Background and purpose Adults with compromised liver function are inherently deficient and especially vulnerable to the consequences of vitamin D deficiency. Consequences of vitamin D deficiency include liver disease progression, infection, and graft failure. A vitamin D supplementation protocol is proposed to systematically optimize serum vitamin D levels according to guidelines in both pre‐ and post‐liver transplanted patients. Methods This quasiexperimental study included a sample of N = 45 post‐liver transplanted patients taking daily cholecalciferol (vitamin D3) 2500 units for 12 weeks, with a pre‐ and post‐lab measure of serum 25‐hydroxyvitamin D levels at a large academic facility. Conclusions Seventy‐eight percent of patients reached minimum guideline levels using the protocol with an average increase of serum vitamin D of 13.8 ng/mL. Long‐term outcomes of clinical significance may include decreased incidence of acute T‐cell‐mediated graft rejection and infections in the immunocompromised patient. Implications for practice Optimizing vitamin D in vulnerable patient populations such as chronic liver disease and the immunosuppressed posttransplanted patient has the potential to curtail complications of vitamin D deficiency. As a result, nurse practitioners employing a vitamin D protocol can create a favorable impact on patient quality of life, safety, and healthcare spending.
Hepatorenal syndrome (HRS) is a serious complication of end-stage liver disease (ESLD) that dramatically increases the patient's mortality risk while waiting for a liver transplant. HRS is the result of portal hypertension and splanchnic arterial vasodilation with subsequent intense renal vasoconstriction and hypoperfusion. The key to managing HRS while waiting for a liver transplant is to differentiate this diagnosis from other forms of acute kidney injury (AKI), such as prerenal azotaemia (PRA) and acute tubular necrosis (ATN). Although there has been previous research guiding physicians to manage HRS, there is a lack of published material to help guide liver-transplant (LT) nurses. The purpose of this evidence-based paper is to bridge this gap in the literature and provide a guide for LT nurses treating HRS through a detailed literature review exploring the aetiology, pathophysiology, diagnosis and management of HRS.
Health professionals providing palliative care aim to give the best quality of life for patients who are terminally ill. This care is accomplished by providing treatments that either prevent or relieve symptoms that are common at the end of life, regardless of the disease process. A person who is ‘actively dying’ is in their last days or hours of life; within this time period, symptoms will become more consistent and intense, therefore they need to be managed to reduce distress for the patient and family. This paper focuses on the pharmacological management of three of the most commonly prescribed medications for the active dying patient—lorazepam, morphine and atropine—which are prescribed for the relief of anxiety, severe dyspnea, and respiratory secretions.
With an increasing number of older people using emergency services, researchers have raised concerns about the quality of care in an environment that is not designed to address older patients' specific needs and conditions. The comprehensive geriatric assessment (CGA) model was developed to address these issues, and to optimise healthcare delivery to older adults. This article introduces a complementary mnemonic, FRAIL, that refers to important elements of health information to consider before initiating care for older patients - falls/functional decline, reactions, altered mental status, illnesses, and living situation. It is not intended to replace the CGA, but can help to quickly identify high-risk older patients who warrant a more in-depth clinical assessment with CGA.
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