Critical care nursing quarterly
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As the United States population ages, patients in intensive care units (ICUs) bring with them the challenges of an aging population. One challenge is the different types of confusions seen in the geriatric patient. ⋯ The purpose of this article was to differentiate between the 3 most common confusions among older adults--delirium, dementia, and depression. In addition, this article discusses confusion seen postoperatively and post-ICU stay.
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Elderly population account for more than 50% of all intensive care admissions, and during their stay, up to 87% of them suffer from delirium. There is a large body of evidence demonstrating increased mortality and worse cognitive function for elderly patients who become delirious during their intensive care unit stay. Although the cause of delirium is multifactorial, inappropriate and outdated sedation methods are preventable causes. We review the current best evidences and provide what we believe are the best sedation strategies that are in line with the Society of Critical Care Medicine's Pain, Agitation and Delirium best practice guideline to reduce the incidence of intensive care unit-associated delirium.
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Nurses Improving Care for Healthsystem Elders provides evidence-based best practices for the care of the hospitalized older adult. Older adults are a vulnerable population at greater risk of functional decline during and after hospitalization, safety concerns related to polypharmacy, ineffective pain management, and population-specific physiological responses to medications. Family members of hospitalized older adults are also vulnerable and may experience postintensive care syndrome. This manuscript explores the application of Nurses Improving Care for Healthsystem Elders standards through a case study approach to optimize patient/family-centered care of the critically ill older adult.
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Nutrition continues to be a concern for the older adult in the intensive care setting despite widespread knowledge of the benefits of adequate nutrition and existing evidence-based protocols. The incidence of malnutrition in hospitalized patients ranges between 22% and 43% with the highest probability of occurrence, 50% or more, in the intensive care unit patient. ⋯ Enteral feeding complications are delineated, and perceived barriers or risks are disputed. This paper concludes with suggestions for future research and a definitive role for advanced nursing nutrition champions.
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Comparative Study Observational Study
Anesthetic choices and breast cancer recurrence: a retrospective pilot study of patient, disease, and treatment factors.
The purpose of this work was to investigate differences in patient, disease, and treatment factors between women who received outpatient surgical treatment of breast cancer with paravertebral and general anesthesia compared with women who received general anesthesia alone. A total of 358 patients with stage 0-III disease received a partial or total mastectomy without axillary node dissection at a large academic cancer center. Study median follow-up time was 28.8 months. ⋯ Overall, no association between anesthesia type and recurrence was detected (P = .53), with an unadjusted estimated hazard ratio of 1.84 (95% confidence interval, 0.34-10.08). The overall rate of recurrence was very small in this population. A larger study is needed to detect significant differences in rates of recurrence attributable to type of anesthesia.