Essay On Glycemic Control

Keywords: intensive care, patient scenario, clinical practicum, pathophysiology, disease processes, interventions, diagnoses, assessments, health prevention, promotion, health outcomes

In this study, patients that had been ventilated in the intensive care unit from April to November of 2010 were included. There were few ways that the person could be excluded, these were if the patient had cardiac arrhythmias or severe obesity. All of the patients were monitored vary closely, such as with an electrocardiogram, invasive and non-invasive arterial pressure, and percutaneous

In a study by Lange (2010), clinical studies have shown the improvement of glycemic control when nurses initiate protocols to

Gélinas, C., Arbour, C., Michaud, C., Robar, L., & Côté, J. (2013). Patients and ICU nurses'

Analysis of the data collected from the AFC and CFC groups yielded a few significant findings. Patients in the AFC group had a longer ICU length of stay than the CFC group, however hospital lengths of stay were similar. The AFC group was less likely to have a poor outcome 12 months after their SAH compared to the CFC group, however, this result was not consistent at the 14 day or 3 month mark. The authors suggest this may be the result of longer ICU stays and need for sedation to tolerate the AFC cooling modality. The only complications significantly different between the two groups were rates of hyperglycemia and arrhythmias: both were more likely to occur in the AFC group. While there was no difference in temperature between the groups on admission, there was significantly less fever burden on the AFC group during the first two weeks after SAH. The authors conclude that while AFC was associated with higher rates of hyperglycemia,

You mentioned medical errors in your post. As a nurse working in the ICU a few years back, I have seen my share of medical errors as it happened. Sad to say, most of them were highly preventable. According to Garrouste (2012), medical errors and adverse events are very common in ICUs, and among them the most prevalent involve medications (Garrouste-Orgeas, et al., 2012) . It is interesting to note that diagnostic errors are also a frequent cause of medical errors in the U.S.( Singh, et al., 2008). The authors cite some examples of diagnostic errors (Singh, et al., 2008): failure to use an indicated diagnostic test, misinterpretation of test results, and failure to act on abnormal results. The authors also added that although diagnostic errors

As reported by both Giddings (2012) and Kohn, Corrigan, and Donaldson (2000), safety is defined as “freedom from accidental injuries” (p. 434). In order to prevent accidental injuries the authors Worthington and Gilbert, (2012) recommend that the patient needs to be hemodynamic stable, have a blood glucose level that is controlled, and have electrolytes that have been corrected before starting PN. This will reduce adverse effects related to therapy (p. 53). Kakoby and Nannapaneni (2012) reference a study done by Chung and colleagues (2005) in their paper. Chung and colleagues state that an “elevated mean daily glucose level was associated with significantly increased risk of death, infection, sepsis, acute renal failure, and cardiac complications

Collection of assessment information and continual analysis and interpretation of data is important to make sure patient’s conditions is successfully monitored (Dresser, 2012). Elliott & Coventry, 2012; Levett-Jones et al., 2010; Preston & Flynn, 2010) state that, patients in acute care setting have been considered as having multiple health issues that can lead to their deterioration if early signs and symptoms are not recognised and managed appropriately in timely manner and within a correct clinical reasoning process. With constant observation, patient safety is implemented and surveillance is then incorporated in order to identify and prevent possible medical errors and adverse events that may be encountered. Clinical judgement and decision

Diabetic ketoacidosis is a complication for some patients with insulin-dependent diabetes mellitus as well as for non-insulin dependent. It is treated commonly in the intensive care unit (ICU), even though clinical data from many studies support management in regular (medical/surgical) wards, avoiding expensive critical care unit costs and preventing bed crisis in these higher level of care units for sicker patients. Once the patient is treated, adequate follow up and education is mandatory. Noncompliance remains the primary concern for repeated admissions.

