Critical care nursing quarterly
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Critically ill patients are particularly at risk for developing hospital-acquired infections. An understanding of the predisposing factors, the epidemiology of disease, and guidelines to treat and to prevent hospital-acquired infections is necessary to incorporate infection control into the daily care of the critically ill trauma patient. Although it remains a challenge, infection control programs have moved from providing surveillance data and guidelines recommendations to implementation and engagement programs aimed at a shared responsibility for hospital-acquired infections prevention. We describe a multidisciplinary approach to infection control in the critically ill trauma patient with a special focus on ventilator-associated pneumonia at a level 1 trauma and burn center.
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Vital signs are indicators of a patient presenting to an emergency department (ED). Abnormal vital signs have been associated with an increased likelihood of admission to the hospital. Physicians have long recognized the importance of vital sign observations, and vital sign measurement has proven to be useful for detecting serious diseases during triage in EDs. ⋯ The measurement of mean blood pressure, systolic blood pressure, and oxygen saturation of the injured patients during the admission to the ED can predict the disease course of patients.
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Adequate nutrition support is a key component in achieving favorable outcomes for the critically ill patient. Significant evidence supports starting enteral nutrition rather than parenteral nutrition as early as possible after injury to promote positive outcomes. Evidence shows that enteral nutrition improves patient outcomes and decreases intensive care unit length of stay by improving splanchnic blood flow, moderating the metabolic response, sustaining gut integrity, and preventing bacterial translocation from the gut to the bloodstream. ⋯ This article describes the rationale for early enteral nutrition, the evidence that favors enteral nutrition over parenteral nutrition, barriers to delivery of full enteral nutrition, and an evidence-based protocol developed at Harborview Medical Center to promote appropriate support. The role of the registered dietitian on the health care team in facilitating appropriate feeding is discussed. In addition, we will describe emerging nutrition therapies including the use of antioxidants, addition of the amino acid glutamine, use of immune-enhancing enteral formulas, and the potential role of probiotics that show promise in improving patient outcome.
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On a 30-bed trauma surgical unit in an academic medical center, a best practice group was established. For a first project, we worked on improving the patient's pain experience. The decision was driven by the units Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) pain scores. ⋯ The nurse manager, educator, pain relief attendant, anesthesia attendant, and 2 trauma surgeons met to discuss how to improve the surgical patient's pain experience. This trauma surgical unit now exceeds the top performers in HCAHPS scores. We have moved from the 1st percentile to the 90th percentile in 5 months.