Ética, ontologia y epistemología del cuidado de enfermería para con el paciente con enfermedad renal / Ethics, ontology and epistemology of nursing care for patients with kidney disease / Ética, ontologia e epistemologia dos cuidados de enfermagem para o paciente com doença renal

Los ensayos y escritos relacionados con el cuidado del paciente renal a través de los años se han enfocado a la calidad de vida, estilos de afrontamiento, satisfacción o percepciones que experimentan los pacientes durante su enfermedad. El presente articulo pretende reconocer que el cuidado de enfermería para con el paciente renal es un aspecto fundamental que proporciona al profesional la comprensión de la realidad del paciente y contribuye de manera positiva a comprender la realidad de enfermería como disciplina; enmarcadas en algunas posiciones que permiten garantizar su significado. Estas posiciones son la ética, la ontología y la epistemología. La ética se logra cuando el profesional de enfermería consigue proteger y respetar la dignidad humana del paciente renal que reciben atención de salud, la ontología se ocupa de reflexionar acerca de las concepciones de la realidad y sus relaciones centrando su finalidad en la búsqueda de la salud, del bienestar, la independencia y la trascendencia del paciente renal y la epistemología consiste en mostrar, de manera holística, la evolución del conocimiento de la enfermería para brindar un cuidado de excelencia al paciente renal.

Abstract Over the years, essays and writings related to kidney patient care have focused on quality of life, coping styles, satisfaction, or perceptions experienced by patients during their illness. This article aims to recognize that nursing care for kidney patients is a fundamental aspect that provides the professional with an understanding of the patient's reality and contributes positively to understanding the reality of nursing as a discipline framed in some positions that guarantee their meaning. These positions are ethics, ontology, and epistemology. Ethics is achieved when the nursing professional manages to protect and respect the human dignity of kidney patients who receive health care. Ontology deals with reflecting on the conceptions of reality and their relationships, focusing its purpose on the search for health, well-being, independence, and transcendence of kidney patients. And epistemology consists of showing, in a holistic way, the evolution of nursing knowledge to provide excellent care to kidney patients.

Resumo: Ensaios e escritos relacionados com os cuidados aos pacientes renais ao longo dos anos têmse focado na qualidade de vida, estilos de enfrentamento, satisfação ou percepções que os pacientes experimentam durante a sua doença. Este artigo tem como objetivo reconhecer que o cuidado de enfermagem para o doente renal é um aspecto fundamental que proporciona ao profissional uma compreensão da realidade do doente e contribui positivamente para a compreensão da realidade da enfermagem como disciplina; emoldurado em algumas posições que permitem garantir seu significado. Estas posições são ética, ontologia e epistemología. A ética é alcançada quando o profissional de enfermagem consegue proteger e respeitar a dignidade humana do paciente renal que recebe cuidados de saúde, a ontologia se preocupa em refletir sobre as concepções da realidade e as suas relações centrando o seu propósito na procura de saúde, bem-estar, independência e transcendência do paciente renal e epistemologia consiste em mostrar, holisticamente, a evolução do conhecimento de enfermagem para prestar um excelente cuidado ao paciente renal.

Implementation of a Nurse-Empowered Renal Anemia Protocol in Children.

A high proportion of patients on hemodialysis persist with low hemoglobin levels despite receiving treatment with erythropoiesis-stimulating agents. A registered nurse-driven renal anemia protocol was designed and implemented by a team in a pediatric hemodialysis unit. We compared proportion of patients achieving the target hemoglobin (Hgb) and transferrin saturation (TSAT) before and after the implementation of the protocol. There was an increase in patients achieving the target Hgb and TSAT range, with an increase in the Hgb concentration. There were no differences in the proportion of patients with left ventricular hypertrophy, erythropoiesis-stimulating agents or intravenous iron dose, transfusion rates, or hospitalization rates. The implementation of a nurse-driven anemia protocol in a pediatric hemodialysis unit increased the proportion of patients achieving target Hgb and TSAT range without a rise in medication doses.

