Seguimiento telefónico de las complicaciones en cirugía mayor ambulatoria / No disponible

Objetivos: Conocer los principales problemas postoperatorios, por los que los pacientes hacen uso del teléfono de contacto de 24 horas de la unidad y evaluar si el personal de enfermería es capaz de resolverlos por sí mismo haciendo uso del protocolo establecido en la unidad. Material y método: Estudio retrospectivo de las llamadas recibidas en la unidad durante el año 2007. Para la realización del estudio se realizó una recogida de datos, utilizando los registros de enfermería de las llamadas al teléfono de contacto de 24 horas que nos hacen los pacientes intervenidos en la unidad. Resultados: En el año 2007 en nuestra unidad se realizaron un total de 8.480 intervenciones. Se recibieron 260 llamadas al teléfono de contacto. Entre los principales motivos de llamada destacan el dolor con un 29,6%, el sangrado un 16,2%, la fiebre con un 11,5%, en siguiente lugar con un 7,3% las consultas de algún tipo de duda, seguidas de las llamadas por inflamación con un 5,4%, el estreñimiento con un 3,8%, el dolor simultáneamente con fiebre con un 3,8% y tener el apósito manchado con un 3,4%, recibiéndose la mayoría de las llamadas entre el segundo día después de la intervención y el octavo. Conclusiones: El fomentar los autocuidados y la formación del cuidador principal, junto con la protocolización de las actuaciones en estas unidades, son fundamentales para la correcta recuperación del paciente en su domicilio (AU)

Objetives: The purpose of this study was to identify the main postoperative complications which cause patients to make use of the 24 hour contact telephone number with our unit and to assess whether the nursing staff is able to solve these problems on their own using the protocol we set out in the Unit. Material and method: For this retrospective study of the calls received in the unit during 2007, we collected data from the nursing staff’s registry of the phone calls made by patients who underwent surgery in our unit. Results: During the year 2007, a total of 8,480 surgical procedures were performed. We received 260 calls to the contact telephone number. The main causes for these calls were: 29.6%for pain, 16.2% for bleeding, 11.5% for fever and 7.3% for doubts regarding postoperative care, followed by 5.4% for inflammation, 3.8% for constipation, 3.8% for pain and fever and 3.4%for blood on the dressing. Most of the calls were made between the second and eighth day after the operation. Conclusions: Promoting self-care and giving the necessary information to the main caregiver, together with the use of protocols for each of the procedures in these Units is essential for the correct recovery of patients after discharge (AU)

El chantaje emocional en el paciente terminal / No disponible

Objetivos: para los profesionales sanitarios el trabajar con enfermos terminales supone un gran desgaste psicológico y un peligro para la estabilidad emocional. Durante nuestra formación básica no nos han enseñado a enfrentarnos a la situación terminal y a la muerte. La presencia continua del sufrimiento y la muerte, junto con otros factores, puede conducir a los profesionales a conductas evasivas o a la sobreimplicación con el paciente y familia, pudiendo llegar a sufrir el denominado síndrome de burnout, que no sólo afecta al profesional, sino que también tiene repercusiones en el equipo multidisciplinar y sobre la calidad de los cuidados. Caso clínico: presentamos el caso de un paciente de 60 años de edad, diagnosticado de cáncer de pulmón, en estadio III, sin familia y con poco amigos que le visiten. A medida que su enfermedad avanza y su estado se deteriora, va conformando el rol del paciente. Conclusiones: la sobreimplicación con el paciente, sobre todo por parte de personal con poca experiencia en cuidados paliativos, llevó a estos a caer en el chantaje emocional, dificultando el cuidado adecuado por parte del resto del equipo. Con la presentación de este caso pretendemos reflexionar sobre nuestros errores para evitar redundar en los mismos. Para evitar sufrir el chantaje emocional por parte de nuestros pacientes o de sus familiares es imprescindible el trabajo en equipo y la comunicación entre sus miembros. Todos los profesionales de la unidad, independientemente de su carácter o forma de ser, deben seguir la misma línea de trabajo para impedir que la presión a la que estamos sometidos en el día adía rompa la cohesión del grupo (AU)

Objectives: for healthcare professionals working with terminally ill persons represents significant psychological stress, and a threat for emotional stability. In their basic education they are not trained to face terminal illness and death. The ongoing presence of suffering and death, along with other factors, can lead professionals to become evasive or over involved with patients and their families, and ultimately develop the so called burnout syndrome, which affects not only professionals but also the team and then quality of care. Clinical case: we report the case of a 60-year-old patient diagnosed with lung cancer, stage III, who had no family and only a few friends. As the disease progressed and his condition deteriorated, his role changed and became manipulative. Conclusions: emotional over involvement, particularly by staff members with little experience in palliative care, led to emotional blackmail, which hampered proper care by the team overall. By reporting this case we invite readers to ponder on such mistakes in order to prevent them on future occasions. To avoid suffering from emotional blackmail by our patients or their family members teamwork and good communication among team members are essential. All professionals in the unit, regardless of their nature or personality, must follow the same line of work to prevent daily pressures from breaking team cohesion (AU)

Cuidados de enfermería ante el estreñimiento del paciente paliativo oncológico / Nursing cares in constipation of the oncology patient

