Bladder scanner accuracy during everyday use on an acute rehabilitation unit.

The use of portable ultrasound scanners is becoming more common in the rehabilitation setting as a noninvasive method of estimating bladder volume. Bladder scanners are used to screen patients for post-void residual volumes and to determine the need for intermittent catheterization based on volume rather than time. Benefits include a decreased number of invasive catheterizations, thus decreasing the potential for urinary tract infections and urethral trauma, and increasing patient satisfaction. Testing at this facility revealed a high potential for inaccuracy, although bladder scanners have been described in the literature as highly accurate, with the equipment easy to use and requiring little staff training. This article reports the authors' findings of staff competency testing and examines patient characteristics that may affect scanner accuracy.

Protecting the skin of the elderly patient in the intensive care unit.

This article summarizes the ways in which factors in the ICU setting can affect skin breakdown in the elderly patient. The effects of aging, the presence of underlying chronic factors, and the imposition of critical illness may affect the skin of the elderly patient in ways not experienced in a younger patient population. It is important that ICU nurses recognize the unique differences and challenges in maintaining the skin integrity of the elderly, critically ill patient. Even though not all pressure ulcers in this population will be preventable in the ICU setting, an awareness of special risk factors in the geriatric patient will enable the ICU nurse to maintain the highest level of skin care for the geriatric patient.

Risk factors for pressure ulcers in the spinal cord injured in the community.

A retrospective review was performed on the medical records of 29 patients with traumatic spinal cord injury who were admitted for pressure ulcer research protocols within the Division of Plastic Surgery at a university medical center in Southeast Texas. The purpose of the study was to identify common factors in the community that may contribute to the development of pressure ulcers in the spinal cord injured person at home, as a prelude to development of a risk assessment scale for use by the home care nurse. Oot-Giromini's Web of Causation was used as the theoretical framework for this study. Findings support current pressure ulcer research literature, implicating a diverse array of physical and psychosocial elements such as nutrition, past history of pressure ulcers, and social support issues as risk factors. Further research is needed before a risk assessment scale is formulated.

Autonomous hyperparathyroidism in patients on maintenance home dialysis.

Ninety-nine patients with end-stage renal failure treated by maintenance home dialysis whose calcium and phosphorus balance was carefully controlled were studied for radiographic evidence of hyperparathyroidism. A total of 43 showed evidence of hyperparathyroidism despite excellent medical management. In 23 the abnormality was stable and the patients were asymptomatic with regard to the skeleton. The other 20 showed progressive bone disease. Sixteen of these patients were operated upon, and 14 were relieved of their symptoms by parathyroidectomy. Following operation, the radiographic evidence of bone disease halted dramatically, and a decided return toward normal was documented on subsequent films. Thus parathyroidectomy can control the skeletal deterioration and bone pain of hyperparathyroidism in patients who develop this complication. Serial radiographic studies are a reliable indicator of this circumstance.