Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Dec 2004
Review Case ReportsMeeting the nutritional needs of the bariatric patient in acute care.
Meeting the nutritional needs of the bariatric (severely obese) patient in acute and critical care can be a challenge. Assessment of metabolic needs and energy expenditure is imperative to calculate nutritional needs. Achieving adequate nutrition is a result of multidisciplinary team collaboration, with the nurse providing important data for the dietitian to calculate needs. This article reviews aspects of nutritional support of the bariatric patient including assessment, planning, implementation, and evaluation.
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Crit Care Nurs Clin North Am · Dec 2004
Review Case ReportsNutritional support in the critically injured.
Nutritional support must be an integral part of the management of trauma victims. This article compares the stress response, a maladaptive response, and starvation, an adaptive process, examines the clinical research regarding total parenteral nutrition and total enteral nutrition, provides an evidence-based approach to initiating nutritional support in critically injured patients, and discusses considerations in selecting nutritional formulas.
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Crit Care Nurs Clin North Am · Dec 2004
ReviewBenefits and methods of achieving strict glycemic control in the ICU.
Hyperglycemia, a frequent complication in critically ill patients, has been shown to have a negative influence on morbidity and mortality. Many factors contribute to hyperglycemia, including the stress response, diabetes, obesity, advanced age, corticosteroids, sepsis, pancreatitis, and the use of nutrition support. Application of intensive insulin therapy, when compared with conventional glycemic control measures, seems to improve outcomes in the critically ill patient. Therefore, effective insulin therapy along with appropriate nutrition support prescriptions provide a means for the critical care nurse and other health care team members to lower complications and enhance recovery in the ICU setting.
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Crit Care Nurs Clin North Am · Dec 2004
ReviewNutritional status: assessing and understanding its value in the critical care setting.
The nutritional assessment is a key determinant in establishing risk for malnutrition and is also valuable in predicting outcomes in the critical care setting. Studies have demonstrated that nurses who are aware of the impact of nutrition and have operational aptitude can influence patient outcomes through early intervention. This intervention can result in shortened recovery time and decreased lengths of stay. Knowledge of nutrition's effect in the acute and critically ill patient is integral for nursing to predict and promote outcomes successfully in the critical care setting.
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When gastric intubation is the chosen method of providing enteral nutrition, a variety of factors must be considered. To choose the proper tube, whether it resides in the gastric area or is postpyloric, it is important to consider the patient's level of consciousness, the duration of feeding, and the patient's overall status. Proper assessment, confirmation of tube placement, and nursing vigilance greatly reduce the likelihood of complications.