Hyperglycemic Emergencies

1992 ◽  
Vol 3 (2) ◽  
pp. 350-360
Author(s):  
Deborah Orange Sauve ◽  
Christine Ashley Kessler
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Receptor Site ◽  
The Elderly ◽  
Positive Outcome ◽  
Fluid Replacement ◽  
Common Denominator ◽  
Critical Care Units ◽  
Beta Cell Destruction ◽  
Clinical Awareness

Hyperglycemic emergencies are the most common endocrinopathies that require intensive care. It is estimated that between 10% and 15% of patients admitted to intensive care units experience complications of acute hyperglycemia. The common denominator of hyperglycemic emergencies is diabetes mellitus, a group of diseases in which, either because of beta-cell destruction of the pancreas or insulin receptor-site defects, there is a relative or absolute deficiency of insulin that results in hyperglycemia. In response to various precipitating factors, staggering hyperglycemia may develop in the form of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic syndrome (HHNK). The existence of DKA has been known since ancient times, and critical care nurses are familiar with the diagnosis. The more lethal disorder of HHNK was “rediscovered” in the 1950s and is occurring with greater frequency as clinical awareness of the condition grows and the elderly (who are at greatest risk for the disorder) populate critical care units in increasing numbers. Prevention is instrumental in abating deadly hyperglycemic emergencies. A positive outcome can be realized but only with timely diagnosis and prompt hormonal and fluid replacement

Designing and Validity Evaluation of Quality of Nursing Care Scale in Intensive Care Units

2014 ◽  
Vol 22 (3) ◽  
pp. 461-471
Author(s):  
Mashaalah Zeraati ◽  
Negin Masoudi Alavi
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Nursing Care ◽  
Content Validity ◽  
Scale Level ◽  
Validity Index ◽  
Critical Care Units ◽  
Quality Of Nursing

Background and Purpose: Quality of nursing care measurement is essential in critical care units. The aim of this study was to develop a scale to measure the quality of nursing care in intensive care units (ICUs). Methods: The 68 items of nursing care standards in critical care settings were explored in a literature review. Then, 30 experts evaluated the items’ content validity index (CVI) and content validity ratio (CVR). Items with a low CVI score (<0.78) and low CVR score (<0.33) were removed from the scale. Results: The 50 items remained in the scale. The Scale level-CVI and Scale level-CVR were 0.898 and 0.725, respectively. Conclusion: The nursing care scale in ICU (Quality of Nursing Care Scale-ICU) that was developed in this research had acceptable CVI and CVR.

Needs of Patients’ Family Members in an Intensive Care Unit With Continuous Visitation

2016 ◽  
Vol 25 (2) ◽  
pp. 118-125 ◽  
Author(s):  
Mini Jacob ◽  
Cynthia Horton ◽  
Sharon Rance-Ashley ◽  
Tera Field ◽  
Robbie Patterson ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Rank Order ◽  
Family Members ◽  
Continuous Family ◽  
Convenience Sample ◽  
Critical Care Units ◽  
Level Of Satisfaction ◽  
National Organizations ◽  
High Level

BackgroundAlthough many critical care experts and national organizations support open visitation in intensive care units (ICUs), most ICU visiting policies do not allow unrestricted presence of patients’ family members.ObjectiveTo describe how well the needs of family members were met in an adult neuroscience ICU with a continuous visitation policy and an adjoining private suite for patients’ family members.MethodsAn exploratory, descriptive study design was used to identify the effects of continuous family visitation in the neuroscience ICU on patients’ family members and their needs and experiences during their time in the unit. A convenience sample of consenting family members completed a survey of family need items 72 hours after the patient was admitted to the unit.ResultsThe most important needs identified by the 45 family members surveyed were items relating to information about the patient, visiting the patient, being given hope, talking with a doctor each day, and being assured that the best care is being given to the patient. Least important items were related to physical comforts for the family members. The vast majority of family members rated their needs as being met for all of the items in the survey and reported a high level of satisfaction with care.ConclusionIn a neuroscience ICU with an open visitation policy and a private suite for patients’ family members, family members rated their needs as being met at a high level, unlike in prior studies in units with limitations on family visitation. The rank order of the importance of each need in the survey was similar to rankings in prior studies in a variety of critical care units.

scholarly journals View. The Dutch Critical Care Triage Guideline on Covid-19: Not Necessarily Discriminatory

2020 ◽  
Vol 27 (5) ◽  
pp. 495-498
Author(s):  
André den Exter
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Selection Criterion ◽  
The Elderly ◽  
Medical Doctors ◽  
Age Limit ◽  
National Emergency

Abstract Recently, the Dutch Medical Doctors Association (Federatie Medisch Specialisten en de Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst) drafted the ‘Covid-19 triage guideline ICU admission’ that has age cut-offs that deprioritise or exclude the elderly. Such an age limit for intensive care unit (ICU) admission in case of a national emergency seems discriminatory, and thus, is it inappropriate to use, or not? The question is whether age in itself can be considered as an acceptable selection criterion.

