Crit Care Nurs Clin North Am
· 2023 Mar · PMID 36774006
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Fever is common in patients with stroke and is associated with worse outcomes. Studies in brain injury informed interventions commonly termed therapeutic temperature management (TTM) to improve the monitoring and managem...Fever is common in patients with stroke and is associated with worse outcomes. Studies in brain injury informed interventions commonly termed therapeutic temperature management (TTM) to improve the monitoring and management of fever. While the role and benefit of TTM in stroke patients has not been well studied, the nurse and healthcare team must extrapolate existing data to determine how to best monitor and apply TTM after stroke. Nurses should be knowledgeable about interventions to monitor and manage complications of TTM (eg, shivering), the studies underway to quantify the impact of fever treatment and emerging technology expected to improve TTM.
Crit Care Nurs Clin North Am
· 2023 Mar · PMID 36774005
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Hypertension affects 1 in 3 Americans and results in nearly 900,000 inpatient admits annually due to ineffective management. As a primary factor in the development of strokes, hypertension management is essential. The ap...Hypertension affects 1 in 3 Americans and results in nearly 900,000 inpatient admits annually due to ineffective management. As a primary factor in the development of strokes, hypertension management is essential. The approach to effectively manage hypertension should be done from a multipoint approach to ensure the specific elements that impede the effective management of hypertension within various patient populations are addressed accordingly, which includes, personal, physical, and health needs. The robust implementation of lifestyle modifications, medication therapy, and self-efficacy interventions can improve hypertension management by almost 37%.
Crit Care Nurs Clin North Am
· 2023 Mar · PMID 36774004
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Managing risk for aspiration in the stroke patient will assist to decrease one of the major complications that these patients experience, which is poststroke pneumonia. Using an evidenced-based dysphagia protocol is show...Managing risk for aspiration in the stroke patient will assist to decrease one of the major complications that these patients experience, which is poststroke pneumonia. Using an evidenced-based dysphagia protocol is shown to reduce mortality, morbidity, and length of stay caused by poststroke pneumonia. Physicians, nurses, speech pathologists, and dieticians will be instrumental in performing ongoing assessments and aspiration-prevention strategies to improve stroke patient outcome and reduce complications. Education, and measurement of comprehension, of the care team, patient, and family concerning dysphagia management and prevention of aspiration pneumonia will assist in achieving the aforementioned goals.
Crit Care Nurs Clin North Am
· 2023 Mar · PMID 36774003
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Stroke is a leading cause of long-term disability and fifth leading cause of death. Acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, the 3 subtypes of strokes, have varying treatment modaliti...Stroke is a leading cause of long-term disability and fifth leading cause of death. Acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, the 3 subtypes of strokes, have varying treatment modalities. Common themes in management advocate for early interventions to reduce morbidity and mortality but not all perception is supported through randomized controlled trials. Each stroke subtype has varying premorbid-related and ictus-related outcome predictive models that have differing sensitivities and specificities.
Crit Care Nurs Clin North Am
· 2022 Dec · PMID 36336438
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The need for a workforce able to address the health care needs of older adults has been well established. Individuals with kidney disease experience an extensive number of transitions of care across health care settings...The need for a workforce able to address the health care needs of older adults has been well established. Individuals with kidney disease experience an extensive number of transitions of care across health care settings related to the kidney disease process and the number of health care providers involved in their care. Kidney disease is multifactorial, and the prevention of progression of disease and poor outcomes are key to improving the health of individuals with kidney disease. Nurses and nurse practitioners can improve the outcomes for individuals with complex comorbid conditions and kidney disease especially during the transitions of care.
Crit Care Nurs Clin North Am
· 2022 Dec · PMID 36336437
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The COVID-19 pandemic disproportionately affected individuals with kidney disease causing significant morbidity and mortality worldwide. Sars-coV-2 infection has been linked to the development of acute kidney injury and...The COVID-19 pandemic disproportionately affected individuals with kidney disease causing significant morbidity and mortality worldwide. Sars-coV-2 infection has been linked to the development of acute kidney injury and worsening of underlying kidney function. Multiple challenges were encountered during the COVID-19 pandemic resulting in valuable lessons learned for future pandemics, public health emergencies, and disasters related to the care of individuals with kidney disease. The COVID-19 pandemic has further exposed the extensive need for more nurses to be knowledgeable about the care of kidney disease and able to provide specialized nephrology care.
