Valerie K. Sabol

Nutrition assessment of the critically ill adult.

Illness and injury are physiologic stressors that alter the bodys metabolic and energy demands. Approximately 30 to 55% of hospitalized patients have evidence of malnutrition, which makes nutrition screening and assessment an integral part of the evaluation of the critically ill adult. Nutritional assessment relies on a complete history and physical examination, appropriate laboratory measurements, and diagnostic testing as warranted. Although a single laboratory result may be helpful for nutritional screening, there is no single parameter that is both sensitive and specific for the diagnosis of malnutrition. Instead, nutritional assessment must be ongoing and be derived from a variety of sources in order to identify nutritional trends over time. Early identification and nutritional intervention can lessen morbidity and mortality risks; however, underlying acute and/or chronic disease processes often need to be identified and corrected before the body can reverse abnormal nutrient metabolism. A comprehensive nutritional assessment, incorporated with clinical status, will provide the basis for a nutritional support plan and evaluation strategies. In order to help the advanced practice nurse determine the appropriate nutritional regimen, this article discusses the importance of the patient history, physical examination, body composition measurement techniques, and laboratory data assessment.

Diarrhea: applying research to bedside practice.

Diarrhea is one of many symptoms that may complicate the hospitalization of a critically ill patient. Diarrhea is caused by a variety of etiologies; identifying the etiology aids in the appropriate selection of interventions. Care of the patient with diarrhea should be guided by the evidence and best practices available in the literature. This article defines and describes diarrhea and its pathophysiology. An evidence-based plan of care for the assessment, planning, intervention, and evaluation of the patient with diarrhea is presented, using levels of recommendation based on the strength of the available evidence. A case study is presented to illustrate application to clinical practice. Commentary about the case is provided to review salient points of care.

Exploring the factors that influence functional performance among nursing home residents.

Objective: To promote healthy aging in older nursing home (NH) residents, it is important to identify factors that impact functional performance. Using the Disablement Process Model, it was hypothesized that variables from all levels of the model would significantly impact the ability of a NH resident to get up from a chair. Method: A stepwise multiple logistic regression model was used to test the impact of sociodemographic, physiologic, physical, psychosocial, and environmental factors on chair rise. Results: Analysis indicated that three factors, strength, gait, and self-efficacy, were significantly associated with chair-rise ability and together explained approximately 64% of the variance and successfully classified 88.4% of the chair-rise cases. Discussion: These findings indicate that identifying physical and psychosocial variables early in the disablement process will help health care providers tailor medical and restorative care interventions that may help older adults maintain the ability to chair rise.

Evaluation of the effect of the modified early warning system on the nurse-led activation of the rapid response system.

The Modified Early Warning System (MEWS) is a scoring rubric used to detect the earliest signs of a change in a patients condition. This mixed-methods study used pre- and postintervention data to describe the impact of the MEWS on the frequency of rapid response system activations and cardiopulmonary arrests among patients admitted to medical-surgical units. Focus groups of nursing staff provided insight into the factors that influence how nurses use the MEWS at the bedside as a framework to identify, intervene, and manage patients in need of an advanced level of care.

The Impact of Anemia on Nursing Home Residents

The purpose of this secondary data analysis was to describe the prevalence and treatment of anemia and test the impact of anemia on physical and psychosocial outcomes at baseline and following restorative care interventions. A total of 451 residents from 12 nursing homes participated in this study. The average age of the participants was 83.74 (SD = 8.24), the majority were female (79%), White (66%), and unmarried (90%). A total of 245 (54%) residents were anemic, and 66% were treated with at least one medication. Physical performance was worse in those with anemia, and those with anemia associated with chronic kidney disease had lower self-efficacy and outcome expectations for functional activities than those without anemia. There was no time by treatment interaction between those with and without anemia. The findings provide some additional support for the prevalence of anemia and suggest that those with anemia associated with chronic kidney disease are less motivated to engage in functional activities.

