Physiologic amputation: a case study.

Acute limb ischemia is a complication of severe peripheral arterial disease that can be a threatening limb as well as life. Multiple procedures exist today to help revascularize extremities; however, even with the latest technologies, surgical amputation of the limb may still be necessary. Cryoamputation, or physiologic amputation, is a method used to treat patients who are hemodynamically unstable for the operating room and who are in need of urgent amputation owing to arterial ischemia. This procedure is used in the rare instance where not only a persons' limb is threatened, but also their life. This is a case study regarding one patient who presented to the hospital with limb-threatening ischemia who became hemodynamically unstable owing to the rhabdomyolysis associated with the ischemia of his lower extremity. Cryoamputation was used to stabilize the patient and prevent further deterioration, so that he could safely undergo surgical amputation of the limb without an increase in mortality risk. Cryoamputation must be followed by formal surgical amputation when the patient is hemodynamically stabilized. It is not a limb salvaging, procedure but it is a life-saving procedure. This case study demonstrates the usefulness of the procedure and discusses the technique used for cryoamputation.

[Patients who undergo cryoplasty. Nursing results (NOC), tolerance to this operation]. / Pacientes sometidos a crioplastia. Resultado de enfermería (NOC) tolerancia a la actividad.

The medical profession has started to use a new treatment for peripheral vascular disease: cryoplasty. The objective of this article is to study the results of nursing treatment "tolerance to this operation" for patients who undergo this technique, cryoplasty. In order to know what indicators are those most adequate to quantify its evolution, the author chose these indicators: Taking a walk, Length of walk, Tolerance to climbing stairs, Ease in carrying out Daily Life Activities, Resistance by the lower body and speaking ability while exercising. The author gave a pre-and post-cryoplasty grade for each of these indicators on a 5 point Likert evaluation scale.

Procedimiento enfermero en criocirugía prostática / No disponible

Se nos presenta una técnica de cirugía mínimamente invasiva que, sin perder eficacia, ofrece múltiples ventajas para el paciente y para la Administración. De la adopción de esta técnica nace una serie de cuestiones como el aprendizaje de la técnica y su aparataje y la necesidad de crear una herramienta de trabajo (procedimiento enfermero) con un triple objetivo claro y definido, consistente en ayudar a la enfermera quirúrgica en su trabajo, aumentar el beneficio para el paciente y coordinarse correctamente con el resto del equipo quirúrgico. Dicho proceder se desarrolla a lo largo del artículo, concluyendo los autores que el trabajo de enfermería es fundamental e insustituible en el equipo quirúrgico para conseguir resultados óptimos con alta calidad y coordinar todos los recursos humanos y materiales capaces de proporcionar cuidados sanitarios a la población (AU)

A technique of minimumly invasive surgery appears to us, that without losing effectiveness, offers manifold advantages for the patient and the administration. Of the adoption of this technique a series of questions like the learning of the technique and its instruments is born and the necessity to create a tool of work (procedure nurse) with three clear and defined objective triple, consisting of helping to the surgical nurse in their work, increasing to the benefit the patient and to coordinate itself correctly with the rest of the surgical team. Concluding the authors who the work of infirmary is fundamental and irreplaceable in the surgical team to obtain optimal results with high quality and to coordinate all the human and material resources able to provide sanitary cares to the population (AU)

The maze III surgical procedure.

The maze III procedure is a surgical treatment for atrial fibrillation (A fib), a rhythm problem in which the heart's upper chambers (i.e., atria) beat rapidly and irregularly, sometimes beating more than 400 times per minute. Approximately 10% of Americans older than 60 years of age suffer from A fib. The maze procedure was designed to create a maze on the atria with multiple incisions that allow sinus rhythm to be conducted to the atrioventricular node without creating a reentry circuit. Currently, it is not a widely used procedure, but its popularity continues to increase. The maze III procedure generally is reserved as a treatment of last resort for a patient with A-fib that is unresponsive to medication therapy, electrical cardioversion, surgical ablation, or pacemaker implantation. The maze III procedure, performed as open-heart surgery, has a high success rate for sustaining normal heart rhythms, usually without the need for a pacemaker; however, all other medical and nonsurgical treatment options are exhausted before the maze III procedure is performed.

Managing patients with cryosurgical ablation of the prostate and liver.

Cryosurgery is an important alternate treatment for some patients diagnosed with prostate and liver metastasis cancer. The procedure, its benefits and side effects, and implications for nurses are discussed.

Cryosurgical ablation of unresectable hepatic tumors.