Pandemic Uncertainty: Considerations for Nephrology Nurses.

The COVID-19 pandemic is a situation of great magnitude that most of us have not experienced in our lifetime. Pandemics are widespread, affecting many geographical areas, and uncertainty is inherent given the rapidly changing situations. As nurses in dialysis providing a life-sustaining therapy, we are required to provide an essential service during pandemics and need to thrive in the uncertainty. This article offers points for consideration that can assist nephrology nurses in their approach to these uncertain times.

Desfecho clínico de pacientes em urgência dialítica: uma revisão integrativa da literatura / Resultado clínico de pacientes en urgencia dialítica: una revisión integradora de la literatura / Clinical outcome of patients in dialysis urgency: an integrative literature review

RESUMO Objetivo : Investigar o desfecho clínico de pacientes em urgência dialítica submetidos à terapia renal substitutiva, por meio de uma revisão integrativa da literatura. Método : Revisão integrativa da literatura de estudos publicados de janeiro de 2010 a julho de 2020, na íntegra, em inglês e português, nas bases de dados: Literatura Latino Americana e do Caribe em Ciência da Saúde, Medical Literature Analysis and Retrieval System Online, Base de dados de Enfermagem e PUBMED. Foram utilizadas palavras-chave e descritores: "hemodiálise", "emergência", "diálise renal", "mortalidade, "desfecho clínico" e "urgência dialítica". Os textos foram pré-selecionados a partir da leitura dos títulos e resumos, verificando sua aderência ao tema, encontrando-se 344 artigos. A seguir, foi realizada a leitura dos resultados e considerações dos estudos. Dos 334 artigos pré-selecionados, apenas 13foram incluídos. Resultados : Há recorrência da urgência dialítica, sendo o óbito o principal desfecho clínico. Conclusão : Os estudos acerca dos desfechos clínicos de pacientes em urgência dialítica ainda são poucos se comparado à dimensão que a doença renal possui na população mundial. Conhecer esses desfechos dará subsídios para novos estudos sobre a sobrevida desses pacientes e para políticas de saúde mais eficazes.

RESUMEN Objetivo : investigar el resultado clínico de pacientes en urgencia dialítica sometidos a la terapia renal sustitutiva, por medio de una revisión integradora de la literatura. Método : revisión integradora de la literatura de estudios publicados de enero de 2010 a julio de 2020, en su totalidad, en inglés y portugués, en las bases de datos: Literatura Latino Americana e do Caribe em Ciência da Saúde, Medical Literature Analysis and Retrieval System Online, Base de dados de Enfermagem y PUBMED. Fueron utilizados los descriptores y las palabras clave en portugués: "hemodiálise", "emergência", "diálise renal", "mortalidade, "desfecho clínico" y "urgência dialítica". Los textos fueron pre-seleccionados a partir de la lectura de los títulos y resúmenes, verificando su adherencia al tema, fueron encontrados 344 artículos. A continuación, fue realizada la lectura de los resultados y las consideraciones de los estudios. De los 334 artículos pre-seleccionados, apenas 13 fueron incluidos. Resultados : hay recurrencia de la urgencia dialítica, siendo el óbito el principal resultado clínico. Conclusión: los estudios acerca de los resultados clínicos de pacientes en urgencia dialítica todavía son pocos comparados a la dimensión que la enfermedad renal posee en la población mundial. Conocer estos resultados dará herramientas para nuevos estudios respecto a la pervivencia de estos pacientes y para políticas de salud más eficaces.

