Abordaje interdisciplinar del cuidado a una mujer con ostomía de alto débito / No disponible

Las complicaciones derivadas de una ostomía de alto débito provocan graves alteraciones nutricionales, cutáneas e infecciosas. El manejo de estas ostomías por parte de la persona portadora es muy complejo y genera problemas de autoestima y afrontamiento. Presentamos el caso de una mujer con ostomía de alto débito secundaria a síndrome de intestino corto, con malnutrición severa, dermatitis periestomal y grandes dificultades para el manejo de su situación. Tras valoración según necesidades de Virginia Henderson realizamos un abordaje interdisciplinar, con la elaboración de un plan de cuidados que contemplaba todos los aspectos del ser humano, biológicos, psicológicos y sociales. Se utilizaron los dispositivos adecuados para el control del efluente y el tratamiento y posterior prevención de la dermatitis. Las dificultades para el afrontamiento se abordaron desde un punto de vista holístico, facilitando el aprendizaje, proporcionando asesoramiento y apoyo emocional. Se adiestró a la persona en el manejo de la ostomía, la dieta y la higiene en la manipulación de los dispositivos para la TIV. Todo ello contribuyó a una mejor adaptación a su nuevo estado de salud

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Clinical Practice Guidelines for the Nursing Management of Percutaneous Endoscopic Gastrostomy and Jejunostomy (PEG/PEJ) in Adult Patients: An Executive Summary.

Enteral nutrition (EN) is the introduction of nutrients into the gastrointestinal tract through a tube placed in a natural or artificial stoma. Tubes may be passed into the stomach (gastrostomy) or the jejunum (jejunostomy) in patients who cannot obtain adequate nourishing via oral feeding. Following placement, nurses are typically responsible for management of gastrostomy or other enteral tube devices in both the acute and home care settings. This article summarizes guidelines developed for nursing management of percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEJ) and gastrojejunostomy (PEGJ) tubes, developed by the Italian Association of Stoma care Nurses (AIOSS-Associazione Italiana Operatori Sanitari di Stomaterapia) in collaboration with the Italian Association of Endoscopic Operators (ANOTE-Associazione Nazionale Operatori Tecniche Endoscopiche) and the Italian Association of Gastroenterology Nurses and Associates (ANIGEA-Associazione Nazionale Infermieri di Gastroenterologia e Associati). The guidelines do not contain recommendations about EN through nasogastric tubes, indications for PEG/PEJ/PEGJ positioning, composition of EN, selection of patients, type of tube, modality of administration of the EN, and gastrointestinal complications.

Improving ostomates' confidence with a discharge-solidifying agent.

Not every person with a stoma will develop problems or even feel that he or she is unable to manage a stoma independently. However, for the individual who does experience problems and struggles to cope, the stoma nurse is pivotal in providing resources and product experience. He or she can enable the ostomate to adapt to the stoma and maintain their quality of life. This article provides an overview of a solidifying agent and case studies illustrating how it can be used to help patients achieve independence.

Jejunostomy enteral feeding in children: outcome and safety.

BACKGROUND: The aim of this study was to report on the clinical outcome and safety of jejunostomy tube feeding used in our clinical setting for more than 14 years. MATERIAL AND METHODS: A retrospective study of all children who underwent a surgical catheter jejunostomy placement between July 1996 and March 2010 was conducted. Data were collected regarding the outcome and complications. RESULTS: Thirty-three children (14 girls) were included. The median age at the time of primary surgery was 1.43 years (range, 0.15-17.7 years), and the median time of follow-up was 2.34 years (range, 0.27-12.6 years). Seventeen children were severely neurologically impaired (NI). Surgical insertion of a jejunostomy tube was performed due to 1 or more of the following indications: gastroesophageal reflux disease (GERD), failure to thrive, recurrent pneumonia, esophageal disease, or oral feeding difficulties. The effect of the indications showed a reduction in GERD and pneumonia. Feeding difficulties also decreased. Weaning was possible in 12 of 16 children without NI but in only 2 of 17 with NI. Major complications requiring surgical reoperation affected 8 children. No mortality was related to the jejunostomy feeding catheter. CONCLUSION: In selected cases, surgically placed jejunostomy tubes for feeding in children is an effective and safe method to overcome GERD, feeding difficulties, or recurrent pneumonia without major surgery.

Intestinal failure and the ward nurses: causes, assessment and management.

In order to manage intestinal failure (IF), a complex regimen of care is required to manage fluid intake and electrolyte balance. In the majority of cases ward nurses will bare the responsibility of managing patients with these specific needs, with the support of the nutritional multidisciplinary team. Therefore, nurses need to ensure they have expert knowledge of each area of IF management. This article defines IF and outlines how it can be managed surgically and medically. The author discusses the role of the ward nurse in monitoring and managing therapy, and states the importance of providing emotional and psychological care.

Techniques for preventing and managing tube-related complications.

