RESUMO
Heart failure, a complex clinical syndrome affecting millions of Americans, is associated with high morbidity and mortality and a significant financial burden on the health care system. Recent health care reform efforts have focused on reducing 30-day heart failure hospital readmissions, increasing the cost-effectiveness of care provided to heart failure patients, and improving health outcomes for these patients. This case report describes an acutely ill patient with multiple comorbidities who was not initially admitted for heart failure but who developed acute decompensated heart failure during his hospital stay. The purpose of this in-depth analysis is to discuss the role of bedside nurses and advanced practice nurses in managing heart failure, describe the challenges of identifying secondary heart failure in patients with complex conditions, and suggest methods of improving health-related outcomes to prevent hospital readmissions.
Assuntos
Enfermagem Cardiovascular/normas , Insuficiência Cardíaca/enfermagem , Insuficiência Cardíaca/prevenção & controle , Assistência Centrada no Paciente/normas , Guias de Prática Clínica como Assunto , Prevenção Secundária/normas , Adulto , Idoso de 80 Anos ou mais , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Estados Unidos/epidemiologiaRESUMO
Hereditary hemorrhagic telangiectasia is a rare, autosomal dominant genetic disease that causes abnormal growth of blood vessels and, subsequently, life-threatening arteriovenous malformations in vital organs. Epistaxis may be one of the initial clues that a patient has more serious, generalized arteriovenous malformations. Recommended treatment involves careful evaluation to determine the severity and risk of spontaneous rupture of the malformations and the management of various signs and symptoms. The disease remains undiagnosed in many patients, and health care providers may miss the diagnosis until catastrophic events happen in multiple family members. Prompt recognition of hereditary hemorrhagic telangiectasia and early intervention can halt the dangerous course of the disease. Critical care nurses can assist with early diagnosis within families with this genetic disease, thus preventing early death and disability.
Assuntos
Hemorragia Cerebral/etiologia , Hemorragia Cerebral/enfermagem , Enfermagem de Cuidados Críticos/métodos , Cuidados Críticos/métodos , Predisposição Genética para Doença , Telangiectasia Hemorrágica Hereditária/genética , Hemorragia Cerebral/fisiopatologia , Terapia Combinada , Diagnóstico Precoce , Epistaxe/diagnóstico , Epistaxe/etiologia , Hospitais Comunitários , Humanos , Unidades de Terapia Intensiva , Masculino , Papel do Profissional de Enfermagem , Diagnóstico de Enfermagem/métodos , Prognóstico , Medição de Risco , Taxa de Sobrevida , Telangiectasia Hemorrágica Hereditária/fisiopatologia , Telangiectasia Hemorrágica Hereditária/terapia , Adulto JovemAssuntos
Competência Cultural , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Manejo da Dor/enfermagem , Melhoria de Qualidade , Assistência Terminal , Atitude Frente a Morte , Comunicação , Disparidades em Assistência à Saúde , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/educação , Humanos , Relações Enfermeiro-Paciente , Medição da Dor/métodos , Medição da Dor/enfermagem , Preferência do PacienteRESUMO
BACKGROUND: Von Hippel-Lindau (VHL) is a rare autosomal dominant hereditary disorder that predisposes individuals to benign and malignant tumors in the brain, eyes, kidneys, pancreas, genital tract, or other body parts. The VHL gene, which is located on the short arm of chromosome 3, prevents cells from dividing too rapidly. Mutations in the VHL gene result in uncontrollable cell growth and tumor formation. OBJECTIVES: The purpose of this article is to summarize the current research literature describing diagnosis, treatment, and nursing implications of VHL. METHODS: Three electronic databases, relevant journals, and relevant websites were searched. FINDINGS: The majority of patients affected with VHL have an affected parent, but a small percentage develop VHL from a new mutation that takes place in a single egg or sperm during conception or from a post-conception mutation. Genetic testing, either through sequence analysis, Southern blot analysis, or quantitative polymerase chain reaction, is considered standard in evaluating patients suspected of having VHL. A diagnosis of VHL can be made by identifying one VHL tumor for a patient who has a confirmed family history of VHL. The presence of at least two tumors is required to make a diagnosis of VHL in a patient without a positive family history. The nursing role includes providing resources on VHL genetic counseling, genetic testing, and palliative care.
Assuntos
Doença de von Hippel-Lindau/enfermagem , Doença de von Hippel-Lindau/terapia , Humanos , Mutação , Doença de von Hippel-Lindau/diagnósticoRESUMO
Atrial fibrillation is an important risk factor for thromboembolic stroke and it significantly increases the risk of stroke. The left atrial appendage (LAA) is the most common site of thrombus formation in nonvalvular atrial fibrillation, and the recent applications of percutaneous LAA closure devices offer a promising alternative for patients who are unable to tolerate lifelong anticoagulation. Critical care nurses who understand the procedures and are familiar with the various devices used for LAA closure will be well prepared to provide optimum care and appropriate education for these patients.