ABSTRACT Objective: To investigate the clinical outcome of patients in dialysis urgency who have undergone renal replacement therapy, through an integrative literature review. Method: Integrative literature review of studies published from January 2010 to July 2020, in full, in English and Portuguese, in the databases: Latin American and Caribbean Literature in Health Science, Medical Literature Analysis and Retrieval System Online, Nursing and PUBMED database. The keywords and descriptors were used: "hemodialysis", "emergency", "renal dialysis", "mortality", "clinical outcome" and "dialysis urgency". The texts were pre-selected from reading the titles and abstracts, verifying their adherence to the theme, and 344 articles were found. Next, the results and study considerations were read. Of the 334 pre-selected articles, only 13 were included. Results: There is recurrence of dialysis urgency, with death being the main clinical outcome. Conclusion: Studies on the clinical outcomes of patients in dialysis urgency are still few compared to the dimension that kidney disease has in the world population. Knowing these outcomes will provide support for further studies on the survival of these patients and for more effective health policies.

Identificação de diagnósticos de enfermagem em nefropatas em hemodiálise à luz da teoria das necessidades humanas básicas / Identification of nursing diagnoses in nephropates in hemodialysis in the light of the theory of basic human needs / Identificación de diagnosticos de enfermería en nefropathes en hemodialisis a la luz dela teoría de las necesidades básicas

Introdução: Nefropatas em tratamento hemodialítico necessitam de assistência de enfermagem qualificada. Objetivo: Identificar os domínios e títulos diagnósticos de enfermagem recorrentes em pacientes em hemodiálise, segundo a taxonomia da NANDA­ I. Material e Método: Estudo descritivo e transversal, desenvolvido no setor de Terapia Renal Substitutiva (TRS) de um hospital de Catanduva-SP. Participaram 78 pacientes em tratamento por hemodiálise. Na coleta de dados utilizaram-se dois instrumentos: um questionário sobre aspectos sociodemográficos e caracterização clínica dos participantes e outro instrumento para a realização da anamnese e do exame físico, segundo o Modelo Conceitual de Wanda Horta. Os diagnósticos de enfermagem foram elaborados utilizando a taxonomia da NANDA-I (2018-2020) considerando apenas os domínios e títulos diagnósticos, sendo ponderadas as medidas de tendência central e percentil. Resultado: Houve equivalência entre os gêneros, cuja idade mediana foi de 58 anos; raça branca (57,7%); ensino fundamental incompleto (60,3%), moradores da região de Catanduva (61,5%); portadores de Insuficiência Renal Crônica (91%); tempo de hemodiálise até dois anos (42,3%). Foram identificados 44 diagnósticos de enfermagem, destes, 50,8% foram de risco, predominando o risco de infecção (100%), enquanto 49,2% tinham foco no problema, para estilo de vida sedentária (73,1%). Conclusão: Estes resultados refletem o panorama dos diagnósticos de enfermagem recorrentes em pessoas com patologia renal.(AU)

Introduction: Nephropaths undergoing hemodialysis require qualified nursing assistance. Objective: To identify domains and recurrent nursing diagnostic titles in hemodialysis patients, according to the NANDA­I taxonomy. Material and Method: Descriptive and transversal study, developed in the Renal Replacement Therapy (RRT) sector of a hospital in Catanduva-SP. 78 patients undergoing hemodialysis treatment participated. In data collection, two instruments were used: a questionnaire on sociodemographic aspects and clinical characterization of the participants and another instrument for conducting anamnesis and physical examination, according to the Conceptual Model of Wanda Horta. Nursing diagnoses were prepared using the NANDA-I taxonomy (2018-2020) considering only the domains and diagnostic titles, with measures of central tendency and percentile being weighted. Result: There was equivalence between genders, whose median age was 58 years; white race (57.7%); incomplete primary education (60.3%), residents of the Catanduva region (61.5%); patients with Chronic Renal Failure (91%); hemodialysis time up to two years (42.3%). 44 nursing diagnoses were identified, of which 50.8% were at risk, with a predominant risk of infection (100%), while 49.2% focused on the problem, for a sedentary lifestyle (73.1%). Conclusion: These results reflect the panorama of recurrent nursing diagnoses in people with renal pathology.(AU)

