RESUMEN
Primary aldosteronism (PA) is an important and commonly unrecognized cause of secondary hypertension. Idiopathic hyperaldosteronism and aldosterone-producing adenomas account for more than 95% of PA and are characterized, respectively, by bilateral or unilateral involvement of the adrenal glands. When there is suspicion for the presence of PA, a plasma aldosterone to renin ratio should be obtained initially. Localization to determine adrenal gland involvement is done by imaging, with computerized tomography or magnetic resonance imaging. After imaging, adrenal vein sampling is done to establish treatment options. Patients with unilateral disease, who are good surgical candidates, are most appropriately managed with adrenalectomy. A biochemical cure is almost certain following adrenalectomy; however, only 30-50% of patients would show adequate blood pressure improvement. Patients with bilateral adrenal disease and those believed not to be surgical candidates are managed with mineralocorticoid antagonists.
Asunto(s)
Hiperaldosteronismo/diagnóstico , Manejo de la Enfermedad , Humanos , Hiperaldosteronismo/complicaciones , Hiperaldosteronismo/terapiaRESUMEN
When encountering unusually appearing dialysate effluent from a patient doing peri- toneal dialysis, it is important to review the patient's recent exposures. In the case of "black"-appearing dialysate effluent, consideration needs to be given to the possibility of someone having undergone a colonoscopy and having tattooing with India ink. Nephrology nurses are frequently the first to be notified when there has been a change in the character of a patient's peritoneal dialysis dialysate effluent. This article describes a case of "black"-appearing dialysate and includes some of the potential differentials that were considered in the evaluation process. Even though "black"-appearing dialysate is a rare occurrence, nephrology nurses need to be aware of some of the potential etiologies, including exposure to India ink.
Asunto(s)
Líquido Ascítico/química , Carbono/efectos adversos , Colonoscopía/efectos adversos , Fallo Renal Crónico/terapia , Peritoneo/metabolismo , Peritonitis/complicaciones , Tatuaje/efectos adversos , Educación Continua en Enfermería , Humanos , Masculino , Persona de Mediana Edad , Peritonitis/microbiología , Diálisis Renal/métodosAsunto(s)
Seguridad del Paciente , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de la Atención de Salud , Diálisis RenalAsunto(s)
Selección de Donante/normas , Trasplante de Riñón/educación , Trasplante de Riñón/enfermería , Donadores Vivos/educación , Enfermería en Nefrología/normas , Educación del Paciente como Asunto , Guías de Práctica Clínica como Asunto , Anciano , Anciano de 80 o más Años , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Rol de la Enfermera , Estados UnidosRESUMEN
Nephrology nurses are often faced with the responsibility of triage. Shortness of breath in a patient receiving chronic dialysis is a frequently heard complaint. Clinicians, at first glance, will consider volume expansion as the probable cause for the shortness of breath, and most often, they are correct. However, for some, that assumption may prove to be detrimental, and moreover, life-threatening. This article discusses pulmonary embolism as a possible consideration when patients present with the complaint of shortness of breath. The incidence, pathogenesis, evaluation, and treatment of pulmonary embolism in patients with chronic kidney disease are reviewed.
Asunto(s)
Embolia Pulmonar/diagnóstico , Educación Continua en Enfermería , Humanos , Fallo Renal Crónico/complicaciones , Masculino , Persona de Mediana Edad , Embolia Pulmonar/complicaciones , Embolia Pulmonar/etiología , Embolia Pulmonar/enfermeríaRESUMEN
Flash pulmonary edema, also termed acute onset pulmonary edema, is characterized by the sudden onset of respiratory distress related to accumulation of fluid in the lung interstitium over a matter of minutes or hours. Chronic kidney disease is often associated with predisposing cardiac risk factors that make patients susceptible to development of flash pulmonary edema. This article highlights the connection between cardiac pathologies found in chronic kidney disease and development of flash pulmonary edema. Nephrology nurses may be instrumental in reducing the risk of flash pulmonary edema by recognizing symptoms of heart failure and need for treatment of acute elevations in blood pressure.
Asunto(s)
Enfermedades Renales/complicaciones , Fallo Renal Crónico/complicaciones , Edema Pulmonar/etiología , Enfermedad Aguda , Presión Sanguínea , Causalidad , Enfermedad Crónica , Diagnóstico Diferencial , Insuficiencia Cardíaca/etiología , Humanos , Enfermedades Renales/fisiopatología , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Neurotransmisores/fisiología , Rol de la Enfermera , Evaluación en Enfermería , Edema Pulmonar/diagnóstico , Edema Pulmonar/prevención & control , Diálisis Renal , Medición de Riesgo , Conducta de Reducción del Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , UrodinámicaAsunto(s)
Movilidad Laboral , Educación Continua en Enfermería/organización & administración , Nefrología/educación , Competencia Profesional/normas , Especialidades de Enfermería/educación , Desarrollo de Personal/organización & administración , Certificación/organización & administración , Toma de Decisiones en la Organización , Atención a la Salud/organización & administración , Predicción , Costos de la Atención en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud , Humanos , Modelos Educacionales , Modelos de Enfermería , Nefrología/organización & administración , Rol de la Enfermera , Admisión y Programación de Personal/organización & administración , Técnicas de Planificación , Autonomía Profesional , Autoevaluación (Psicología) , Especialidades de Enfermería/organización & administración , Gestión de la Calidad Total/organización & administración , Estados UnidosRESUMEN
The portability of non-invasive ultrasound has resulted in an expansion of its utilization into a variety of clinical settings. Since ultrasound is recommended for initial vein cannulation during catheter placement, it is conceivable that ultrasound may also be used to verify catheter position. The purpose of this study was to evaluate the feasibility of tunneled hemodialysis catheter placement without the use of fluoroscopy. Determination of appropriate catheter length using physical exam measurements and verification of correct placement using portable ultrasound were examined. A total of 61 subjects, 31 with and 30 without a tunneled hemodialysis catheter underwent echocardiographic examination using the SonoSite 180PLUS (HCU; Bothell, WA) portable ultrasound. The investigator, using dynamic ultrasound imaging, was able to identify correct position in 30 of the 31 subjects with catheters. Still echocardiographic images were reviewed by two cardiologists and determined to be inconclusive. Physical examination measurements correlated well with the interventional radiologist guide-wire measurements (p < .01; r = 0.65) and concluded to be a useful method for determining appropriate cuffed catheter length.
Asunto(s)
Cateterismo Venoso Central/métodos , Catéteres de Permanencia , Examen Físico/métodos , Diálisis Renal/instrumentación , Ultrasonografía Intervencional/métodos , Índice de Masa Corporal , Cardiología/métodos , Ecocardiografía/métodos , Ecocardiografía/enfermería , Diseño de Equipo , Fluoroscopía , Humanos , Nefrología/métodos , Resultado del TratamientoRESUMEN
Cutaneous manifestations occurring in patients with end stage renal disease (ESRD) can indicate systemic problems that have significant morbidity and mortality risks. Skin changes are sometimes a consequence of the disease that caused the renal failure or may be an ESRD manifestation. Pruritus is the most prevalent ESRD cutaneous complaint, but its pathogenesis is not understood. The pathophysiology, presentation, and nursing implications of perforating dermatosis, metastatic calcification, polytetraflouroethylene graft infection, and lichen planus are discussed with corresponding case reports.