Understanding, recognizing, and managing chronic critical illness syndrome.

PURPOSE: No evidence-based guidelines exist for the care of patients with chronic critical illness syndrome (CCIS), a growing population of patients being cared for by nurse practitioners (NPs). The purpose of this article is to provide NPs with a beginning physiological framework, allostasis, to guide their understanding and management of patients with CCIS. DATA SOURCES: Scientific publications, related clinical guidelines. CONCLUSIONS: Patients with CCIS are a distinct group of critically ill patients whose care needs are different from those of patients who are acutely critically ill. These patients demonstrate widespread tissue and organ damage. The widespread tissue and organ damage results in a syndrome of interrelated elements, which include neuroendocrine problems, severe malnutrition, wounds, infections, bone loss, polyneuropathy and myopathy, delirium and depression, and suffering. IMPLICATIONS FOR PRACTICE: In caring for patients with CCIS, NPs need to focus on treating the elements of the syndrome as a cohort of interrelated elements and on re-establishing normalcy for the patient.

Acquired long QT syndrome: risk assessment, prudent prescribing and monitoring, and patient education.

PURPOSE: To inform nurse practitioners (NPs) about risk factors that precipitate the potentially fatal cardiac arrhythmia torsade de pointe (TdP) in patients with long QT syndrome (LQTS), and to recommend preventative strategies and prudent prescribing advice to use in clinical practice. DATA SOURCES: A review of the current literature is used to explain factors that cause prolonged repolarization during phase 2 and phase 3 of the cardiac action potential and relate these to the development of LQTS and TdP. The major risk factors reviewed are drugs, drug-drug interactions, electrolyte disturbances, and populations at risk for LQTS. CONCLUSIONS: The LQTS is an increasingly recognized cardiovascular problem. Nurse practitioners should be cognizant of the risk factors and be able to apply them in clinical practice. IMPLICATIONS FOR PRACTICE: Recognition of patients at risk for acquired LQTS is imperative in primary care practice. Currently, there are no practice guidelines that address acquired LQTS. In lieu of practice guidelines, the prudent NP uses physiology to guide treatment decisions, especially those decisions related to the use of drugs.