Introducción: Los pacientes renales que se someten a hemodiálisis requieren asistencia de enfermería calificada. Objetivo: Identificar los dominios y títulos diagnósticos de enfermería recurrentes en pacientes en hemodiálisis, de acuerdo con la taxonomía NANDA-I. Material y Método: Estudio descriptivo y transversal, desarrollado en el sector de la Terapia de Reemplazo Renal (TRR) de un hospital en Catanduva-SP. 78 pacientes fueron sometidos a tratamiento por hemodiálisis. En la recolección de datos, se utilizaron dos instrumentos: un cuestionario sobre aspectos sociodemográficos y caracterización clínica de los participantes, y otro instrumento para realizar anamnesis y examen físico, de acuerdo con el Modelo Conceptual de Wanda Horta. Los diagnósticos de enfermería se realizaron utilizando la taxonomía NANDA-I (2018-2020) considerando solo los dominios y los títulos de diagnóstico, con medidas de tendencia central y percentil ponderado. Resultado: Hubo equivalencia entre géneros, cuya mediana de edad fue de 58 años; raza blanca (57.7%); educación primaria incompleta (60.3%), residentes de la región de Catanduva (61.5%); Insuficiencia Renal Crónica (91%); tiempo de hemodiálisis hasta dos años (42.3%). Se identificaron 44 diagnósticos de enfermería, de los cuales el 50.8% estaban en riesgo, con un riesgo predominante de infección (100%), mientras que el 49.2% se centró en el problema, para un estilo de vida sedentario (73.1%). Conclusión: Estos resultados reflejan el panorama de los diagnósticos de enfermería recurrentes en personas con patología renal.(AU)

Comprehensiveness of care-permanence in nephrology: nurses' conceptions. / Integralidade do cuidado-permanência na nefrologia: concepções de enfermeiros.

OBJECTIVE: To discuss how care-permanence comprehensiveness is for patients undergoing treatment in nephrology. METHOD: A qualitative, exploratory and descriptive study anchored in Sociopoetics, conducted in the first semester of 2018, in Rio de Janeiro, Brazil, with nurses from nephrology services. The data were produced after applying the creative technique with drawings and collages and taking recorded statements about the signifieds and signfiers of care-permanence. The analysis was performed based on the principles of Sociopoetics from the philosophical conceptions of the research groups. RESULTS: Fifteen (15) nurses with experience in nephrology services participated in this study. Four conceptual axes were shared referring to: comprehensive care; complex care; continuous care; and inclusive care, which considers the patient's family, team, society and their context, in addition to the patient themselves. CONCLUSION: A philosophical reflection on care of the human being implies considering the physical, emotional, and individual dimensions, but also its micro and macromolecular revolutions of existence as a social being. The nature of knowledge from the ludic production enabled reflection and awareness for all the time and at all times about the comprehensiveness of care by nurses in nephrology.

High-Fidelity Simulation Nurse Training Reduces Unplanned Interruption of Continuous Renal Replacement Therapy Sessions in Critically Ill Patients: The SimHeR Randomized Controlled Trial.

