Nursing problems in patients with toxic epidermal necrolysis and Stevens-Johnson syndrome in a Dutch burn centre: A 30-year retrospective study.

OBJECTIVE: Multiple studies have been published on toxic epidermal necrolysis (TEN) and Stevens-Johnsen syndrome (SJS). Nursing care is an important part of the treatment of TEN patients. Unfortunately, limited information on nursing in TEN/SJS patients has been published in the current literature. Nursing research is needed to improve the complex nursing care required for these rare patients. Therefore, the objective was to assess nursing problems in TEN patients in a burn centre setting over a 30-year period. METHODS: The data for this study were gathered retrospectively from nursing records of all patients with TEN/SJS admitted to Burn Centre Rotterdam between January 1987 and December 2016. Dutch burn centres were recently accepted as expertise centres for TEN patients. Nursing problems were classified using the classification of nursing problems of the Dutch Nursing Society. RESULTS: A total of 69 patients were admitted with SJS/TEN. Fifty-nine patient files were available. The most frequently reported nursing problems (>20% of the patients) were wounds, threatened or disrupted vital functions, dehydration or fluid imbalance, pain, secretion problems and fever. Furthermore, TEN-specific nursing problems were documented, including oral mucosal lesions and ocular problems. The highest number of concomitant nursing problems occurred during the period between days three and 20 after onset of the disease and varied by nursing problem. CONCLUSIONS: The most frequently reported nursing problems involved physical functions, especially on days three to 20 after onset of the disease. With this knowledge, we can start nursing interventions early in the treatment, address problems at the first sign and inform patients and their families or relatives of these issues early in the disease process. A next step to improve nursing care for TEN patients is to acquire knowledge on the optimal interventions for nursing problems.

Validation of the nursing interventions and activities for patients on hemodialytic therapy. / Validação de intervenções e atividades de enfermagem para pacientes em terapia hemodialítica.

OBJECTIVE: To validate interventions and nursing activities proposed by the Nursing Interventions Classification for patients with acute renal failure or acute chronic renal disease in hemodialysis therapy with the Excess Fluid Volume and Risk for Imbalanced Fluid Volume nursing diagnoses. METHODS: Validation of content with 19 expert nurses from a university hospital. The data collection was made from September to November 2011 through instruments that contained the interventions and nursing activities in study. The data analysis considered the average of scores obtained in the validation process. RESULTS: The Fluid Management was validated as a priority intervention (mean ≥ 0.8), with eight main activities for the Excess Fluid Volume nursing diagnosis and eight for the Risk for Imbalanced Fluid Volume nursing diagnosis. CONCLUSION: The validated intervation of the Fluid Management enables the monitoring of the hydric balance and facilitates the prevention of complications, which are important activities in the nursing care of the patients in hemodialysis therapy.

Tumor Lysis Syndrome: A Unique Solute Disturbance.

Tumor lysis syndrome (TLS) is a life-threatening disorder that is an oncologic emergency. Risk factors for TLS are well-known, but the current literature shows case descriptions of unexpected acute TLS. Solid tumors and untreated hematologic tumors can lyse under various circumstances in children and adults. International guidelines and recommendations, including the early involvement of the critical care team, have been put forward to help clinicians properly manage the syndrome. Advanced practice nurses may be in the position of triaging and initiating treatment of patients with TLS, and need a thorough understanding of the syndrome and its treatment.

Validação de intervenções e atividades de enfermagem para pacientes em terapia hemodialítica / Validación de intervenciones y actividades de enfermería para pacientes en terapia hemodialítica / Validation of the nursing interventions and activities for patients on hemodialytic therapy

RESUMO Objetivo Validar intervenções e atividades de enfermagem propostas pela Nursing Interventions Classification, para pacientes com insuficiência renal aguda ou doença renal crônica agudizada, em terapia hemodialítica com os diagnósticos de enfermagem Volume de Líquidos Excessivo e Risco de Volume de Líquidos Desequilibrado. Métodos Validação de conteúdo com 19 enfermeiros peritos de um hospital universitário. A coleta de dados ocorreu de setembro a novembro de 2011, por meio de instrumentos que continham as intervenções e atividades de enfermagem em estudo. A análise considerou a média dos escores obtidos na validação. Resultados O Controle Hídrico foi validado como intervenção prioritária (média ≥ 0.8), com oito atividades principais para o diagnóstico Volume de Líquidos Excessivo e oito para o diagnóstico Risco de Volume de Líquidos Desequilibrado. Conclusão A intervenção validada de Controle Hídrico possibilita o monitoramento do equilíbrio hídrico e facilita a prevenção de complicações, consideradas importantes atividades do cuidado ao paciente em terapia hemodialítica.

