Practical management of home parenteral nutrition in infancy.

The child born today with chronic intestinal failure (IF) can expect to survive throughout childhood and into adult life even if dependent on parenteral nutrition (PN) support. The three major aetiologies of chronic IF are short bowel syndrome (SBS), intestinal dysmotility and mucosal disease. SBS is the commonest of these conditions in infancy, most frequently subsequent to resection for necrotising enterocolits (NEC). The focus of IF management is to ensure appropriate weight gain and growth whilst minimising complications (related to underlying disease as well as to PN) and aiming for intestinal autonomy. Strategies to avoid complications and aid PN weaning include early oral/enteral feed introduction, 'cycling' PN as soon as tolerated, limiting lipid infusions and discharging home on overnight PN with formally trained parents. A newer treatment for SBS is GLP-2 analogue. Multidisciplinary care in a specialist intestinal rehabilitation centre with collaboration with local professional support is key to success.

Abordaje interdisciplinar del cuidado a una mujer con ostomía de alto débito / No disponible

Las complicaciones derivadas de una ostomía de alto débito provocan graves alteraciones nutricionales, cutáneas e infecciosas. El manejo de estas ostomías por parte de la persona portadora es muy complejo y genera problemas de autoestima y afrontamiento. Presentamos el caso de una mujer con ostomía de alto débito secundaria a síndrome de intestino corto, con malnutrición severa, dermatitis periestomal y grandes dificultades para el manejo de su situación. Tras valoración según necesidades de Virginia Henderson realizamos un abordaje interdisciplinar, con la elaboración de un plan de cuidados que contemplaba todos los aspectos del ser humano, biológicos, psicológicos y sociales. Se utilizaron los dispositivos adecuados para el control del efluente y el tratamiento y posterior prevención de la dermatitis. Las dificultades para el afrontamiento se abordaron desde un punto de vista holístico, facilitando el aprendizaje, proporcionando asesoramiento y apoyo emocional. Se adiestró a la persona en el manejo de la ostomía, la dieta y la higiene en la manipulación de los dispositivos para la TIV. Todo ello contribuyó a una mejor adaptación a su nuevo estado de salud

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Malabsorption Syndromes.

Malabsorption syndrome refers to the small intestines' inability to absorb certain nutrients and fluids. There are several common associated disorders, which may present with subtle and/or overt symptoms. With subtle symptoms, it is difficult to determine the cause, making diagnosis difficult or even inaccurate. Malabsorption can originate from an immune response, an inflammatory process, or alternation of the small intestines by surgical methods. This article reviews common malabsorption disease processes of the small bowel and the resulting pathophysiology. Diagnostic studies, treatment, and prognosis of various conditions within the malabsorption disease state are discussed.

Psychosocial impact of intestinal failure: a familial perspective.

Intestinal failure is a complicated long-term condition that can have profound physical and psychosocial consequences for a patient's life. Hospitalisation can be long, with many distressing and unpleasant medical procedures being endured. Patients often have to deal with large volumes of unmanageable faecal fluid from stomas or fistulae and usually require home parenteral nutrition (HPN) for the remainder of their life. The literature focuses on how patients often have to tolerate long periods of suffering, which can be the basis for significant emotional anguish. It also addresses how the condition can contribute to myriad psychosocial difficulties, which can have devastating effects on their body image and quality of life. However, there is a lack of information regarding the effects of this condition on the family, who not only have to provide ongoing support for the patient, but also have to attempt to function normally while coping with their own fears and emotions. This article reviews the experiences of two patients, father and daughter, living with intestinal failure; it discusses their experiences and reveals how they cope with the physical aspects. It also addresses how the condition can effect psychosocial disturbances, not only for them but for those living closely with them. The article addresses ways that nurses could develop their relationship with the patient, enabling them to recognise and act early on signs of emotional malady.

Intestinal transplant: the long and short of it.

Intestinal failure (IF), typically due to short bowel syndrome in adults and congenital disorders in pediatric patients, is universally managed with parenteral nutrition (PN). When patients fail PN due to recurrent infection, loss of central venous access or PN-induced liver disease, intestinal transplant (ITx) is indicated. ITx consists of transplant of the small bowel, small bowel plus liver, or intestine plus multiple abdominal viscera. ITx allows for freedom from PN but is complicated by rejection and infection. Early referral of patients with IF to centers with experience in intestinal rehabilitation and transplantation is essential to improve patient outcome.

Management of the patient with short bowel syndrome.

Extensive resection of the small bowel results in impaired digestion of macronutrients and malabsorption of nutrients, fluid, electrolytes, and minerals. Gastric acid hypersecretion and alterations in gut hormonal response further contribute to the problem. Diarrhea, dehydration, electrolyte and acid/base abnormalities, and macronutrient and micronutrient deficiencies ensue, and is termed the short bowel syndrome (SBS). Rare disorders, such as essential fatty acid deficiency and D-lactic acidosis, are a greater concern for the SBS patient. These patients' lives are significantly impacted, and they require close monitoring by a medical team knowledgeable about the disease and its nutritional, metabolic, and psychosocial consequences. Immediate therapies are directed toward fluid resuscitation, wound healing, and initiation of early nutrition support. After medical stabilization, multiple nutritional and medicinal therapies are used to aid bowel adaptation and prevent medical crisis. Advanced practice nurses should be knowledgeable about SBS to educate patients and families about this disease, associated therapies and changes in lifestyle, and how to detect and manage acute changes in medical condition.

Small bowel transplantation.

Small bowel transplantation (SBT) presents a formidable challenge to perioperative nurses. Patients who survive these procedures have difficult postoperative courses with lengthy intensive care stays. They also are at significant risk for graft rejection and long-term immunosuppression complications. The option for SBT is reserved for patients who otherwise face the prospect of life-long total parenteral nutrition (TPN). Advances in donor and recipient surgical techniques and improvements in immunosuppressive therapies have raised hopes that patients with intestinal failures who undergo SBT procedures will be allowed to resume full oral nutrition and independence from TPN.

Small intestine transplantation: a nursing perspective.

Intestinal transplantation has become a viable treatment modality for the patient with short gut syndrome. The potential for the development of serious postoperative complications contributes to the complexity of caring for these patients. Through astute observation, thorough assessment, and intelligent intervention, the nurse can directly affect the ultimate success of intestinal transplantation. A dedicated team approach, along with a sincere patient/family commitment, will help to provide for optimal patient management and a successful outcome.

The short bowel syndrome: an update and a case study.

Infants with the short-bowel syndrome are living longer and are increasing in number due to new medical treatments and a larger number of survivals with very low birth weights. This article reviews the medical and nursing management of these infants. A case study of an infant with the short-bowel syndrome is presented with a detailed nursing care plan emphasizing the physical, emotional, and social care of these infants.