Paciente con fístula enterocutánea e importante deterioro de la integridad cutánea / No disponible

Plan de cuidados individualizado para un paciente de 77 años que desarrolla una fístula enterocutánea de alto débito tras varias cirugías urgentes, debidas a complicaciones en el postoperatorio de una eventroplastia compleja y hemicolectomía derecha urgente por diagnóstico de suboclusión intestinal y eventración paraestomal. El manejo inicial se realizó con terapia de presión negativa. Debido al gran número de fugas e irritación de la piel, se optó por la bolsa de drenaje postquirúrgico Sistema para el manejo de Fístulas y Heridas Coloplast(R). El principal objetivo de los cuidados debe ser la protección de la piel frente al efecto corrosivo del efluente, para favorecer la epitelización, la disminución de la pérdida de la integridad cutánea y mejorar notablemente la calidad de vida percibida por el paciente. Una apropiada selección del material de curas y los cuidados individualizados permiten alcanzar estos objetivos

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Cuidados de la herida con fístula enterocutánea postoperatoria / No disponible

Las fístulas enterocutáneas son un problema mayor en la práctica quirúrgica. En general son secundarias a complicaciones postoperatorias. Hasta el 90% de los casos se desarrolla después de una cirugía. La morbilidad y la mortalidad continúan siendo muy elevadas a pesar de los avances en el manejo de esta patología. Las tres complicaciones principales de los pacientes con fístulas son desequilibrio hidroelectrolítico, desnutrición y sepsis, las cuales están en relación con la localización de la fístula, el gasto, las características bioquímicas y electrolíticas de la descarga y la condición patológica subyacente. El objetivo final en el manejo de los pacientes con fístulas es el cierre de la misma. En 1964, Chapman propuso un plan de tratamiento de los pacientes con base en cuatro prioridades. El propósito del tratamiento médico es el cierre espontáneo de la fístula o la preparación del paciente para cirugía. La instalación de un apoyo nutricional adecuado juega un papel esencial para el éxito del tratamiento. El control de la sepsis es una prioridad; la sepsis descontrolada debe ser atacada rápidamente ya que es la principal causa de muerte. El cierre espontáneo ha aumentado en los últimos años; sin embargo, es probable que todavía una gran parte de los pacientes necesite tratamiento quirúrgico, y éste debe ser realizado en el momento adecuado

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Management of intestinal failure and high-output stomas.

Intestinal failure and a high faecal output from a stoma or fistula are rare gastrointestinal complications. Intestinal failure occurs when the intestine fails to absorb sufficient fluids and nutrients to maintain life, and can result from bowel resection or malabsorption. The management of these conditions raises many issues which nurses caring for affected patients need to consider. This article will discuss those relating to feeding, appliances and medication. Two methods of feeding that can be useful in patients with intestinal failure, namely parenteral nutrition (intravenous feeding) and fistuloclysis (feeding via an intestinal fistula), will be explored. Finally, a short case study will be presented to highlight the effects of some of these interventions and the problems that they can cause for patients.

Colocutaneous fistula management in a dehisced wound: a case study.

A fistula is an abnormal opening between two or more organs or structures. Wound drainage containment is a key component of nonsurgical fistula management and may include pouches, skin barriers, transparent dressings, troughing procedures, saddle bagging, bridging, and condom and suction catheters used in combination with complex or routine pouching. Following extensive abdominal surgery, the wound of a 50-year-old woman dehisced and a colocutaneous fistula formed inside the wound. The wound containing the fistula, which was draining liquid stool, was too large for existing commercial pouching systems. When initial management efforts, including negative pressure wound therapy, failed to achieve containment goals, clinicians adapted the negative pressure wound therapy dressing to surround the fistula, which helped facilitate therapy while providing a platform for an ostomy appliance to contain the fistula drainage. The system was changed every 2 days until discharge. The wound and fistula management combination improved patient comfort and mobility, facilitated healing, and reduced patient dietary restrictions.

[Tables of Moses: nursing research project]. / Mosè--le tavole, progetto di ricerca infermieristica.

UNLABELLED: A review of literature and in others realities of our country has been done to verify the existence of welfare procedure in stomatherapy. It has been pointed out that the behaviours are not supported by evidence and that the given performances are not measurable. It borns the idea to start a nursing research finalized to define care standards procedures supported by evidence. MATERIALS AND METHOD: Once the project group is formed with nurses, ET nurses and surgeons, the research is structured in the following points: predisposition of nursing protocols; predisposition of evaluation tools for each protocol; experimentation of the tools with 150 national investigators specifically trained; gathering, elaboration and interpretation of the data; on 13.172 forms picked up, 2.034 has been regularly fulfilled; distribution of the knowledge through a text, the associative magazine, presentation at courses and associative congresses; Research development: the critic results analysis has permitted to recognize areas on which continue the research. CONCLUSION: Data confirms the validity of specifics check-lists and protocols even if the research says the achievement of care standards results through codified performances, to disadvantage of a case-control way for example.

