Martha K. Raymond, RN, BSN, BS

antipsychotic drug therapy are at increased risk for hyperglycemia, according to a study published in the 

 that included 13,817 patients aged 66 or older with preexisting diabetes. Patients were divided into those treated with insulin (14.4%), those taking oral hypoglycemic agents (45.5%), and those not taking any diabetes treatment (40.2%).

During follow-up, 11.0% of the patients were hospitalized for hyperglycemia. Of these, 24.1% were taking insulin, 13.1% were taking oral hypoglycemic agents, and 3.8% were not taking any diabetes medications.

Patients currently taking antipsychotic drugs had an overall higher likelihood of hyperglycemia when compared with those not taking the drugs in the preceding 180 days. The adjusted rate ratio was 1.40 among the insulin-treated group, 1.36 for those treated with oral hypoglycemic agents, and 2.43 for the group with no diabetes treatment.

Lipscombe LL, Lévesque L, Gruneir A, et al. Antipsychotic drugs and hyperglycemia in older patients with diabetes. 

Articles

An Archives of Internal Medicine study reported that older diabetes patients who started antipsychotic drug therapy had higher overall likelihoods of hyperglycemia.

Antipsychotics cause hyperglycemia in some older diabetics

NON-INVASIVE VENTILATION AFTER EXTUBATION 

can prevent respiratory failure in at-risk patients. A recent issue of 

described a study in which mechanically ventilated patients in intensive care, who had chronic respiratory disorders and hypercapnia, were extubated and assigned to either non-invasive ventilation or conventional oxygen treatment.

Respiratory failure after extubation in patients assigned non-invasive ventilation was 15%, compared with 48% in the conventional oxygen therapy group. In patients with respiratory failure, non-invasive ventilation as rescue therapy avoided reintubation in 17 of 27 patients. The 90-day mortality was lower in patients assigned non-invasive ventilation than in those allocated conventional oxygen (p=0·0146).

Ferrer M, Sellarés J, Valencia M, et al. Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: randomised controlled trial. [Published online ahead of print August 13, 2009]. 

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61038-2/abstract/

A recent study showed that non-invasive oxygen ventilation reduced rates of respiratory failure and reintubation in recently extubated, at-risk patients more effectively than convention oxygen therapy.

Non-invasive ventilation after extubation can cut risk of respiratory failure

-we've all cared for patients who seem to take these medications by the handful. When I imagine these patients, I picture a diabetic with sugar in his blood, making it as thick as syrup, flowing through arteries that are already constricted from hypertension, now narrowed with a coating of lipids pulsing through his torso, where abdominal girth due to obesity puts pressure on his weak cardiovascular network, increasing the work of an already overworked heart. One day, the plaque in the artery builds up a little too thickly, or his blood pressure spikes too high, and the heart becomes the victim of myocardial infarction and stops pumping.

Diabetes, lipid disorders, and hyper-tension don't comprise the trifecta of health, but that of demise. Surprisingly, these patients aren't even admitted because of diabetic ketoacidosis, hyperlipidemia, or hypertension. They're admitted due to an ordinary foot ulcer or congestive heart failure. Often, you'll see these patients time and time again. They'll become known as "train wrecks" or "frequent fliers." These disparaging monikers are always out of place, but especially when a patient suffers conditions that combine into a complicated disorder that wreaks havoc on the body-cardiometabolic disorder. One thing you'll find in common in many of these patients is obesity. Cardiometabolic disorders and weight are complex, and numerous guidelines have been written to teach practitioners risk-factor management of the disease.

Let's revisit the patient for a moment, and ask "How could we, as nurses, have helped this patient, who seems to be hopeless?" The first step is to understand the etiology of conditions comprising cardiometabolic disorders and weight.

 will feature four articles covering nursing care plans based on current medical guidelines for each of the cardiometabolic component conditions: diabetes and lipid disorders in this issue; hypertension in October; and obesity in November.

Each article includes a patient case, describing the signs and symptoms of the disorder identified during an assessment. The disease state and medical diagnosis guide the nursing diagnosis and the goals for patient outcomes. We show how to focus interventions based on current medical guidelines to help eliminate knowledge deficiencies the patient might have about cardiometabolic disorders and weight. Practitioners will learn more about how to plan and incorporate healthcare interventions, including medication, therapeutic lifestyle modifications, and other treatments.

Practitioners are encouraged to help patients incorporate new health regimens into their lifestyles so they can control and manage the disease, and feel more in charge of their lives. We detail evaluation criteria, established by the success in meeting national guideline goals measured through follow-up appointments, and give you the resources you need to inform and support patients.

We investigate cardiometabolic disorders and how they interrelate to significantly increase cardiovascular risk. We provide the tools and information that primary care physicians, specialists, midlevels, nurses, pharmacists, managed care professionals, and the pharmaceutical industry need in order to work together to address this growing problem and ultimately improve patient outcomes.

The CardioMetabolic Disorders and Weight Resource Center can be accessed through 

									http://www.modernmedicine.com/cardiometabolic/

. We offer an array of publications that provide current and practical clinical information, including 

 explains diabetes and lipid disorder management in an action-for-outcomes format, which is familiar to you as the care plan. Also, 

 Radio will air a podcast focusing on motivating the diabetic client to adhere to therapeutic lifestyle changes. Next month, 

 will publish a table explaining the various guidelines for risk factors-blood pressure, lipids, central obesity, and microalbuminuria-that you'll no doubt encounter in your practice.

What would you like to see in print or on our web site? Send an e-mail to 

As part of Advanstar and ModernMedicine's cross-publication focus on cardiometabolic disorders and weight, RN will present four nurse-oriented care plans for diseases in this spectrum, starting with features on diabetes and blood lipids.

Opinion: Diagnosis SOS: RN Magazine participates in ModernMedicine's Action for Outcomes Series

with a stroke risk are often treated with warfarin. A new technique used for left atrial appendage (LAA) closure may be an alternate treatment. Researchers enrolled 707 patients with non-valvular atrial fibrillation, who had at least one of the following criteria: stroke, transient ischemic attack, congestive heart failure, diabetes, hypertension, or age of at least 75 years. The patients were randomized to receive either percutaneous closure of the LAA and warfarin cessation, or usual warfarin treatment, with a target international normalized ratio between 2.0 and 3.0. The end point of the study was a composite of stroke, cardiovascular death, and systemic embolism.

At 1,065 patient-years of follow-up, the combined rate for stroke, cardiovascular death, and systemic embolism was 3.0 per 100 patient-years in the study group and 4.9 per 100 patient-years in the control group. Warfarin therapy was stopped at 45 days in 87% of the patients in the study group.

Holmes DR, Reddy VY, Turi ZG, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. 

A study of patients with atrial fibrillation and one or more comorbidities showed that using left atrial appendage closure reduced rates of stroke, cardiovascular death, and systemic embolism more effectively than warfarin therapy.

Author | Martha K. Raymond, RN, BSN, BS

Articles

Antipsychotics cause hyperglycemia in some older diabetics

Non-invasive ventilation after extubation can cut risk of respiratory failure

Opinion: Diagnosis SOS: RN Magazine participates in ModernMedicine's Action for Outcomes Series

New technique for stroke patients with a-fib offers warfarin alternative