RESUMEN
Objective: Gynecological patients receiving abdominal surgery commonly experience bowel symptoms which result from impairment of bowel motility after the surgery. The purpose of this study was to identify abdominal distention symptom in gynecological patients receiving abdominal surgery. Methods: Gynecological patients who received elective abdominal surgery at Gynecological Unit, Obstetrics and Gynecological Department, Siriraj Hospital from December 2003 to February 2004 were recruited in this study. The data were collected five days after surgery by using Abdominal Distention Assessment Record for Gynecological Patient Receiving Abdominal Surgery which was applied from Abdominal Distention Assessment Record by Wattanawetch (2002). Abdominal distention was defined as belching, flatus excretion, perception of fullness, bowel sound, and difference of abdominal girth. The total score is ranged from 1 to 20 points. The severity of abdominal distention symptom is presented as: 1-10 points= mild abdominal distention; 10-15 points= moderate abdominal distention; 16-20 points= severe abdominal distention. The data were analyzed by using descriptive statistics. Results: All participants were hospitalized three days after surgery while 15.4% and 42.3% of them were discharged on the forth and the fifth day after surgery. Since the first through the third day after surgery, most of the participants experienced moderate to severe abdominal distention (PO day 1= 98.7%; PO day 2=93.6%; PO day 3= 67.9%). Most of the participants had no belching (61.5%) and no flatus excretion (83.3%), with mild to severe perception of fullness (50.0%); their bowel sound was less than three times per minute (88.5%), and the difference of abdominal girth was less than 1.3 centimeters (61.5%) on the first day after surgery. On the second day after surgery most of them were belching 1-5 times in the last 4 hours (55.1%), no flatus excretion (46.2%), with mild to severe perception of fullness (66.4%); their bowel sound was less than 3 times per minute (53.8%), and the difference of abdominal girth was less than 1.3 centimeters (57.7%). On the third day most of them were belching 1-5 times in the last 4 hours (59.0%); their flatus excretion was 1-3 times in the last 4 hours (50.0%), with mild perception of fullness (60.3%); their bowel sound was 3-5 times per minute (51.3%), and the difference of abdominal girth was less than 1.3 centimeters (73.1%). On the forth and on the fifth day after surgery, 1.3% and 2.6% of the participants still experienced severe abdominal distention symptom while 41% and 15.4% of them had moderate distention score. Conclusion: This study revealed that more than a half of the gynecological patients receiving abdominal surgery had moderate to severe abdominal distention after surgery. This indicates the need for an improvement of abdominal distention management program for gynecological patient receiving abdominal surgery.
RESUMEN
This study is a hospital based concurrent cohort study with the objectives of investigating the risk factors and the predictive level of the risk factors of pressure ulcers in hospitalized elderly The study was conducted between January 9th and March 12th 2002, in the medical, surgical, and orthopedic wards of Pranangklao Hospital, a 430-bed tertiary hospitsl under the Ministry of Public Health in Nonthaburi Province. The participants in this study were 117 hospitalized elderly patients who were 60 years or older, did not have pressure ulcers on admission, and were hospitalized for at least four days. Data were collected by the researcher and the research assistant who achieved an inter-rater reliability for pressure ulcer risk assessment and skin assessment on the research instrument of 0.905 and 0.954 resprctively. Pressure ulcer risk assessment and skin assessment were conducted daily by utilizing the Braden pressure ulcer risk assessment scale and the Bergstrom’s skin assessment scale throughout the study period. Logistic regres- sion analysis was employrd to analyze the data. The results of the study revealed the greatest frequency of pressure ulcers was found in those aged 70 to 79 years old (41%) and had neurological or spinal problems (30.8%). The assessment of elderly patients’ risk of pressure ulcers on admission correctly predicted 71.8% of pressure ulces. Of the elderly patients who were predicted to have pressure ulcers, 28.2% developed this complication during the hospitalization period. Most pressure ulcers occurred on the second day after admission. Of the elderly who were predicted not to develop this complication, 93.6% were free from pressure ulcers. An increase in friction and shearing (OR=4.592, 95% CI=1.531-13.770) was the risk factor that had the most influence among the participants, where the second most important risk factor was an increase in core temperature (OR=2.760, 95%CI=1.105-6.891). This study indicates the need for pressure ulcer risk assessment at the time of admission and a need for a pressure ulcer education program for the elderly or their caregivers and for all health care providers. In addition, this study also reveals the need for proper management of these elderly patients who are prone to develop pressure ulcers at the time of admission, especially among those who have increases in friction and shear-ing forces and an increase in core temperature.