Understanding the issues experienced by older people undergoing emergency surgery.

The number of older people undergoing surgery in the UK is increasing, partly due to an ageing population and advances in surgical techniques. However, outcomes for older patients who have undergone surgery are suboptimal when compared with younger people, especially following emergency surgery. To minimise the risk of adverse events affecting older people following surgery, it is essential that nurses understand how to manage common challenges for this patient group such as delirium, pain, reduced mobility and inadequate hydration.

Self-confidence for emergency intervention: adaptation and cultural validation of the Self-confidence Scale in nursing students / Autoconfiança para intervenção em emergências: adaptação e validação cultural da Self-confidence Scale em estudantes de Enfermagem / Autoconfianza para intervención en emergencia: adaptación y validación cultural de la Self-confidence Scale en estudiantes de enfermería

Objective: develop the cultural adaptation and validation of a Portuguese version of the Self-confidence Scale. Method: descriptive and exploratory methodological research for the adaptation and validation of a measuring instrument. The translation, synthesis, back-translation, revision, pretest and semantic evaluation phases were accomplished. The evaluation involving 178 students from a Teaching Diploma Program in Nursing. The ethical principles were complied with. Results: the internal consistency analysis of the scale reveals good Alpha coefficients (0.92 for the global scale and superior to 0.83 for the different dimensions). The factor analysis presents a three-factor solution with rational meaning. Conclusion: The scale is easy to answer and understand. Based on the obtained results, it can be affirmed that the scale reveals good psychometric properties, with great potential to be used in future research. .

Objetivo: realizar a adaptação cultural e validação de uma versão portuguesa da Self-confidence Scale. Método: estudo descritivo, exploratório, de investigação metodológica, de adaptação e validação de instrumento de medida. Foram cumpridas as etapas de tradução, síntese, retrotradução, revisão, pré-teste e avaliação semântica. A avaliação foi desenvolvida com 178 estudantes do Curso de Licenciatura em Enfermagem. Foram respeitados os princípios éticos. Resultados: a análise de consistência interna da escala revela bons valores de alpha (0,92 no global e superiores a 0,83 para as diferentes dimensões). A análise fatorial apresenta uma solução com três fatores, tendo esses significado racional. Conclusão: a escala é de fácil resposta e compreensão. Pelos resultados obtidos, pode-se afirmar que a escala revela boas propriedades psicométricas, apresentando elevado potencial para utilização em investigações futuras. .

Objetivo: efectuar la adaptación cultural y validación de una versión portuguesa de la Self-confidence Scale. Método: estudio descriptivo, exploratorio, de investigación metodológica, de adaptación y validación de instrumento de medida. Fueron seguidas las etapas de traducción, síntesis, retro traducción, revisión, pre-prueba y evaluación semántica. La evaluación fue desarrollada con 178 estudiantes del Curso de Licenciatura en Enfermería. Fueron respetados los principios éticos. Resultados: el análisis de consistencia interna de la escala revela buenos valores de Alpha (0,92 global y superiores a 0,83 para las diferentes dimensiones). El análisis factorial muestra una solución con tres factores que poseen significado racional. Conclusión: La escala es fácil de responder y comprender. Con base en los resultados alcanzados, podemos afirmar que la escala revela buenas propiedades psicométricas, con elevado potencial para utilización en investigaciones futuras. .

Proyecto de implementación del dispositivo de triage en enfermeria en la guardia del Sanatorio Allende (Cerro) / Project triage device implementing nursing central guard sanatorio Allende

El presente proyecto de intervención sera llevado a cabo en el Sanatorio Allende, villa Belgrano, y el mismo es planteado ante la realidad observada en el servicio de guardia central, en el transcurso del ultimo año. El constante aumento de los motivos de consulta, sobretodo en epoca invernal, la necesidad de educacion de la poblacion acerca del correcto uso de los servicios de guardia y urgencias medicas y la planificacion de recursos humanos para estos servicios, son los principales motivos para plantear este trabajo. El objetivo es mejorar la calidad del servicio que se presta en la guardia central del sanatorio, mejorando a su vez la calidad de toda la institución. Tipo de estudio: proyecto de intervencion.

Research to practice: developing an integrated anaphylaxis education curriculum for school nurses.

