Influencia de la familia en el paciente hospitalizado con patología neurológica cuando presete síndrome confusional agudo / Influence of family in patient with neurological pathology and acute confusional syndrome

En la Unidad de Hospitalización de Neurología del Hospital de Cabueñes (Gijón), por el tipo de patología y edad de los pacientes, el síndrome confusional agudo (SCA) es muy frecuente. Objetivo. Determinar la influencia que ejerce la familia, dentro del ámbito hospitalario, en el paciente con patología neurológica, que presenta SCA. Metodología. Se realizó un estudio observacional, descriptivo prospectivo de 53 pacientes con patología neurológica que presentaron SCA. Las variables a estudio fueron: desorientación, agitación, medicación, efectividad y sujeción en cada turno, con familia y sin familia. Se descartaron todos aquellos pacientes que padecían, antes del ingreso, cualquier tipo de demencia o problema psiquiátrico. Resultados. La edad media de los pacientes estudiados fue de 83 años. La patología más común fue el ictus. Con familia estuvieron un 47.4 %, frente a un 52.6 % sin familia en los tres turnos. Se desorientó un 70.3 % con familia, frente a un 83.8 % sin familia. En cuanto a la agitación, con familia fue el 11.4 % en los tres turnos. Sin familia el 29.4 %. Se administró medicación con familia en el 33 %. Sin familia en el 44 %. La efectividad con familia fue de un 66.5 % y sin familia de un 48 %. La sujeción con familia fue del 7.6 % en los tres turnos y sin familia del 64.5 %. Conclusiones. La familia produce un efecto beneficioso en el paciente neurológico con SCA, sobre todo reduciendo el uso de contención mecánica, ayudando a preservar la dignidad del paciente anciano dentro de un medio adverso como es el hospitalario (AU)

Given the type of pathology and age of patients in the inpatient unit of Neurology, Hospital de Cabueñes (Gijón), acute confusional syndrome (ACS) is very common in this service. Objective. To determine the influence of the family, within the limits of the hospital, in patients with neurological disease suffering from SCA. Methodology. A prospective, observational, descriptive study of 53 patients with neurological disease that suffered from SCA was performed. The study variables were: disorientation, agitation, medication, effectiveness, and body grip on each shift with and without family. All those patients suffering from any dementia or psychiatric problem before entering were discarded. Results. The mean age of the patients was 83 years old. The most common pathology was ICTUS. The patients with family were 47.4 % versus 52.6 % without family in three shifts. 70.3 % of the patients became disoriented with family; for patients without family the percentage increased up to 83.8 %. As far as nervousness is concerned, 11.4 % of the patients with family experienced this behaviour in the three shifts; nofamily patients suffering from nervousness were 29.4 %. Medication was administered to 33 % of the patients with family, and to 44 % of no-family patients. The effectiveness was 66.5 % for patients with family and 48 % for no-family patients. The use of body grip in the three shifts was 7.6 % for patients with family and 64.5 % for no-family patients. Conclusions. Family has a beneficial effect on neurological patients with ACS, specially by reducing the use of mechanical restraint, helping to preserve the dignity of elderly patients in an adverse environment such as hospital (AU)

[Influence of Family in the Patient with Neurological Pathology and Acute Confusional Syndrome]. / Influencia de la familia en el paciente hospitalizado con patología neurológica cuando presenta síndrome confusional agudo.

Summary: Given the type of pathology and age of patients in the inpatient unit of Neurology, Hospital de Cabueñes (Gijon), acute confusional syndrome (ACS) is very common in this service. Objective: To determine the influence of the family, within the limits of the hospital, in patients with neurological disease suffering from SCA. Methodology: A prospective, observational, descriptive study of 53 patients with neurological disease that suffered from SCA was performed. The study variables were: disorientation, agitation, medication, effectiveness, and body grip on each shift with and without family. All those patients suffering from any dementia or psychiatric problem before entering were discarded. Results: The mean age of the patients was 83 years old. The most common pathology was ICTUS. The patients with family were 47.4% versus 52.6% without family in three shifts. 70.3% of the patients became disoriented with family; for patients without family the percentage increased up to 83.8%. As far as nervousness is concerned, 11.4% of the patients with family experienced this behaviour in the three shifts; no-family patients suffering from nervousness were 29.4%. Medication was administered to 33% of the patients with family, and to 44% of no-family patients. The effectiveness was 66.5% for patients with family and 48% for no-family patients. The use of body grip in the three shifts was 7.6% for patients with family and 64.5% for no-family patients. Conclusions: Family has a beneficial effect on neurological patients with ACS, specially by reducing the use of mechanical restraint, helping to preserve the dignity of elderly patients in an adverse environment such as a hospital.

