Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Dec 2004
Review Case ReportsThe metabolic response to stress: a case of complex nutrition support management.
The ICU patient with burns, neurotrauma, sepsis, or major surgery typifies the classic hypermetabolic patient. These patients have increased energy and nutrient needs as a result of their injuries and require early nutrition support. Although these patients are likely to benefit from nutritional intervention, the complexity of the stress response to injury and subsequent changes in nutrient metabolism make the design and implementation of nutrition care challenging. This article reviews the pathophysiology of common hypermetabolic conditions and provides strategies to manage the complications associated with nutrition support.
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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
ReviewNutrition in critically ill adults: key processes and outcomes.
Malnutrition is a common problem that can have serious consequences for the already compromised critically ill adult. Nurses are often challenged to quantify the risk or degree of malnutrition, identify the amount or type of support needed, or measure the effectiveness of nutritional intervention. This article focuses on key processes used to provide nutrition therapy to critically ill adults. These processes and how nurses employ them have the greatest potential impact on outcomes related to nutrition in critically ill adults.
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Crit Care Nurs Clin North Am · Sep 2004
The experience of four outcomes managers: an institutional approach to weaning patients from long-term mechanical ventilation.
Care of patients requiring long-term mechanical ventilation (LTMV) is the focus of many hospitals nationwide. Because the care of patients who require LTMV is complex and morbidity and mortality are high, associated costs often exceed reimbursement. This article describes a successful institutional program for the care of the patient population requiring LTMV using advanced practice nurses (APNs) in the role of outcomes managers (OMs). So that others may benefit from the experiences of the clinicians, this article describes the historical background, the selection and qualifications of APNs, the process APNs use to manage and monitor the patients, role challenges, and associated outcomes.
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Crit Care Nurs Clin North Am · Sep 2004
Review Case ReportsSedation assessment: easier said than done!
Sedation assessment commonly is performed in critically ill patients to evaluate their need for, and response to, sedation therapy. Although many sedation assessment scales have been published, few have been tested properly to assure their appropriateness for use in critically ill patients. This article highlights the published sedation assessment scales that have the strongest scientific basis, identifies limitations of the current scales, and suggests characteristics for future sedation assessment scales that would overcome many of the current problems.