The numbers of school-aged children with life-threatening allergies that cause anaphylaxis continues to increase. Many states, including Washington, have responded to this by developing specific guidelines for school districts to follow in order to provide a safe learning environment for children with medical conditions that put them at risk for anaphylaxis. School nurses require resources to assist them in providing health training for school staff on how to manage potentially life-threatening health conditions for children in their school, however, resources to address this training are limited. A search for and content analysis of currently available literature and resources about anaphylaxis and anaphylaxis training curricula revealed a lack of an integrated curriculum to train school staff. This article presents a discussion of the development of a train-the-trainer anaphylaxis education program providing school nurses with curriculum, lesson plans, teaching-learning activities, and resources for anaphylaxis education of all school staff.

Nursing management of common oncological emergencies.

This article examines three of the most common oncological emergencies. It considers the underlying pathophysiology of these conditions and the symptoms. The role of the nurse in identifying these conditions and expediting timely care to reduce patient morbidity and mortality is discussed.

Emergency: Variceal hemorrhage from esophageal varices associated with alcoholic liver disease.

Esophageal varices occur in about half of all people with alcoholic cirrhosis. About one-third of these will experience variceal hemorrhage, a life-threatening event. This article describes alcoholic cirrhosis and its complications, discusses the etiology of esophageal varices and the risk factors for hemorrhage, and addresses emergent treatment. Further treatment options, including endoscopic variceal ligation, endoscopic injection sclerotherapy, balloon tamponade, and transjugular intrahepatic portosystemic shunt placement, are also discussed.

Rescue ventilation: resolving a "cannot mask ventilate, cannot intubate" situation during exchange of a Combitube for a definitive airway.

Our anesthesia care team was called to care for a patient who was admitted to the emergency department with the esophageal-tracheal double-lumen airway device (Combitube, Tyco Healthcare, Nellcor, Pleasanton, California) in place, which needed to be exchanged for a definitive airway because the patient required an extended period of mechanical ventilation. Several techniques were attempted to exchange the esophageal-tracheal Combitube (ETC) without success. First, we attempted direct laryngoscopy with the ETC in place after deflation of the No. 1 proximal cuff and sweeping the ETC to the left. We were prepared to use bougie-assisted intubation but could not identify any airway anatomy. After removal of the ETC, we unsuccessfully attempted ventilation/intubation with a laryngeal mask airway (LMA Fastrach, LMA North America, San Diego, California). Our third attempt was insertion of another laryngeal mask airway (LMA Unique, LMA North America) with marginal ventilation, but we again experienced unsuccessful intubation using a fiberscope. The ETC was reinserted after each intubation attempt because mask ventilation was impossible. Before proceeding with cricothyrotomy, we repeated direct laryngoscopy but without the ETC in place. We identified the tip of the epiglottis, which allowed for bougie-assisted intubation. This obviated the need for emergency cricothyrotomy.

Emergency department management of penetrating eye injuries.

Penetrating injuries are rare but important for the patient both visually and socioeconomically. This guide intends to provide a structure for emergency department personnel to enable targeted history taking, effective examination, appropriate investigation and timely referral for those presenting with penetrating eye trauma.

Gingivitis: diagnosis and treatment.

Most emergency nurses have little education on dental conditions yet some new attendances to emergency departments are for dental problems. This article describes the signs and symptoms of three common gingival conditions, and briefly outlines treatment.

Toxic alcohol ingestions: focus on ethylene glycol and methanol.

The ingestion of toxic alcohols, specifically ethylene glycol (EG) and methanol, provides unique therapeutic challenges for emergency personnel. If untreated, these agents can result in significant morbidity and mortality. The toxicity of EG and methanol is dependent on endogenous metabolic processes rather than the actual parent compound ingested. These metabolites lead to the characteristic metabolic acidosis and cellular dysfunction typically seen with toxic alcohol ingestions. Fortunately, several options exist for the treatment of these ingestions, which, if implemented in the appropriate time period, can significantly decrease associated morbidity and mortality. The intent of this review is to discuss relevant management issues associated with EG and methanol intoxication in the emergency department.

Infusion reactions triggered by monoclonal antibodies treating solid tumors.

Monoclonal antibodies (mAb) are potent agents with significant therapeutic advantages and represent the new standard of care in oncology. Although fairly well tolerated, a major health issue with mAbs is the development of infusion reactions that can range in severity from mild to life threatening. Therefore, it is critical to know how to manage these reactions when the first symptoms appear. Oncology nurses need to be proactive in monitoring, assessing, and managing infusion reactions throughout the entire course of therapy. Nurses are also instrumental in developing a protocol on how to address infusion reactions. Building a partnership with patients and caregivers ensures that patients are safely treated and can fully benefit from mAb therapy.