Crit Care Nurs Clin North Am
· 2022 Dec · PMID 36336436
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Both nephrologists and palliative care specialists are frequently consulted on patients admitted to the intensive care unit suffering from both acute kidney injury and end-stage kidney disease. Dialysis continues to be t...Both nephrologists and palliative care specialists are frequently consulted on patients admitted to the intensive care unit suffering from both acute kidney injury and end-stage kidney disease. Dialysis continues to be the predominant treatment recommendation for kidney failure despite the aging population and increased incidence of comorbid conditions. Research shows patients request prognostic information and dialysis survival rates before initiating treatment; however, many patients initiate dialysis naive of their increased morbidity and mortality. Palliative care, in collaboration with nephrology, can help improve communication and a focus on shared decision making.
Crit Care Nurs Clin North Am
· 2022 Dec · PMID 36336435
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Onco-nephrology focuses on the care of patients with cancer and kidney disease. Patients with acute kidney injury, tumor lysis syndrome, and malignancy-associated hypercalcemia are frequently treated in a critical care s...Onco-nephrology focuses on the care of patients with cancer and kidney disease. Patients with acute kidney injury, tumor lysis syndrome, and malignancy-associated hypercalcemia are frequently treated in a critical care setting. Oncological emergencies can have a high mortality rate when not promptly recognized and appropriately treated. The critical care nurse should be knowledgeable regarding the risk factors, clinical manifestations, and laboratory abnormalities of common renal manifestations of malignancy and oncological emergencies to optimize care and improve patient outcomes.
Crit Care Nurs Clin North Am
· 2022 Dec · PMID 36336434
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This article provides fundamental information to health care providers on kidney transplant. It reviews some of the preoperative testing, postoperative complications, and treatments. It is to help those who help assist w...This article provides fundamental information to health care providers on kidney transplant. It reviews some of the preoperative testing, postoperative complications, and treatments. It is to help those who help assist with postoperative care of kidney transplants ensure care is optimal. This article will help educate and inform caregivers of guidelines and suggested plans of care to follow for best outcomes for transplant recipients. The short- and long-term care of these patients are extremely important, and health care providers need to follow practice guidelines to achieve optimal outcomes. This discussion will benefit anyone who has direct care to transplant recipients including, but not limited to: nursing staff, nurses aids, training physicians, general practitioners, and mid-level providers.
Crit Care Nurs Clin North Am
· 2022 Dec · PMID 36336433
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The incidence and prevalence of inpatient acute kidney injury is continuing to increase. Acute kidney injury (AKI) is an all-encompassing topic in renal care as well as critical care. The definition and criteria for diag...The incidence and prevalence of inpatient acute kidney injury is continuing to increase. Acute kidney injury (AKI) is an all-encompassing topic in renal care as well as critical care. The definition and criteria for diagnosis of AKI have evolved over time. There are many causes of AKI and identifying the cause is key in reversing and controlling the progression of disease. Metabolic acidosis, fluid overload, and sepsis require detailed evaluation to best provide the most appropriate plan and execution. Critical care nurses are vitally important when identifying and managing acute kidney injury. Renal replacement therapy is a remarkable tool that requires expertise from the critical nurse. Once it is mastered, the most vulnerable patient in the ICU can become the recipient of good and positive outcomes.
Crit Care Nurs Clin North Am
· 2022 Dec · PMID 36336432
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Older adults receiving critical care have a high risk for acute kidney injury (AKI) for many reasons. It is important that critical care nurses know and have the skills to address the risk factors, conduct a comprehensiv...Older adults receiving critical care have a high risk for acute kidney injury (AKI) for many reasons. It is important that critical care nurses know and have the skills to address the risk factors, conduct a comprehensive geriatric assessment, and implement evidence-based interventions. This article provides a review of this information.
Crit Care Nurs Clin North Am
· 2022 Dec · PMID 36336431
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Volume overload is a common complication of a multitude of disease states, as well as a complication of many medical therapies. For the critically ill patient in the intensive care unit, volume overload is especially con...Volume overload is a common complication of a multitude of disease states, as well as a complication of many medical therapies. For the critically ill patient in the intensive care unit, volume overload is especially concerning when persistent past the first few days of admission. In the setting of chronic kidney disease, the maintenance of fluid balance presents additional challenges. This article focuses on the causes of volume overload as well as treatment options of the critically ill patient, including the nuances of the kidney patient, and ends with outpatient guidelines and recommendations to avoid recurrence.