BACKGROUND: Although continuous renal replacement therapy (CRRT) is common, unplanned interruptions (UI) often limit its usefulness. In many units, nurses are responsible for CRRT management. We hypothesized that a nurse training program based on high-fidelity simulation would reduce the rate of interrupted sessions. METHODS: We performed a 2-phase (training and evaluation), randomized, single-center, open study: During the training phase, intensive care unit nurses underwent a 6-hour training program and were randomized to receive (intervention) or not (control) an additional high-fidelity simulation training (6 hours). During the evaluation phase, management of CRRT sessions was randomized to either intervention or control nurses. Sessions were defined as UI if they were interrupted and the interruption was not prescribed in writing more than 3 hours before. RESULTS: Study nurses had experience with hemodialysis, but no experience with CRRT before training. Intervention nurses had higher scores than control nurses on the knowledge tests (grade, median [Q1-Q3], 14 [10.5-15] vs 11 [10-12]/20; P = .044). During a 13-month period, 106 sessions were randomized (n = 53/group) among 50 patients (mean age 70 ± 13 years, mean simplified acute physiology II score 69 [54-96]). Twenty-one sessions were not analyzed (4 were not performed and 17 patients died during sessions). Among the 42 intervention and 43 control sessions analyzed, 25 (59%) and 38 (88%) were labeled as UI (relative risk [95% CI], 0.67 [0.51-0.88]; P = .002). Intervention nurses required help significantly less frequently (0 [0-1] vs 3 [1-4] times/session; P < .0001). The 2 factors associated with UI in multilevel mixed-effects logistic regression were Sequential Organ Failure Assessment score (odds ratio [95% CI], 0.81 [0.65-99]; P = .047) and the intervention group (odds ratio, 0.19 [0.05-0.73]; P = .015). CONCLUSIONS: High-fidelity simulation nurse training reduced the rate of UI of CRRT sessions and the need for nurses to request assistance. This intervention may be particularly useful in the context of frequent nursing staff turnover.

Complications of Solid Organ Transplantation: Cardiovascular, Neurologic, Renal, and Gastrointestinal.

Despite improvements in overall graft function and patient survival rates after solid organ transplantation, complications can lead to significant morbidity and mortality. Cardiovascular complications include heart failure, arrhythmias leading to sudden death, hypertension, left ventricular hypertrophy, and allograft vasculopathy in heart transplantation. Neurologic complications include stroke, posterior reversible encephalopathy syndrome, infections, neuromuscular disease, seizure disorders, and neoplastic disease. Acute kidney injury occurs from immunosuppression with calcineurin inhibitors or as a result of graft failure after kidney transplantation. Gastrointestinal complications include infections, malignancy, mucosal ulceration, perforation, biliary tract disease, pancreatitis, and diverticular disease. Immunosuppression can predispose to infections and malignancy.

Kidney Influence on Fluid and Electrolyte Balance.

The frontline nurse is confronted daily with patients that have some type of kidney dysfunction or disease. Some renal issues resolve themselves, some disorders can be reversed, and others are permanent. Major complications from kidney impairment discussed are fluid and electrolyte disequilibrium with common problems in volume overload, hyperkalemia, metabolic acidosis, hyperphosphatemia, and hormonal secretion. Each problem is presented with potential clinical manifestations and management.

Renal Diet.

Caring for a patient with renal disease requires an understanding of the basics renal nutritional therapy. The goals of nutritional therapy include maintaining renal function, preventing complications, and providing adequate nutrients. Because cardiovascular disease and hypertension are highly correlated with renal disease, sodium reduction is a major goal of the renal diet. Particularly in early stage renal disease, the Mediterranean diet and the dietary approaches to stop hypertension (DASH) eating plan may help to prevent disease progression. The role of other nutrients such as phosphorous, calcium, protein, and potassium will also be discussed.

Nursing diagnoses of patients with kidney disease undergoing hemodialysis: a cross-sectional study.

OBJECTIVE: to identify Nursing Diagnoses of 5th stage chronic kidney disease patients undergoing hemodialysis. METHOD: cross-sectional, descriptive and quantitative study carried out with 151 patients undergoing hemodialysis in a clinic specialized in nephrology from the Northwest of the Paraná State. Nursing Diagnoses were determined through Nanda-I in which had the percentage greater than 50%. The analysis used was the simple statistics. RESULTS: 17 Nursing Diagnoses were identified, emphasizing the risks present in 100% of patients: risks for electrolyte imbalance; ineffective kidney perfusion; infection: vascular injuries, adverse response to the iodine-based contrast-enhanced and impaired urinary elimination. CONCLUSION: the main diagnoses listed reflect the more frequent risks that patients undergoing hemodialysis are exposed to. Being aware of these risks allows the nursing planning with early interventions, in order to prevent complications related to the disease and to promote best life conditions.

