scholarly journals How Differences in the Disease Process of the COVID-19 Pandemic Pose Challenges to the Delivery of Critical Care Nutrition

2021 ◽  
Author(s):  
Mohamed Eisa ◽  
Stephen A. McClave ◽  
Sally Suliman ◽  
Paul Wischmeyer
Keyword(s):  
Critical Care ◽  
Disease Process

Hypertensive disease

2020 ◽  
pp. 493-520
Author(s):  
Eleanor Lewis ◽  
Stuart Davies
Keyword(s):  
Critical Care ◽  
Wide Spectrum ◽  
Mode Of Delivery ◽  
Disease Process ◽  
Hypertensive Disease ◽  
System Disease ◽  
Critical Care Management ◽  
Labour Ward ◽  
The Uk ◽  
In Pregnancy

Hypertension affects ~1 in 10 pregnant women in the UK, whilst pre-eclampsia (PET) complicates 2–8% of pregnancies. Hypertensive disease is the 4th leading cause of direct deaths, with recent triennium deaths due to intracerebral causes. This chapter explores the pathophysiology of hypertensive disease and its current management in pregnancy, including the treatment of eclampsia on labour ward. PET is a multi-system disease, which may present across a wide spectrum of organs. Therefore, the anaesthetic plan of management is greatly influenced by the extent of the disease process and which systems may be involved. This chapter provides detailed recommendations for the anaesthetic plan of care, whichever mode of delivery is indicated, and the peripartum critical care management required.

End-of-Life Issues in Intensive Care Units

2020 ◽  
Author(s):  
Victoria Metaxa
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
End Of Life ◽  
Death And Dying ◽  
Disease Process ◽  
Life Issues ◽  
Advance Care Directives ◽  
Advance Care ◽  
End Of Life Issues ◽  
Potential Improvement

AbstractCritical care clinicians strive to reverse the disease process and are frequently faced with difficult end-of-life (EoL) situations, which include transitions from curative to palliative care, avoidance of disproportionate care, withholding or withdrawing therapy, responding to advance treatment directives, as well as requests for assistance in dying. This article presents a summary of the most common issues encountered by intensivists caring for patients around the end of their life. Topics explored are the practices around limitations of life-sustaining treatment, with specific mention to the thorny subject of assisted dying and euthanasia, as well as the difficulties encountered regarding the adoption of advance care directives in clinical practice and the importance of integrating palliative care in the everyday practice of critical-care physicians. The aim of this article is to enhance understanding around the complexity of EoL decisions, highlight the intricate cultural, religious, and social dimensions around death and dying, and identify areas of potential improvement for individual practice.

scholarly journals Two Case Reports of Neuroinvasive West Nile Virus Infection in the Critical Care Unit

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Edgardo M. Flores Anticona ◽  
Hadeel Zainah ◽  
Daniel R. Ouellette ◽  
Laura E. Johnson
Keyword(s):  
Critical Care ◽  
West Nile Virus ◽  
Lower Extremity ◽  
Mental Status ◽  
Critical Care Unit ◽  
Disease Process ◽  
Care Providers ◽  
West Nile ◽  
Lower Extremity Weakness ◽  
Csf Analysis

We describe the clinical course of two cases of neuroinvasive West Nile Virus (WNV) infection in the critical care unit. The first case is a 70-year-old man who presented during summer with mental status changes. Cerebrospinal fluid (CSF) analysis revealed pleocytosis with lymphocyte predominance. WNV serology was positive in the CSF. His condition worsened with development of left-sided weakness and deterioration of mental status requiring intensive care. The patient gradually improved and was discharged with residual left-sided weakness and near-complete improvement in his mental status. The second case is an 81-year-old man who presented with mental status changes, fever, lower extremity weakness, and difficulty in walking. CSF analysis showed pleocytosis with neutrophil predominance. WNV serology was also positive in CSF. During the hospital stay his mentation worsened, eventually requiring intubation for airway protection and critical care support. The patient gradually improved and was discharged with residual upper and lower extremity paresis. Neuroinvasive WNV infection can lead to significant morbidity, especially in the elderly. These cases should be suspected in patients with antecedent outdoor activities during summer. It is important for critical care providers to be aware of and maintain a high clinical suspicion of this disease process.

scholarly journals Potential for Cognitive Communication Impairment in COVID-19 Survivors: A Call to Action for Speech-Language Pathologists

2020 ◽  
Vol 29 (4) ◽  
pp. 1821-1832
Author(s):  
Amy E. Ramage
Keyword(s):  
Critical Care ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Disease Process ◽  
The United States ◽  
Cochrane Central Register ◽  
Clotting Factors ◽  
Speech Language Pathologists ◽  
Call To Action ◽  
Communication Impairment

