18 Definition

Management of the acutely ill adult is a complex and perplexed procedure. It requires underpinning knowledge of the pathophysiology of the disease currently affecting the patient, as well as ensuring that professionals are equipped to deal with the development of a rapid deterioration. The National Institute for Clinical Excellence (2007) explain that patients are sometimes inadequately treated due to staff not acting in a sufficient time manner, and so a systematic assessment of the patient recommended by the Resuscitation Council (2006) should initially be followed (Jevon, 2009).

ii. Hypothermia, defined as a core body temperature less than 36C, is a relatively common occurrence in the unwarmed surgical patient. A mild degree of perioperative hypothermia can be associated with significant morbidity and mortality. (Hart et al., 2011)

In regards to informed consent, the mature minor doctrine requires the physician or other healthcare provider to make determinations on a case by case basis. The physician should employ the same criteria used to determine the ability of an adult to consent whose decisional

On the other hand, the rectal thermometer is placed in the rectum of a pediatric patient which can be time consuming and uncomfortable. The researchers of this study used the two types of thermometers to measure the body temperature of each patient simultaneously.Statistical analysis was used to compare temperature readings from the two types of thermometers to determine if they had different accuracies. Based on the findings, the rectal

Because body temperature is usually lower in older adults, a nursing assistant must know the “normals” for not only an adult who is younger than sixty-five years of age, but also an older adult who is older than sixty-five years of age. For an adult under the age of sixty-five, a normal oral temperature ranges from 97.6 to 99.6 degrees Fahrenheit; a normal rectal from 98.6 to 100.6; a normal axillary from 95.3 to 98.4; and a normal tympanic from 96.6 to 99.7 (American National Red Cross, 2013). For an adult over the age of sixty-five, these “normals” are slightly lower. A normal oral temperature ranges from 96.4 to 98.5 degrees Fahrenheit; a normal rectal from 97.1 to 99.2; a normal axillary from 96.0 to 97.4; and a normal tympanic from 96.4 to 99.5 (American National Red Cross, 2013). Additionally, because older adults’ arteries have lost some of their elasticity and cannot constrict quickly, and because this may lead to orthostatic hypertension, it is important for nursing assistants and nurses to measure older adults’ blood pressures both when they are in a seated or supine position as well as when they are standing up (American National Red Cross,

Malignant hypothermia is a disease, caused by a bad reaction of anesthetics. This disease causes an immensely rapid temperature rise and extreme muscle contractions. MH (malignant hypothermia) is passed down through families and inherited by one parent carrying it giving it to the child. “Malignant hyperthermia occurs in 1 in 5,000 to 50,000 instances in which people are given anesthetic gases” (NIH, 2007). Most people aren’t aware that they are prone to this disease/reaction because they have never been under anesthesia drugs, or have never received surgery.

aspect to assess the safety and appropriateness of IV acetaminophen use in hospital setting. Several published hospital utilization medication reports showed an increase consumption of intravenous acetaminophen.

The use of medications is limited due to the effects they may have on the patient’s body resulting in organ failure. Hospital mortality is more common as the signs of sepsis are either lacking or not evident to a patient, the staff at their facility or the caregivers at home. As seen by our patient, who was not receiving treatment for her symptoms until brought to the hospital, in which she was already in a state of high sepsis to include loss of consciousness, fluid dehydration of all three spaces with flushes of the face and clammy skin. The use of early goal directed therapy can increase mortality within the hospital along with increased awareness of doctor’s offices, nursing homes and EMT personnel. (Dellinger et al.,

The study subjects were gathered from various ICU centers at various institutions, which is appropriate for study given the study objective and what the study was aiming to examine and determine (using a study drug vs. placebo in an ICU environment). Inclusion criteria were appropriate to assess the effects of the anti-pyretic acetaminophen due to their specificity of including those patients who were febrile with an infection that had been initiated with antimicrobial therapy. The exclusion criteria was extensive and included patient characteristics and disease states that may have skewed the true effect of acetaminophen. It was appropriate to limit these patients with the exclusion criteria from receiving treatment since their comorbidities

Six studies were conducted in Midwestern hospitals (Carayon et al., 2007; DeYoung et al., 2009; Harrington et al., 2013; Ludwig-Beymer et al., 2012; Morriss et al., 2011; Seibert et al., 2014). One study was conducted in a western hospital in the United States (Hardmeier et al., 2014), one in New England hospitals (Richardson et al., 2012) and one study was conducted in a hospital in the Netherlands (Van Onzenoort et al., 2008). Two studies were conducted throughout the United States (Koppel et al., 2008; Mims et al., 2009). Of the thirteen studies, eleven were cross sectional observational studies while the remaining two were literature reviews (Keane, 2014; Young et al., 2010).

did not reveal the sampling technique used. It is assumed that a consecutive sampling technique was used to select the sample group of patients that met the study’s eligibility criteria, including the inclusion and exclusion criterion. Tests such as the mini-mental state examination were performed to control confounding variables. Descriptors were utilized including medical condition, location, and enrollment in a diabetes and hypertension monitoring system of the population. Machado et al. did fail to list the number and characteristics of potential participants who declined to participate in the study but did account for this occurrence with a 10% increase to the sample calculation for losses and refusals (2017).

Most of the literature is made up of low quality retrospective non-randomised cohort studies with small sample sizes. Ultimately, large multi-centred, adequately powered, well-designed randomised trials are needed to establish clearer guidelines for the management of these patients.

A significant finding from this study is that MRSA groin carriers have a higher risk of SSI compared to nasal and axillary MRSA carriers (Sasi et al., 2015). The result of the experiment showed that 10 out 21 (47.6%) treated MRSA carriers developed an SSI while only nine out 24 (37.5%) untreated MRSA carriers developed SSI (Sasi et al., 2015). This finding is the part where the author thinks that the non-randomization of samples could have affected the study outcome. The additional one person who developed SSI despite undergoing decolonization treatment in the study group resulted in a 10.1% difference in the effectiveness measurement. This result looks very significant if one looks at it percentage-wise, but when looking at the actual numbers 10 SSIs out 21 treated subjects in the study group and nine SSIs out 24 untreated subjects in the control group, it will raise a red flag that there could have been a possibility for bias since the results are too close.

The American Journal of Critical Care is a bi-monthly, peer-reviewed journal focused on improving the care of critically ill patients and their families. The authors provide resources in the form of research studies, case reports, reports on new techniques, clinical/basic science reviews, guest editorials and clinical studies. The editors strongly encourage works focused on collaborative practice and research targeted at health professionals caring for critical care populations.

he patient recruitment was done appropriately. Patients could not be enrolled in the study if they had fever for linger than 12 hours in the ICU was appropriate to be able to measure the outcome of early administration of acetaminophen. Recruitment of only patients admitted into the ICU and not transferred in the ICU would have eliminated the chance of the results being skewed due to previous hospital exposure. Usually hospital acquired diseases are harder to eradicate than community acquired diseases