AACN clinical issues in critical care nursing
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AACN Clin Issues Crit Care Nurs · Nov 1994
ReviewThe role of total parenteral nutrition in critical illness: guidelines and recommendations.
Critically ill patients experience a multitude of metabolic derangements in response to sepsis, shock, and severe injury. The result of extreme stress is characterized by alterations in carbohydrate and fat metabolism and persistent catabolism of lean body mass. ⋯ In this article, the author identifies the patient at risk, defines the appropriate time to initiate parenteral nutrition, and outlines current recommendations for energy and protein prescription. The author also briefly reviews administration issues, discusses possible complications of therapy, and defines effective strategies to monitor the response to therapy.
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AACN Clin Issues Crit Care Nurs · Nov 1994
ReviewTerminal weaning from mechanical ventilation: a review.
Terminal weaning is a clinical intervention for withdrawing mechanical ventilatory support when such support is an unacceptable outcome for a patient. Withdrawal of life support must be done in a humane manner for the patient, the family, and the patient's care providers. Research-based directions for clinical practice are limited because of the paucity of research in this area. Recommendations for future study are related to methods, facilitative therapy, patient, family, and caregiver responses, and care delivery models.
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The recognition and treatment of malnutrition has been shown to improve the survival of patients. Current research to prevent and improve patient outcome with nutritional interventions in the critically ill is promising. Nurses are responsible for identifying the signs and symptoms of malnutrition, administering nutritional therapy while assessing for complications and side effects associated with these treatments, and monitoring the effectiveness of nutritional interventions. ⋯ Various feeding devices, products, and complications related to enteral nutrition are explained in detail. Comprehensive nursing care as related to the delivery of feeding products through various feeding devices is reviewed. Nursing research applicable to the practice of enteral nutrition in the intensive care unit is presented.
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The gastrointestinal tract is a major immunologic organ that must be maximally supported during critical illness. Gastrointestinal tissues require direct contact with nutrients to support their own rapid cellular turnover rate and carry out the multitude of metabolic and immunologic functions needed for successful adaptation to stress. ⋯ Early enteral nutrition has been shown to be a viable, economic, and physiologically beneficial way to support the gastrointestinal tract during critical illness. The fortification of enteral formulas with glutamine, arginine, or fiber is being studied to determine each one's unique role in the gut and immunologic changes that occur with severe stress.
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AACN Clin Issues Crit Care Nurs · Nov 1994
ReviewAlcohol-related end-stage liver disease and transplantation: the debate continues.
Liver transplantation has been an acceptable treatment for end-stage liver disease for many years. The greatest number of patients needing transplantation for survival are those suffering from alcohol-related end-stage liver disease. Throughout the years, many debates and much research have been completed looking at the medical and ethical responsibility to give transplants to these patients. In this article, the author looks at some of the arguments facing transplantation in patients with alcoholism and some of the related research published.