Preoperative assessment and evaluation of patients including those with diabetes undergoing elective surgical procedures provides optimum cardiopulmonary risk assessment and modification. Diabetes is a chronic illness that puts patients at a higher and complex intraoperative and postoperative complications (Fairburn & Elliot ,2014). This writer works in pre-surgical unit where patients undergoing surgical procedures under anesthesia are evaluated. For those patients with diabetes, glycemic control and optimization is part of the process. However, it remains to be an issue often leading to last minute surgery cancelations which can be very costly (Fairburn & Elliot ,2014) and/or not so optimal management of patients leading to untoward complications and increased length of stay.

T2DM is often managed with strict glycaemic control. Glycaemic control is a way of maintaining euglycemic blood glucose levels through a balance of both biological and psychosocial factors, including diet, exercise, supplements and medication.7 Once a patient has been diagnosed with T2DM their doctor will put them on a strict diet and exercise regime, this alone can sometimes be an effective method of glycaemic control for patients.

A key secret, and a major factor, to keeping your weight down and reducing your chances of diabetes and other diet-related health issues lies in eating foods low on the Glycemic Index (as most raw foods are). Foods that are low on the Glycemic Index tend to be high in fiber as well and actually provide your body with slow, sustained energy throughout the day instead of sending it an energy burst that fizzles out and crashes an hour later.

A patient with electrolyte imbalance is defined as “change in serum electrolyte levels that may compromise health” (Doenges, Moorhouse, and Murr, 2013, pg 341). These changes in serum electrolyte level whether there is a deficit or an excess may result in cardiac dysrhythmias, hypo- or hypermobility of muscles, seizures, and cognitive dysfunction. Nurses must be aware of the acute or chronic conditions and demographics of patients that are commonly associated with electrolyte imbalance. The demographics who are predisposed to acquire some form of electrolyte imbalance are the elderly, infants, comatose patients, and victims of severe trauma usually related to burns or crushing trauma. Confirmation of the diagnosis of electrolyte imbalance can

Hyperlactatemia is a prevalent condition in ICU patients and it occur because of the disturbance between oxygen supply and oxygen consumption, hyperlactatemia also occurs as a result of increased aerobic glycolysis in hypermetabolic conditions [1]. Multiple organ dysfunctions that occurs postoperatively, following trauma, and in septic shock are often associated with increased lactate levels [2], and it has been found that hyperlactatemia is associated with bad prognosis [3]. The PRISM III score was calculated to evaluate the disease severity in the first 24 hours after hospital admission, it uses age-related physiological variables estimated during the first day after admission, including: temperature, systolic blood pressure, heart rate, pupillary reflexes, mental status, acidosis, pCO2, pO2, glucose, potassium, creatinine concentration, blood urea, white blood cell count, platelet count, prothrombin and partial thromboplastin time [4]. Early detection of children who are at high risk for mortality gives chance for early changes in therapy and improves the prognosis. Although improvement in critical care in pediatric patients in the last several decades, there is no consistent marker for predicting mortality in the critically ill children [5]. A single elevated serum lactate measurement at the beginning of emergency department care in pediatric sepsis is associated with a 5-fold increase in the risk of organ dysfunction, but no previous studies have investigated the

“Hyperglycemia (typically defined as a blood glucose of >200 mg/dL) is a well-known phenomenon in critically ill patients without a prior history of diabetes mellitus” (Langdon & Shriver, 2004, p. 163). While many studies have been completed with respect to management of hyperglycemia in diabetic surgical patients, there has been minimal research regarding the impact that tight glycemic control has on non-diabetic trauma and medical patients. With managed care requiring decreases in length of hospitalization and hospitals attempting to conserve cost expenditure, placing non-diabetic patients on insulin drips immediately upon entry into the health care system may adversely affect both of these areas. Trauma patients without a diagnosis of diabetes mellitus will require prolonged lengths of stay in the intensive care unit related to the fact that they must have closely monitored blood glucose levels. In addition to the increased duration of their intensive care unit admission, they are subjected to administration of medications they would not normally take at home. Furthermore, this patient population has