neuroscience nurse needs to have an understanding of DAI anatomy and physiology, including the differences and similarities in the clinical presentation and neurologic functional outcome in both adult and pediatric populations.
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Investigation into the use of osmotic therapy for ICP reduction began in 1919. Mannitol is the osmotic agent currently in use. Mannitol's effectiveness in reducing ICP has been shown. ⋯ Lastly, mannitol may exert a protective effect against biochemical injury. The most common complications of therapy are fluid and electrolyte imbalances, cardiopulmonary edema and rebound cerebral edema. Nursing care of the patient receiving mannitol requires vigilant monitoring of electrolytes and overall fluid balance, and observation for the development of cardiopulmonary complications in addition to neurologic assessment.
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Confusion is frequently undetected by nurses due to superficial patient interviews. This is potentially dangerous for critically ill patients because they may injure themselves and prolong their recovery. Reliable and valid methods of identifying those at risk for developing confusion are needed. ⋯ The Mini-mental State Examination, Clinical Assessment of Confusion-A and Visual Analog Scale of Confusion were administered to 53 critically ill patients for 3-8 days yielding 140 sets of data. Psychometric analyses demonstrated the MMSE, CAC-A and VAS-C were reliable, valid instruments in this population. High correlations were found between instruments, and in over 75% of study days there was agreement in all test scores and clinical assessment of confusion.
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Review Case Reports
Munchausen syndrome by proxy: neurological manifestations.
Munchausen syndrome by proxy (MSP) is a recently described form of child abuse in which a caregiver fabricates or induces symptoms in a child in order to attract medical attention. The epidemiology, clinical features, diagnosis and the spectrum of MSP are reviewed. ⋯ Three cases are reported to illustrate the most common neurological manifestations. It is important for neuroscience nurses to have an awareness that MSP can present as a neurologic problem, because appropriate management depends on early identification and treatment.