Infecciones de orina en pacientes sondados con patología neurológica. Estudio de las posibles causas / Urinary tract infections in patients with urinary catheterization who suffer neurological disorders. Study of the possible causes

Por estudios realizados en nuestro hospital, se observó que todos los años existía una diferencia considerable entre las infecciones de orina en pacientes sondados del servicio de Neurología con respecto a otras unidades de hospitalización. Esto nos llevó a realizar el presente estudio. Objetivo. Determinar las causas que aumentan las infecciones del tracto urinario (ITU) en el paciente sondado con patología neurológica. Metodología. Estudio observacional descriptivo prospectivo de 50 pacientes con patología neurológica ingresados en la planta de Neurología del Hospital de Cabueñes (Gijón), que precisaron sondaje vesical (SV). El trabajo de campo consistió en recoger una muestra para sedimento y cultivo de orina pre y post-SV, además de anotar las causas del sondaje, duración, edad, sexo y diagnóstico en una hoja de registro. Se descartaron aquellos pacientes sondados de urgencias, los que estaban tomando antibiótico y aquellos cuya patología no era neurológica. Resultados. De 50 pacientes estudiados que precisaron SV, el 40 % fue por retención de orina, un 40 % por orden médica y el 20 % por tratamiento con manitol. El 88 % tuvo un diagnóstico de ictus. Un 12 % ya tenía el cultivo positivo antes de ser portadores de SV. Conclusiones. El ictus es la patología neurológica que más precisa SV. Una de las causas más importantes de aquel es la retención de orina. Algunos de los pacientes sondados ya tenían ITU antes de la colocación de SV (AU)

In previous studies carried out in our hospital (Hospital de Cabueñes, Gijón, Spain) it could be noticed/stated that every year there was a considerable difference between the patients with urine catheterization in the Neurology Service and the patients in the other hospital wards. This encourages us to carry out the following research. Objectives. The purpose of this study is to determine the causes that increase the urinary infections in neurological patients with bladder catheterization compared to catheterized patients with other diseases. Analysis of sediment and urine culture before and after the urinary bladder catheterization. Methods. Retrospective, descriptive and observational study of fifty patients with neurological disorders who were hospitalized in the neurological care unit of Hospital de Cabueñes (Gijón, Spain) and who needed urinary catheterization. The fieldwork consisted of collecting a sample for sediment and culture before and after the urinary catheterization and also of registering the causes of the catheterization, the length of the treatment, age and sex of patients on a medical record sheet. Patients who were catheterized in the Emergency (A&E) unit, those who were taking antibiotics and those who did not suffer a neurological disease did not take part in this study. Results. 20 patients (40 %) out of the 50 who took part in this study and who needed urinary catheterization (UC) suffered from urinary retention, another 20 (40 %) were under medical diagnosis and supervision and the last 10 (20 %) were treated with manitol. 44 patients (88 %) were diagnosed with strokes. 12 % of them had a positive culture prior to UC placement. Conclusions. Patients who suffered stokes have a high risk of urine retention due to their functional disability. Some of them had already the urine values altered, they even had infection prior to the urinary catheter placement (AU)

Vigilancia y monitorización de la tensión arterial y electrocardiograma en una Unidad de Ictus / Surveillance and monitoring of blood pressure and electrocardiogram in a Stroke Unit

Uno de los aspectos esenciales en el abordaje de la patología cerebral vascular es la identificación y control de factores de riesgo,como la hipertensión arterial (HTA) y las arritmias cardiacas.Objetivos: conocer a cuántos pacientes se les había detectado y tratado precozmente HTA y/o arritmias no diagnosticadas previamente desde que se puso en marcha la Unidad de Ictus de nuestro hospital. Metodología: estudio descriptivo y retrospectivo de la totalidad de pacientes ingresados en la Unidad de Ictus del Hospital de Cabueñes (Gijón), durante los primeros seis meses desde su apertura. Se diseñó una hoja de registro específico para recoger los datos del estudio: diagnóstico tipo de ictus, HTA,arritmias, otras patologías previas y el tratamiento que tomaba en su domicilio.Se revisaron los datos obtenidos de la monitorización continua durante los tres turnos (mañana, tarde, noche) y se registraron la elevaciones de la TA por encima de los límites establecidos según tipo de ictus y se recogieron los episodios de arritmiascardiacas. Resultados: se revisaron 214 historias disponibles de los 219 pacientes ingresados. Un 88% (188) tuvo ictus isquémico yun 12% (26) ictus hemorrágico. El 14% (30) presentaron alteraciones en el ECG no conocidas y el 15% (32) rebasaron los límites de la TA. No se apreciaron diferencias significativas entre ambos sexos. Conclusiones: la monitorización de la tensión arterial y elelectrocardiograma ha permitido detectar las alteraciones y actuar en un corto período de tiempo para evitar la repeticióndel ictus y sus secuelas (AU)

One of the essential aspects in the approach to vascular brainpathology is the identification and control of risk factors, such as blood hypertension and cardiac arrhythmias.Objectives: to determine the number of patient in whom highblood pressure and/or non-diagnosed arrhythmias had beenpreviously diagnosed since the Stroke Unit was first created inour hospital.Methodology: descriptive and retrospective study of the total number of patients admitted to the Stroke Unit of the Cabueñes Hospital (Gijón) during its first six months of operation. Aspecific data collection form was design to gather study data:diagnosis of type of stroke, high blood pressure, arrhythmias,other previous pathologies and the treatment the patient wason at home.The data derived from continuous patient monitoring during the three shifts (morning, evening and night) were revised and increased values of high blood pressure above the establish limitswere recorded according to type of stroke. The episodes of cardiac arrhythmias were also recorded.Results: 214 available clinical records from the 219 admitted patients were reviewed. 88% of patients (188) had suffered anischemic stroke and 12% (26) a hemorrhagic stroke. 14% (30)presented no previously known ECG alterations and 15% (32)exceeded the preset limits of blood pressure. No significant differences were noted between both genders.Conclusions: arterial blood pressure monitoring and electrocardiogram has enabled us to detect alterations and to takemeasure in a short period of time to avoid repeated strokes and their sequelae (AU)