BACKGROUND: The management of jejunostomy and gastrostomy tubes that are not well stabilized and leak effluent around the insertion site present significant challenges to WOC nursing practice. The result is often peritubular skin erosion, patient discomfort, and high-volume fluid losses that are not measurable. CASE: WOC nursing was consulted when a 70-year-old woman with a jejunostomy tube experienced leakage, skin erosion, and pain. A novel technique for tube stabilization and local treatment of the peritubular skin was successful in stabilizing her jejunostomy tube, protecting the skin surrounding the tube, relieving associated pain, and enabling accurate measurement of output from the tube. Alternative strategies for stabilization and treatment are discussed. CONCLUSION: The outcomes of patients who have been treated with these strategies has been improved comfort since they do not feel any tube movement and decreased pain since the skin is protected from the caustic effluent and remains healthy and intact.

Enteral tube feeding--from hospital to home.

There are a number of benefits to providing home enteral feeding, however, problems can occur if care is not taken to arrange training and after-care appropriately. It is therefore essential to facilitate an informed and thorough transfer of care to minimize potential problems. This article will address some of the issues that arise when patients who require home enteral feeding are discharged from hospital to their own homes or to care homes. These issues include the knowledge that is required to enable the patient and/or carer to safely manage their feeding tube, the feeding regimen, the continuing support required from health-care professionals, and some of the more common problems that may arise.

Enteral feeding in neurologically impaired children with gastroesophageal reflux: Nissen fundoplication and gastrostomy tube placement versus percutaneous gastrojejunostomy.

Parents or caregivers of neurologically impaired children with gastroesophageal reflux who require enteral nutrition are often faced with the option of having their child undergo an antireflux surgery and placement of a gastrostomy tube or have a percutaneous gastrojejunostomy tube placed under fluoroscopic guidance. It is important that nurses have an understanding of these procedures and their associated risks and benefits as well as knowledge of the impact each might have on the daily life and care of these children to help support families during this decision-making process.

Nutritional support via enteral tube feeding in hospital patients.

Patients receiving enteral tube feeding are often encountered in the ward environment of an acute care setting. Patients may receive enteral tube feed through tubes intended for short-term feeding, or they may have a long-term feeding tube in situ. This article aims to provide a practical overview of feeding solutions and administration to enable nursing staff to understand prescribed regimens and provide patients with optimum care.

Nasojejunal tube placement in paediatric intensive care.

Nasojejunal delivery of enteral feeds is a safe and effective alternative to parenteral nutrition in critically ill children in whom intra-gastric feeding is usually poorly tolerated. A guideline for bedside placement of nasojejunal tubes (NJTs) was developed by a mulit-disciplinary group. An audit of practice was carried out following implementation of the guideline. During the audit period 27 NJTs were successfully passed in 21 patients. The result of this innovation has been early initiation of nasojejunal feeding and an increase in bedside placement of NJTs within the PICU. Paediatric radiologists have reported a reduction in requests for NJT placement under X-ray screening and there has been a reduction in the use of medication and X-ray to place NJTs. Based on the audit data, 58 per cent of the children would have definitely or probably commenced parenteral nutrition had NJT placement and feeding been unsuccessful. The audit also demonstrated that 26 out of 27 nurses and doctors reported they found the guidelines easy or very easy to follow. Reducing variations in practice through the use of guidelines increases the frequency of jejunal feeding. This benefits critically ill patients by improving tolerance of enteral feeding for better nutritional outcomes.

Management of a high-output stoma in the community: case study.

Nursing care of patients with high-output stomas in the community can be challenging. Large quantities of liquid effluent make containment and skin care high priorities. These issues can in some cases be further complicated by the need for parenteral nutrition (PN). Issues related to high output stomas will be briefly discussed and then a case study will show how one team of community nurses assisted a patient with a jejunostomy.

Case study of a patient with a distal jejunostomy.

A young man with a short but complicated medical history was seen in our enterostomal therapy department in a large acute-care facility. The patient had a distal jejunostomy with an extremely high and problematic output. Cases such as his force WOC nurses to review basic anatomy, physiology, and psychosocial development to provide holistic care in a specialized practice. Such cases can justify the existence of WOC nurses and prove they are a valuable asset in the health care system.

Bedside placement of small-bowel feeding tubes in the intensive care unit.

Early enteral feeding is beneficial to critically ill patients, although it is often a challenge to accomplish. When required, placing feeding tubes into the small bowel can be costly and difficult to carry out in a timely manner, often requiring fluoroscopic or endoscopic guidance. We implemented a modified protocol that enabled nurses to place feeding tubes at the bedside without fluoroscopy. This technique has resulted in timely placement, with initiation of enteral feeding in less than 24 hours. Ninety-five percent of the attempted placements were successfully completed at the bedside. Transport of patients was avoided, and no specialized equipment was required. Therefore, greater satisfaction for patients with less risk was possible, and caregivers benefited as well.

Swallowing difficulties protocol: medication administration.

Following his research (Wright 2002), David Wright developed this protocol for nurses to use when administering medication to patients who have swallowing difficulties.