[My stomach, the monster under my bed]. / Mon ventre, ce monstre caché sous mon lit.

Care for patients with eating disorders is complex and plurimodal. Care plans need to be adapted in order to take into account the body in crisis. A series of hospital admissions combined with specific psychomotor approaches, can contribute to the patient being reappropriated with their own body.

Implementation and evaluation of a nurse-centered computerized potassium regulation protocol in the intensive care unit--a before and after analysis.

BACKGROUND: Potassium disorders can cause major complications and must be avoided in critically ill patients. Regulation of potassium in the intensive care unit (ICU) requires potassium administration with frequent blood potassium measurements and subsequent adjustments of the amount of potassium administrated. The use of a potassium replacement protocol can improve potassium regulation. For safety and efficiency, computerized protocols appear to be superior over paper protocols. The aim of this study was to evaluate if a computerized potassium regulation protocol in the ICU improved potassium regulation. METHODS: In our surgical ICU (12 beds) and cardiothoracic ICU (14 beds) at a tertiary academic center, we implemented a nurse-centered computerized potassium protocol integrated with the pre-existent glucose control program called GRIP (Glucose Regulation in Intensive Care patients). Before implementation of the computerized protocol, potassium replacement was physician-driven. Potassium was delivered continuously either by central venous catheter or by gastric, duodenal or jejunal tube. After every potassium measurement, nurses received a recommendation for the potassium administration rate and the time to the next measurement. In this before-after study we evaluated potassium regulation with GRIP. The attitude of the nursing staff towards potassium regulation with computer support was measured with questionnaires. RESULTS: The patient cohort consisted of 775 patients before and 1435 after the implementation of computerized potassium control. The number of patients with hypokalemia (<3.5 mmol/L) and hyperkalemia (>5.0 mmol/L) were recorded, as well as the time course of potassium levels after ICU admission. The incidence of hypokalemia and hyperkalemia was calculated. Median potassium-levels were similar in both study periods, but the level of potassium control improved: the incidence of hypokalemia decreased from 2.4% to 1.7% (P < 0.001) and hyperkalemia from 7.4% to 4.8% (P < 0.001). Nurses indicated that they considered computerized potassium control an improvement over previous practice. CONCLUSIONS: Computerized potassium control, integrated with the nurse-centered GRIP program for glucose regulation, is effective and reduces the prevalence of hypo- and hyperkalemia in the ICU compared with physician-driven potassium regulation.

Pathophysiology of hypokalemia in patients with cancer: implications for nurses.

Hypokalemia is a potentially life-threatening complication that occurs in many patients with cancer. Nurses need to be aware of the many common causes of this electrolyte disorder as well as appropriate assessment strategies that will enable potential problems to be detected and treated early. This article begins with a review of normal potassium balance and physiology, followed by a discussion of potential causes of hypokalemia in patients with cancer. These causes are grouped into four categories: inadequate dietary intake, extrarenal losses, redistribution abnormalities, and renal losses. Common causes of hypokalemia in patients with cancer are illustrated with case examples. Signs and symptoms associated with hypokalemia are discussed. Finally, implications for nursing assessment and intervention related to the administration of potassium are reviewed.

Hypokalemia.

Hypokalemia is an electrolyte imbalance that can have serious effects on the patient if not detected early. Therefore, it is important for the nurse to: (1) be aware of those patients at risk for excess potassium loss, (2) monitor those patients' ECG to observe for any changes indicative of hypokalemia, and (3) assess for physical signs and symptoms indicative of hypokalemia. Early detection of hypokalemia and early intervention will prevent potential catastrophic events.