Journal of ET nursing : official publication, International Association for Enterostomal Therapy最新文献

Peristomal varices are a manifestation of severe liver disease and portal hypertension. Unfortunately, they may bleed profusely, usually as a result of pressure from a hard faceplate on the appliance or denudation from leakage of stomal output. This article provides a case study, followed by a review of the causes, the medical management, and surgical management of this condition. Some implications for ET nurses are also given.

Approximately 60,000 major lower extremity amputations annually are performed on diabetic patients in the United States. Diabetic foot ulcers are a major factor in 84% of these amputations. The ulcers develop as a result of minor trauma or callus breakdown in the insensate foot. Infection and vascular insufficiency lead to gangrene and amputation. Delay in treatment of these ulcers is a major factor leading to gangrene and amputation. The most important treatments of the ulcer are debridement to healthy bleeding tissue, proper culture and antibiotic therapy, identification of osteomyelitis, metabolic control, keeping weight off the foot, and (when indicated) peripheral arterial reconstruction to improve blood flow. Therapeutic shoes to prevent recurrence of the ulcer are extremely important in posttreatment of these ulcers. Because the management of ulcers is complicated, the team approach and consultation are frequently necessary. The most important step in prevention of foot ulcers in the diabetic is repeated patient education in foot care.

Pressure ulcer prevention and treatment are major issues in health care, with new products flooding the market constantly. This article presents the results of a clinical investigation of four pressure-reducing mattresses and a foam overlay used in five different nursing units (neurology, oncology, respiratory, medical/surgical intensive care, and cardiovascular surgery). A total of 246 patients were evaluated on the trial mattresses and 46 were evaluated on the foam overlay.

Creation of an ileoanal reservoir involves a two-stage surgical procedure. Each stage requires extensive patient education. After stage I, the patient must learn to manage an ileostomy, maintain fluid and electrolyte balance, care for perianal skin irritation, implement dietary changes, and reestablish bowel control. Stage II involves reanastomosis of the bowel, and patient education continues with emphasis on bowel reeducation and skin care. Complications can be frequent, but they may be eliminated or at least minimized by educating the patient. Patients having this procedure usually have had a stressful medical history and are highly motivated to return to a normal lifestyle, yet they still need emotional support. Patient education sheets provide a means to summarize the necessary information. Written instructions provide reinforcement for demonstrations and aid in retention of knowledge.

Burn injuries to the perineum and genitals present the bedside care provider with a unique set of management problems. Traditionally, thermal injuries to these areas have been allowed to close by secondary intention, with epithelialization occurring from remnants protected within skin folds. Partial-thickness wounds of the perineum and genitals must be kept clean and free of bacterial infection to prevent necrosis and development of full-thickness injury. Although full-thickness thermal injuries to the penis and vulva are rare, they require special attention during the immediate postgrafting period to ensure complete engraftment. Control of scarring in this area requires tailor-made pressure garments, with customized inserts to provide controlled pressure to the skin folds.

We wished to determine whether 24-hour monitoring of urinary incontinence without video urodynamics would provide adequate information for treatment. Twelve subjects with urinary incontinence (seven women and five men) were investigated, average age 75 years (range 44 to 89 years). Setting was a community hospital (80 beds), a nursing home, and a lodge, 60 miles from the nearest assessment center. Twenty four-hour monitoring consisted of 2 hourly preweighed pad changes, postchange weighing, Uroflow set-up in subject's bathroom, fluid intake record, and 1 postvoid residual ultrasonogram. All subjects had history and physical and evaluation of medications. Findings included probable urge incontinence, stress incontinence, chronic retention with overflow, and normal bladder function. Recommendations included oxybutynin chloride, timed toileting, timed fluid restriction, diuretic manipulation, intermittent catheterization, pessary, and surgery. At 6 weeks, 25% (4/12) were better (three with urge incontinence and one after operation for stress incontinence). Video urodynamics were conducted only for the patient with stress incontinence after operation. We suggest that 24-hour monitoring is noninvasive, is less disruptive and less expensive than video urodynamics, and provides adequate information for initial treatment in many patients with urinary incontinence.