AACN clinical issues
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AACN clinical issues · Nov 2000
ReviewEstimating energy expenditure in critically ill adults and children.
Designing effective nutrition support regimens for critically ill patients requires an understanding of the energy needs of each patient. Many disease processes result in elevated caloric requirements, whereas some clinical procedures and medications may diminish the metabolic response. Experienced clinicians are unable to predict the extent to which trauma or injury will affect energy requirements for an individual. ⋯ In the complex and rapidly changing context of critical illness, individualized assessment of energy requirements is crucial. Whichever technique is used initially to assess energy requirements, sequential monitoring and constant reassessment of each patient is essential to provide the appropriate nutritional care regimen. The purpose of this article is to review the equations for estimating and the techniques, practical aspects, and interpretation of measuring energy expenditure in critically ill patients.
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AACN clinical issues · May 2000
ReviewPathophysiology and implications for treatment of acute respiratory distress syndrome.
Acute respiratory distress syndrome is a complex group of signs and symptoms caused by direct or indirect lung injury. In spite of decades of research, it is still associated with a high mortality rate. ⋯ However, novel therapies are in development, based on the knowledge of the pathologic processes of acute respiratory distress syndrome. In this article an overview of the disease process and mediator involvement is presented, followed by a review of pharmacologic and ventilation treatments currently in use or under study.
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The number of elderly, both in society at large and in the critical care population, is increasing at an unprecedented rate. Critical care nurses must address how best to provide care to these elders. ⋯ The critical care environment may also be a factor in facilitating delirium, common in critically ill elders. Critical care nurses can proactively help to create a healing environment for these elders by facilitating sleep, implementing strategies to reduce delirium, preventing or minimizing painful experiences, and liberalizing family visitations.
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AACN clinical issues · Feb 2000
ReviewMusic therapy as a nursing intervention for patients supported by mechanical ventilation.
Music therapy is a nonpharmacologic nursing intervention that can be used as a complementary adjunct in the care of patients supported by mechanical ventilation. This article details the theoretical basis of music therapy for relaxation and anxiety reduction, highlights the research testing the intervention in such patients, and discusses areas of needed research to extend further the implementation of music therapy in critical care nursing practice in an effort to promote a healing environment for patients.
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As the climate of healthcare continues to change, critical care nurses are under increasing stress, which in turn puts them at risk for stress-related illnesses. Nurses can benefit from having a repertoire of healthy coping mechanisms, and one of the means available to them is humor. ⋯ Without considering the elements of bond, environment, and timing, however, humor can come across as offensive and hurtful. This article explores some of the precursors of stress for nurses, the use of humor to combat stress, how to keep humor constructive, and the importance of being active rather than passive in producing humor.