British journal of nursing (Mark Allen Publishing)
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The procedure of fasting from midnight until induction of anaesthesia arose from concern that patients could regurgitate during induction of general anaesthesia when the pharyngeal and laryngeal refluxes are depressed. In this situation, the contents of the stomach do not come out of the patient's mouth, but go up into the oesophagus and trachea and are drawn back down into the lungs. ⋯ This article considers the current evidence for preoperative fasting times and examines why patients are still being subjected to prolonged preoperative fasting. Based on the evidence presented, recommendations are made regarding this aspect of care.
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This article outlines the pathophysiology associated with hypovolaemic, cardiogenic and distributive shock, and discusses how each of these might present clinically in the patient. Nursing assessment of a patient in shock is explored, and the use of tools such as the pulse oximeter is examined. ⋯ The importance of recognizing the clinical presentation of shock is highlighted, with an emphasis on understanding the pathophysiology and potential systemic effects. Treatment is discussed and covers: providing optimal oxygen therapy, appropriate patient monitoring and location of care, using effective communication skills, assisting with activities of living, psychological support, and working collaboratively to maximize the overall quality of patient care delivered.
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Phantom limb pain (PLP) is thought to occur in most amputees. This common clinical phenomenon often provides a challenge to those involved in the treatment and management of pain, since the causes of PLP are often misunderstood. ⋯ The article will then consider pain management strategies used in PLP in the ward setting. These pain management strategies include the use of drugs not traditionally known as analgesics, but which are usually used in the treatment of epilepsy and depression.
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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.