Plan de cuidados individualizado durante oxigenación con membrana extracorpórea. Caso clinic / Individualised care plan during extracorporeal membrane oxygenation. A clinical case

Describimos un plan de cuidados individualizado de una mujer diagnosticada de neumonía, intubada y con ventilación mecánica invasiva que ingresa en la Unidad de Cuidados Intensivos para oxigenación por membrana extracorpórea (ECMO). Se realiza valoración enfermera por patrones funcionales de Marjory Gordo, priorizando los diagnósticos enfermeros más relevantes, utilizando un modelo de razonamiento clínico (Análisis de Resultado del Estado Actual) y la taxonomía NANDA. Se describen: ansiedad ante la muerte, deterioro del intercambio de gases, disminución del gasto cardíaco, motilidad gastrointestinal disfuncional, riesgo de síndrome de desuso, riesgo de infección y riesgo de sangrado. Los objetivos principales son: disminuir el miedo de la familia, conseguir un óptimo estado respiratorio y cardiocirculatorio, mantener la función gastrointestinal, evitar las posibles complicaciones de la inmovilidad y disminuir al máximo el riesgo de infección y sangrado. En cuanto a las actividades, se han realizado: apoyo a la familia, correcto manejo de la vía aérea-ventilación mecánica, monitorización cardiorrespiratoria, de la piel y del estado nutricional, control de posibles infecciones y hemorragias (manejo de terapias, catéteres…). Para la evaluación de los resultados se ha utilizado la escala Likert, cumpliéndose todos los indicadores de resultado planteados. No se han encontrado casos que desarrollaran un plan de cuidados individualizado con taxonomía NNN utilizando ECMO veno-venosa. Los planes descritos con otro tipo de ECMO no utilizaron el modelo análisis de resultado del estado actual. Este caso puede apoyar a enfermeras a prestar atención a pacientes sometidos a ECMO veno-venosa, aunque son necesarios más casos para estandarizar los cuidados según la taxonomía NANDA

An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy

[Individualised care plan during extracorporeal membrane oxygenation. A clinical case]. / Plan de cuidados individualizado durante oxigenación con membrana extracorpórea. Caso clínico.

An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy.

Genetic consequences of interglacial isolation in a steppe bird.

In response to climate changes that have occurred during Pleistocene glacial cycles, taxa associated to steppe vegetation might have followed a pattern of historical evolution in which isolation and fragmentation of populations occurred during the short interglacials and expansion events occurred during the long glacial periods, in contrast to the pattern described for temperate species. Here, we use molecular genetic data to evaluate this idea in a steppe bird with Palaearctic distribution, the little bustard (Tetrax tetrax). Overall, extremely low genetic diversity and differentiation was observed among eight little bustard populations distributed in Spain and France. Mismatch distribution analyses showed that most little bustard populations expanded during cooling periods previous to, and just after, the last interglacial period (127,000-111,000 years before present), when steppe habitats were widespread across Europe. Coalescent-based methods suggested that glacial expansions have resulted in substantial admixture in Western Europe due to the existence of different interglacial refugia. Our results are consistent with a model of evolution and genetic consequences of Pleistocene cycles with low between-population genetic differentiation as a result of short-term isolation periods during interglacials and long-term exchange during glacial periods.

A review of the effects of agricultural and industrial contamination on the Ebro delta biota and wildlife.

The Ebro delta (NE Spain) is a 320 km2 wetland area of international importance for conservation. The area is devoted to rice farming and receives large amounts of pesticides. Industrial pollutants are also carried to the delta by the river. The information accumulated during the last 25 year on the effect of such pollution on the biota is reviewed in order to identify the existing gaps and needs for management. Organochlorine pesticides were legally used until 1977, which has resulted in the widespread presence of these compounds in the Ebro delta biota. Lethal, sublethal or other detrimental effects of these pesticides on wildlife in the area were poorly investigated, but negative effects on the reproduction of ducks and herons were reported. Nowadays, polychlorinated biphenyls (PCBs) are the main responsible of organochlorine pollution in the area: concentrations in biota samples are higher than levels observed in nearby coastal areas, as a result of the significant PCB inputs by the river which, in 1990, were evaluated at 126 kg yr(-1). The massive use of herbicides is thought to have contributed to the elimation of macrophyte vegetation in the lagoons during the eighties, which had strong consequences on diving ducks and coot populations. Weed control is also related to the loss of biodiversity held by rice fields. The massive and inadequate use of organophosphorus and carbamate pesticides (involving more than 20,000 t yr(-1) has produced some waterbird mortality events, and may have direct and indirect effects on other non-target organisms. The accumulation in the soil of lead pellets used in waterfowl shooting is estimated to kill some 16,300 waterbirds in the Ebro delta every year.

Trichomoniasis in a Bonelli's eagle population in Spain.

During 1980-97, trichomoniasis was detected in nestlings of Bonelli's eagle Hieraaetus fasciatus in Catalonia (Spain). In 1993 Trichomonas gallinae was isolated in 36% of nestlings (n = 39) and affected 41% of broods (n = 22). Overall, trichomoniasis was one of the most important single nestling mortality factor, accounting for 22% of total chick mortality, and causing the death of 2% of chicks. Trichomoniasis deaths took place during the second half of the nestling period. The median age at death was 45.5 days. Although the presence of the parasite was not related to the composition of the diet or parental age, pairs that developed the disease ate more pigeons and included more often non-adult birds. At present trichomoniasis apparently has little demographic impact on the Bonelli's eagle population in Catalonia, but the eventual spread of this disease in chicks and its unknown effects on adults might be of concern.

Animal poisonings: the 10-year experience of a veterinary analytical toxicology laboratory.

Data on 10-y of chemical toxicological analyses carried out in a veterinary laboratory in Barcelona, Spain for suspected wild and domestic animal poisonings are summarized. The 218 cases involved more than 1 million animals, some 7,500 of which died. Pesticides, especially insecticides (46.6%) and rodenticides (37.9%), were frequently involved. Strychnine (n = 11) and aldicarb (n = 10) were the most usual toxic agents in baits prepared for intentional poisonings; other cases involved pentachlorophenol, hexachlorocyclohexane or anticoagulant rodenticides. Service to veterinarians and others could be improved if a coordinated network of national and regional Animal Poison Centers were created.