RESUMEN Objectivo Validar intervenciones y actividades de enfermería propuestas por la Nursing Interventions Classification, para pacientes con insuficiencia renal aguda o enfermedad renal crónica agudizada, en terapia hemodialítica con los diagnósticos de enfermería Volumen de Líquidos Excesivo y Riesgo de Desequilibrio de Volumen de Líquidos. Métodos Validación de contenido con 19 enfermeros expertos de un hospital universitario. La recolección de datos fue realizada de septiembre a noviembre de 2011 con instrumentos que contenían las intervenciones y actividades de enfermería en estudio. El análisis consideró el promedio de los puntajes obtenidos en la validación. Resultados El Manejo de Líquidos fue validado como intervención prioritaria (media >0.8), con ocho actividades principales para el diagnóstico Volumen de Líquidos Excesivo y ocho para el diagnóstico Riesgo de Desequilibrio de Volumen de Líquidos. Conclusión La intervención validada de Manejo de Líquidos posibilita el monitoreo del balance hídrico y facilita la prevención de complicaciones, consideradas importantes actividades del cuidado al paciente en terapia hemodialítica.

ABSTRACT Objective To validate interventions and nursing activities proposed by the Nursing Interventions Classification for patients with acute renal failure or acute chronic renal disease in hemodialysis therapy with the Excess Fluid Volume and Risk for Imbalanced Fluid Volume nursing diagnoses. Methods Validation of content with 19 expert nurses from a university hospital. The data collection was made from September to November 2011 through instruments that contained the interventions and nursing activities in study. The data analysis considered the average of scores obtained in the validation process. Results The Fluid Management was validated as a priority intervention (mean ≥ 0.8), with eight main activities for the Excess Fluid Volume nursing diagnosis and eight for the Risk for Imbalanced Fluid Volume nursing diagnosis. Conclusion The validated intervation of the Fluid Management enables the monitoring of the hydric balance and facilitates the prevention of complications, which are important activities in the nursing care of the patients in hemodialysis therapy.

Applicability of nursing outcomes in patients with heart failure and fluid volume excessive. / Aplicabilidade dos resultados de enfermagem em pacientes com insuficiência cardíaca e volume de líquidos excessivo.

OBJECTIVE: The purpose of this study was to test the clinical applicability of the Nursing Outcomes Classification in patients with decompensated heart failure and the nursing diagnosis of fluid volume excess. METHODS: This is a longitudinal study conducted in two stages at a university hospital, in 2013. During the first stage the consensus of experts was used to select the nursing outcomes and the indicators related to diagnosing fluid volume excess. The longitudinal study was conducted in the second stage to clinically evaluate the patients using the instrument containing the results and indicators produced in the consensus. RESULTS: A total of 17 patients were assessed. The nursing outcomes were measured during the clinical evaluation by analysing their indicators. The scores increased in six of the results, in comparison with the average results of the first and last assessment. The Nursing Outcomes Classification during medical practice revealed a clinical improvement among the patient who were admitted following decompensated heart failure. CONCLUSION: The Nursing Outcomes Classification managed to detect changes in the clinical status of patients.

Aplicabilidade dos resultados de enfermagem em pacientes com insuficiência cardíaca e volume de líquidos excessivo / Aplicabilidad de los resultados de enfermería en pacientes con insuficiencia cardíaca y exceso de volumen de líquidos / Applicability of nursing outcomes in patients with heart failure and fluid volume excessive

RESUMO Objetivo Testar a aplicabilidade clínica da Nursing Outcomes Classification em pacientes com insuficiência cardíaca descompensada e Diagnóstico de Enfermagem Volume de Líquidos Excessivo. Métodos Estudo longitudinal conduzido em duas etapas em um hospital universitário no ano de 2013. Na primeira etapa, utilizou-se a validação por consenso de especialistas para selecionar os resultados de enfermagem e os indicadores relacionados ao diagnóstico de enfermagem; na segunda, foi realizado um estudo longitudinal para avaliação clínica dos pacientes, utilizando-se o instrumento contendo os resultados e indicadores produzidos no consenso. Resultados Foram realizadas avaliações em 17 pacientes. Na avaliação clínica, mensuraram-se os resultados de enfermagem através da avaliação de seus indicadores. Seis resultados apresentaram aumento nos escores, quando comparados às médias da primeira e da última avaliação. A utilização da Nursing Outcomes Classification na prática clínica demonstrou melhora dos pacientes internados por insuficiência cardíaca descompensada. Conclusão A Nursing Outcomes Classification foi sensível às alterações no quadro clínico dos pacientes.

RESUMEN Objetivo Testar la aplicabilidad clínica de la Nursing Outcomes Classification en pacientes con insuficiencia cardíaca descompensada y Diagnóstico de Enfermería Volumen de Líquidos Excesivo. Método Estudio longitudinal, realizado en dos etapas, en un hospital universitario, en 2013. En la primera etapa se utilizó la validación por consenso de especialistas para seleccionar los resultados de enfermería y los indicadores relaciones al diagnóstico de enfermería; en la segunda fue realizado un estudio longitudinal para evaluación clínica de los pacientes, utilizándose el instrumento que contiene los resultados y los indicadores producto del consenso. Resultados Fueron realizadas evaluaciones en 17 pacientes. Durante la evaluación clínica se midieron los resultados de enfermería a través de la evaluación de sus indicadores. Seis resultados mostraron un aumento en las puntuaciones, cuando se comparó las medias de los resultados de la primera y última evaluación. La utilización de la Nursing Outcomes Classification en la práctica clínica fue capaz de demostrar mejoría clínica de los pacientes internados por insuficiencia cardíaca descompensada. Conclusión La Clasificación de Resultados de Enfermería fue sensible a las alteraciones en el cuadro clínicos de los pacientes.