Evaluating Diabetes Outcomes and Costs Within an Ambulatory Setting: A Strategic Approach Utilizing a Clinical Decision Support System

Diabetes affects 22.3 million people in the United States.1 It is a major cause of heart disease and stroke and is the seventh leading cause of death.2 Patients with diabetes are at two to four times greater risk of myocardial infarction (MI) than those without diabetes, and diabetes is the primary reason for renal failure, blindness, and nontraumatic limb amputations.3 Preventive care practices can reduce the development of severe vision loss by 50–60%, reduce foot amputations by 45–85%, and lower blood pressure to reduce proteinuria, a risk factor for developing kidney disease, by ~ 35%.2 Despite evidence that complications related to diabetes are preventable,4,5 only 52% of individuals with diabetes meet guidelines targeting an A1C of < 7.0%, and only 18% meet combined glycemic, lipid, and blood pressure goals.6 In addition to significant morbidity, diabetes has a substantial financial impact. Medical expenses for people with diabetes are more than two times higher than for those without diabetes.2 Total national health care and related costs for the treatment of all people with diabetes total ~

Anemia evaluation and management in nursing home residents.

245 billion.1 Complications from diabetes, such as chronic kidney disease, can cost health care organizations

Anemia and its impact on function in nursing home residents: What do we know?

33 billion per year.2 Most diabetes care is provided in the community in the primary care setting,3 and diabetes is the fourth most frequent reason for ambulatory physician visits.7 A gap exists between optimal and actual care, constituting a wide “quality chasm,”8 which underscores the need for innovative approaches to change the current practice of diabetes care. Clinical decision support systems (CDSSs) have been suggested as a viable solution to these pressing issues.9 CDSSs have been defined as systems providing an automated process for comparing patient-specific characteristics against a computerized knowledge base, with resulting recommendations or …

Using Trigger Films as a Bariatric Sensitivity Intervention: Improving Nursing Students' Attitudes and Beliefs About Caring for Obese Patients.

Anemia is often an unrecognized and/or undertreated diagnosis in older adults. Failure to diagnose anemia leads to delayed treatment and thus delayed relief of symptoms. Given the potentially significant impact of anemia on cardiovascular disease and physical performance among older nursing home (NH) residents, it is important to evaluate current clinical practice related to anemia.The purpose of this secondary data analysis was to evaluate the frequency of laboratory evaluation and medication treatment for anemia among older NH residents. Results indicated that more than half of NH residents were anemic at baseline, and of those, less than 20% had additional testing done to further evaluate for an underlying cause of their anemia and only 45.3% received any pharmacologic treatment. Future research is needed to clarify the potential benefits of timely diagnosis and appropriate treatment for anemic older adults in long-term-care settings and establish evidence-based guidelines to direct care in this area.

So you want to be a Fellow in the American Association of Nurse Practitioners: Navigating the Fellowship process to ensure your success

Purpose: To provide the advanced practice nurse (APN) information on the prevalence and causes of anemia in elderly nursing home (NH) residents, in order to affect diagnostic and management strategies that may help improve physical function and mobility outcomes. Data Sources: Literature review of current peer‐reviewed research articles. Conclusions: In the United States, the prevalence of anemia increases with advancing age, and are reported to be much higher among older NH residents than among community‐dwelling older adults. Causes of anemia among the elderly are often multifactorial. Older individuals with anemia, including mild anemia and even low normal level, have demonstrated lower muscle strength, physical function, mobility, and increased morbidity and mortality outcomes. Implications for Practice: Given the potentially significant relationship between anemia and physical performance outcomes among NH residents, gaining a better understanding will help guide future evidence‐based care by allowing the APN an opportunity to tailor both medical and restorative care interventions. Because anemia is a potentially modifiable condition, intervention may preserve, limit, or reverse functional impairment and/or disablement, and allow for maximal functional independence.