Nursing diagnoses of patients with kidney disease undergoing hemodialysis: a cross-sectional study / Diagnósticos de enfermería de portadores de enfermedad renal en hemodiálisis: un estudio transversal / Diagnósticos de enfermagem de portadores de doença renal em hemodiálise: estudo transversal

ABSTRACT Objective: to identify Nursing Diagnoses of 5th stage chronic kidney disease patients undergoing hemodialysis. Method: cross-sectional, descriptive and quantitative study carried out with 151 patients undergoing hemodialysis in a clinic specialized in nephrology from the Northwest of the Paraná State. Nursing Diagnoses were determined through Nanda-I in which had the percentage greater than 50%. The analysis used was the simple statistics. Results: 17 Nursing Diagnoses were identified, emphasizing the risks present in 100% of patients: risks for electrolyte imbalance; ineffective kidney perfusion; infection: vascular injuries, adverse response to the iodine-based contrast-enhanced and impaired urinary elimination. Conclusion: the main diagnoses listed reflect the more frequent risks that patients undergoing hemodialysis are exposed to. Being aware of these risks allows the nursing planning with early interventions, in order to prevent complications related to the disease and to promote best life conditions.

RESUMEN Objetivo: identificar los Diagnósticos de Enfermería de portadores de enfermedad renal crónica en estadio 5 hemodialítico. Método: estudio transversal, descriptivo, de abordaje cuantitativo, realizado con 151 individuos en hemodiálisis de una clínica especializada en nefrología en la región Noroeste de Paraná. Se determinaron los Diagnósticos de Enfermería por medio de la Nanda-I que obtuvieron el porcentaje más alta al 50%. El análisis utilizado fue la estadística simple. Resultados: se identificaron 17 Diagnósticos de Enfermería, con destaques para los de riesgos presentes en el 100% de los individuos: riesgos de desequilibrio electrolítico; perfusión renal ineficaz; infección: trauma vascular y respuesta adversa al medio de contraste con yodo y el de eliminación urinaria perjudicada. Conclusión: los principales diagnósticos enumerados reflejan los riesgos más frecuentes a los cuales están expuestos los pacientes en hemodiálisis. El conocimiento de estos riesgos permite la planificación de enfermería con intervenciones tempranas, con miras a la prevención de complicaciones relacionadas con la enfermedad y promoción de mejores condiciones de vida.

RESUMO Objetivo: identificar os Diagnósticos de Enfermagem de portadores de doença renal crônica em estádio 5 hemodialítico. Método: estudo transversal, descritivo, de abordagem quantitativa, realizado com 151 indivíduos em hemodiálise de uma clínica especializada em nefrologia na região Noroeste do Paraná. Foram determinados os Diagnósticos de Enfermagem por meio da Nanda-I que obtiveram o porcentual maior que 50%. A análise utilizada foi a estatística simples. Resultados: foram identificados 17 Diagnósticos de Enfermagem, com destaques para os de riscos presentes em 100% dos indivíduos: riscos de desequilíbrio eletrolítico; perfusão renal ineficaz; infecção: trauma vascular e resposta adversa ao meio de contraste com iodo e o de eliminação urinária prejudicada. Conclusão: os principais diagnósticos elencados refletem os riscos mais frequentes aos quais os pacientes em hemodiálise estão expostos. O conhecimento desses riscos permite o planejamento de enfermagem com intervenções precoces, com vistas à prevenção de complicações relacionadas à doença e promoção de melhores condições de vida.

Nephrotoxicity: Evidence in Patients Receiving Cisplatin Therapy

BACKGROUND: Cisplatin has been used as a chemotherapeutic agent to treat many different cancers. A well-known side effect of cisplatin is nephrotoxicity, which is the primary dose-limiting toxicity. Hydration in conjunction with appropriate diuresis can decrease the incidence of nephrotoxicity. OBJECTIVES: This article aims to identify best practices in supportive therapy for patients receiving cisplatin therapy. METHODS: A team was assembled to review research-based evidence and summarize recommendations to address appropriate hydration regimens and forced diuresis for patients receiving cisplatin chemotherapy. FINDINGS: After a systematic search of the literature, only one pediatric study was found. The remaining 22 research-based studies of adults were synthesized and critically appraised. Hydration is necessary to prevent nephrotoxicity with cisplatin administration. In addition, the administration of magnesium and mannitol may assist in maintaining renal function and reducing nephrotoxicity in adults receiving cisplatin. Additional research is needed to evaluate outcomes of these interventions in the pediatric population.

