Clinical supervision in the palliative care team setting: a concrete approach to team wellness.

Clinical supervision is a structured, case-based approach to learning that is used most often in the mental health field. An established palliative care consultation service at a large, academic medical center implemented a modified clinical supervision model in an effort to improve team members' awareness of their own emotions and the way those emotions impact behavior during, primarily, clinical encounters. This report discusses clinical supervision in detail and, by way of a case, illustrates the power of this intervention as a source of self-care and a concrete approach to managing palliative care team well-being.

Nurses' experiences caring for patients and families dealing with malignant bowel obstruction.

Malignant bowel obstruction (MBO) is a well-recognised complication of advanced abdominal and pelvic cancers. Often surgical intervention is not feasible, resulting in complex symptoms and an unpredictable course. Although symptom management is a crucial part of nursing care, psychosocial and emotional issues frequently emerge for patients and families. This qualitative study explored the perspectives of nurses from a palliative care unit, in-patient acute care oncology units, ambulatory cancer setting, and the community on their experiences of caring for patients with MBO and their families. Six individual interviews and two focus groups were conducted. Eight overarching messages were identified related to nurses' experiences. Highlights include aspects of patients' and families' emotional distress, and the nurse-patient relationship in relieving suffering. Nurses have an important and privileged role that involves identifying MBO signs and symptoms, having knowledge of treatment and symptom management options, and helping patients transition from a curative to a palliative philosophy of care.

Responding to 4 gastrointestinal complications in cancer patients.

If your patient has cancer, be prepared to help her manage such serious GI complications as bowel obstruction, peritonitis, fistula formation, and intestinal perforation.

Manejo anestésico en pacientes pediátricos con diagnóstico de obstrucción intestinal en el hospital Manuel de Jesús Rivera La Mascota noviembre 2004 / I manage anesthetic in patient pediatric with diagnosis of intestinal obstruction in the hospital Manuel of Jesus Rivera The Mascot November 2004

Presenta estudio de caso realizado en el Hospital Manuel de Jesús Rivera en el año 2004, sobre Manejo anestésico en pacientes pediátricos con diagnóstico de obstrucción intestinal, lo constituyó un paciente de 13 años de edad que fue atendido de emergencia por traslado del Hospital Infantil Fernando Vélez Paiz, se selecciono como muestra a un paciente equivalente al 100 porciento del universo a través del muestreo aleatorio simple. Se somete a cirugia y la anestesia empleada fue una Anestesia General Orotraquial Balanceada la cual se basa en la combinación de fármacos y técnicas, cada una con peculiaridad y efectos específicos, pero con efectos secundarios superpuestos. Los fármacos utilizados fue un halogenado de alto solubilidad en la sangre además de relanjantes musculares de media duración. Al valorar el manejo anestesico, se puede decir que fue una cirugia y anestesia exitosa sin ningún problema durante el pre-trans y post-quirurgicoel paciente se mantuvo sin complicaciones.

Palliation of gastrointestinal obstructive disorders.

Gastrointestinal and biliary obstructive disorders are complications encountered in advanced cancer nursing that are associated with significant morbidity and mortality. Patients with bowel gastric, or hepatobiliary obstruction require prompt and accurate diagnosis, so that appropriate care is initiated to treat the obstruction and related symptoms. Intensive nursing care aimed at comfort, psychological support, and patient/family education is essential for the well-being of patients suffering from a gastrointestinal obstructive disorder.

Bowel obstruction.

Bowel obstruction is a serious problem requiring prompt medical intervention to relieve intestinal distention, restore intravascular volume, and correct fluid and electrolyte balance. If these efforts fail, either curative or palliative surgical interventions become necessary. Oncology nurses are important members of the healthcare team caring for patients with bowel obstructions. Accurate nursing assessments are critical to monitoring the effects of these therapies and key to reducing the risk of preoperative and/or postoperative complications.

Metastases involving the gastrointestinal system.

OBJECTIVES: To provide a review of metastases involving the gastrointestinal system, including the specific problems of liver metastasis, bowel obstruction, ascites, biliary obstruction, and gastrointestinal fistulas. DATA SOURCES: Research studies, review articles, and book chapters. CONCLUSIONS: When metastasis involves the gastrointestinal tract, the emotional distress is coupled with debilitating symptoms and marked nutritional deficits. Treatment decisions must consider potential benefits and risks and affect on quality of life. IMPLICATIONS FOR NURSING PRACTICE: An understanding of the disease process and alternative treatment interventions will assist nurses to effectively anticipate and manage symptoms that may develop and educate patients and families so they can participate in decisions regarding their treatment.

Síndrome de intestino corto

El síndrome de intestino corto (SIC) es definido como malabsorción, pérdida de líquidos y electrolitos y malnutrición debidos a resección masiva de intestino delgado. Tanto como la mitad del intestino delgado puede perderse sin problemas significativos a largo plazo para mantener una nutrición normal, con tal, que sean conservados el duodeno, íleon distal y la válvula ileocecal (VIC). En contraste, resecciones ileales distales que incluyen la VIC pueden inducir diarrea severa aunque sólo el 25 por ciento del intestino delgado haya sido resecado. La resección del más del 75 por ciento del intestino delgado con la preservación de la VIC invariablemente produce malabsorción inicial intratable y diarrea (1). Hoy en los países desarrollados se ha informado de niños con SIC que sobreviven con tan poco 25 cm de intestino delgado sin VIC y 11 cm de intestino delgado con la VIC intacta (2). Varios factores influyen en la severidad del SIC (tabla 1).

Selected complications in the patient with cancer: spinal cord compression, malignant bowel obstruction, malignant ascites, and gastrointestinal bleeding.

The growth rate of a tumor, patterns of tumor growth and metastatic spread, and toxicity of therapy contribute to the type and severity of complications. Four common critical care complications resulting from compressive and invasive properties of tumors include spinal cord compression, malignant bowel obstruction, malignant ascites, and gastrointestinal bleeding. Knowledge of the clinical presentations of each of these complications provides a foundation for nursing assessment.

Diagnosis and management of intestinal obstruction in individuals with cancer.

Small bowel obstructions, which account for two-thirds of all intestinal obstruction, are caused by adhesions, hernias and cancer. Large bowel obstructions are usually the result of a malignancy, but may also be caused by diverticulitis or volvulus. Previously treated individuals with a known diagnosis of advanced cancer originating in the pelvis are at highest risk for developing intestinal bowel obstruction. Since 30 percent of Americans will develop cancer in their lifetimes, and colorectal cancer is the most common type, this represents a significant population at risk to be followed by nurse practitioners. The pathophysiology, assessment and management of an individual with a bowel obstruction is reviewed. Morbidity and mortality in this population is high. Wound healing problems, including infection, dehiscence, evisceration and fistula formation, contribute significantly to the morbidity and can cause long-term problems. In today's health care system, it's likely that patients will be discharged from the hospital earlier after bowel surgeries. Therefore, nursing care focusing on wound management is outlined.