Respuesta a «La metodología enfermera aplicada a la práctica clínica: ¿realidad o ficción?» / Respons to «Nurse methodology applied to clinical practice: Reality or fiction?»

No disponible

Botulismo en la UCI: proceso de cuidados / Botulism in the ICU: nursing care plan

Introducción y valoración del caso. El botulismo es una enfermedad poco frecuente en Europa, causada por la bacteria Clostridium botulinum, de declaración obligatoria, no transmisible de persona a persona y potencialmente mortal (entre un 5 y 10%) si no se trata rápidamente. Se obtuvo el dictamen favorable del Comité de Ética de Investigación Clínica. Se presenta el proceso de cuidados enfermero de un varón de 49 años con diagnóstico de intoxicación bacteriana por Clostridium botulinum, secundario a la ingesta de alubias en mal estado, que estuvo ingresado en la UCI un total de 35 días. Diagnósticos y planificación. Valoración enfermera de forma holística durante las primeras 24 h, con priorización de los sistemas que presentaron un deterioro más rápido: el neurológico y el respiratorio. Se priorizaron 9 diagnósticos según la taxonomía NANDA: riesgo de respuesta alérgica, patrón respiratorio ineficaz, deterioro de la mucosa oral, deterioro de la movilidad física, riesgo de síndrome de desuso, riesgo de motilidad gastrointestinal disfuncional, deterioro de la eliminación urinaria, riesgo de confusión aguda y riesgo de cansancio del rol del cuidador. Discusión. El proceso de cuidados enfermero, estandarizado y organizado con la taxonomía NANDA y priorizado con el método sistemático AREA, garantizó los mejores cuidados basados en la evidencia y prueba de ello fue la mejoría de las puntuaciones de los indicadores de resultado NOC. Resultó imposible comparar la actuación enfermera con la de otros casos documentados

Introduction and case evaluation. Botulism is a rare disease in Europe, caused by the bacterium Clostridium botulinum, notifiable, non-transmissible person-to-person and potentially fatal (between 5 and 10%) if not treated quickly. The favourable opinion of the Clinical Research Ethics Committee was obtained. We present the nursing care plan of a 49-year-old man with a diagnosis of bacterial intoxication caused by Clostridium botulinum, secondary to ingestion of beans in poor condition, who was admitted to the ICU for a total of 35 days. Diagnosis and planning. Holistic nursing evaluation during the first 24hours, with prioritisation of the systems that were deteriorating fastest: neurological and respiratory. Nine diagnoses were prioritised according to the NANDA taxonomy: Risk for allergy response, Ineffective breathing pattern, impaired oral mucous membrane, Impaired physical mobility, Risk for disuse syndrome, Risk for dysfunctional gastrointestinal motility, Impaired urinary elimination, Risk for acute confusion and Risk for caregiver role strain. Discussion. The nursing care plan, standardised and organised with the NANDA taxonomy and prioritised with the outcome-present state-test (OPT) model, guaranteed the best care based on evidence, as the NOC scores improvement demonstrated. It was impossible to compare the nursing intervention with other case reports

Botulism in the ICU: Nursing care plan. / Botulismo en la UCI: proceso de cuidados.

INTRODUCTION AND CASE EVALUATION: Botulism is a rare disease in Europe, caused by the bacterium Clostridium botulinum, notifiable, non-transmissible person-to-person and potentially fatal (between 5 and 10%) if not treated quickly. The favourable opinion of the Clinical Research Ethics Committee was obtained. We present the nursing care plan of a 49-year-old man with a diagnosis of bacterial intoxication caused by Clostridium botulinum, secondary to ingestion of beans in poor condition, who was admitted to the ICU for a total of 35 days. DIAGNOSIS AND PLANNING: Holistic nursing evaluation during the first 24hours, with prioritisation of the systems that were deteriorating fastest: neurological and respiratory. Nine diagnoses were prioritised according to the NANDA taxonomy: Risk for allergy response, Ineffective breathing pattern, impaired oral mucous membrane, Impaired physical mobility, Risk for disuse syndrome, Risk for dysfunctional gastrointestinal motility, Impaired urinary elimination, Risk for acute confusion and Risk for caregiver role strain. DISCUSSION: The nursing care plan, standardised and organised with the NANDA taxonomy and prioritised with the outcome-present state-test (OPT) model, guaranteed the best care based on evidence, as the NOC scores improvement demonstrated. It was impossible to compare the nursing intervention with other case reports.

