Impact of implementing standardized nursing care on hepatic encephalopathy patients outcomes in intensive care unit at Assuit university hospital

Hepatic encephalopathy is the occurrence of confusion, altered level of consciousness and coma us a result of liver failure. In the advanced stages it is called hepatic coma. It may ultimately lead to death. It is caused by accumulation in the blood stream of toxic substances that are normally removed by-the liver. Standards of nursing care provide the required knowledge and skills that can be used to orient new staff and guide nurses in clinical practice; moreover, standards form a basis for monitoring, evaluating and improving quality of care. Therefore, the aim was to identify the impact of implementing standardized nursing care on hepatic encephalopathy patient's outcome. Quasi-, experimental research design was used to conduct this research. This study was carried out in intensive care unit of gastroenterology and hepatology in internal medicine department at main Assuit University Hospital. The sample of this study consisted of 60 patients, divided into study and control group equally. Tools used in this study comprised three main. Tool 7> patients groups assessment sheet. Tool II:- Neurological examination including mental state assessment. Tool 111:-Evaluation sheet of hepatic encephalopathy patients. The results: it revealed that majority of the study sample was older than 55 years with a mean age [55.9 +/- 7.8 and 60.2 +/- 5.1 respectively] for the study and control group with significant difference. Regarding length of hospital stay there was a significant difference between both study and control group with p-value [< 0.001]. There results revealed significant difference between both groups regard the level and grade of lower limb edema [p < 0.01]. On the other hand, the result showed skin ulceration with statistically significant difference ktween both groups [p< 0.01]. In addition the current study revealed significant increase in both groups as regard neurological assessment using GCS, while it showed significant decrease as regards west haven criteria [p < 0.05].Conclusion:-Based on the findings of the present study, it can k concluded that the standardized nursing care were better than the routine care of the hospital for hepatic encephalopathy

Evaluation of parenteral nutrition on the immune system of patients with polytrauma

Nutritional support for trauma and critically ill patients has been advocated to promote immune system recovery and to prevent as much tissue break down and nutritional deficit. The present study aiming to assessment of the parenteral nutrition on the immune system of patient with multiple trauma. Compare the effect of early parenteral nutritional and conventional hospital diet on the nutrition and immunology markers in trauma patients. A convenient sample of 40 severely traumatized patients within 8 hours after trauma they were enrolled sequentially into conventional [n = 20] and total parenteral nutrition [n = 20] groups [TPN]. Criteria for subject inclusion were, age 18-<45 years, Injury severity score [ISS] 20-40 score. Tools of data collection, four tools were utilized to collect data pertinent to the study. These tools were, nutritional assessment sheet, trauma scales and [APACHE] score [checklist], parenteral nutrition plans, evaluation tool which includes [Anthropometric measurement, Laboratory studies Immunological parameters]. Total parenteral nutritional has positive impact for trauma patients on anthropometric measurement, [weight loss, TSF and MAC] which was observed at the end of therapy [7th day.] for the conventional group while there were no changes for the same parameters in TPN group. As regard, laboratory tests, there were significantly increase in the values of total serum protein and albumin among patients of the TPN group after the end of therapy at [7th day] .As regard immune function, it was found that the mean values of [IL-10, IL-6, CD8] were significantly dropped in the TPN group after the end of therapy as compared to the admission. Also there were significantly increase in the values of complement C3, IGA, CD4, and CD4/CD8 ratio among patient of the TPN group at [7th day]. Establishment and implement of standardized protocol of parenteral nutrition support using nutritional screening and physical assessment forms, for the critically ill patients