ABSTRACT Objective The purpose of this study was to test the clinical applicability of the Nursing Outcomes Classification in patients with decompensated heart failure and the nursing diagnosis of fluid volume excess. Methods This is a longitudinal study conducted in two stages at a university hospital, in 2013. During the first stage the consensus of experts was used to select the nursing outcomes and the indicators related to diagnosing fluid volume excess. The longitudinal study was conducted in the second stage to clinically evaluate the patients using the instrument containing the results and indicators produced in the consensus. Results A total of 17 patients were assessed. The nursing outcomes were measured during the clinical evaluation by analysing their indicators. The scores increased in six of the results, in comparison with the average results of the first and last assessment. The Nursing Outcomes Classification during medical practice revealed a clinical improvement among the patient who were admitted following decompensated heart failure. Conclusion The Nursing Outcomes Classification managed to detect changes in the clinical status of patients.

Identifying acid-base and electrolyte imbalances.

Acid-base and electrolyte imbalances often complicate patient management in acute care settings. Correctly identifying the imbalance and its cause is vital. This article will review the physiology of acid-base and electrolyte balance, their common disturbances, associated causes, clinical manifestations, and management implications for nurse practitioners.

Electrolyte disorders in the cardiac patient.

In conclusion, electrolyte disorders are common in cardiovascular patients and complicate the care of these patients. The vigilant nurse expects electrolyte abnormalities in their patients and assesses for signs and symptoms related to them. The symptomatology of electrolyte disorders can be vague or the patient's symptoms may have multiple causes. Therefore, the nurse should always assess for the most recent laboratory work available for patients and be alert for changes in electrolyte values. Cardiac monitoring is indicated for these patients because many electrolyte disorders can contribute to cardiac arrhythmias or may cause electrocardiographic changes.

Measuring and managing fluid balance.

Ensuring patients are adequately hydrated is an essential part of nursing care, yet a recent report from the Care Quality Commission found "appalling" levels of care in some NHS hospitals, with health professionals failing to manage dehydration. This article discusses the importance of hydration, and the health implications of dehydration and overhydration. It also provides an overview of fluid balance, including how and why it should be measured, and discusses the importance of accurate fluid balance measurements.

Hydration status of nursing home residents in Taiwan: a cross-sectional study.

AIM: To investigate fluid intake, dehydration and the key factors affecting nursing home residents' fluid intake and dehydration. BACKGROUND: Inadequate fluid intake is a common problem in nursing homes, but related studies on risk factors of inadequate fluid intake and dehydration in nursing homes have seldom been explored in detail in nursing research. METHODS: A cross-sectional design was developed and implemented. The sample was composed of 111 residents from nursing homes in Kaohsiung, Taiwan. Data of demographic characteristics, activities of daily living, and modes of feeding were collected and tested for association with hydration status. Laboratory data on hydration status were also collected. Data was collected from October to December 2005. RESULTS: Average daily fluid intake of the residents was 2083 mL. Forty-five per cent of the residents had a daily fluid intake that was less than their estimated requirements. Seventeen per cent of the residents had a blood urea nitrogen/creatinine ratio that was higher than 20. Mode of feeding and a diagnosis of dementia were the significant predictors of daily fluid intake and contributed to 28.8% of the total variance in daily fluid intake. Age, gender and a diagnosis of heart disease were the significant predictors of blood urea nitrogen/creatinine ratio, contributing to 17.0% of the total variance in the ratio. CONCLUSION: The nursing home residents in our study, especially females or those fed orally, had a comparatively higher prevalence of inadequate fluid intake. It is important to assess periodically the hydration status of nursing home residents and adjust their fluid intake accordingly.

How to recognize and respond to refeeding syndrome.

If your patient is malnourished, you need to assess her carefully before she restarts nutrition by any route to avoid potentially lethal consequences.

[Nursing diagnosis for allogeneic bone marrow transplantation patient: case study]. / Diagnósticos de enfermagem de paciente submetido à transplante de medula óssea alogênico: estudo de caso.

This case study aims at presenting the follow-up of a patient who underwent allogeneic bone marrow transplantation and the experience of the nursing team of the Centro de Transplante de Medula Ossea (Bone Marrow Transplantation Center) at the Hospital de Clínicas de Porto Alegre, Brazil, during the development of the systematization of the nurse practice emphasizing the period of elaboration of the nursing diagnosis. Twenty-six diagnosis established in this case are discussed and put together in the format of a table to allow the reader to have a view of their initial and ending periods, during the in-patient treatment time.