老年危重患者肠内营养的护理

目的：探讨老年危重患者实施肠内营养的效果。方法：对41例老年危重患者经鼻胃管给予早期肠内营养支持，认真做好鼻饲管、营养液输注及口腔护理，开展肠内营养的监测工作，重视心理护理，积极预防并发症。结果：通过积极有效的肠内营养护理，无1例护理并发症发生。结论：肠内营养是临床上进行营养支持的有效手段，是老年危重患者整体治疗的保证。     

ICU危重症患者肠内营养的观察与护理

总结了ICU危重症患者肠内营养支持的护理方法,包括肠内营养与护理.认为危重症患者早期进行肠内营养,根据不同情况选择不同肠内营养剂,可改善患者营养状况,提高治疗效果,同时采取有效的护理措施,能促进患者康复.     

危重病人肠内营养的护理进展

肠内营养(EN)是经胃肠道用口服或管饲来提供代谢需要的营养基质及其他营养素的营养支持方式[1]。它是一种符合正常生理习惯的营养途径。而从肠外营养(TPN)出现以来,在病人病情危重的时期,胃肠道功能是否正常不是抢救生命的首要问题,因而忽视了对危重疾病时胃肠反应的了解与监测,营养支持多用TPN。但是胃肠黏膜在应激期间容易发生溃疡和出血是众所周知的,随着危重病学的不断发展,越来越多的临床工作者认识到EN不但能改善营养,还有与抗酸药物一样有效的预防应激性溃疡的作用,因而EN在危重病人救治中已经被广泛应用,在某些疾病治疗中已取…     

危重病人肠内营养的护理进展

肠内营养(EN)是经胃肠道用口服或管饲来提供代谢需要的营养基质及其他营养素的营养支持方式[1].它是一种符合正常生理习惯的营养途径.而从肠外营养(TPN)出现以来,在病人病情危重的时期,胃肠道功能是否正常不是抢救生命的首要问题,因而忽视了对危重疾病时胃肠反应的了解与监测,营养支持多用TPN.但是胃肠黏膜在应激期间容易发生溃疡和出血是众所周知的,随着危重病学的不断发展,越来越多的临床工作者认识到EN不但能改善营养,还有与抗酸药物一样有效的预防应激性溃疡的作用,因而EN在危重病人救治中已经被广泛应用,在某些疾病治疗中已取代了TPN.EN的广泛应用也使其护理操作和并发症的处理得到进一步的发展,现就EN的护理进展综述如下.     

外科危重患者早期肠内营养的并发症及护理

目的 研究外科危重患者早期肠内营养的临床并发症及护理要点。方法 回顾外科术后人ICU的40例应用肠内营养患者的临床资料。结果 外科危重患者早期应用肠内营养发生胃肠道疾病并发症比例较高。结论 危重症患者早期肠内营养需预防胃肠道并发症的发生。     

危重病人肠内营养支持的护理

现代重症医学与临床营养支持理论和技术的发展几乎是同步的，已经经历了约半个世纪的历史。数十年来大量强有力的证据表明，住院病人中存在着普遍的营养不良。而早期的合理的肠内营养支持已成为重症病人临床治疗的重要措施之一。只要肠道功能允许，优先选择肠内营养支持已作为营养支持的基本准则。     

危重病人肠内营养治疗并发症的观察及护理进展

肠内营养（enteral nutrition,EN）是一种从20世纪80年代以后迅猛发展起来的不同于肠外营养的营养支持方法[1].近年来,肠内营养（EN）在临床营养支持中所占的比例越来越高.当病人身体遭受重大疾病时新陈代谢率高,每天需要大量营养素,最新研究,危重病人实施肠内营养治疗具有十分重要的临床价值.但由于各种原因,危重病人经过肠内营养治疗后易发生各种并发症.防止并发症的发生成为医护人员面临的问题.为更好地提高肠内营养的疗效,提升护理工作质量,更好地为病人服务,对肠内营养治疗并发症的护理进展进行综述.     

