Critical care nursing quarterly
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Review Case Reports
Promoting quality of life for geriatric oncology patients in acute care and critical care settings.
In 2004, the Oncology Nursing Society published a position paper on cancer in the elderly identifying cancer as a disease of aging. The National Cancer Institute Surveillance Epidemiology End Results data report that more than 50% of all cancers are diagnosed in individuals who are aged 65 or greater. Comorbidities prevalent in the elderly population place them at increased risk of developing side effects and toxicities from cancer treatment. ⋯ Evidence-based practice and interdisciplinary collaboration for the purpose of achieving comprehensive patient- and family-centered care are outlined. Quality-of-life concerns, including decisional capacity, are addressed. The role of the critical care nurse in promoting quality of life in the care of the oncology geriatric patient in the acute care and critical care settings is discussed.
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Tight glucose control can significantly improve outcomes of critically ill geriatric patients in the critical care unit (CCU). In the past, blood glucose levels were managed by a point-of-care testing every 4 to 6 hours and using a sliding scale of insulin therapy. ⋯ Studies have shown that patient outcomes improve by having a specific set of standing orders, a well-defined algorithm, and empowering the CCU nurses with these tools. Methods for initiating intensive intravenous insulin therapies are discussed along with some of the biggest challenges faced by CCU nurses at the bedside.
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The purpose of this article is to define our current understanding of appropriate prescribing and outline the potential hazards of overprescribing, while acknowledging the benefits of modern pharmacologic treatment. Finally, we discuss practical strategies to attempt to achieve optimal prescribing patterns for the elderly. ⋯ Attention to prescribing of medications, consistent review of medication lists, and reevaluation of indications and outcomes of prescribing are essential to ensure that polypharmacy is minimized and safety for patients is maximized. This article acts as a practical review for caregivers in multiple practice situations including acute care hospitals, outpatient settings, long-term care, and home care.
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In the United States, 4.9 million people aged 65 years and older have Alzheimer's disease (AD). Medicare costs for patients with heart disease, diabetes, congestive heart failure, or chronic obstructive pulmonary disease and dementia are higher than for those without dementia. Although one principle of care for persons with AD is "do not hospitalize," comorbidities may require inpatient care. This article presents a definition, the diagnostic criteria for AD, and information about differential diagnosis, risk factors, pathology, progression, evidence base for practice, assessment, pharmacologic management, guidelines for general inpatient care, discharge planning, and interventions related to communications, environment, spirituality, special tasks (eating, protecting tubes and dressings, bathing), stages of AD, and special problems (wandering, pain, incontinence, hallucinations, aggression).
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The purpose of this article is to describe and measure the impact of a multifaceted program developed to reduce the falls rate on an acute medical unit at an academic tertiary care center. According to national benchmarks, this unit was one of the hospital's top 3 units for numbers of falls for several years. ⋯ The success of these interventions is discussed, including the effect on the falls rate benchmark. The discussion addresses implications and outcomes associated with the empowerment of nursing staff to respond to benchmarking measures, implement evidence-based practices, and use the same benchmarking procedure to measure outcomes.