Purpose Severe acute respiratory syndrome coronavirus 2 is the virus resulting in COVID-19 infections in nearly 4.3 million Americans with COVID-19 in the United States as of July 29, 2020, with nearly 150,000 deaths and hundreds of thousands of survivors ( https://www.coronavirus.jhu.edu/map.html ). This tutorial reviews (a) what has been reported about neurological insults in cases of COVID-19 infection, (b) what is known from similar conditions in other disorders, and (c) how that combined information can inform clinical decision making. Method PubMed and the Cochrane Central Register of Controlled Trials were searched for COVID-19 or other coronavirus infections, cognitive impairment observed following critical care, and disorders for which intermittent or chronic hypoxia is characteristic. These were combined with searches relating to cognition, brain, and communication. All searches were conducted between April 8 and May 23, 2020. Meta-analyses and randomized clinical trials addressing other critical illnesses were also included to extend findings to potential cognitive communication outcomes following COVID-19. Results COVID-19 infection results in a combination of (a) respiratory infection with mechanical ventilation secondary to inadequate oxygenation, (b) inflammatory system reactivity, and (c) increased blood clotting factors. These affect central nervous system function incurring long-term cognitive communication impairment in a proportion of survivors. Diagnostic and intervention approaches for such impairments are discussed. Conclusions The existing literature on cognitive sequela of COVID-19 infection is small to date, but much can be learned from similar viral infections and disorders. Although COVID-19 is novel, the speech-language pathology approaches to evaluation and intervention of other populations of critical care patients are applicable. However, speech-language pathologists have not routinely been involved in these patients' acute care. As such, this is a call to action to speech-language pathologists to address the unprecedented numbers of patients who will need their services early in the disease process and throughout recovery.

Providing end-of-life care to patients seeking hope for cure: Improving Mayo Clinic palliative care utilization

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18552-18552
Author(s):  
K. Swetz ◽  
T. Moynihan ◽  
S. Ruegg ◽  
A. Tan ◽  
P. J. Atherton ◽  
...  
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
Survival Analysis ◽  
End Of Life ◽  
Hospital Discharge ◽  
Median Survival ◽  
Symptom Control ◽  
Disease Process ◽  
Care Utilization ◽  
Palliative Care Consultation

18552 Background: We reviewed Palliative Care Consultation Service (PCCS) referrals to attempt to promote earlier referrals, and to improve overall patient care. Methods: Eligibility for PCCS referral is life expectancy of one year or less. Data was collected prospectively on the first 461 referrals (452 individual patients) over the initial 30-month period (January 1, 2003 to July 1, 2005). Additional factors were retrospectively abstracted from documentation. Kaplan-Meier survival analysis was then performed. Results: 452 patients were seen (mean age 71.9 years), and 387 (86%) have died. Median length of inpatient stay was 8 days, with PCCS consultation requested 3 days prior to discharge. 107 patients (24%) died prior to hospital discharge. 345 patients survived to discharge, 236 (68%) died within 3 months, and 262 (76%) died within 6 months. Median survival from consultation to death was 12 days and after hospital discharge was 6 days. Secondary analysis determined that patients with malignancy had longer median survival from discharge to death than those with other diagnoses (11 days versus 3 days, p = 0.025). Median survival was longer with referrals from general surgery and surgical specialties (37 days and 8 days, respectively), compared to hematology-oncology and critical care (2 days and 0 days, respectively). Conclusions: The primary goal of the PCCS is to provide symptom control and maximize quality of life at the end of life. These data suggest palliative care services are unnecessarily delayed until too late. Education is necessary to facilitate earlier PCCS intervention. Survival analysis suggests providers are more likely to consider PCCS involvement in patients with malignancy compared with other diseases. Critical care and hematology-oncology, showed the lowest median survivals. Education efforts must be focused on these areas. Programs are underway to identify eligible patients earlier in their disease process, and educate providers about key end-of-life services provided to patients and families. No significant financial relationships to disclose.

Congenital intracardiac shunting in the adult: outline for nursing care

1990 ◽  
Vol 10 (5) ◽  
pp. 146-152
Author(s):  
PC Waggoner
Keyword(s):  
Critical Care ◽  
Therapeutic Response ◽  
Disease Process ◽  
Left Ventricular ◽  
Unique Challenge ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Anatomy And Physiology ◽  
Assessment Skills ◽  
Pressure Dynamics

Adults with an untreated intracardiac shunt present a unique challenge to the critical care nurse. The disease process necessitates an understanding of cardiac anatomy and physiology in order to determine the etiology of the cardiac defect and resulting shunt. An understanding of fluid and pressure dynamics is also of importance since anatomic shunting alters usual adult hemodynamics. Arterial and mixed venous oximetry monitoring is most helpful in determining the response to therapies. One must rethink some of the hemodynamic goals that are traditionally used in caring for adults with primary left ventricular dysfunction. Therapeutic response is usually limited to a narrow hemodynamic range. Many of these patients have superimposed health problems such as atherosclerosis, hypertension, and cigarette smoking. Therefore, the critical care nurse is confronted with caring for a patient with unique problems that test creativity and assessment skills.