肠瘘患者肠内营养实施途径及护理

肠瘘是胃肠外科疾病的严重并发症。营养支持在肠瘘患者的治疗中是一项主要的措施,不仅能够提供机体生理需要、组织合成、瘘口和伤口愈合所需的能量物质、蛋白质、电解质、维生素和微量元素等,同时可纠正酸碱失衡及电解质紊乱,维持和改善患者的营养状况和内稳态,恢复患者机体组织构成,增加内脏蛋白合成,提高免疫能力。目前对于需行营养支持治疗的患者首选肠内营养（EN）支持,南京军区南京总医院普通外科自20世纪70年代即非常重视EN在肠瘘患者中的应用,并积累了大量的经验,现总结如下。     

危重病人实施肠内营养过程的护理安全管理

肠内营养是危重病病人重要支持治疗手段。与肠外相比,肠内营养能减少肠道菌群易位,降低感染率,保护胃肠道黏膜的结构和功能[1]、改善预后、减少感染、缩短入住重症监护病房(ICU)的时间和住院时间[2]。但在危重症病人实施肠内营养的过程中可能会出现错误连接、非计划性拔管、皮肤烫伤、误吸、堵     

营养泵用于ICU危重患者肠内营养支持的护理

目的探讨营养泵用于ICU危重患者肠内营养支持的应用效果。方法将80例需肠内营养支持的ICU危重患者按随机数字表法分为研究组43例和对照组37例。2组均在常规治疗基础上进行肠内营养支持。肠内营养液采用能全力,按患者平均总热量100kJ.kg-1.d-1：研究组患者1 000～1 500mL.d-1,用肠内营养泵24h均匀持续滴注;对照组患者进入ICU后3d胃肠功能正常时给予鼻饲流质,按定时推注法,150～200mL.次-1,3次.d-1,逐渐递增至6～8次.d-1。对2组患者并发症（腹泻,便秘,呕吐、反流,误吸和堵管）发生情况进行观察和护理。结果研究组腹泻,便秘,呕吐、反流,误吸和堵管的发生率明显较对照组少（均P〈0.01）。结论对于ICU危重患者,营养泵持续泵入法安全、有效,能减少并发症的发生。     

危重患者持续护理质量改进

目的：探讨基层医院危重患者的持续护理质量改进。方法：不断针对具体护理过程及环节，收集资料，确定问题，制订措施，评估质量，进行持续护理质鲢改进。结果：实施持续护理质量改进后，护理人员素质提高，患者满意度由85％上升至98％，特、I级护理合格率≥95％，基础护理合格率≥95％，健康教育覆盖率100％，无护理投诉，年护理事故、压疮发生率为0。结论：对危重患者进行持续护理质量改进能有效提高护理服务质量。保障患者及护士安全。     

多频振动排痰机应用于危重患者的护理体会

危重症患者都存在着不同程度的肺通气障碍，因此保持呼吸道的通畅，加强呼吸道的管理尤为重要，而保持呼吸道通畅的首要措施就是排痰的护理。我科自2006年1月起采用多频振动排痰机对40例ICU危重患者进行呼吸道的管理，并与传统的人工徒手翻身拍背方法进行比较，取得了较好的效果。提高了护理质量。现报道如下。     

Extrication of the seriously injured road crash victim

In any accident scene, rapid removal of the casualty to hospital improves their chances of survival. The term the "Golden Hour" was first introduced in 1961, but because of misinterpretation as to what period this actually referred to, a second concept, the "Platinum Ten Minutes" was proposed as the time taken to move a casualty to the ambulance. To achieve this rapid removal, the ambulance and medical personnel must work in harmony with the police and fire service to secure the scene and remove the casualty safely without causing injury either to the casualty or other personnel on the scene. Care should also be taken to preserve evidence at the scene for future investigation. This paper describes the role of the emergency services, in particular that of the fire officer in charge, when attending the scene of a road traffic accident. The methods and equipment used to extricate a casualty from a motor vehicle are explained.     

Intrahospital transport of seriously ill or injured children

Critically ill children are frequently subject to transfer between hospitals or even between units in hospitals. Safety is an important concern for the ensuing transport in order to minimize risk and maximize efficiency. Nurses should give careful consideration to many aspects of the intrahospital transport when planning the move. Principles outlined in this article can be included in critical care educational programs.     

