British journal of nursing (Mark Allen Publishing)
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Review Case Reports
Improving glycaemic control in a metabolically stressed patient in ICU.
This article describes a clinical experience where the careful application of problem-solving skills has resulted in positive changes in glycaemic care in a critical care environment. The metabolic stress response to trauma injuries leads to episodes of hyperglycaemia. ⋯ The importance of strict control of blood glucose levels in the critically ill patient is highlighted. Although the practice areas in this article is a specialized intensive care environment, in light of recent government-led recognition that many patients in hospital are increasingly ill (Department of Health (DoH), 1998a), this situation may arise in many ward environments.
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Older clients are at increased risk during surgical intervention because of age-related system changes and comorbid conditions. However, recent advances in surgical and anaesthetic techniques, together with modern monitoring technology and the proliferation of ambulatory surgery, have reduced mortality in older patients undergoing surgery. Nevertheless, inadvertent hypothermia in older clients remains problematic. Therefore, an understanding of specific diseases prevalent in old age, coupled with a comprehensive knowledge of the physiological impact of ageing in all body systems, underpins the role of the anaesthetic nurse.
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Chronic neuropathic pain is experienced by a large number of patients. It can affect the individual physically, psychologically and socially. This review examines the evidence base for the assessment of chronic neuropathic pain and discusses some of the main tools and their suitability for use for this particular type of pain. ⋯ The evidence recommends that chronic pain be assessed using a multidimensional assessment tool. Currently the only tool specifically designed to measure neuropathic pain is the Neuropathy Pain Scale. The author describes how the evidence was applied to make changes in her own area of practice and why the Brief Pain Inventory was considered more suitable than the Neuropathy Pain Scale.
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Being a sexual being and having sexual feelings is a part of what it is to be a human being--there are no age limits to enjoying a healthy sex life and having the ability to love and be loved. There are many misconceptions surrounding sexuality and in general these misconceptions become even more problematic as the older person and sexuality are discussed. This article aims to consider misconceptions that nurses may have about sex and sexuality concerning older people. ⋯ Nurses need to demonstrate empathy and understanding if the patient is to disclose intimate feelings concerning his/her sexual health. Information is offered that may help nurses to ensure that a truly holistic approach to care is provided to older patients. Finally, recommendations are suggested in order to act in the patient's best interests.
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Review Case Reports
Integration of critical care and palliative care at end of life.
End-of-life care in the critical care environment suffers from a lack of clarity and uncertainty. Critical care nurses may often feel torn between wanting to do everything possible to sustain a patient's life and wanting to do what is in the patient's best interests. ⋯ Futility, conflict and resources all factor in such decisions. Nurses must ensure the transition from cure to comfort does not emphasize a dichotomy between palliative care and critical care but instead focuses on the provision of the best possible end-of-life care.