Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Jun 2014
ReviewNutrition in the chronically ill critical care patient.
Chronic critical illness is a problem in the critical care environment. The ultimate goal in managing care for the chronically critically ill is liberation from mechanical ventilation, leading to improved survival and enhanced quality of life. Clinical practice guidelines are presented as a framework in providing care for this distinct patient population. Research studies supplement the recommendations to ensure best care guides critical care decisions using the best evidence in the context of patient values and clinical expertise.
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Malnutrition has been identified as a cause for disease as well as a condition resulting from inflammation associated with acute or chronic disease. Malnutrition is common in acute-care settings, occurring in 30% to 50% of hospitalized patients. Inflammation has been associated with malnutrition and malnutrition has been associated with compromised immune status, infection, and increased intensive care unit (ICU) and hospital length of stay. The ICU nurse is in the best position to advocate for appropriate nutritional therapies and facilitate the safe delivery of nutrition.
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Crit Care Nurs Clin North Am · Jun 2014
ReviewBedside caregivers as change agents: implementation of early enteral nutrition in critical care.
Enteral nutrition is an important aspect of caring for critically ill patients, yet delays in implementation of guidelines and recommendations occur. Bedside caregivers are in a key position to evaluate current practice and lead change to implement evidence-based practice guidelines. Interdisciplinary teams can use change models, such as Larrabee's, to provide guidance and support success of practice change projects.
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An astounding 30% to 50% of older patients who are hospitalized for a medical condition also have a psychiatric disorder. The intent of this article is to prepare acute care nurses to meet the mental health needs of older adults with a critical illness and prevent untoward sequelae of medical events. The authors discuss the importance of baseline assessment data, issues related to informed consent, manifestations of common psychiatric disorders that may be seen in older adults in the acute care setting, as well as strategies to improve patient outcomes.
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Several neurologic conditions are commonly seen with elderly adults in the critical care area. This article addresses a common neurologic condition commonly seen in elderly adults: delirium.