Management of the mild traumatic brain injured patient using a multidisciplinary observation unit protocol

ObjectivesWe developed an ED based multidisciplinary observation unit (OU) protocol for patients with mild traumatic brain injury (mTBI). We describe the cohort of patients who were placed in the ED OU and we evaluated if changes to our inclusion and exclusion criteria should be made.MethodsWe conducted a retrospective cohort study to evaluate subjects who were admitted to the mTBI observation protocol. We included adults within 24 h of sustaining an mTBI with a Glasgow Coma Scale (GCS) of 14 or 15 who had pre-specified head CT findings, and did not meet exclusion criteria. Predictors of need for hospital admission after completing the OU protocol were determined using multivariable logistic regression analysis.ResultsThe mean age was 49 (SD 23), 58 (33%) were female, and 136 (78%) were Caucasian. No subjects discharged home required a surgical intervention or ICU admission, and there were no deaths in discharged or admitted subjects. 28 subjects (16%) were admitted to the hospital following their OU stay. Subjects admitted were older (mean age: 56 vs. 48, p = 0.1) and had a higher proportion of traumatic bleeds on head CT (85% vs. 76%, p = 0.3). In multivariable logistic regression, GCS of 15 (aOR 4.24), African-American race (aOR 5.84), and no comorbid cardiac disease predicted discharge home after the observation protocol (aOR 0.28).ConclusionsA period of observation for a pre-defined cohort of patients with mTBI provided a triage plan that could allow appropriate patient management without requiring admission in the majority of subjects.     

Transfusion of the injured patient: proceed with caution

Transfusion of the injured patient with packed red blood cells (PRBCs) is a dynamic process requiring vigilance during the acute resuscitative and recovery phases postinjury. Although adverse events have been reported in 2% to 10% of injured patients, the advent of new detection techniques for viral pathogens has markedly decreased the risk of infectious transmission. However, transfusions are strongly associated with immunosuppression in the host, which may occur days after the initial injury and may lead to bacterial infections. Conversely, early transfusion of stored PRBCs, > 6 units in the first 12 h postinjury, contributes to an early state of hyperinflammation that is a strong, independent predictor of multiple organ failure (MOF) in those patients with intermediate injury severity scores. The roles of prestorage leukoreduction are also reviewed with respect to the promotion of both immunosuppression and hyperinflammation. We further summarize studies with hemoglobin substitutes, whose use may obviate many of the untoward events of transfusion and promise to lead to better outcomes for injured patients.     

Factors associated with the time nurses spend at the bedsides of seriously ill patients with poor prognoses

BACKGROUND: Little is known about the time health professionals spend with inpatients that are close to the end of life. SUBJECTS AND METHODS: We asked day-shift nurses to use a standardized log sheet to record how much time they spent in various categories of activity for 146 seriously ill medical inpatients with poor prognoses at 2 teaching hospitals. RESULTS: The mean patient age was 68, and the mean APACHE-III physiology score 28; 59% were white, 56% were women, 41% had cancer or HIV, and 81% had do not resuscitate (DNR) orders. The mean amount of time nurses spent with patients per 12-hour day shift was 53 min. In bivariate analyses, sex, religion, diagnosis and insurance status were not associated with nursing bedside time. In an ANOVA model, patients with DNR orders received more time than those without DNR orders (56 vs. 39 min, P = 0.04), and white patients received more bedside time than nonwhites (57 vs. 46 min, P = 0.01), even after controlling for severity of illness and DNR status. Among the 47 mentally alert patients who could be interviewed, symptom severity, quality of care, and satisfaction ratings were not associated with nursing bedside time. CONCLUSIONS: In this population, nurses spent less time with nonwhite patients and more time with patients with DNR orders. That patients with DNR orders received more time may be reassuring. However, further investigation will be required to confirm these results, to understand why nonwhite patients appear to have received less bedside nursing time, and to investigate further the relationship between time, satisfaction, and quality of care.