Necessidades nutricionais do doente crítico

Sá‐Couto

Journal of Clinical Nursing

et al. 2021

Aims To study the correlation between the workload of intensive care nursing teams and the sociodemographic, anthropometric and clinical characteristics of patients in critical condition in a Portuguese Intensive Care Unit (ICU) during a 5‐year period. Background Currently, indices of nursing workload quantification are one of the resources used for planning and evaluating ICUs. Evidence shows that there are several factors related to critical patients and their hospitalisation which potentially influence the nursing workload. Design Retrospective cohort analysis of a health record database from adult patients admitted to a Portuguese ICU between 1 January 2015–31 December 2019. Methods Simplified Therapeutic Intervention Scoring System (TISS‐28) scores of 730 adult patients. Three TISS‐28 assessments were considered: first assessment, last assessment and average. The STROBE guidelines were used in reporting this study. Results The TISS‐28 has an average of 34.2 ± 6.9 points at admission, which is considered a high nursing workload. A somewhat lower result was found for the discharge and average assessments. It shows that basic activities accounted for the highest percentage of time spent (38.0%), followed by the cardiovascular support category (26.5%). The TISS‐28 shows consistent results throughout the study period, despite a small trend reduction in the last 2 years. Conclusions Lower workloads were found for age ≤44 years and with a shorter length of stay. Higher workload was more probable in patients classified in Cullen Class IV (OR = 2.5) and with a normal to higher weight percentile (OR = 1.9 and 1.5, respectively). Relevance to clinical practice Knowledge of the factors influencing the nursing workload facilitates the implementation of rules to improve performance in nursing interventions, based on the redefinition of care priorities, increased productivity, human resources management and reduction of additional costs to the organisation, related to possible adverse events, among others.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nursing workload assessment in an intensive care unit: A 5‐year retrospective analysis

Sá‐Couto

Journal of Clinical Nursing

et al. 2021

“…Harris Benedict equation are used for calculating caloric requirement of the patients. [11][12][13] Clinical nutritionist plays a major role in determining the metabolic needs of the client and adequately measure and provide diet plan for the patients by using standardized equation and methods.…”

Section: Determine the Need For Enteral Feeding (Swallowing Unconscio...mentioning

confidence: 99%

Evidence based – Enteral feeding algorithm for Neurosurgery ICU/Ward

Shirke,

Anand,

Sahu

et al. 2023

IJN

Enteral feeding is a procedure that is in practice internationally by nurses. Providing enteral feeding to the patients is an art and science of nursing that follows careful steps and principles. Nurses role is not only confined to administering enteral feed but also of educating, giving instructions to the family members, directing caregivers and significant others regarding initiating and maintaining enteral feeding, so that continuity of nutritional care is maintained even in the home setting. Once the patient is admitted in neurosurgical ICU, hemodynamic stability of the patient is utmost important, as hemodynamic instability of the patient may preclude the safe initiation of EN in the critical care patients. Initial stabilization is the key for patient survival followed by maintenance therapy like drugs, mobilization, position, continuous monitoring and nutrition. For determining the need of enteral feeding especially for neurosurgical and neurological patients three things should be given utmost importance i.e. Swallowing deficit, Unconsciousness (Level of consciousness) and Nutritional requirement. Can be easily remembered as pneumonic SUN.Confirming tube position is one of the critical step in effective enteral feeding practice in spite of that it has given least importance. It is recommended to confirm the tube position immediately after ryles’ tube insertion through radiologic methods which may be not feasible sometimes, therefore bedside methods can also be adopted Auscultation methods and Aspiration method are the most widely used method among all the bed side methods for confirming tube placement. Gastric residual volume is the amount aspirated from the stomach following administration of the enteral feed. An aspirate among of less than 500ml in 4-6 hours or less than 50% of last enteral feed is safe and indicates that GIT is functioning. Most patients nicely tolerate enteral feeding via gastric tube while few patients has delayed gastric emptying and high GRVs as a result of sedation, pain medications, hypothermia, decreased movement and the effect of being critically ill. Intolerance of enteral feeding is defined as more than 500ml or more than 50% of last enteral feeding. Though enteral feeding is the most popular procedure for ICU Nursing officer, but it is the most crucial in terms of deciding patient outcome. Effective enteral feeding requires through knowledge of initiation and maintenance of enteral feeding. Thus, this article propose simple algorithm to follow. Effectively delivering nutrition to the patient requires the help of dietitian and physician/surgeon to deal with its challenges that comes along with this golden feeding technique.

“…The World Health Organization's (WHO) definitions of obesity (body mass index (BMI) > 30 kg/m 2 ) and overweight (BMI 25-29.9 kg/m 2 ) were used [28]. The basal energy expenditure (BEE) was calculated according to the Harris and Benedict equation (HBE) [29], while the ideal weight of each patient was calculated using the Lorenz equation, as described in our previous work.…”

Section: Body Composition Assessmenmentioning

confidence: 99%

Body Composition Change, Unhealthy Lifestyles and Steroid Treatment as Predictor of Metabolic Risk in Non-Hodgkin’s Lymphoma Survivors

Daniele

Guarini

Summa

et al. 2021

JPM

Unhealthy lifestyle, as sedentary, unbalanced diet, smoking, and body composition change are often observed in non-Hodgkin’s lymphoma (NHL) survivors, and could be determinant for the onset of cancer treatment-induced metabolic syndrome (CTIMetS), including abdominal obesity, sarcopenia, and insulin resistance. The aim of this study was to assess whether changes in body composition, unhealthy lifestyles and types of anti-cancer treatment could increase the risk of metabolic syndrome (MetSyn) and sarcopenia in long-term NHL survivors. We enrolled 60 consecutive NHL patients in continuous remission for at least 3 years. Nutritional status was assessed by anthropometry-plicometry, and a questionnaire concerning lifestyles and eating habits was administered. More than 60% of survivors exhibited weight gain and a change in body composition, with an increased risk of MetSyn. Univariate analysis showed a significantly higher risk of metabolic disorder in patients treated with steroids, and in patients with unhealthy lifestyles. These data suggest that a nutritional intervention, associated with adequate physical activity and a healthier lifestyle, should be indicated early during the follow-up of lymphoma patients, in order to decrease the risk of MetSyn’s onset and correlated diseases in the long term.