Nutrition in critical care

2020 ◽  
Vol 11 (6) ◽  
pp. 256-262
Author(s):  
Steph Phillips
Keyword(s):  
Critical Care ◽  
Disease Process ◽  
Holistic Care ◽  
Feeding Tubes ◽  
Increased Risk ◽  
Dietary Requirements ◽  
The Status ◽  
Muscle Catabolism ◽  
Critical Patients ◽  
Made In

Veterinary professionals in emergency and critical care see the sickest and most unstable patients, and it is understandable that nutrition is not at the forefront of their minds. This article demonstrates why nutrition is important in the most critical patients, and why studies show it is no longer advisable to delay assisted nutrition. Absence of nutrition in the critical patient leads to muscle catabolism, protein deficiencies and increased risk of sepsis. There are options for enteral or parenteral nutrition, and various feeding tubes that can be used depending on the status of the patient. Both underfeeding and overfeeding can be detrimental to the critical patient; requirements should be calculated for each patient on an individual basis, considering the dietary requirements and risks associated with each presentation and disease process. There are also changes that can be made in the hospital to encourage patients to eat voluntarily; it is important not to forget holistic care in the critical patient.

Ulcerogenic Tumors of the Pancreas

1968 ◽  
Vol 26 ◽  
pp. 186-187
Author(s):  
J. C. Garancis ◽  
J. F. Kuzma ◽  
S. D. Wilson ◽  
E. H. Ellison
Keyword(s):  
Endoplasmic Reticulum ◽  
Tumor Cells ◽  
Islet Cell ◽  
Disease Process ◽  
Central Core ◽  
Islet Cell Tumors ◽  
Opaque Zone ◽  
Granular Form ◽  
Zollinger Ellison Syndrome

It has been proposed that a gastrin-like hormone elaborated by non-beta islet tumors of the pancreas may be responsible for a fulminating ulcer diathesis. Subsequently, a potent gastric secretagogue was isolated from ulcerogenic tumors of the pancreas. This disease process is known now as “Zollinger-Ellison syndrome”.In our studies of two cases of Zollinger-Ellison syndrome, pancreatic lesions were identified as alpha islet cell tumors (Fig. 1). Tumor cells were fairly uniform. The sizes of the alpha granules were not significantly different, but their number and distribution varied greatly from one cell to another. Each granule consisted of a round, highly dense central core, separated from the limiting membrane by an opaque zone. The granular form of the endoplasmic reticulum was particularly prominent. Numerous mitochondria, round or elongated, were dispersed throughout the cytoplasm. Individual or clusters of lysosomes were observed in the majority of cells.

Electron microscopy analysis of degenerating pancreatic ß cells in transgenic mice expressing the MHC Class I antigen Dd

1990 ◽  
Vol 48 (3) ◽  
pp. 548-549
Author(s):  
T. A. Stewart ◽  
D. Liggitt ◽  
S. Pitts ◽  
L. Martin ◽  
M. Siegel ◽  
...  
Keyword(s):  
Type I Diabetes ◽  
Disease Process ◽  
Class Ii ◽  
Class I ◽  
Type I ◽  
Aberrant Expression ◽  
Mhc Molecules ◽  
Endogenous Insulin ◽  
Class Ii Mhc ◽  
Ifn Γ

Insulin-dependant (Type I) diabetes mellitus (IDDM) is a metabolic disorder resulting from the lack of endogenous insulin secretion. The disease is thought to result from the autoimmune mediated destruction of the insulin producing ß cells within the islets of Langerhans. The disease process is probably triggered by environmental agents, e.g. virus or chemical toxins on a background of genetic susceptibility associated with particular alleles within the major histocompatiblity complex (MHC). The relation between IDDM and the MHC locus has been reinforced by the demonstration of both class I and class II MHC proteins on the surface of ß cells from newly diagnosed patients as well as mounting evidence that IDDM has an autoimmune pathogenesis. In 1984, a series of observations were used to advance a hypothesis, in which it was suggested that aberrant expression of class II MHC molecules, perhaps induced by gamma-interferon (IFN γ) could present self antigens and initiate an autoimmune disease. We have tested some aspects of this model and demonstrated that expression of IFN γ by pancreatic ß cells can initiate an inflammatory destruction of both the islets and pancreas and does lead to IDDM.

Auditory Dysfunction in Alzheimer's Disease

2010 ◽  
Vol 15 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Sridhar Krishnamurti
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Health Care ◽  
Care Setting ◽  
Neurodegenerative Disorder ◽  
Disease Process ◽  
Clinical Protocols ◽  
Speech Language Pathologist ◽  
Auditory Dysfunction

Alzheimer's disease is neurodegenerative disorder which affects a growing number of older adults every year. With an understanding of auditory dysfunction in Alzheimer's disease, the speech-language pathologist working in the health care setting can provide better service to these individuals. The pathophysiology of the disease process in Alzheimer's disease increases the likelihood of specific types of auditory deficits as opposed to others. This article will discuss the auditory deficits in Alzheimer's disease, their implications, and the value of clinical protocols for individuals with this disease.

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