American journal of critical care : an official publication, American Association of Critical-Care Nurses
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The incidence of morbid obesity is increasing epidemically in the United States. Multiple factors affect the disease process. Numerous methods have been used to treat morbid obesity. ⋯ Nurses' application of current nursing literature and standards of care for postoperative gastric bypass patients puts nurses in a pivotal position to affect both early and late outcomes of these patients after surgery. Morbid obesity is defined, and current treatment trends and postoperative complications are discussed. Recognition and identification of unique nursing considerations and use of critical thinking skills to best meet the needs of postoperative gastric bypass patients, including how obesity affects hemodynamic parameters and airway management, are highlighted.
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Little research has been conducted to validate pain assessment tools in critical care, especially for patients who cannot communicate verbally. ⋯ The Critical-Care Pain Observation Tool showed that no matter their level of consciousness, critically ill adult patients react to a noxious stimulus by expressing different behaviors that may be associated with pain. Therefore, the tool could be used to assess the effect of various measures for the management of pain.
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Tight glycemic control is important in critically ill patients and involves insulin infusions and monitoring of blood glucose levels. Hourly measurements of blood glucose levels and adjustments of intravenous insulin doses require additional work by nurses. ⋯ Although most nurses endorse tight glycemic control, the work associated with it is burdensome and costly. Because up to 2 hours might be required for tight glycemic control for a single patient in a 24-hour period, the costs in time and money are high. Easier clinical methods for monitoring blood glucose levels are needed.