Mucormycosis in diabetes.

Mucormycosis is a rare opportunistic infection caused by ubiquitous fungi typically found in soil, spoiled foods, bread, and dust. The acute infection most commonly is rhinocerebral and is associated with metabolic acidosis. Mucormycosis spreads quickly and can progress from the paranasal area to the brain in a few days. In the case presented, a young diabetic woman had diabetic ketoacidosis and classic signs and symptoms of mucormycosis. Even after aggressive and appropriate treatment with surgical debridement and IV administration of amphotericin B, the fungus invaded the central nervous system. This article discusses current methods of treating mucormycosis and important critical care nursing considerations for patients who have the infection.

Who dispenses pharmaceuticals to children at school?

Use of both prescription and non-prescription pharmaceuticals has increased among children. Many of these drugs are taken during school hours and dispensed by school personnel who are not health professionals. They know little or nothing about the drugs themselves or the medical conditions requiring their use. This survey examined the extent to which pharmaceuticals are dispensed in schools in one Florida county. Public elementary, middle, and high schools and six private schools were surveyed for one week. All medications dispensed by school personnel during that time were recorded. Of 28,134 children surveyed, 1,016 children received 5,411 doses of medication. Thirty-one categories of drugs were dispensed including controlled substances. Methylphenidate was the most widely dispensed drug, comprising about half of all the medications given in school. Medication use was evaluated in terms of gender, race, and socioeconomic status of the children.

Use of a clinical assessment tool for orally intubated patients.

BACKGROUND: Although oral hygiene is difficult to perform in orally intubated, critically ill patients, oropharyngeal status may be related to acquisition of nosocomial organisms and should therefore be addressed. OBJECTIVE: To develop a clinical tool for assessment of the mouth in orally intubated patients. METHODS: Sixteen orally intubated patients from one surgical and one medical intensive care unit were subjects. Demographic, clinical, and baseline oropharyngeal assessment data, including sputum and mouth cultures, were obtained on patient admission to the study and every other day. RESULTS: Oropharyngeal cultures of four subjects grew nosocomial bacterial organisms and of two subjects, fungal species. These same organisms were cultured from sputum specimens. Seven patients displayed severe xerostomia; 10 lip lesions were identified in nine subjects, 8 tongue lesions in nine subjects, and 8 mucosal lesions in nine subjects. CONCLUSION: Systemic oropharyngeal assessment in critically ill orally intubated patients may prevent more serious oropharyngeal infections.

Interruption of enteral feedings in head injured patients.

This study was undertaken to determine differences between caloric intake and requirements of critically ill, enterally fed, neurosurgical and neurotrauma patients and to determine the nature and frequency of interruptions in enteral feedings in this same population. This descriptive, prospective study was conducted in a surgical intensive care unit (ICU) in a university teaching hospital. The sample consisted of 52 mechanically ventilated, critically ill patients with a mean age of 48.96 years who were receiving enteral nutrition for at least two days. Basal energy requirements, daily nutritional intake and enteral feeding interruption characteristics were recorded for a total of 586 study days. Underfeeding due to interruptions occurred in the majority of patients for the first eight days following initiation of enteral feeding. Reasons for underfeeding were interruptions of continuous tube feedings due to medication administration via the feeding tube (31%), feeding tube displacement (27%), surgery (12%), ileus (9%), radiologic studies (9%), airway management (8%), bedside procedures (3%) and agitation (1%). The frequency of these enteral feeding interruptions may indicate inadequate nutritional support, highlighting the importance of performing daily nutritional monitoring to prevent malnutrition.

The effect of nonnutritive sucking on oxygenation in healthy, crying full-term infants.

Crying in healthy, recently born infants has been associated with decreased oxygenation, which may prolong adjustment to extrauterine life. This research investigated the use of nonnutritive sucking (NNS) as an intervention to reduce crying and prevent any decreases in oxygenation that may occur in crying healthy term infants between 9 and 72 hours of life. Twenty-nine experimental group infants, who received a pacifier (NNS) immediately after crying was induced by a heelstick, had statistically significantly higher transcutaneous oxygen tensions (tcPO2S) compared with baseline values than 30 control (ONNS) infants who did not. Infants who received NNS also had higher tcPO2S after crying than infants who did not. NNS, which attenuates crying, may alleviate crying-induced oxygen decreases in healthy, transitional newborn infants.

The effect of familiar and unfamiliar voice treatments on intracranial pressure in head-injured patients.

Limited research has been conducted exploring the relationship between verbal stimulation and intracranial pressure (ICP). The purpose of this study was to investigate effects of verbal stimulation on ICP in head-injured patients. The sample consisted of 12 head-injured patients with a mean age of 31.5 years and mean Glasgow Coma Scale score of 7.8. A message was recorded by a familiar voice (family) and an unfamiliar voice (researcher). The familiar voice message was played to each subject. After a rest period, the unfamiliar voice message was played. ICP was recorded before, during and after playing both taped messages. Results demonstrated little change in ICP of head-injured patients when exposed to recorded verbal stimuli. Paired t-tests demonstrated no statistically significant differences between means. Results suggest families of head-injured patients with normal ICP can verbally interact with the patients for short periods without significant increases in ICP.

Pulmonary aspiration in tube-fed patients with artificial airways.

Based on the results of this study, it appears that critically ill patients may receive nutritional supplements through the use of a small-gauge, flexible enteral feeding tube without significant danger of pulmonary aspiration. However, the potential for aspiration of tube feedings in any critically ill patient still exists, and further research in this area would contribute to a decrease in morbidity and mortality rates.