Tecnologia de cuidado: intervenção resolutiva de enfermagem ao portador de fístula faringocutânea

Fístula faringocutânea (FFC) é considerada uma séria complicação após laringectomia total, pois aumenta a morbidade e a mortalidade no tratamento de portadores de câncer de laringe. Por este motivo, os objetivos desta pesquisa foram apresentar a tecnologia de cuidado de enfermagem aplicada aos clientes laringectomizados com FFC e mostrar os resultados da tecnologia de cuidado usada como terapêutica de enfermagem sobre a cicatrização da FFC. Foi desenvolvido um estudo do tipo descritivo, retrospectivo, com abordagem quantitativa, numa amostra de 153 clientes laringectomizados com FFC, no período de janeiro de 2000 a agosto de 2003, no Instituto Nacional de Câncer, após aprovação pelo Comitê de Ética em Pesquisa. O referencial do estudo foi fundamentando na teoria de Enfermagem de Nightingale, no conceito de tecnologia do cuidado de Ceccim e na classificação das tecnologias em saúde de Merhy. Os achados foram analisados estatisticamente pelo programa EpiInfo 6.04. Os resultados mostraram que, em 90,85% dos casos estudados, ocorreu cicatrização da FFC numa média de 21,95 dias. Idade avançada, desnutrição e irradiação pré-operatória foram fatores de retardo cicatricial e, também, implicaram no aumento do quantitativo de ações de enfermagem, tanto técnicas como educativas e interdisciplinares. Conclui-se que a tecnologia de cuidado empregada como terapêutica de enfermagem foi eficaz na promoção da recuperação dos clientes estudados e que se constitui num modelo de cuidar. Portanto, propõe-se a utilização deste modelo com fins de validação.

The nursing management of enterocutaneous fistulae: a challenge for all.

This article focuses on the principles of managing patients with enterocutaneous fistulae. Successful management involves comprehensive assessment, planning, implementation and evaluation of care and involves all members of the multidisciplinary team in both primary and secondary care. The main challenge for the nursing team is effective containment of the effluent to prevent excoriation of the skin thereby ensuring patient comfort. The article includes suggestions for choice and application of suitable appliances which have been successfully used by the authors. Early involvement in of patient and carer in all aspects of management is recommended for successful discharge of patients into the community.

The nursing care of a patient with enterocutaneous faecal fistulae.

This article discusses the nursing care given to a patient with a large abdominal, enterocutaneous faecal fistula. It highlights classification, signs, symptoms and some causal factors related to fistulas. Fistulas are rare and there is minimal evidence-based knowledge on the subject. However, incorporating knowledge from other specialties, such as tissue viability, can assist in caring for this client group. Diagrams illustrate the extent of the problems and assist with understanding the appliance techniques. There are many problems that may be encountered in the care of fistulas that are not encountered with planned stomas. Difficulties may include containment of the faecal matter within a wound, problems associated with skin care, leakage and dietary issues. The author's methods of confronting and coping with these problems in this case study are discussed, with the aim of assisting other nurses in similar situations.

Managing the complications of diverticular disease.

This article provides an update on diverticular disease and its complications, focusing on the physical and psychological considerations in the nursing management of the disease. To illuminate the topic a case study is presented describing a patient who underwent Hartmann's procedure with temporary end colostomy. The patient subsequently developed three abscesses and a complex fistula around the stoma. Nursing care and the optimum interventions to preserve skin integrity during such complications are discussed. The article concludes with a summary of key facts regarding diverticular disease, abscess and fistula.

Fistula management following an appendicectomy: nursing challenges.

Preservation of skin integrity, nutritional support and removal of odour are key features of fistula management. This case study describes the care of a patient with a fistula wound that discharged copious amounts of semi-solid faecal matter.

The use of wound drainage bags for complex wounds.

The routine use of drainage devices for wound management is relatively uncommon because of the extensive range of dressings available. However, there is an almost equally large range of wound drainage devices with different designs and properties from which to choose. Large, complex wounds with a fistula draining small bowel content are difficult to manage. This article focuses on wound drainage bags and explores the case of a patient with a large abdominal wound with a fistula at the lower end whose effluent was contained by Wound Manager (manufactured by Craig Medical, obtained from ConvaTec).