Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Mar 2013
ReviewManagement of hyperglycemia in the intensive care unit: when glucose reaches critical levels.
Hyperglycemia among hospitalized critically ill patients has been shown to be an independent predictor of poorer outcomes. Appropriate treatment of hyperglycemia among these patients has been associated with reduced mortality and morbidity. ⋯ The ultimate goal of treatment is to obtain glycemic control without causing undue hypoglycemia. This article discusses issues related to glycemic control among critically ill patients, glucose targets in this population, and best practices in the management of hyperglycemia in patients in the intensive care unit.
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Proper care of patients with diabetes during the perioperative period is crucial for preventing acute complications such as hyperglycemia, hypoglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state, dehydration, and electrolyte imbalances. Many factors influence the optimal care plan, including the usual home diabetes regimen, the level of diabetes control before surgery, the surgery type, the duration of surgery, and the amount of time the patient will be fasting. An optimal plan of care is based on a thorough presurgical assessment and prescribing a regimen that will minimize acute complications. This article discusses recommendations for target blood glucose and diabetes medication adjustment during the perioperative period.
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The role of vitamin D in critical illness is under investigation. Recent data indicate declining levels of serum vitamin D in multiple adult populations. ⋯ Vitamin D deficiency that is present at the onset of critical illness may impact the severity of illness and contribute to less-than-optimal outcomes. This article describes the function of vitamin D, the effects that deficiencies have on body systems, and the emerging role of vitamin D deficiency for critically ill patients.
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Crit Care Nurs Clin North Am · Dec 2012
Case ReportsJourney of a survivor of near drowning, polymicrobial pneumonia, and acute respiratory distress syndrome.
This article discusses a woman who collapsed and landed in a puddle of water in a park near a horse trail. Her rescue and resuscitation started an extraordinary effort by her body to heal from multiple insults. ⋯ It highlights the evidence for treatment of the polymicrobial nature of submersion injury, acute lung injury, and benefits of progressive mobility. Social media as a tool for the family's communication and coping are also discussed.
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Crit Care Nurs Clin North Am · Sep 2012
Self/unplanned extubation: safety, surveillance, and monitoring of the mechanically ventilated patient.
The purpose of this article is to provide an appreciation for a significant risk to quality of care affecting patients receiving mechanical ventilation: unplanned extubation. A summary of the current literature provides evidence-based recommendations for how to minimize this potentially dangerous complication. In addition, recommendations for proceeding after unplanned extubation are made.