A propósito de un caso: intervenciones enfermeras a una paciente con shock anafiláctico en la UCI / A case report: Nursing interventions on a patient with anaphylactic shock in ICU

Introducción y objetivos: Se presenta el plan de cuidados de una señora de 42 años con shock anafiláctico secundario a la ingesta de amoxiclavulánico, con compromiso de la vía aérea superior por angioedema de laringe. Previamente tuvo 2 episodios de angioedema. La incidencia de este fenómeno oscila entre 3,2 y 10 casos/100.000 personas/año. Observación clínica: Se realizó una valoración donde destacaron tres necesidades alteradas: respiración y circulación (precisó ventilación mecánica invasiva y perfusión de noradrenalina), eliminación (requirió furosemida para mantener diuresis horarias aceptables) e higiene y protección de la piel (presentó hiperemia generalizada, edema labial, lingual y orofaríngeo). El Comité de Ética de Investigación Clínica del Hospital solicitó el consentimiento informado de la paciente para el acceso a la historia clínica. Intervenciones: De acuerdo con las necesidades destacadas, se priorizaron siete diagnósticos según la taxonomía NANDA: riesgo de respuesta alérgica, riesgo de infección, riesgo de perfusión renal ineficaz, disminución del gasto cardíaco, deterioro de la ventilación espontánea, riesgo de nivel de glucemia inestable y riesgo de motilidad gastrointestinal disfuncional. Discusión y conclusiones: Los criterios de resultados evidenciaron una evolución favorable pasadas 24h. El desarrollo del lenguaje estandarizado NANDA-NOC-NIC en el caso clínico presentado nos permitió organizar metodológicamente el trabajo enfermero, facilitando el registro y normalizando la práctica. Como limitación, no se dispuso de niveles plasmáticos de histamina y triptasa para valorar la evolución del cuadro anafiláctico. Destacar la importancia de la educación sanitaria en una paciente con antecedentes de angioedema

Introduction and objectives: The care plan of a 42-year-old woman with anaphylactic shock, secondary to ingestion of amoxicillin/clavulanic acid, with upper airway involvement due to laryngeal angioedema, is presented. Previously she had had two episodes of angioedema of unknown origin. The incidence of this phenomenon is between 3.2 and 10 cases/100,000 people/year. Clinical observation: An evaluation was made and three altered necessities stood out: breathing and circulation (she needed mechanical ventilation and noradrenalin perfusion), elimination (she required furosemide to keep an acceptable diuresis time), and hygiene and skin protection (she presented generalised hyperaemia, lip, lingual and oropharyngeal oedema). The hospital's Clinical Research Ethics Committee requested the patient's informed consent to access her clinical history. Interventions: According to the altered necessities, seven diagnoses were prioritised according to NANDA taxonomy: risk of allergic response, risk of infection, risk of ineffective renal perfusion, decreased cardiac output, impaired spontaneous ventilation, risk of unstable blood glucose level, and risk of dysfunctional gastrointestinal motility. Discussion and conclusions: Scores of outcome criteria showed a favourable evolution after 24 hours. The development of a standardised NANDA-NOC-NIC language in the clinical case presented allowed us to organise the nursing work, facilitating recording and normalising clinical practice. As a limitation of this case, we didn’t have serial plasma levels of histamine and tryptase to assess the evolution of anaphylactic symptoms. Highlight the importance of health education in a patient with a history of angioedema

A case report: Nursing interventions on a patient with anaphylactic shock in ICU. / A propósito de un caso: intervenciones enfermeras a una paciente con shock anafiláctico en la UCI.

