ABSTRACT
It is important for nurses to increase their understanding of poststroke dysphagia because nurses are often the first to observe the signs and symptoms of dysphagia. An increased awareness of dysphagia and its complications should help prepare nurses to assess high-risk clients, advocate for prompt diagnosis, use compensatory interventions, and educate clients and their family members. Dysphagia is common after clients have had a stroke, and it places them at risk for numerous complications. Prompt assessment and intervention are required and may decrease clients' problems. This article presents an overview of the normal swallowing reflex to facilitate readers' understanding of dysphagia and discusses the assessment, diagnosis, and treatment of dysphagia as well as related nursing implications. An individualized plan of care for a dysphagic client requires input from the entire interdisciplinary team, and nurses must ensure adherence to this plan on a 24-hour-per-day basis.
Subject(s)
Deglutition Disorders/etiology , Deglutition Disorders/nursing , Stroke/complications , Deglutition Disorders/diagnosis , Deglutition Disorders/physiopathology , Deglutition Disorders/rehabilitation , Humans , Nursing Assessment/methods , Patient Care Planning , Patient Care Team , Rehabilitation Nursing/methods , Risk FactorsABSTRACT
Autonomic dysreflexia, or hyperreflexia, is a life-threatening condition that can occur in a person with a spinal cord injury at or above the T6 level. The classic signs and symptoms are severe hypertension, pounding headache, and diaphoresis. Prevention is the key to avoiding this disease process. This article reviews the pathophysiology, precipitating factors, signs and symptoms, nursing management, and effects of the problem. All healthcare providers must be aware of this condition in order to prevent permanent impairments in clients who may experience it.
Subject(s)
Autonomic Nervous System Diseases , Autonomic Nervous System Diseases/diagnosis , Autonomic Nervous System Diseases/etiology , Autonomic Nervous System Diseases/physiopathology , Autonomic Nervous System Diseases/therapy , Humans , Nursing Assessment , Nursing Diagnosis , Precipitating Factors , Rehabilitation NursingABSTRACT
PURPOSE: To test the usefulness of lower limb Doppler venous compression ultrasound (US) and serum D-dimer measurements in diagnosis of pulmonary embolism in patients in whom ventilation-perfusion (V-P) scans indicate intermediate probability of pulmonary embolism. MATERIALS AND METHODS: V-P scanning, pulmonary angiography, US, and D-dimer measurements were performed in 36 patients without known deep venous thrombosis but with intermediate probability of having a pulmonary embolism. RESULTS: Pulmonary angiography demonstrated pulmonary embolism in 15 (41%) of 36 patients. US demonstrated deep venous thrombosis in only two patients, both with pulmonary embolism. Sensitivity of US was only 13%, but specificity was 100%. Five (14%) of the 36 patients had normal (< 220 micrograms/L) D-dimer levels; none of the five had pulmonary embolism. Sensitivity and specificity of D-dimer values were 100% and 16%, respectively, with a negative predictive value of 100%. CONCLUSION: Combined D-dimer measurement and US were helpful in correctly diagnosing pulmonary embolism in only seven (20%) of 36 patients. Pulmonary angiography is still required to diagnose pulmonary embolism in the majority of patients.
Subject(s)
Fibrin Fibrinogen Degradation Products/analysis , Pulmonary Embolism/diagnostic imaging , Enzyme-Linked Immunosorbent Assay , Humans , Predictive Value of Tests , Pulmonary Embolism/diagnosis , Radionuclide Imaging , Sensitivity and Specificity , Thrombophlebitis/diagnosis , Thrombophlebitis/diagnostic imaging , UltrasonographyABSTRACT
Patients with recurrent high bile duct strictures pose special problems for management. Relief of obstruction by hepaticojejunostomy is usually possible but the standard technique does not permit long term access. Six patients with benign strictures involving hepatic ducts have been treated by a simple modification of hepaticojejunostomy retaining access for either balloon dilatation of intrahepatic strictures or investigation and treatment at a later stage if problems recur. Employing a longer than usual Roux-en-Y loop, the sutured anastomosis of right and left hepatic ducts is performed 10-15 cm from the free end of jejunum. Silastic tubes are placed into each hepatic duct crossing the anastomosis to exit from the free end of the jejunum which is closed around the tubes. The closed end of jejunum is buried in the peritoneum deep to linea alba and the tubes emerge in the epigastrium. Safe access is retained via the tubes. If the tubes are removed, a 'mini-lap' will expose the Roux loop for endoscopic or radiological access.
Subject(s)
Cholestasis, Extrahepatic/surgery , Hepatic Duct, Common/pathology , Jejunum/surgery , Liver/surgery , Adolescent , Adult , Cholangitis/complications , Cholestasis, Extrahepatic/etiology , Constriction, Pathologic/surgery , Female , Humans , Male , Sclerosis/complicationsABSTRACT
The pulse volume recorder has been used in studying 62 limbs to assess its accuracy in localization of arteriosclerotic lesions of the lower limbs, realizing the limitations of clinical examination and simple pressure measurements. Its advantages over simple pressure measurements are illustrated. It was shown to be most accurate in locating isolated stenoses. The technique helps differentiate aorto-iliac from high superficial femoral artery obstruction. It can be used when severe medial sclerosis is present and is very helpful when distal pulses cannot be detected for technical reasons.