Characteristics of Nonpharmacological Interventions for Pain Management in the ICU: A Scoping Review

2019 ◽  
Vol 30 (4) ◽  
pp. 388-397 ◽  
Author(s):  
Geraldine Martorella
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pain Management ◽  
Pain Relief ◽  
Scoping Review ◽  
Elderly Women ◽  
The Elderly ◽  
Self Report ◽  
Pharmacological Interventions

Pain relief in the intensive care unit (ICU) is of particular concern since patients are exposed to multiple painful stimuli associated with care procedures. Considering the adverse effects of pharmacological approaches, particularly in vulnerable populations such as the elderly, the use of non-pharmacological interventions has recently been recommended in the context of critical care. The main goal of this scoping review was to systematically map the research done on non-pharmacological interventions for pain management in ICU adults and describe the characteristics of these interventions. A wide variety of non-pharmacological interventions have been tested, with music and massage therapies being the most frequently used. An interesting new trend is the use of combined or bundle interventions. Lastly, it was observed that these interventions have not been studied in specific subgroups, such as the elderly, women, and patients unable to self-report.

Answering the Call: Impact of Tele-ICU Nurses During the COVID-19 Pandemic

2020 ◽  
Vol 40 (4) ◽  
pp. 25-31 ◽  
Author(s):  
Sandy L. Arneson ◽  
Sara J. Tucker ◽  
Marie Mercier ◽  
Jaspal Singh
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Holistic Approach ◽  
Critical Care Units ◽  
Work From Home ◽  
New Strategy ◽  
High Level ◽  
Intensive Care Unit Nurses

Background The coronavirus disease 2019 pandemic has exacerbated staffing challenges already facing critical care nurses in intensive care units. Many intensive care units have been understaffed and the majority of nurses working in these units have little experience. Objective To describe how the skilled tele–intensive care unit nurses in our health system quickly changed from a patient-focused strategy to a clinician-focused approach during the coronavirus disease 2019 crisis. Methods We modified workflows, deployed home workstations, and changed staffing models with the goal of providing additional clinical support to bedside colleagues while reducing exposure time and conserving personal protective equipment for those caring for this highly contagious patient population. The unit changed focus and granted more than 300 clinicians access to technology that enabled them to care for patients remotely, added nearly 200 mobile carts, and allowed more than 20 tele–intensive care unit nurses to work from home. Results Tele–intensive care unit nursing provided clinical knowledge to the nurses covering current and expanded critical care units. Using technology, virtual rounding, and increased collaboration with nurses, tele–intensive care unit nursing minimized the risk to bedside nurses while maintaining a high level of care for patients. Conclusion Tele–intensive care unit nurses provided a proactive, holistic approach to caring for critically ill patients via camera as part of their routine workflow. In addition, during the coronavirus disease 2019 pandemic, these nurses created a new strategy in virtual health care to be implemented during a crisis.

scholarly journals Infusion medication concentrations in UK’s critical care areas: Are the Intensive Care Society’s recommendations being used?

2016 ◽  
Vol 18 (1) ◽  
pp. 30-35 ◽  
Author(s):  
Yovita D Titiesari ◽  
Greg Barton ◽  
Mark Borthwick ◽  
Susan Keeling ◽  
Peter Keeling
Keyword(s):  
Critical Care ◽  
Patient Safety ◽  
Intensive Care ◽  
Intensive Care Society ◽  
Care Society ◽  
Critical Care Units ◽  
The Uk

Following two studies done in 2007 and 2009, a follow-up of the adherence to the suggested guidelines on drug standardisation has been performed with a suggestion for future standards that can be achieved, to complement the recently published Carter report. The Intensive Care Society (ICS) introduced recommendations for infusion concentrations of 16 medications commonly used in critical care areas. The importance being improvement in patient safety and rationalised use of available critical care resources. Five years after publication of these recommendations, a further audit has been undertaken to assess the level of acceptance and application. This revealed that 89.5% of the 133 surveyed units (representing 42.49% critical care units across the UK) have adopted the recommendations. There are further medication concentrations which could also be standardised.

