ABSTRACT
Both gastric and duodenal feeding tubes are used to provide enteral nutrition. Most studies comparing the two methods have focused primarily on rates of complications, rather than on nutritional outcomes, and show no difference in complications between the two methods. It is not clear which feeding route provides the best nutritional outcomes. The primary purpose of this randomized clinical pilot study was to compare the percentage of recommended calories and protein received by patients with neurological disease being fed enterally via gastric or duodenal feeding tubes. Secondary aims were to compare the following between groups: physiological effects of feeding, reasons for delay in feeding, volume of feeding residual, number of feeding tubes replaced, cost of feeding, and number and types of complications. A convenience sample of 25 neuro intensive care unit patients was randomly assigned to gastric or duodenal feeding. Enteral feeding was ordered by using a standardized prescription formula and provided by the nursing staff. Serum albumin and prealbumin levels were measured at baseline, day 3, and day 10. Nitrogen balance was measured on day 10. Enteral feeding data were collected daily. No significant differences were found between gastric and duodenal groups in nutritional outcomes, including percentage of recommended calories and protein received, physiological effects of feeding, reasons for delay in feeding, feeding residual, number of feeding tubes replaced, cost of feeding, and number and types of complications. Neither group achieved mean recommended caloric or protein intake during the 10 days of the study. Further research is needed to address how recommended nutrients can be provided enterally in a more timely and complete manner in critically ill NICU patients.
Subject(s)
Central Nervous System Diseases/nursing , Enteral Nutrition/nursing , Adult , Aged , Critical Care , Female , Humans , Male , Middle Aged , Nutrition Assessment , Pilot Projects , Prospective Studies , Treatment OutcomeABSTRACT
An increased understanding of the frequency and troublesomeness of symptoms for family members who are caring for a victim of Alzheimer's disease (AD) would be helpful for nurses in working with these families. This article reports on the changes of these symptoms over time as well as the troublesomeness of these symptoms for 30 families over an 18-month period. A symptom checklist based on George's Patient Illness Symptoms Checklist (George, 1983) was used. Over time the reported symptoms reflected increased mental impairment, which is associated with AD. For some of the symptoms, there was an increase in the symptoms' frequency, but their troublesomeness did not increase. Family caregivers who reported more symptoms for each time period also reported an increase in institutionalization of the AD member.
Subject(s)
Alzheimer Disease/nursing , Aged , Aged, 80 and over , Analysis of Variance , California , Caregivers/statistics & numerical data , Female , Home Nursing/statistics & numerical data , Humans , Institutionalization/statistics & numerical data , Male , Middle Aged , Surveys and Questionnaires , Time FactorsSubject(s)
Alzheimer Disease/nursing , Caregivers , Health Services Needs and Demand , Home Nursing/psychology , Adaptation, Psychological , Adult , Aged , Aged, 80 and over , Alzheimer Disease/psychology , Caregivers/psychology , Female , Humans , Interviews as Topic/methods , Male , Middle Aged , Social AdjustmentABSTRACT
Invasive intracranial pressure (ICP) monitoring and the data it provides have merit as a treatment and prognostic indicator. The most common complication associated with ICP monitoring is infection. This article categorizes and reviews the risk factors associated with ICP monitor-related infections, and outlines recommendations to minimize the risk of infection. The factor most consistently associated with ICP monitor-related infections was the duration of monitoring. Additional factors related to the development of infection were the age and diagnosis of the patient monitored, the consistency of maintaining a closed system, the insertion environment and technique, and the type of ICP monitor device used.
Subject(s)
Cross Infection/etiology , Intracranial Pressure , Monitoring, Physiologic/adverse effects , Age Factors , Critical Care , Humans , Monitoring, Physiologic/instrumentation , Monitoring, Physiologic/methods , Risk Factors , Time FactorsABSTRACT
The brain is capable of mediating complex regulatory functions in the cardiopulmonary and gastrointestinal systems. Increased intracranial pressure may have detrimental effects not only upon cerebral structure and function but also upon the cardiopulmonary and gastrointestinal systems. Although the manifestations of systemic dysfunction produced by cerebral disease have been defined, the precise role of the interaction and interrelationship of increased intracranial pressure and the nervous system pathways to specific organ systems in delineating the mechanisms of these manifestations continues to be a topic of inquiry.