El estreñimiento es común incluso en personas sanas, de ahí su importancia. La incidencia en el paciente oncológico es del 70-80% en fase terminal, del 40-50% en enfermedad avanzada y del 90% en enfermos con cáncer agresivo. No sólo supone una incomodidad para el paciente, también complicaciones en su evolución. Un estreñimiento prolongado puede causar dolor abdominal e incluso aumento del dolor provocado por el propio tumor, aumentándose la analgesia cuando lo que presenta es un estreñimiento no resuelto. Puede ocasionar obstrucción intestinal, diarrea por rebosamiento, disfunción urinaria, anorexia, halitosis, náuseas y vómitos, inquietud, malestar y confusión. Al analizar este problema pretendemos unificar criterios y actuaciones enfermeras, y destacar la importancia de la prevención, intentando resolver el problema. La educación sanitaria, tanto del paciente como del cuidador principal, favorecerá su control al alta hospitalaria. Será capaz de identificar su aparición, sus causas y síntomas, conocer el tratamiento, y cuándo y dónde acudir para revisarlo (AU)

The importance of constipation lies in its frequency, even among the healthy. The incidence of constipation inoncological patients is 70-80% in the final stage, 40-50% in advanced disease, and 90% in patients with aggressive cancer. This disorder is not only uncomfortable for the patient but also causes complications. Prolonged constipation can cause abdominal pain and even increase the pain caused by the tumor and stronger pain relief can be required when the constipation is unresolved. Among the complications that can occur are intestinal obstruction, diarrhea by spillage, urinary dysfunction, anorexia, nausea and vomiting, restlessness, malaise, and confusion. When analyzing this problem, we aim to unify criteria and nursing interventions, emphasize the importance of prevention, and solve the problem. Health education of both the patient and the main caregiver aid control of this disorder after discharge. The patient will be able to identify the appearance of constipation, its causes and symptoms and will be familiar with the treatment and when and where to go to review it (AU)

[High rate of early hospitalization in healthy newborns]. / Alta hospitalaria temprana en recién nacidos a término sanos.

OBJECTIVE: The length of hospital stay of healthy term newborns and their mothers varies in different developed countries. The American Academy of Pediatrics defines early postpartum discharge (EPD) as a discharge occurring within 48 hours of postpartum. EPD has been advocated by patients as part of the humanization of care after delivery and by health services as a more efficient management of resources. Controversies in relation to EPD focus on its impact on initiation and maintenance of breastfeeding, the possible increase of readmissions of newborns with jaundice and the influence on newborn screening for endocrine and metabolic disorders. PATIENTS AND METHODS: Five years ago we started an EPD program for healthy term newborns. We present a descriptive observational study including a series of 2798 consecutive live newborns over a period of 19 months (April 1996 to October 1997). Data about breastfeeding at the time of discharge, coverage of hypothyroidism and phenylketonuria screening and readmissions for newborn jaundice were collected during this period. RESULTS: During the defined period of time, 2798 live newborns were registered. Of these, 2109 (75.38%) were included in the EPD group, the majority of them (75.86%) between 24 and 40 hours postpartum. Breastfeeding was implemented in 95.82% of the newborns, 3.56% of the mothers decided to use artificial formulas and 0.52% were prescribed artificial formulas due to health problems in the mother. In relation to newborn screening of endocrine and metabolic diseases, we found similar coverage of hypothyroid screening compared to the other 7 maternities in our province (public and private) and of phenylketonuria screening compared to the other 5 primary care districts. Regarding newborn jaundice, we detected 47 readmissions, which is 2.23% of the total EPD. These newborns were treated with phototherapy and none required exchange transfusion. The mean value of total serum bilirubin at the time of readmission was 18.7 mg/dl, with a range between 15.1 and 22.6 mg/dl. CONCLUSIONS: In our experience, 75.38% of live newborns were included in a EPD program that has been shown to be safe in relation to controversial subjects, although the limitations of an observational study must be taken into consideration. The safety of this program is inferred by the high proportion of breastfeeding on EPD (95.82%), coverage of endocrine and metabolic screening comparable to other surrounding hospitals and adequate control of hyperbilirubinemia in the newborn period.

[Effectiveness of brain imaging in children with headache]. / Efectividad de los estudios de neuroimagen en niños con cefalea.

OBJECTIVE: Headache is a common complaint in children and brain imaging has become widely used to evaluate this clinical condition. We studied the value of neuroimaging in children with chronic headaches. PATIENTS AND METHODS: A retrospective chart review was conducted of all children referred to the pediatric outpatient clinic for evaluation of headache over a 3-year period. The charts were reviewed for headache characteristics, clinical indications for performing neuroimaging, and imaging results. Special attention was paid to evidence of space-occupying lesions. RESULTS: A total of 160 records were studied, with subjects ranging in age from 4 to 14 years. Most patients were diagnosed as having migraine headaches (60%) or chronic tension headaches (29.5%). Other diagnoses were post-traumatic (6%) and unclassified (4%). Sixty-six patients (41%) had computed tomography imaging performed. In most cases, brain imaging studies were performed because of clinical data (41%) like atypical pattern, sleep-related headache or increase of headache, because of the parents' concerns about brain lesions (38%) and because of an age less than 5 years (14%). Structural changes were found on brain imaging in 4 patients, but none indicated the presence of a treatable space-occupying lesion and all were deemed unrelated to the headache. Our findings of no relevant abnormalities in a series of 66 neuroimaging studies indicate that the maximal rate at which such abnormalities might appear in this population is 4.4%. CONCLUSIONS: These results indicate that neuroimaging studies have very limited value in the clinical evaluation of pediatric patients with chronic headache and should be reserved for those patients with clinical evidence suggestive of underlying structural lesion.