¿Están incluidos los cuidados paliativos en la atención al enfermo renal? / Is palliative care included in care of renal disease?

Objetivos: Describir el perfil de utilización del servicio público de atención de salud desde la inscripción en el programa de cuidados paliativos renales (CPR) hasta la muerte, evaluar la prevalencia de síntomas y las intervenciones de las últimas 2 semanas de vida y describir la satisfacción familiar de pacientes con enfermedad renal terminal (ERT) en programa CPR. Métodos: Estudio longitudinal retrospectivo (cohorte retrospectiva), realizado en el Caritas Medical Centre de Kowloon, Hong Kong. Se incluyeron 335 pacientes con ERT que se inscribieron en el programa de CPR con seguimiento solo a los pacientes fallecidos. La recogida de datos se realizó del 1 de junio de 2006 al 31 de diciembre de 2011. Se analizó la utilización del servicio de atención de salud, la prevalencia de los síntomas, las intervenciones realizadas en las últimas 2 semanas de vida y la causa de muerte. Se utilizaron estadísticos descriptivos para el análisis de las características del paciente y la prueba Chi-cuadrado para la comparación entre los grupos. Se estimó la supervivencia a largo plazo a través del test Kaplan-Meier y se analizaron predictores de supervivencia mediante la regresión de Cox. Resultados: Se incluyeron 335 pacientes con CPR, de los cuales 226 fallecieron durante el período de estudio, siendo los síntomas más prevalentes la disnea (63,7%), la fatiga (51,8%), el edema (48,2%), el dolor (44,2%) y la anorexia (38,1%), y las 5 intervenciones más frecuentes fueron: oxígeno (69,5%), infusión parenteral (67,3%), antibióticos (53,5%), cateterismo vesical (44,7%) y analgésico (39,8%) en las 2 últimas semanas de vida (3,4%). Cada paciente recibió 3,5+4,4 visitas a consultas externas, 3,4+10,3 visitas domiciliarias y 3,1+2,7 ingresos hospitalarios; además de IRC (51,8%), las causas de muerte más frecuentes fueron eventos cardiovasculares (18,6%) e infección (17,2%). Conclusiones: La implementación del programa de CPR en el centro hospitalario proporcionó una atención sanitaria más adecuada para los pacientes con ERT. Los eventos infecciosos y cardiovasculares supusieron la principal causa de muerte durante las 2 últimas semanas de vida de los pacientes (AU)

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Farmacoterapia en la Enfermedad Renal / Pharmacotherapy in Renal Disease

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Urostomías: marcaje a medida versus complicaciones / No disponible

La atención integral a la persona ostomizada se inicia en el momento de la indicación quirúrgica invasiva de la extirpación completa de la vejiga que en determinadas patologías urológicas se indican: la cistitis, la litiasis vesical y en la gran mayoría de los tumores vesicales infiltrantes. Tras el primer contacto con el paciente, el objetivo de enfermería es proporcionar educación sanitaria y soporte emocional al paciente y/o cuidador durante todo el proceso, dar información individualizada para que recupere la autonomía lo antes posible

The treatment of ostomized patient is initiated when the bladder removal surgery has been performed in cases such as cystitis, vesical lithiasis and most of the bladder tumours. It is important that a professional nursing staff who has the very first contact with the patient radiate friendliness and concern, offer emotional support to the patient and/or caregiver and provides the patient with relevant information about the recovery process so the patient can restore autonomy