Assessment and management of fungating wounds: a review

Fingating wounds always present a management challenge. Not only is it often difficult to manage the physical aspects of the wound - pain, bleeding, exudate and odour - but also the psychological impact of a fungating wound on the patient and their family or carers is often considerable. This review examines current practice in relation to fungating wounds, and emphasizes the central important of assessment, communication and sensitivity in nursing management.

Diagnósticos e Intervenções de Enfermagem aos pacientes em terapia anticoagulante

Os pacientes que fazem uso de anticoagulante orais apresentam necessidades especificas, para as quais, o atendimento de enfermagem tem um importante papel, principalmente, no sentido de prevenir complicações. A presente revisão foi realizada visando discutir os diagnósticos de enfermagem para esses pacientes, utilizando-se do sistema North American Nursing Diagnoses Association - NANDA. Os diagnósticos para esses pacientes retratam o risco de sangramento e retrombose quase sempre devido ao controle ineficaz do regime terapêutico e o déficit de volume de líquidos quando ocorre perda ativa de sangue. Propõem-se ainda as intervenções de enfermagem e os critérios de avaliações para tais condições. Os autores consideram relevante, no sucesso da assistência o preparo da equipe para lidar com essa terapia.

Patients' quality of life and clean intermittent self-catheterization

This article examines the available literature surrounding the procedure of clean intermittent self-catheterization (CISC) and its impact on patients' quality of life. Many articles have been written about, and much research has been carried out into, the practicalities of performing CISC regarding dexterity, disability, etc, and its advantages and disadvantages related to infection rates and complications. However, there appear to be very few articles addressing the day-to-day problems that having to perform CISC presents to patients. While many articles do acknowledge that CISC improved patients' quality of life, very few go on to identify and discuss the daily life activities that are impacted upon by having to perform the procedure. There is a need for further research from patients' perspectives: to identify the issues that they have in living with this inconvenience and in order for carers to understand fully the implications of CISC on a patient's quality of life. With this insight, carers will be better armed to help patients overcome their fears and be more supportive in the ongoing care of the patient. Non-compliance is the main reason for patients' inability to perform CISC and with a better understanding of the problems, carers will be able to give practical help and support.

Assessment of infants with peripherally inserted central catheters: Part 2. Detecting less frequently occurring complications

Peripherally inserted central catheters (PICCs) are frequently placed in neonates to optimize nutrition and provide stable infusions of critical medications into the central vascular system. PICCs have been associated with a number of device-specific complications that can manifest during insertion, while the line is indwelling, and/or after the removal of the line. The first article of this series in Focus on the Physical, titled "Assessment of Infants With Peripherally Inserted Central Catheters: Part I. Detecting the Most Frequently Occurring Complications," presented assessment strategies to detect common complications such as catheter occlusions and catheter-related bloodstream infections. Part 2 of this series emphasizes the importance of ongoing systematic assessment of PICCs for device-specific complications such as catheter migration, dislodgement, breakage, phlebitis, and thrombosis, as well as the life-threatening complications of pleural and pericardial effusion and tamponade. Each complication is described, along with a review of the etiology, a description of presenting signs and symptoms, and key clinical interventions.

Managing the oral sequelae of cancer therapy

Patients undergoing systemic chemotherapy and/or head and neck radiotherapy frequently experience treatment side effects. Oral complications are among the most common problems associated with these therapies. These sequelae include mucositis, oral hemorrhage, infection, and xerostomia (dry mouth). Occasionally, oral complications are so severe that the cancer treatment must be reduced or even terminated. By providing comprehensive care, nurses work to help prevent, identify, and manage these oral sequelae, and thus maximize quality of life. Limiting the effects of oral sequelae increases patient adherence to treatment protocols, improves the quality of life, and increases the odds of long-term survival.

Postmenopausal bleeding: a practical approach

PURPOSE

To provide nurse practitioners (NPs) with a practical approach for the management of postmenopausal bleeding in office settings.

