Plan de cuidados individualizado durante oxigenación con membrana extracorpórea. Caso clinic / Individualised care plan during extracorporeal membrane oxygenation. A clinical case

Describimos un plan de cuidados individualizado de una mujer diagnosticada de neumonía, intubada y con ventilación mecánica invasiva que ingresa en la Unidad de Cuidados Intensivos para oxigenación por membrana extracorpórea (ECMO). Se realiza valoración enfermera por patrones funcionales de Marjory Gordo, priorizando los diagnósticos enfermeros más relevantes, utilizando un modelo de razonamiento clínico (Análisis de Resultado del Estado Actual) y la taxonomía NANDA. Se describen: ansiedad ante la muerte, deterioro del intercambio de gases, disminución del gasto cardíaco, motilidad gastrointestinal disfuncional, riesgo de síndrome de desuso, riesgo de infección y riesgo de sangrado. Los objetivos principales son: disminuir el miedo de la familia, conseguir un óptimo estado respiratorio y cardiocirculatorio, mantener la función gastrointestinal, evitar las posibles complicaciones de la inmovilidad y disminuir al máximo el riesgo de infección y sangrado. En cuanto a las actividades, se han realizado: apoyo a la familia, correcto manejo de la vía aérea-ventilación mecánica, monitorización cardiorrespiratoria, de la piel y del estado nutricional, control de posibles infecciones y hemorragias (manejo de terapias, catéteres…). Para la evaluación de los resultados se ha utilizado la escala Likert, cumpliéndose todos los indicadores de resultado planteados. No se han encontrado casos que desarrollaran un plan de cuidados individualizado con taxonomía NNN utilizando ECMO veno-venosa. Los planes descritos con otro tipo de ECMO no utilizaron el modelo análisis de resultado del estado actual. Este caso puede apoyar a enfermeras a prestar atención a pacientes sometidos a ECMO veno-venosa, aunque son necesarios más casos para estandarizar los cuidados según la taxonomía NANDA

An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy

[Individualised care plan during extracorporeal membrane oxygenation. A clinical case]. / Plan de cuidados individualizado durante oxigenación con membrana extracorpórea. Caso clínico.

An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy.