RESUMEN
OBJECTIVES: The objectives of this article are to describe the therapeutic options available and develop an appropriate clinical approach suitable to the individual needs of the patient with arterial insufficiency, based on the wound bed preparation paradigm. This information will also assist in the integration of decision making regarding appropriate clinical intervention in an interprofessional team approach, according to the International Inter-professional Wound Caring Model 2012, with inclusion of patient-centered concerns within the patient's circle of care.
Asunto(s)
Arteriopatías Oclusivas/terapia , Úlcera de la Pierna/terapia , Manejo del Dolor , Cicatrización de Heridas , Amputación Quirúrgica , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/enfermería , Quimioterapia Adyuvante , Toma de Decisiones , Educación Continua , Procedimientos Endovasculares , Humanos , Oxigenoterapia Hiperbárica , Úlcera de la Pierna/etiología , Úlcera de la Pierna/enfermería , Terapia de Presión Negativa para Heridas , Manejo del Dolor/enfermería , Cuidados Paliativos , Educación del Paciente como Asunto , Trasplante de PielAsunto(s)
Arteriosclerosis/enfermería , Síndrome Metabólico/enfermería , Anciano , Arteriopatías Oclusivas/enfermería , Arteriopatías Oclusivas/fisiopatología , Arteriopatías Oclusivas/prevención & control , Arteriosclerosis/fisiopatología , Arteriosclerosis/prevención & control , Infarto Cerebral/enfermería , Infarto Cerebral/fisiopatología , Infarto Cerebral/prevención & control , Endotelio Vascular/fisiopatología , Humanos , Síndrome Metabólico/fisiopatología , Síndrome Metabólico/prevención & control , Infarto del Miocardio/enfermería , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/prevención & control , Enfermedad Arterial Periférica/enfermería , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/prevención & control , Factores de RiesgoAsunto(s)
Dimensión del Dolor/enfermería , Infección de Heridas/diagnóstico , Infección de Heridas/enfermería , Muñones de Amputación , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/enfermería , Edema/etiología , Humanos , Diagnóstico de Enfermería , Úlcera por Presión/diagnóstico , Úlcera por Presión/etiología , Úlcera por Presión/enfermería , Úlcera por Presión/prevención & control , Factores de Riesgo , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/etiología , Úlcera Varicosa/enfermería , Úlcera Varicosa/prevención & control , Infección de Heridas/etiología , Infección de Heridas/prevención & controlRESUMEN
The prevalence of peripheral arterial occlusive disease (PAOD) in hemodialysis patients is several times higher than among the general population, and is the main reason for amputations in this group. Patients with peripheral arterial occlusive disease face higher hospitalization and mortality rates associated with cardiovascular disease than non-PAOD patients. The ankle brachial index (ABI) is a widely used PAOD screening tool that may under-estimate PAOD prevalence in the hemodialysis population in the presence of extensive vascular calcification. Studies have demonstrated oxygen saturation in the upper and lower limbs and the "Edinburgh Claudication Questionnaire" as simple screening methods that, in combination with ABI, can increase screening test effectiveness. Early PAOD detection, risk factor modification, medical treatment, and exercise rehabilitation therapy can improve walking function and reduce mortality in PAOD patients.
Asunto(s)
Arteriopatías Oclusivas/terapia , Diálisis Renal , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/enfermería , HumanosAsunto(s)
Conducta Cooperativa , Comunicación Interdisciplinaria , Grupo de Atención al Paciente , Heridas y Lesiones/enfermería , Anciano , Anciano de 80 o más Años , Arteriopatías Oclusivas/epidemiología , Arteriopatías Oclusivas/etiología , Arteriopatías Oclusivas/enfermería , Benchmarking/normas , Enfermedad Crónica , Ahorro de Costo/tendencias , Pie Diabético/epidemiología , Pie Diabético/etiología , Pie Diabético/enfermería , Predicción , Alemania , Costos de la Atención en Salud/tendencias , Humanos , Grupo de Atención al Paciente/economía , Dinámica Poblacional , Úlcera Varicosa/economía , Úlcera Varicosa/epidemiología , Úlcera Varicosa/enfermería , Heridas y Lesiones/economía , Heridas y Lesiones/epidemiologíaRESUMEN
PURPOSE: The purpose of this study was to determine if toe pressures (TPs) obtained by a registered nurse using a portable photophlethysmograph (PPG) were equivalent to TPs obtained by a registered vascular technologist (RVT) using standard laboratory equipment. DESIGN: A within-subjects, comparative design was used for the study. SETTING AND SUBJECTS: Thirty subjects referred to a vascular laboratory for arterial studies were recruited. All tests were performed in the outpatient vascular laboratory of a large, urban medical center. METHODOLOGY: Toe pressures were measured on subjects by the same RN and RVT during the same visit. Data were analyzed using the Bland-Altman method that compares bias (mean difference) and precision (limits of agreement) of measurements to previously determined criterion for clinically important limits of difference (±15 mm Hg) in order to assess equivalence and repeatability of measurements. Kappa statistic was calculated to assess RVT/RN agreement to detect lower extremity arterial disease (LEAD) (ie, TP<50 mm Hg). Sensitivity and specificity of the portable PPG measures were determined. RESULTS: Precision for RVT-RN TPs exceeded the previously determined cutoff criteria (±15 mm Hg), but precision for repeated RN PPG measures fell within the clinically important limits. Kappa statistic calculation (κ=0.76) revealed substantial agreement (90%) between the RVT and RN measures to detect LEAD (<50 mm Hg). The portable PPG technique had good sensitivity (79%) and high specificity (95%) for detection of LEAD. CONCLUSION: Although TPs obtained by the portable PPG were not equivalent to standard laboratory tests, the portable technique agreed sufficiently with the RVT to detect LEAD. The good sensitivity and high specificity of the portable PPG make it suitable for nurses and other primary care providers to use for high-risk patients or patients with wounds, when the ankle brachial index either is elevated above 1.3 or cannot be performed. Photophlethysmograph is also suitable to assess healing potential and the need for referrals to the vascular laboratory, surgeon, or the need for adjunctive therapies.
Asunto(s)
Arteria Braquial , Enfermeras Clínicas , Enfermedad Arterial Periférica/diagnóstico , Dedos del Pie/irrigación sanguínea , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/métodos , Tobillo/irrigación sanguínea , Índice Tobillo Braquial , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/enfermería , Técnicas de Laboratorio Clínico/normas , Estudios de Cohortes , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/enfermería , Fotopletismografía/instrumentación , Fotopletismografía/métodos , Reproducibilidad de los ResultadosRESUMEN
Lower-extremity arterial disease (LEAD) affects 8 to 10 million people in the United States, resulting in pain, tissue loss, infection, limb loss, and an impaired quality of life. LEAD is underdiagnosed, undertreated, and often unrecognized. The purpose of this article is to provide a summary of the recommendations from the 2008 evidence-based, clinical practice guideline, Guideline for the Management of Patients With Lower-Extremity Arterial Disease, recently released from the Wound, Ostomy and Continence Nurses Society. This article presents an overview of the process used to develop the guideline, a discussion of risks for LEAD, and specific recommendations for assessment, interventions, patient education, and risk-reduction strategies.
Asunto(s)
Arteriopatías Oclusivas/enfermería , Pierna/irrigación sanguínea , Estomía/enfermería , Sociedades de Enfermería , Arteriopatías Oclusivas/epidemiología , Población Negra/estadística & datos numéricos , Complicaciones de la Diabetes/enfermería , Angiopatías Diabéticas/enfermería , Medicina Basada en la Evidencia , Humanos , Hipertensión/complicaciones , Hipertensión/enfermería , Incidencia , Inflamación/complicaciones , Estados Unidos/epidemiologíaRESUMEN
Lower extremity arterial disease (LEAD) affects millions of Americans, causing impaired function and a high risk of nonhealing wounds, infection, and limb loss. This chronic, progressive condition is often silent until a life- or limb-threatening complication occurs and impacts the quality of life of individuals and their families and results in high healthcare costs. Assessment forms the cornerstone of effective nursing care, yet despite several national guidelines, LEAD remains unrecognized in half of persons with the condition. This article presents an overview of assessment of LEAD, including descriptions of the risks, pathogenesis, and common characteristics of arterial disease.
Asunto(s)
Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/enfermería , Rol de la Enfermera , Enfermedades Vasculares Periféricas/diagnóstico , Enfermedades Vasculares Periféricas/enfermería , Calidad de Vida , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/epidemiología , Diagnóstico Diferencial , Humanos , Claudicación Intermitente/etiología , Pierna/irrigación sanguínea , Evaluación en Enfermería/métodos , Investigación en Evaluación de Enfermería , Dolor/etiología , Enfermedades Vasculares Periféricas/complicaciones , Enfermedades Vasculares Periféricas/epidemiología , Flujo Sanguíneo Regional/fisiología , Medición de Riesgo , Estados Unidos/epidemiología , CaminataAsunto(s)
Tobillo/irrigación sanguínea , Arteriopatías Oclusivas/diagnóstico por imagen , Arteria Braquial/diagnóstico por imagen , Evaluación en Enfermería/métodos , Índice de Severidad de la Enfermedad , Arteriopatías Oclusivas/epidemiología , Arteriopatías Oclusivas/enfermería , Documentación , Humanos , Matemática , Rol de la Enfermera , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Valores de Referencia , Ultrasonografía Doppler/métodos , Ultrasonografía Doppler/enfermería , Estados Unidos/epidemiologíaRESUMEN
Lucy Aldeen describes recommendations that aim to assist tissue viability nurses and managers in acute trusts to implement guidelines on leg ulcer management. The goal is to improve and sustain standards of care for this patient group.
Asunto(s)
Úlcera de la Pierna/enfermería , Enfermedad Aguda , Arteriopatías Oclusivas/enfermería , Vendajes , Humanos , Úlcera de la Pierna/etiología , DolorRESUMEN
This article aims to explain the difference between venous and arterial leg ulcers, methods of treatment and prevention for each kind of ulcer, and the social and emotional impact of venous ulcers.
Asunto(s)
Úlcera de la Pierna/enfermería , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/enfermería , Arteriopatías Oclusivas/terapia , Vendajes , Diagnóstico Diferencial , Humanos , Úlcera de la Pierna/diagnóstico , Úlcera de la Pierna/psicología , Úlcera de la Pierna/terapia , Dolor/prevención & control , Educación del Paciente como Asunto , Apoyo Social , Úlcera Varicosa/diagnóstico , Úlcera Varicosa/enfermería , Úlcera Varicosa/terapiaAsunto(s)
Arteriopatías Oclusivas/enfermería , Manejo de Caso/legislación & jurisprudencia , Prestación Integrada de Atención de Salud/legislación & jurisprudencia , Grupos Diagnósticos Relacionados/legislación & jurisprudencia , Programas Nacionales de Salud/legislación & jurisprudencia , Rol de la Enfermera , Arteriopatías Oclusivas/economía , Manejo de Caso/economía , Control de Costos/legislación & jurisprudencia , Prestación Integrada de Atención de Salud/economía , Grupos Diagnósticos Relacionados/economía , Medicina Basada en la Evidencia/economía , Medicina Basada en la Evidencia/legislación & jurisprudencia , Alemania , Humanos , Programas Nacionales de Salud/economía , Guías de Práctica Clínica como Asunto/normas , Garantía de la Calidad de Atención de Salud/economía , Garantía de la Calidad de Atención de Salud/legislación & jurisprudenciaRESUMEN
This qualitative study describes the meaning of Caring from the viewpoint of the patient with chronic wounds due to peripheral vascular disease (PVD). Because the meaning of Caring can not be understood independent from the life context of the persons involved, the following questions have been formulated: 1) What influence does living with chronic wounds have on the everyday life of the patient? 2) What is the meaning of Caring for patients with chronic wounds? To answer these questions, qualitative research methods according to Mayring were chosen. A convenience sample of twelve patients, seven women and five men, with ages ranging from 69 to 86 years (median 77 years), were interviewed from April to November 2002. Data were analyzed according to Mayring (2000) through content analysis. The results show that the everyday life of the patient is strongly influenced by the effects of having chronic wounds. Patients view their lives with chronic wounds, the effects on their day to day life and the support from health professionals and family caregivers as a whole. Patients differentiate between Caring from Health professionals and Caring from family caregivers. Caring from health professionals is described primarily in the context of treatments and support situations. Caring from family caregivers is experienced as a part of the everyday life. Patients assume that healthcare professionals have the needed expertise, knowledge and skills. They hope, however, to be valued and respected and describe these characteristics as "kind and nice". When patients experience these attitudes from the nurses they feel they are taken seriously and are cared for. This is a requirement to enable or empower patients to understand and implement their treatment regimen. Caring must always be an element of nursing care and determines the standard of the quality of the patient-nurse relationship.
Asunto(s)
Arteriopatías Oclusivas/enfermería , Empatía , Úlcera de la Pierna/enfermería , Relaciones Enfermero-Paciente , Úlcera Cutánea/enfermería , Actividades Cotidianas/psicología , Adaptación Psicológica , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Úlcera de la Pierna/psicología , Masculino , Dolor/enfermería , Dolor/psicología , Satisfacción del Paciente , Calidad de Vida , Rol del Enfermo , Úlcera Cutánea/psicologíaRESUMEN
Palpation of pedal pulses alone is known to be an unreliable indicator for the presence of arterial disease. Using portable Doppler ultrasound to measure the resting ankle brachial pressure index is superior to palpation of peripheral pulses as an assessment of the adequacy pf the arterial supply in the lower limb. Revisiting basics, this article aims to aid the clinician to understand and perform hand-held Doppler ultrasound effectively while involving the client or patient in the process. The author describes the basics of Doppler ultrasound, how to select correct equipment for the process, and interpretation of results to further enhance clinicians' knowledge.