DATA SOURCES

Selected scientific literature and the author's own experience.

CONCLUSIONS

Postmenopausal bleeding should be considered cancer until proven otherwise, despite the fact that abnormal pathology is found in only 15% of endometrial biopsies.

IMPLICATIONS FOR PRACTICE

Post menopausal bleeding can be safely evaluated and managed by NPs using aspiration endometrial biopsies and/or transvaginal ultrasound. Hospitalization for dilation and curettage under anaesthesia can often be avoided.

Case report: a nursing challenge, the unstable pelvic fracture

A case report is presented that describes the initial care of a severely injured patient who was hemodynamically unstable. The discussion highlights the process used to recognize life-threatening injuries, to differentiate internal sources of hemorrhage, to provide damage-control surgery, and to stop further bleeding with an interventional radiologic examination. The emergency nursing care of a patient with unstable pelvic trauma is included.

Minimizing bleeding complications of percutaneous coronary intervention and glycoprotein IIb-IIIa antiplatelet therapy

Percutaneous coronary intervention in patients with coronary artery disease can lead to thrombotic occlusion of the artery and to subsequent ischemic complications. Patients undergoing these procedures have been treated with aspirin, heparin, or both as a means of preventing thrombosis. The arsenal of antithrombotic agents has recently been augmented by the addition of a new class of drugs the platelet receptor glycoprotein (GP) IIb-IIIa inhibitors, which include abciximab, eptifibatide, and tirofiban. Unlike aspirin or heparin, which inhibit some but not all pathways leading to thrombosis, GP IIb-IIIa inhibitors block the final common pathway of platelet aggregation. When used in conjunction with aspirin and heparin, GP IIb-IIIa inhibitors have yielded favorable clinical outcomes, reducing the incidence of death, myocardial infarction, and urgent intervention. However, GP IIb-IIIa inhibitors also have been associated with an increased risk of bleeding complications, especially at the femoral access site. This presents new challenges for nurses charged with the care of patients treated with these agents. The goal of nursing care for this population is to ensure the optimal benefits of GP IIb-IIIa inhibitor therapy while simultaneously preventing or minimizing groin bleeding in patients undergoing percutaneous coronary procedures.

Nursing interventions to decrease bleeding at the femoral access site after percutaneous coronary intervention. SANDBAG Nursing Coordinators. Standards of Angioplasty Nursing Techniques to Diminish Bleeding Around the Groin

BACKGROUND

This trial is the first prospective, multicenter clinical nursing trial conducted to measure the effect of nursing interventions on bleeding at the femoral access site after percutaneous coronary intervention with or without a potent antiplatelet agent given along with heparin and aspirin.

OBJECTIVE

To measure the relationship between nursing interventions and complications at the arterial access site in patients undergoing percutaneous coronary interventions and to recommend a standard of care to minimize bleeding complications.

METHODS

In a descriptive, correlational 4010-patient study, nursing care interventions after coronary procedures were measured. Observed standards of care were assessed, and regression techniques were used to evaluate nursing interventions and the effect of the interventions on bleeding at the access site after percutaneous coronary procedures.

RESULTS

Several significant correlations between nursing interventions and the occurrences of moderate to severe bleeding at the access site were found; however, most interventions had little effect. The most significant factors in decreasing complications at the access site were early removal of the arterial sheath, the type of pressure mechanism used to achieve arterial hemostasis, staffing allocation, and the person and method used to remove the sheath.

CONCLUSION

Many nursing interventions after percutaneous coronary intervention have become routine in the absence of clinical outcome data. Most nursing interventions aimed at decreasing bleeding at the vascular access site increase nursing workload but do not significantly affect bleeding in the groin. These results underscore the importance of continued clinical research studies to validate nursing practice on the basis of patients' outcomes.

Assessment of haemostasis

Major surgery and some therapies carry with them the chance of severe bleeding. Recognising who is at risk and knowing what to do if it happens are important parts of the nurse's job. Debbie Field explains.