Nursing process decision support system for urology ward.

PURPOSE: We developed a nursing process decision support system (NPDSS) based on three clinical pathways, including benign prostatic hypertrophy, inguinal hernia, and urinary tract stone. NPDSS included six major nursing diagnoses - acute pain, impaired urinary elimination, impaired skin integrity, anxiety, infection risk, and risk of falling. This paper aims to describe the design, development and validation process of the NPDSS. METHODS: We deployed the Delphi method to reach consensus for decision support rules of NPDSS. A team of nine-member expert nurses from a medical center in Taiwan was involved in Delphi method. The Cronbach's α method was used for examining the reliability of the questionnaire used in the Delphi method. The Visual Basic 6.0 as front-end and Microsoft Access 2003 as back-end was used to develop the system. A team of six nursing experts was asked to evaluate the usability of the developed systems. A 5-point Likert scale questionnaire was used for the evaluation. The sensitivity and specificity of NPDSS were validated using 150 nursing chart. RESULTS: The study showed a consistency between the diagnoses of the developed system (NPDSS) and the nursing charts. The sensitivities of the nursing diagnoses including acute pain, impaired urinary elimination, risk of infection, and risk of falling were 96.9%, 98.1%, 94.9%, and 89.9% respectively; and the specificities were 88%, 49.5%, 62%, and 88% respectively. We did not calculate the sensitivity and specificity of impaired skin integrity and anxiety due to non-availability of enough sample size. CONCLUSIONS: NPDSS can help nurses in decision making of nursing diagnoses. Besides, it can help them to generate nursing diagnoses based on patient-specific data, individualized care plans, and implementation within their usual nursing workflow.

Urinary tract stones: types, nursing care and treatment options.

Stones (calculi) in the urinary tract (urolithiasis) or kidney (nephrolithiasis) occur in 5% of the population. The lifetime risk of passing a stone is 8-10%. Men are twice as likely to develop stones, with the first episode occurring before 30 years of age. Stones are caused by the aggregation of crystalline mineral deposits in the urine. Calcium stones are the most common type of stone. Investigations for stone disease include plain X-ray, X-ray with contrast media, ultrasound imaging, and computed tomographic (CT) scanning. Treatment of stones is dependent on the size and location, e.g. lithotripsy is used to break down stones in the ureter or kidney, whereas litholapaxy is used for stones in the bladder that are too large to be passed urethrally. Alpha-blocker medication (e.g. tamsulosin) can facilitate spontaneous passing of a stone. Nurses have a crucial role in assessment, management and provision of discharge advice for patients. Strategies for preventing stones include increasing the urine output (by giving 2-3 litres of fluid per day) and dietary modification, particularly reduction in animal protein and salt content.

Planes de cuidados de enfermería en litotricia extracorpórea por ondas de choque / No disponible

El diagnóstico médico ya nos viene dado por el médico que lo remite a nuestra unidad, y es el de litiasis renal o ureteral y sus distintas localizaciones. Pero el diagnóstico enfermero es otro muy distinto, pues se basa en la conducta del paciente frente a la enfermedad y al tratamiento, y en otros factores que influyen negativamente o tienen la posibilidad de afectar perjudicialmente a la obtención de un resultado óptimo del tratamiento de ondas de choque. Para que las actuaciones de enfermería sean llevadas a cabo mediante un método científico y el resultado del tratamiento sea lo más eficaz posible, hay que hacer en un principio la identificación de las alteraciones que presenta el paciente, es decir, hacer un diagnóstico. Para posteriormente describir las actuaciones que se deben llevar a cabo según los diagnósticos, y finalmente hacer una valoración de los resultados obtenidos. Así, realizando el método científico mediante la NANDA, el NIC y el NOC, haremos los siguientes diagnósticos y actuaciones (AU)