Nurse-physician collaboration in an intensive care unit

2001 ◽  
Vol 10 (5) ◽  
pp. 341-350 ◽  
Author(s):  
PA Miller
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Quality Improvement ◽  
National Study ◽  
Improvement Program ◽  
Critical Care Units ◽  
Improvement Programs ◽  
Nurses And Physicians ◽  
Collaborative Interaction

BACKGROUND: Collaborative interaction between nurses and physicians on critical care units is significantly related to mortality rates and length of stay in the units. For this reason, collaborative interaction should be an integral part of quality improvement programs. OBJECTIVES: To examine perspectives of nurses and physicians on collaborative interaction in an intensive care unit, to examine differences between groups in perceptions of collaborative interaction in the unit, and to compare this unit with units examined in a national study. METHODS: A modification of the ICU Nurse-Physician Questionnaire was used to collect data from 35 nurses and 45 physicians. Descriptive statistics and analysis of variance were used to determine group scores and to examine differences between groups. RESULTS: The level of collaborative interaction in the unit was high. However, nurses and physicians and all other staff groups examined except one had significant differences in perceptions of collaborative interaction. The high level of collaborative interaction was confirmed by a comparison of the results with the results from a national sample. CONCLUSIONS: Critical care units can use this example to incorporate an assessment of the level of collaborative interaction into their quality improvement program.

Clinical Pharmacology in Aged Intensive Care Unit Patients

1993 ◽  
Vol 8 (6) ◽  
pp. 289-297
Author(s):  
Edward T. Zawada ◽  
John L. Boice
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Medical Technology ◽  
The Elderly ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Population Demographics ◽  
Drug Dosing ◽  
Care Services ◽  
Age Related

Elderly patients are presenting themselves for advanced critical care services in ever-increasing numbers due to changing population demographics coupled with advances in medical technology and pharmacology. Medical management of the elderly in critical care settings is complicated by pre-existing multisystem chronic disease, polypharmacy, and age-related changes in pharmacokinetics and pharmacodynamics. Three principles in the management of the elderly in an intensive care unit (ICU) setting are discussed: (1) the protection of renal function from common nephrotic drugs; (2) the necessity of altered drug dosing due to changes in pharmacokinetics and pharmacodynamics; and (3) the necessity of avoiding polypharmacy. Strategies for the prevention of acute renal failure in ICU contrast studies are described. A review of pharmacodynamics and pharmacokinetics in the elderly is presented with examples of commonly seen ICU medication problems.

scholarly journals Prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) infections among patients admitted in critical care units in a tertiary care hospital

2017 ◽  
Vol 5 (6) ◽  
pp. 2362 ◽  
Author(s):  
Arunkumar V. ◽  
Prabagaravarthanan R. ◽  
Bhaskar M.
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Critical Care ◽  
Intensive Care ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Methicillin Resistant ◽  
Critical Care Units ◽  
Two Samples

Background: The emergence of Methicillin-resistant Staphylococcus aureus (MRSA) infections in hospital leads to significant morbidity and mortality. Hence the present study was undertaken to estimate the prevalence of MRSA in critical care units (CCUs) at our centre. The objective of this study was to find the prevalence of MRSA infections in CCUs, to determine their antibiotic profile. And to screen for MRSA in the environment of CCUs in order to find whether they act as a source of infection.Methods: The present cross-sectional study included 100 patients admitted to various CCUs in our hospital. The clinical specimens (urine, Sputum, pus, blood and CSF) were collected from the admitted patients along with environmental samples from these CCUs. Two samples were collected from each patient and subjected to culture and antibiotic susceptibility testing.Results: 168 samples from 100 patients were processed. Out of which five pus samples from five different patients admitted in surgical intensive care unit (SICU) were positive for MRSA infection showing 5% prevalence in CCUs. All MRSA strains were sensitive to vancomycin and teicoplanin. Out of 30 environmental swabs, 1 swab taken from paediatric intensive care unit (PICU) showed positivity for MRSA (3%).Conclusions: CCUs in our hospital have shown 5% prevalence of MRSA among the admitted patients. There was no correlation between environmental MRSA presence and infection in the samples from patient.

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