Patients with End-Stage Renal Disease and Acute Surgical Abdomen: Opportunities for Palliative Care.

Background: End-stage renal disease (ESRD) is a life-limiting condition that is often complicated by acute abdominal emergency. Palliative care (PC) has been shown to improve the quality of life in patients with serious illness and yet is underutilized. We hypothesize that ESRD patients with abdominal emergency have high unmet PC needs. Objective: To characterize the outcomes of ESRD patients with acute surgical abdomen, define PC utilization patterns, and identify areas of unmet PC needs. Design: Retrospective study querying the National Inpatient Sample database (2009-2013). Setting and Subjects: Subjects were identified using ICD-9 codes for those aged ≥50 with preexisting diagnosis of ESRD with an acute abdominal emergency diagnosis of gastrointestinal perforation, obstruction, or ischemia. Measurements: Outcomes included PC rate, in-hospital mortality, discharge disposition, and intensity of care. Multivariable logistic regression analysis was used to identify predictors of PC. Results: A total of 9363 patients met the inclusion criteria; 24% underwent surgery, 16% died in hospital, and 43% were discharged to dependent living. Among in-hospital deaths, 23% received PC. Only 4% of survivors with dependent discharge received PC. Surgical mortality was 26%. PC was less utilized in surgical patients than nonsurgical patients. PC was associated with shorter hospital stay. Predictors of PC included increasing age, severity of underlying illness, white race, teaching hospitals, and the Western region. Conclusions: Patients with ESRD admitted for acute abdominal emergency have high risk for mortality and functional dependence. Despite this, few receive PC and have a high utilization of nonbeneficial life support at the end of life.

Toma de medición intraabdominal a personas en estado crítico, por el profesional de enfermería / Taking measurement intraabdominal people in critical condition, by the nursing professional", "_e": "n

El aumento de la presión dentro de la cavidad abdominal se asocia a múltiples alteraciones fisiopatológicas, con una importante repercusión en aparatos y sistemas originando disfunción orgánica múltiple, lo que conlleva a un incremento en la morbimortalidad en pacientes en estado crítico, la medición de presión intraabdominal es un procedimiento que se está realizando con mayor frecuencia en las Unidades de Cuidados Intensivos, en donde los profesionales de enfermería tienen un papel muy importante en la toma e identificación de posibles complicaciones que ponen en riesgo la vida del paciente. La siguiente revisión tiene la finalidad de difundir el conocimiento y dar a conocer la importancia e intervenciones de enfermería en la medición de la presión intraabdominal.

The increase in the pressure inside the abdominal cavity is associated with multiple pathophysiological changes, with a significant impact in systems causing multiple organic dysfunction, leading to increased the morbidity and mortality in critically ill patients, the measurement of intra-abdominal pressure is a procedure that is being performed more frequently in the intensive care units, where nurses have an important role in taking and identifying possible complications that endanger the patient’s life. The following review has the purpose of disseminate knowledge and explain the importance and the nursing interventions in measuring intra-abdominal pressure.

Evaluation of acute abdominal pain.

Abdominal pain is a common complaint encountered in primary care and in the ED. Varying levels of pain dictate the immediacy of the intervention. Time is vital when making the decision to initiate therapeutic interventions. A comprehensive assessment with physical exam and diagnostic studies is required.

Acute abdomen: what a pain!

So many things-some life-threatening-can cause abdominal pain. Here's how to capture the clues quickly and accurately.

The challenge of assessing and diagnosing acute abdomen in tetraplegics: a case study.

The assessment and diagnosis of an acute abdomen in a spinal cord-injured patient presents a significant challenge to even the most experienced practitioners because of the muted or altered presentations secondary to paralysis. Because the patient with spinal cord injury is at increased risk for peptic or duodenal ulcers and a number of other gastrointestinal emergencies, clinicians need to maintain a high index of suspicion for acute abdomen when working with this population.

Acute abdomen in infants of adolescent mothers: diagnostic challenges.

Caring for children of adolescent parents presents unique challenges. Because adolescent parents may lack parenting skills and knowledge of medical terminology, symptoms of life-threatening illnesses may be misinterpreted. We present two cases of unexpected acute abdomen in young infants with adolescent mothers. The first case involves midgut volvulus, which was discovered during a routine newborn visit. The second case, involving pyloric stenosis, presented a clinical management challenge when the adolescent mother refused diagnostic studies.

Rol de Enfermería en la detección de la distensión abdominal Hospital Materno. Sancti Spíritus 2000 / Nursing rule in the detection of abdominal distension. Maternity Hospital. Sancti SpÃritus. 2000

La tendencia al incremento de la operación cesárea constituye un fenómeno casi universal, este incremento ha traído una creciente preocupación por la salud perinatal y materna, debido a esto se realizó un estudio descriptivo, transversal y prospectivo a un universo de 707 pacientes cesareadas y se tomó una muestra de 115 pacientes que presentaron distensión abdominal en su puerperio mediato que comprende desde las 24 horas hasta los 10 días en el Hospital Gineco ­ Obstétrico Docente Provincial " Isabel María de Valdivia y Salas" en el año 2000. Con el objetivo de determinar las posibles causas que originan la distensión, así como la participación del personal de enfermería en esta complicación para lo cual se tuvo en cuenta algunas características de la muestra: edad, paridad, nivel escolar, duración de la intervención y sepsis antes o durante del parto. Los datos fueron obtenidos de la revisión de historias clínicas y del comité de parto y cesáreas, los datos fueron procesados por calculadoras y el método de estudio fue porcentual. El grupo de mayor porciento de distensión fue el de 21-30 años con 33% seguido de 17-20 años con el 23,4%, el nivel escolar fue de secundaria con 34%, el tipo de cesárea fue primitiva con 59,1% y según residencia fue la rural con 60%, la distensión fue más frecuente en los 46-55 minutos de duración de la intervención, la deambulación tardía de 25-48 horas y fue donde más se distendieron con 50,4% y el 87,8% fue detectada por el personal de enfermería.

Bringing acute abdomen into focus.

When you care for a patient with acute abdominal pain, you can't waste time-his life could depend on fast assessment and treatment. Follow this systematic approach to zero in on the diagnosis and intervene appropriately.

Evaluation of the child with acute abdominal pain.

Acute abdominal pain is a frequent and potentially serious episodic complaint. Evaluation of the child with acute abdominal pain is always challenging, even for the experienced nurse practitioner. Some of the difficulties include obtaining accurate historical information and the subleties of abdominal examination. However, approaching the differential diagnosis of acute abdominal pain from a developmental perspective may assist the nurse practitioner in coming to a more timely and accurate diagnosis. Pertinent historical data and techniques of examination are reviewed. Age-specific causes of acute abdominal pain and their clinical manifestations are presented.