AACN clinical issues
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AACN clinical issues · May 1995
ReviewEarly administration of enteral nutrients in critically ill patients.
Aggressive nutrition intervention has become an essential component in the therapy of critically ill patients. Early provision of enteral nutrients within 24 hours of injury or surgery appears optimal and is associated with benefits such as a reduction in septic complications, a decrease in the hypermetabolic response to severe burn injury, and improved wound healing. Early enteral nutrient administration has a significant impact on preserving gastrointestinal integrity and barrier function and maintaining intestinal immunologic defenses, which may have a role in decreasing infectious outcomes in critically ill patients. ⋯ Small intestine feeding usually is preferred to gastric nutrient administration, yet some declare biologic superiority with intragastric feedings. The optimal enteral product for use in critically ill patients remains unknown. Key nutrients, such as glutamine, arginine, fiber, and alternative lipids, may have potential benefits and need to be considered when formulating an enteral regimen in this patient population.
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AACN clinical issues · May 1995
Review Case ReportsExtracorporeal lung assist in the adult trauma patient.
Acute respiratory distress syndrome (ARDS) is a common complication of trauma and critical illness. Despite medical advances, the mortality associated with this disease process remains consistently around 50%. ⋯ This therapy removes all or a substantial percentage of total body carbon dioxide production, allowing for much lower ventilator support and facilitating "lung rest". Although the use of ECLA is controversial, it represents a viable option for patients with severe respiratory failure.
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AACN clinical issues · May 1995
ReviewPharmacologic symptom control during the withdrawal of life support: lessons in palliative care.
The withdrawal of life support is now a common practice in the critical care setting. This treatment provides patients and families with greater opportunities for positive end-of-life experiences. ⋯ Dyspnea, pain, anxiety, and excessive secretions are troubling symptoms that often occur during the withdrawal of life support. In this article, the author reviews pharmacologic interventions that control these symptoms, focusing on the titration of potentially lethal drugs using patient responses and the ethical principle of double effect to guide nursing practice.
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Traumatic injury places the patient at risk for hypothermia in both pre-hospital and hospital settings. Hypothermia significantly affects physiologic processes in the body and increases mortality in the trauma patient. Identifying trauma patients at risk for hypothermia, preventing hypothermia, and managing its complications are essential for positive outcomes. This article explores the physiologic ramifications of hypothermia, patients at risk, and management strategies in the trauma patient.
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AACN clinical issues · May 1995
ReviewPulmonary dysfunction related to immobility in the trauma patient.
Immobility is associated with multisystem pathophysiologic sequelae, especially in the critically ill trauma patient. Pulmonary embolus from deep vein thrombosis and nosocomial pneumonia are causes of pulmonary dysfunction that are directly related to immobilization in this population. Because of the high incidence of these complications, early identification of those at risk and institution of aggressive interventions to prevent nosocomial pneumonia and pulmonary embolus are crucial responsibilities of nurses caring for severely injured patients.