Asunto(s)
Anestesia Epidural/efectos adversos , Anestesia Raquidea/efectos adversos , Anticoagulantes/efectos adversos , Hematoma/etiología , Heparina de Bajo-Peso-Molecular/efectos adversos , Enfermedades de la Columna Vertebral/etiología , Anticoagulantes/uso terapéutico , Espacio Epidural , Hematoma/diagnóstico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Evaluación en Enfermería/métodos , Factores de Riesgo , Compresión de la Médula Espinal/etiología , Trombosis/prevención & controlRESUMEN
BACKGROUND: The meaning of do-not-resuscitate orders and their impact on nursing care have been a source of confusion, and the results of the few studies that have examined nursing care of ICU patients with these orders have been conflicting. OBJECTIVES: To assess nursing workload associated with caring for patients with do-not-resuscitate orders and to better understand the patients and selected events associated with these orders. METHOD: Sixty patients from medical, surgical, and neuroscience ICUs met the criteria for the study. The Medicus Systems Corporation InterAct 2000 Workload and Productivity System was used to classify patients by type; the results reflected the number of hours of nursing care required per 24 hours. Data on patient type for 1 day before and 1 day after do-not-resuscitate orders were written were available for 31 of the 60 patients. These data were analyzed. RESULTS: The number of hours of nursing care required 1 day before and 1 day after a do-not-resuscitate order did not change. The amount of nursing care remained the same or increased for 74% (23/31) of the patients after the order was written. Patients were classified as types IV (n = 8), V (n = 20), and VI (n = 3) after the order was written. CONCLUSIONS: A high level of nursing care was required for this group of critically ill patients, and the do-not-resuscitate order did not alter the number of hours of nursing care required after the order was written.
Asunto(s)
Unidades de Cuidados Intensivos , Atención de Enfermería , Órdenes de Resucitación , Carga de Trabajo , APACHE , Anciano , Humanos , Tiempo de Internación , Persona de Mediana Edad , Factores de TiempoRESUMEN
We present a prospective observational study of ovarian function following Wertheim's hysterectomy and its relationship to age at hysterectomy. Serum gonadotrophin measurements were made annually on 55 women following Wertheim's hysterectomy with ovarian preservation. Within 1 year of surgery four women (4/54) had biochemical evidence of ovarian failure, three of whom were over the age of 40 at operation. At 2 years eight women (8/51) had ovarian failure, seven of these women were over the age of 40 at the time of surgery. After 4 years 11 women had ovarian failure (11/34), eight of these were over the age of 40 at operation. Ovarian function following Wertheim's hysterectomy is well maintained in women under the age of 40 at the time of their surgery, 87% of these women had normal gonadotrophin levels 4 years after their surgery. For women over the age of 40 ovarian function is poorly maintained, with only 27% with normal gonadotrophins 4 years following surgery. These data suggest that we should carefully consider recommending bilateral oophorectomy at Wertheim's hysterectomy in women over the age of 40.
RESUMEN
The aetiology of postoperative back pain is contentious. Although the role of the surgical position has not been fully established, the lithotomy position is often implicated. In order to investigate this common surgical complication further, a prospective study has been performed on 101 hysterectomy patients. The supine (52 patients) and the lithotomy (49 patients) positions have been compared and contrasted within this series. Ten patients in the supine group (20%) and seven patients in the lithotomy group (14%) developed postoperative low back pain (p > 0.1). The mean duration of symptoms postoperatively for the whole series was 7 months. We conclude that postoperative backache is an under-estimated complication of surgery and that this problem occurs equally whether the supine or the lithotomy positions are used.
Asunto(s)
Histerectomía/métodos , Dolor de la Región Lumbar/etiología , Complicaciones Posoperatorias/etiología , Postura , Adulto , Anestesia General , Femenino , Humanos , Incidencia , Periodo Intraoperatorio , Dolor de la Región Lumbar/epidemiología , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Prevalencia , Estudios Prospectivos , Equipo QuirúrgicoRESUMEN
Fluid movement between the plasma and interstitial compartments is regulated by a balance of forces at the capillary level. Several factors can alter this balance and lead to edema formation. Since the body has no compensatory mechanism to rid the body of excess fluid once edema appears, it is essential for nurse practitioners to accurately assess clients who may be at risk for fluid retention. This article describes the factors responsible for excess fluid accumulation, client assessment and treatment of generalized edema.