Ultrasound-guided hepatic cryosurgery is a potential treatment option for select patients with unresectable tumors. Intraoperative placement of cryoprobes and monitoring of tumor freezing with ultrasonography produce complete remission in 22% to 29% of patients with unresectable metastatic colorectal tumors to the liver. Perioperative nurses should be knowledgeable about cryosurgical techniques and be prepared to participate in this innovative treatment modality to provide optimal care to surgical patients.

Hepatic cryosurgery for metastatic colorectal carcinoma.

PURPOSE/OBJECTIVES: To review an innovative, potentially curative surgical approach for the treatment of select patients with colorectal cancer metastatic to the liver. DATA SOURCES: Published articles and reported and unreported research results. DATA SYNTHESIS: The liver is the primary site of recurrence in 60%-80% of patients who develop recurrent disease following resection of the colorectal primary cancer. Less than 25% of patients with liver metastases are candidates for hepatic resection because of the location or number of liver metastases. Hepatic cryosurgery provides a viable treatment option for some patients with unresectable metastatic colorectal carcinoma confined to the liver, including patients with bilobar and multiple lesions. CONCLUSIONS: Because colorectal cancer is the second most common cause of cancer mortality in the United States, interventions that improve survival rates are an important focus of care. With knowledge of patient selection criteria and implications of hepatic cryosurgery, informed oncology nurses are resources for patients contemplating this therapy. IMPLICATIONS FOR NURSING PRACTICE: Preoperative evaluation and postoperative nursing care focus on careful assessment, education, and interventions aimed at preventing and detecting complications unique to hepatic cryosurgery. Knowledge of hepatic cryosurgery as a treatment option for colorectal liver metastases, patient selection criteria, and related implications allows oncology nurses to serve as resources for patients and families considering this therapy.

Cryosurgical ablation of the prostate.

A new surgical procedure, cryosurgical ablation of the prostate, offers patients with organ-confined prostate cancer another treatment option. The advantages of this cryosurgical technique are complete ablation of prostatic cancers without radical prostatectomy procedures, less blood loss, decreased hospital stays, reduced health care costs, and minimal associated morbidity. Some possible complications of cryosurgical ablation of the prostate procedures include incontinence, impotence, rectal freezing from inadequate monitoring of the freezing process, urethrocutaneous and urethrorectal fistula formations, and urethral tissue sloughing. The intraoperative nurse's prime responsibility is to monitor the subfreezing temperatures of the cryoprobes. Postoperatively, patients have only a few perineal incisions covered with sterile dressings and a suprapubic catheter. Most patients have minimal discomfort that is managed easily with opiate analgesics.

Cryosurgical ablation of the prostate: a nursing perspective.

1. Cryosurgical ablation of the prostate is an attempt to use the proved cytodestructive abilities of cryosurgery in combination with the guidance of transrectal ultrasound to provide local disease control with less morbidity and a quicker recovery period. 2. Cryosurgical ablation of the prostate begins as a same day admission. Patients are out of bed and eating as tolerated that evening. They are generally discharged the following day if able to manage the suprapubic tube. 3. Though the recovery period is generally a quick one, there exist many idiosyncrasies to this recovery which make careful interaction between the physician, nurse, and patient critical.

Home care of the prostate cryosurgery patient.

1. Through the use of the pathway process, variation in home care of the prostate cryosurgery patient is reduced in caregiver technique and efficiency of care delivery is improved. More importantly, patient outcomes are closely monitored and multidisciplinary continuity of care is promoted. The pathway helps ensure that appropriate resources are initiated and used in appropriate timeframes. 2. A patient version of the critical pathway, written in lay terminology, is given to patients to define their responsibilities in the care process. This method encourages patient participation in care. 3. The purpose of home care is to educate the patient about his disease process and treatment regimen, and encourage him to participate in his treatment and recovery. The prostatic cryosurgery pathway gives him an opportunity to be active in his care.

Retinoblastoma.

Retinoblastoma, although a rare childhood cancer, is the most common primary malignant intraocular tumor of infancy and early childhood. In 75% of the cases, retinoblastoma is unilateral, and in 25% of the cases, retinoblastoma is bilateral. Presenting signs and symptoms of retinoblastoma, genetics, diagnostic tests, and their implications are reviewed in this paper. Treatment options for retinoblastoma (enucleation, external beam radiation, radioactive plaque, cryotherapy, photocoagulation, and chemotherapy) and their nursing care are discussed. Finally, second tumors such as osteosarcomas are discussed.

Cryosurgery for the dermatology nurse.

While cryosurgery is not a panacea for all malignant skin tumors, it is a very useful tool in the armamentarium of the cancer therapist confronted with a malignancy of the skin. Cryosurgery and the nurse's role in educating patients receiving the treatment are discussed.