Summary: Severe burn patients experience pronounced metabolic changes that caused hyperglycemia. Other existing metabolic conditions such as diabetes mellitus may worsen this condition. Early, adequate, and personalized nutrition therapy may result in better glycemic control and prognosis.A 44-year-old male with severe burn injury involving 27,5% total body surface area (TBSA) and type 2 diabetes mellitus (T2DM) was given early and diabetes-specific nutrition therapy to meet the recommended energy and protein needs. Lower carbohydrate contents and higher mono-unsaturated fatty acids (MUFA) were components of diabetes-specific nutrition therapy. Desirable blood glucose levels, a positive trend of albumin levels, and reduced inflammatory markers were achieved while being given this nutrition therapy. Sepsis was not diagnosed in this patient. The patient was discharged from the hospital after an improvement in clinical condition. Hyperglycemia commonly occurs in critically ill patients, especially with pre-existing T2DM. The provision of prompt and personalized nutrition therapy will improve clinical outcomes.
Schizophrenia is a mental disorder characterized by disturbances of thought, perceptual language and sensations including psychotic experiences that affect the function of individual areas. Clients with schizophrenia have one of the main symptoms, namely the problem of hallucinations. Hallucinations are states in which a person experiences a change in the pattern and amount of stimulation initiated internally or externally by the absorption, exaggeration, distortion, or abnormal response to each stimulus. The purpose of this writing is to provide mental assistance to Mr.I at PROF. Dr. M. ILDREM. The writing method is descriptive, namely a case study by carrying out nursing care to patients with hallucination problems with a treatment implementation strategy (SP) carried out for 6 days on Mr. I. Data collection techniques were carried out using interviews, observation, and physical examination techniques. Agreement problems found in Mr. I is Hallucination. With management for 6 days, Mr. I am able to control the hallucinations that I experience by scolding, taking medication regularly, conversing with others and carrying out scheduled activities. Suggestions in managing patients are expected that with this medical staff assessment they can build a relationship of mutual trust with clients so that they can communicate well and clients can express problems so that the development process is achieved, the role of the family is to visit clients and provide sufficient support and attention to speed up the client's healing process.
Background Carbohydrate loading is one of the steps in the preoperative procedure of Enhanced Recovery after Surgery (ERAS). The advantages of the ERAS pathway have positive effects on postoperative outcomes, including a reduction in the length of stay/LOS in hospital. Objective: This study aims to critically analyze the effectiveness of carbohydrate loading on the reduction in the length of hospital stay among patients undergoing non-invasive gynecologic surgical procedure. Methods: A search was conducted to find several literatures from PubMed, Cochrane and Scopus. This study assesses the relevance and feasibility of the literatures. The search found three selected literatures to further conduct a critical assessment. Results: A critical review was conducted towards three randomized controlled trial literatures. Two literatures showed a significant reduction in the length of stay with preoperative carbohydrate loading (p<0.001), while one literature showed an insignificant finding (p=0.684). Conclusions: Carbohydrate loading as a part of the preoperative management of ERAS could reduce the length of hospital stay among patients undergoing non-invasive gynecologic surgery procedure. Differences in the results of several studies indicate the need for further studies using the similar intervention method. Keywords: enhanced recovery after surgery, gynecologic surgery, carbohydrate loading, length of stay.
Objectives Ascending colon cancer makes up of 27% colorectal cancers, and its incidence has continuously increased. Malnutrition is common in cancer patients, posing as a risk of poor surgical outcome. High output stoma (HOS) is a commonly encountered complication with an incidence of 23%. Not only causes fluid and electrolyte imbalance, it also deteriorates patient's nutritional status, forming a vicious cycle of malnutrition. Methods A 43-year-old malnourished female with ascending colon cancer presented to the emergency department with signs of bowel obstruction. The patient underwent tumor resection and ileocolostomy surgery. Starting from the third postoperative day, ileostomy effluent drastically increased to 2700 mL/day. Simultaneously, severe hyponatremia, severe hypokalemia, and hypomagnesemia were observed. Intravenous electrolyte correction and antimotility drug were given. It was decided that oral nutrition intake remained to be given. Oral hypotonic fluid intake was limited to 1000 mL/day. Malignancy-related retroperitoneal abscess further complicated patient's condition. Results Hypersecretory phase was expected in first days after ileostomy surgery. However, HOS, especially with output of more than 2000 mL/day, could cause fluid and electrolyte imbalance. Moreover, HOS could cause malnutrition due to reduced nutrient absorption. Risk factors of HOS identified in this case were prokinetic medication use and unresolved retroperitoneal abscess causing intraabdominal inflammation. Increment of food intake was also observed from prior anorexic period, specifically fruits high in insoluble fiber were consumed. Fruit pulp was found in the stoma effluent, raising concern of reduced bowel absorption capacity. High output stoma was resolved by abscess drainage, discontinuation of prokinetic agent, and administration of antimotility agent. Hyponatremia and hypomagnesemia improved with correction, whereas hypokalemia needed longer time to be resolved. Oral nutrition was maintained and increased gradually to prevent further malnutrition, while stoma production was monitored strictly. Conclusions This case report showed that strict evaluation on stoma production and management of HOS in malnourished cancer patients must be done promptly, preventing further deterioration. Funding Sources None.
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