INTRODUCTION AND OBJECTIVES: The care plan of a 42-year-old woman with anaphylactic shock, secondary to ingestion of amoxicillin/clavulanic acid, with upper airway involvement due to laryngeal angioedema, is presented. Previously she had had two episodes of angioedema of unknown origin. The incidence of this phenomenon is between 3.2 and 10 cases/100,000 people/year. CLINICAL OBSERVATION: An evaluation was made and three altered necessities stood out: breathing and circulation (she needed mechanical ventilation and noradrenalin perfusion), elimination (she required furosemide to keep an acceptable diuresis time), and hygiene and skin protection (she presented generalised hyperaemia, lip, lingual and oropharyngeal oedema). The hospital's Clinical Research Ethics Committee requested the patient's informed consent to access her clinical history. INTERVENTIONS: According to the altered necessities, seven diagnoses were prioritised according to NANDA taxonomy: risk of allergic response, risk of infection, risk of ineffective renal perfusion, decreased cardiac output, impaired spontaneous ventilation, risk of unstable blood glucose level, and risk of dysfunctional gastrointestinal motility. DISCUSSION AND CONCLUSIONS: Scores of outcome criteria showed a favourable evolution after 24hours. The development of a standardised NANDA-NOC-NIC language in the clinical case presented allowed us to organise the nursing work, facilitating recording and normalising clinical practice. As a limitation of this case, we didn't have serial plasma levels of histamine and tryptase to assess the evolution of anaphylactic symptoms. Highlight the importance of health education in a patient with a history of angioedema.

Complicaciones durante la neuromodulación de raíces sacras en el tratamiento de la incontinencia fecal grave / Complications during sacral nerve stimulation in the treatment of severe fecal incontinence

Objective: to evaluate the complications of sacral nerve stimulation for the treatment of fecal incontinence. Background: sacral nerve stimulation is considered to be nowadays an effective treatment for fecal incontinence in selected patients. Many authors have reported excellent results and indication for his use have increased. Nevertheless, even being a simple technique, not it exempts this from complications. Methods: fifty-two patients with severe faecal incontinence, treated with sacral nerve stimulation between january 2002 and december 2010, were analysed. All adverse events during follow-up were recorded. Results: there was not surgical complication during peripheral neural evaluation test. In our series, with an average follow-up to 55.52 +/- 31.84 months (range: 12-121), we had a rate of adverse effects of 14 percent, infection of surgical wound in two patients, break of electrode in two patients and the presence of pain in the place of the implant, with episodes of extremity pain and paresthesias in low members in 3 patients. Conclusions: sacral nerve stimulation in severe fecal incontinence is a safe treatment, with a low index of complications.

Objetivo: evaluar las complicaciones de la neuromodulación de raíces sacras en el tratamiento de la incontinencia fecal. Introducción: la neuromodulación de raíces sacras ha sido descrita como un tratamiento quirúrgico eficaz en pacientes con incontinencia fecal grave. Muchos autores han comunicado excelentes resultados y las indicaciones en su uso han aumentado. Sin embargo, a pesar de ser una técnica quirúrgica sencilla, no está exenta de complicaciones. Material y Método: 52 pacientes con incontinencia fecal grave, tratados mediante neuromodulación de raíces sacras entre enero de 2002 y diciembre de 2010, fueron analizados. Todas las complicaciones, tanto durante la implantación del dispositivo como durante el seguimiento, fueron registradas. Resultados: no se registraron complicaciones durante la prueba de estimulación. En nuestra serie, con un seguimiento de 55,52 +/- 31,84 meses, observamos un 14 por ciento de efectos adversos, infección de la herida quirúrgica en dos pacientes, rotura o movilización del electrodo en 2 pacientes y dolor y parestesias en 3 pacientes. Discusión: la neuroestimulación de raíces sacras en el tratamiento de la incontinencia fecal es un tratamiento seguro, con un bajo índice de complicaciones.

Chronic atrial fibrillation in presence of aortic stenosis in a patient with polysplenia syndrome.

We report a rare case of "situs viscerum ambiguous" with polysplenia syndrome, in a 69 year old female patient with aortic stenosis and chronic atrial fibrillation. The presenting symptom was dyspnoea on moderate exertion and an ECG showed supra ventricular arrhythmia. Patients trans-thoracic echocardiogram revealed a dilated left atrium, reduced ejection fraction, mild tricuspid regurgitation, moderate-severe pulmonary hypertension and severe aortic stenosis. The patient was successfully treated with a replacement of her aortic valve and ascending aorta.

Hysteroscopic metroplasty: the role of ultrasound in the diagnosis and monitoring of patients with uterine septa.

52 patients with septate uterus underwent hysteroscopic metroplasty in the Obstetric and Gynecologic Clinic "R" in Palermo. In this group of patients ultrasound examinations were also performed in order to define their role in diagnosis of type of malformations and in monitoring the endoscopic surgical procedure. Preliminary results seem to indicate that real-time ultrasound is a reliable technique for both purposes.