Critical care nursing quarterly
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Review Case Reports
Special feature: exploring the benefits and myths of enteral feeding in the critically ill.
Patients in the intensive care unit setting have been nutritionally deprived for various reasons. Many patients who are critically ill cannot absorb nourishment by traditional routes. Enteral feeding should be considered for all patients who cannot meet caloric needs. ⋯ Many critical care nurses subscribe to myths for not feeding their patients. The myths for not feeding critically ill patients involve gut motility, feeding residuals, and patient positioning. There is significant evidence both to support nutrition as integral to recovery from a critical illness and to suggest that enteral feeding is efficient and effective at providing nutrition.
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Clinical Trial
Effect of head positioning on intracranial blood flow velocities in acute ischemic stroke: a pilot study.
Current nursing practice for the care of patients with ischemic stroke advocates routine elevation of the head of the bed (HOB) to 30 degrees. Evidence supporting this practice is lacking, and it may reflect inappropriate generalization of findings from studies conducted primarily on traumatic brain injury patients with associated increased intracranial pressure to the ischemic stroke population. We used a repeated measures design to conduct a pilot study of the effect of three HOB positions on middle cerebral artery mean flow velocities (MCA-MFV) in patients with acute ischemic stroke. ⋯ Mean arterial pressure, heart rate, and pulse pressure remained stable without significant change throughout the positioning intervention and measurement period. The overall increase in MCA-MFV achieved from lowering the HOB position from 30 degrees to a flat position was 13.1% (p = .054). Our findings from this small sample suggest that patients with acute ischemic stroke may benefit from lower HOB positions, in particular flat positioning, to promote an increase in flow to ischemic brain tissue that may ultimately reduce brain infarct volume.