Crit Care Nurs Clin North Am
· 2022 Dec · PMID 36336430
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Chronic kidney disease (CKD) is a widespread condition that predisposes patients to a myriad of complications, including cardiovascular disease, electrolyte and acid-base derangements, anemia, mineral-bone disease, and v...Chronic kidney disease (CKD) is a widespread condition that predisposes patients to a myriad of complications, including cardiovascular disease, electrolyte and acid-base derangements, anemia, mineral-bone disease, and volume excess. The frequency of CKD complications increases with the stage of disease, becoming nearly ubiquitous in later stages. The complications of CKD have profound implications for patient management, laboratory monitoring, medication prescribing, and follow up. Management of CKD seeks to slow disease progression and mitigate the risks posed by these complications.
Crit Care Nurs Clin North Am
· 2022 Dec · PMID 36336429
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Cardiorenal syndromes (CRS) describe disorders effecting critically ill and hospitalized patients with concurrent heart and kidney dysfunction. The presence of CRS is associated with a poor prognosis. This article is a r...Cardiorenal syndromes (CRS) describe disorders effecting critically ill and hospitalized patients with concurrent heart and kidney dysfunction. The presence of CRS is associated with a poor prognosis. This article is a review of the epidemiology, pathology, and evidence-based evaluation and management strategies for cardiorenal syndromes. All nurses should understand the significance that chronic heart and kidney disease has upon a patient's risk for CRS. Registered and advanced practice nurses should maintain the knowledge and skills of understanding the pathology of CRS to improve the evaluation and management of patients who present with CRS.
Crit Care Nurs Clin North Am
· 2022 Dec · PMID 36336428
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This article seeks to inform the reader about the global burden of hypertension and highlight the need for therapies to reduce societal costs and mortality associated with hypertension. Hypertension is a worldwide health...This article seeks to inform the reader about the global burden of hypertension and highlight the need for therapies to reduce societal costs and mortality associated with hypertension. Hypertension is a worldwide health concern for which international and European evidence and guidelines should be incorporated with the high-quality evidence that has been generated and synthesized in the United States. Together the guidelines broaden our understanding of hypertension and how best to manage the disease based upon realistic resources available across countries and regions where resources are more limited in availability.
Crit Care Nurs Clin North Am
· 2022 Dec · PMID 36336427
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Medications are a common cause of injury to the kidney and can contribute to the increased progression of disease, poorer outcomes, and increased health care costs. Improved prescribing practices can decrease the risk fo...Medications are a common cause of injury to the kidney and can contribute to the increased progression of disease, poorer outcomes, and increased health care costs. Improved prescribing practices can decrease the risk for the development of acute kidney injury and the progression to end-stage kidney disease. KDIGO Clinical Practice Guidelines recommend the use of caution when prescribing potentially nephrotoxic medications for patients with kidney disease. More than 50-72% of individuals across all stages of kidney disease utilized potentially nephrotoxic medications contributing to poorer outcomes. Annually, 1.5 million adverse drug events causing medication-induced nephrotoxicity occur in the US. Medication-induced nephrotoxicity accounts for 14-26% of cases of AKI in adults and 16% of hospitalized children. It is imperative that nurses and all health care providers are practicing nephrotoxic stewardship to prevent medication-induced nephrotoxicity.
Crit Care Nurs Clin North Am
· 2022 Sep · PMID 36049854
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The liver is the most frequently damaged organ in abdominal trauma. There is a high risk of hemorrhage and mortality as severity of injury and stage increases. During the last decade, management of liver trauma standards...The liver is the most frequently damaged organ in abdominal trauma. There is a high risk of hemorrhage and mortality as severity of injury and stage increases. During the last decade, management of liver trauma standards changed when the American Association of the Surgery of Trauma adjusted their guidelines to focus on early computed tomography scanning to determine the severity of liver injury trauma and the need for surgical verses nonsurgical management. Liver injury can be blunt or penetrating. Trauma teams became more multidisciplinary to focus not only on the physical but also on the psychosocial issues with trauma. Algorithms were developed to guide trauma flow and determination of severity of injury by grade. Nursing considerations and management include maintaining hemodynamic stability via accurate fluid resuscitation, monitoring of frequent vitals signs and abdominal assessment. Care must be taken to address pain and the psychosocial and emotional issues of trauma.
Crit Care Nurs Clin North Am
· 2022 Sep · PMID 36049853
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Currently, there are 6.2 million people with heart failure (HF) in the United States with 1 million new HF cases being diagnosed annually. Twenty to 30% of patients with acute heart failure also have liver dysfunction. T...Currently, there are 6.2 million people with heart failure (HF) in the United States with 1 million new HF cases being diagnosed annually. Twenty to 30% of patients with acute heart failure also have liver dysfunction. The dual diagnoses of chronic heart and liver disease has significant prognostic implications.