Assuntos
Anticoagulantes/uso terapêutico , Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Acidente Vascular Cerebral/prevenção & controle , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Enfermagem de Cuidados Críticos , Humanos , Fatores de RiscoRESUMO
It is estimated that 375,000 Americans are utilizing insulin pump therapy to manage their diabetes. This article will educate community health care nurses regarding use of the insulin pump, and how to operate special settings for more effective glycemic control. Complications of pump therapy, as well as hyperglycemia, are not always avoidable; however, interventions are in place to prevent and treat complications. Furthermore, important assessment questions are employed to assist community health nurses in evaluating the patient knowledge base and management skills of their disease process in hyperglycemic episodes and emergency situations.
Assuntos
Enfermagem em Saúde Comunitária , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/enfermagem , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/enfermagem , Sistemas de Infusão de Insulina , HumanosRESUMO
The International Association for the Study of Pain neuropathic pain guidelines are presented. Nursing considerations, including neuropathic pain assessment and medication efficacy, are reported to explain medications' primary mechanisms of action and provide a nursing reference for patient education.
Assuntos
Analgésicos/normas , Analgésicos/uso terapêutico , Educação Continuada em Enfermagem , Neuralgia/tratamento farmacológico , Cuidados de Enfermagem/normas , Recursos Humanos de Enfermagem Hospitalar/educação , Guias de Prática Clínica como Assunto , Humanos , Manejo da Dor/enfermagem , Medição da Dor/enfermagemRESUMO
The objective of this mixed methods study was to examine current sexual risk behaviors, acceptability and potential adoption of pre-exposure prophylaxis (PrEP) for HIV prevention, and sexual behavior intentions with PrEP adoption among HIV-negative gay and bisexual men (GBM) in HIV serodiscordant relationships. A multiracial/ethnic sample of 25 HIV-negative GBM in serodiscordant relationships completed a qualitative interview and a brief interviewer-administered survey. A modified grounded theory approach was used to identify key themes relating to acceptability and future adoption of PrEP. Participants reported engaging in sexual risk behaviors that place them at risk for HIV infection. Participants also reported a high level of acceptability for PrEP and willingness to adopt PrEP for HIV prevention. Qualitative themes explaining future PrEP adoption included: (1) the opportunity to engage in sex using a noncondom HIV prevention method, (2) protection from HIV infection, and (3) less anxiety when engaging in sex with an HIV-positive partner. Associated with the future adoption of PrEP, a majority (64%) of participants indicated the likelihood for an increase in sexual risk behaviors and a majority (60%) of participants also indicated the likelihood for a decrease or abandonment of condom use, both of which are in contrast to the findings from the large iPrEx study. These findings suggest that the use of PrEP by HIV-negative GBM in serodiscordant relationships carries with it the potential for risk compensation. The findings suggest that PrEP only be offered as part of a comprehensive HIV prevention strategy that includes ongoing risk reduction counseling in the delivery of PrEP to help moderate risk compensation.
Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Prevenção Primária/métodos , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologia , Adulto , Bissexualidade/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Homossexualidade Masculina/psicologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Motivação , Assunção de Riscos , Comportamento Sexual/estatística & dados numéricosRESUMO
People living with HIV infection have a significantly higher rate of anal cancer as compared with that of uninfected people. It is believed that high-grade anal dysplasia secondary to human papillomavirus infection is a precursor to anal cancer. Considering this, screening and treatment of high-grade anal dysplasia is a possible means of preventing the development of anal cancer. No national or international guidelines exist to guide practice for screening and management of anal dysplasia. On the basis of a review of research and expert recommendations, a guide to practice for screening and management of anal dysplasia and anal cancer is made for clinicians.
Assuntos
Neoplasias do Ânus/complicações , Infecções por HIV/complicações , Neoplasias do Ânus/diagnóstico , Neoplasias do Ânus/epidemiologia , Neoplasias do Ânus/terapia , Humanos , MasculinoRESUMO
We examined condom attitudes, perceived vulnerability to HIV, HIV testing experiences, and sexual and substance use risk behaviors of 161 active Latino male gang members, aged 18-26 years old, living in Los Angeles, California. Gang members reported negative condom attitudes and a perceived vulnerability to HIV. The majority (53%) of gang members reported unprotected vaginal intercourse (UVI) in the previous 12 months. Multivariate analyses indicated that participants who engaged in the following behaviors were more likely to report UVI: had sex with someone they just met (adjusted odds ratio [AOR] = 3.66), received money or drugs for sex (AOR = 5.05), or had sex with someone who had a sexually transmitted disease (AOR = 4.99). Participants with a higher perceived vulnerability to HIV were less likely to report UVI (AOR = 0.82). Our findings offer implications for development of an HIV prevention intervention for Latino male gang members.