The medical diagnosis or comes dice by the doctor who sends to our unit, and is a renal or ureteral litiasis and its different locations. But the diagnosis nurse is very different other, because it is based as opposed to on the conduct of the patient the disease and to the treatment, and in other factors that influence negatively or have the possibility detrimentally of affecting the obtaining of an optimal result of the treatment of shock waves. So that the infirmary performances are carried out by means of a scientific method and the result of the possible most effective treatment, it is necessary to make at first the identification of the alterations that presents the patient, that is to say, make a diagnosis. Later to describe the performances that are due to carry out according to the diagnoses, and finally to make a valuation of the obtained results. Thus, making the scientific method by means of the NANDA, the NIC and the NOC we will make the following diagnoses and performances (AU)

Urolithiasis/nephrolithiasis: what's it all about?

Urolithiasis (urinary tract calculi or stones) and nephrolithiasis (kidney calculi or stones) are well-documented common occurrences in the general population of the United States. The etiology of this disorder is multifactorial and is strongly related to dietary lifestyle habits or practices. Proper management of calculi that occur along the urinary tract includes investigation into causative factors in an effort to prevent recurrences. Urinary calculi or stones are the most common cause of acute ureteral obstruction. Approximately 1 in 1,000 adults in the United States are hospitalized annually for treatment of urinary tract stones, resulting in medical costs of approximately dollar 2 billion per year (Ramello, Vitale, & Marangella, 2000; Tanagho & McAninch, 2004).

Percutaneous nephrostolithotomy: a means of managing urinary calculi.

Percutaneous nephrostolithotomy is a minimal invasive procedure designed to identify and remove kidney and ureteral stones using a percutaneous tract. Although a radiologist establishes the tract, the preoperative preparation and setup by the circulating nurse and surgical technician establishes appropriate equipment, a safe surgical environment for skin preparation, positioning, draping, and for performing the surgical procedure with a positive patient outcome.

Urinary tract stones: causes, complications and treatment.

Stones or calculi in the urinary tract affect up to 12% of men and 5% of women by the age of 70 years, with more than a third of individuals having a strong family history (Unwin, 1996). Complications include obstruction in the urinary tract, pain, nausea, vomiting and sepsis. Common causes are: urine stasis, infection, presence of foreign bodies, dehydration, diet and periods of immobility. Encouraging initial diuresis could exacerbate rather than relieve symptoms. Discharge advice is a key feature of preventing recurrence once the predisposing factors have been identified. The relationship between patient and nurse is an invaluable and ideal opportunity for nurses to educate patients in appropriately changing dietary habit and in maintaining a urine output of greater than 2 litres per day.

Laser lithotripsy. Patient care, staff education.

The high cost of laser equipment and the required specialization of staff members make extension of laser lithotripsy to every hospital impractical. At present, in Ontario, laser lithotripsy is available only in Toronto and Kingston, and ESWL is available only in Toronto and London. Laser lithotripsy is a viable alternative to invasive surgical treatment of urinary calculi that are resistant to ESWL. For the suitable candidate, laser lithotripsy is a welcome alternative to an extensive surgical procedure and recovery period. Hospitalization is reduced significantly, and patients can return to work after the calculus and residue have been passed. Patients can be managed safely and effectively, resulting in reduced morbidity and mortality and reduced cost in time and expense to the patient and hospital.

Laser lithotripsy: a nursing perspective.

Laser lithotripsy represents the urologist's newest option in urinary stone management and is fast becoming the procedure of choice when treating calculi. Approximately 400,000 people yearly require treatment for urinary stone disease. 60% pass the calculi spontaneously while 40% require some type of intervention (Dretler, 1988). While the initial cost of the laser is expensive, maintenance cost is relativity low. Therefore, the laser lithotripter becomes a very cost effective tool when compared with other alternatives because of the decreased hospital stay and the absence of significant complications. Adverse effects to the patient are primarily due to the endoscopic procedure and not the laser itself. Additional benefits to the patient include reduced pain and edema, minimal bleeding, no incision and decreased convalescence time.