Articles: critical-illness.
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Surg Gynecol Obstet · Mar 1992
Randomized Controlled Trial Clinical TrialTolerance to enteral tube feeding diets in hypoalbuminemic critically ill, geriatric patients.
Tolerance of elemental (for example, Peptamen [PEP]) or free amino acid (for example, Vivonex TEN [VIV]) tube feeding diets is controversial, especially in the critically ill patient who is hypoalbuminemic. A prospective, randomized trial was conducted to compare differences between feeding PEP (n = 8) or VIV (n = 8) in critically ill, elderly (average age of 66 years) patients. Diets were administered through nasogastric or postpyloric feeding tubes. ⋯ Serum albumin concentrations upon initiation of the diets were 2.3 grams per deciliter in both groups. We conclude that tolerance to the two diets were similar because it was possible to feed enterally either PEP or VIV in critically ill, hypoalbuminemic patients (serum albumin concentrations of less than 2.5 grams per deciliter) successfully, irrespective of diet. Although there were more stools in the VIV group, this did not reduce compliance with the goals.
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AACN Clin Issues Crit Care Nurs · Feb 1992
Adverse psychologic responses of the elderly to critical illness.
Afflicting as many as 80% of critically ill elderly (older than 65 years) patients, adverse psychologic reactions (e.g., acute confusional states) to critical illness and its treatment present a unique challenge to medical and nursing intensive care practitioners. Additionally, the consequences of these adverse psychologic reactions financially strain health-care organizations, placing additional constraints on the delivery of health-care services. This article presents information regarding the origins of these adverse psychologic reactions and nursing strategies for the prevention, identification, and management of these clinical states. With such information, nurses who work in critical care units may be better equipped to identify and care for patients at risk of or experiencing an adverse psychologic reaction to critical illness.
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Elderly patients who enter the critical care setting have special nursing care needs based on the physiologic changes of aging. An overview of the changes of aging associated with the immunologic, cardiovascular, integumentary, musculoskeletal, and renal systems provides the basis for care planning to meet the needs of older adults in the intensive care unit.
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To provide up-to-date practical information, relevant to Australian conditions and practice, on stabilising the condition of critically ill children who need transport to a paediatric hospital. ⋯ A recent study found that 47% of 100 children who needed emergency interhospital transfer experienced problems which should have been preventable by greater availability to referring doctors of information on pretransport stabilisation of critically ill children. Hypoventilation, hypoxaemia and hypotension are commonly found in critically ill children before transport, as are difficulties with endotracheal tube care, sedation and analgesia. Mild physiological disturbances are likely to become severe and life-threatening during transfer unless they are corrected before departure. Early discussion of the child's problems and the transfer plan with senior staff at the nearest paediatric intensive care unit may be helpful in planning the pre-transfer resuscitation.