Critical care nursing quarterly
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Elderly population account for more than 50% of all intensive care admissions, and during their stay, up to 87% of them suffer from delirium. There is a large body of evidence demonstrating increased mortality and worse cognitive function for elderly patients who become delirious during their intensive care unit stay. Although the cause of delirium is multifactorial, inappropriate and outdated sedation methods are preventable causes. We review the current best evidences and provide what we believe are the best sedation strategies that are in line with the Society of Critical Care Medicine's Pain, Agitation and Delirium best practice guideline to reduce the incidence of intensive care unit-associated delirium.
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Nurses Improving Care for Healthsystem Elders provides evidence-based best practices for the care of the hospitalized older adult. Older adults are a vulnerable population at greater risk of functional decline during and after hospitalization, safety concerns related to polypharmacy, ineffective pain management, and population-specific physiological responses to medications. Family members of hospitalized older adults are also vulnerable and may experience postintensive care syndrome. This manuscript explores the application of Nurses Improving Care for Healthsystem Elders standards through a case study approach to optimize patient/family-centered care of the critically ill older adult.
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Nutrition continues to be a concern for the older adult in the intensive care setting despite widespread knowledge of the benefits of adequate nutrition and existing evidence-based protocols. The incidence of malnutrition in hospitalized patients ranges between 22% and 43% with the highest probability of occurrence, 50% or more, in the intensive care unit patient. ⋯ Enteral feeding complications are delineated, and perceived barriers or risks are disputed. This paper concludes with suggestions for future research and a definitive role for advanced nursing nutrition champions.
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Older adults comprise approximately 50% of patients admitted to critical care units in the United States. This population is particularly susceptible to multiple morbidities that can be exacerbated by confounding factors like age-related safety risks, polypharmacy, poor nutrition, and social isolation. The elderly are particularly vulnerable to health conditions (heart disease, stroke, and diabetes) that put them at greater risk of morbidity and mortality. ⋯ There are myriad challenges for critical care nurses in caring for patients experiencing pain-inadequate communication (cognitively impaired or intubated patients), addressing the concerns of family members, or gaps in patients' knowledge. The purpose of this article was to discuss the multidimensional nature of pain and identify concepts innate to pain homeostenosis for elderly patients in the critical care setting. Evidence-based strategies, including an interprofessional team approach and best practice recommendations regarding pharmacological and nonpharmacological pain management, are presented.
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Treatment of sepsis involves prompt recognition and treatment to optimize outcome. Several medication considerations are pertinent to patients with sepsis, severe sepsis, and septic shock. ⋯ Ongoing research will continue to focus on this disease process and will continue to shape treatment in the future. The use of medication therapies directed at treatment of sepsis will be reviewed in this article.