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

Which factors make clean intermittent (self) catheterisation successful?

AIMS AND OBJECTIVES: To explore which factors determine successful intermittent catheterisation. BACKGROUND: Intermittent catheterisation is a safe, effective treatment and is associated with improved quality of life, although negative issues are reported. Factors which determine adherence are largely unknown. An additional qualitative study was conducted to gain insight into patient's experience with intermittent catheterisation in everyday life. DESIGN: A prospective multicentre study was conducted between March 2012-March 2013 with one year follow-up. METHODS: Patients with a variety of diagnoses referred to the outpatient clinic, ≥18 years, performed catheterisation at least once a day for ≥3 months were included. Data were obtained by patients' specific questionnaire Visual Analog Scale of quality of life regarding voiding problems, a questionnaire about catheterisation in daily practice, King's Health questionnaire, and a short questionnaire after one year. RESULTS: Of the 129 (72 male) patients, mean age 62 (22-86) years, seven died and 63 stopped, 32/63 (50%) due to recovered bladder function. Fifty-nine (47%) continued to perform catheterisation after one year. Forty-seven (86%) patients reported catheterisation had become part of their life or had a positive effect on their life. A weak correlation was found between increasing age and cessation of catheterisation. Visual Analogue Scale - score on quality of life improved for the total group. The King's Health questionnaire identified in the total group that the impact of the bladder problem in daily life, limitations in daily activities and negative emotions decreased over time. CONCLUSION: Adherence of successful intermittent catheterisation can be influenced negatively by increasing age. However, we think catheterisation should be considered as an option for older patients. We could not conform that if intermittent catheterisation was beneficial for the patient, it would positively influence adherence. Further prospective studies on adherence of intermittent catheterisation in larger groups need to be undertaken. RELEVANCE TO CLINICAL PRACTICE: After implementation of the national guideline in 2008, we were able to perform a multicentre study. This prospective study gives insight into patients who were undertaking intermittent catheterisation and which factors determine successful intermittent catheterisation adherence. After following the national guideline, we found no factors for additional interventions in assessment or coaching intermittent catheterisation. Post void residual volume turned out to be not a predictor for the necessity of intermittent catheterisation. A large group of patients could discontinue intermittent catheterisation during follow-up due to bladder function recovery. Although a weak correlation was found between increasing age and ceasing of catheterisation, we think the older can benefit from intermittent catheterisation. In the first period, additional support, for example given by a district nurse, may be necessary for this group to achieve better outcomes.

Patients' experience with intermittent catheterisation in everyday life.

AIMS AND OBJECTIVES: This study reports about the experiences of 11 patients in the Netherlands who use intermittent self-catheterisation to manage their symptoms. The aim of the study was to get insight in underlying barriers and facilitators for patients dealing with intermittent catheterisation in everyday life. BACKGROUND: Studies show that intermittent catheterisation has an impact on everyday life. A positive effect does not guarantee that patients maintain catheterisation over a longer period of time. After the implementation of a guideline, a quantitative study was performed to determine successful intermittent catheterisation. The patients of this study had previously taken part in this quantitative study. DESIGN: This is a qualitative multicentre study using semistructured in-depth interviews with 11 patients between March-May 2013. METHODS: Inclusion criteria included patients of a quantitative study (n = 124) with a variety of diagnoses referred to the outpatient clinic. Those who received instruction from the researcher and who at start of the study performed catheterisation ≤3 months were excluded. Of the total number that met the inclusion criteria, every fourth patient was invited to participate in an interview. Patients were asked about the introducing of intermittent catheterisation, the incorporation into everyday life, the progress after the instruction and guidance perceived, the cause of the bladder problem and the motivation to start intermittent catheterisation. RESULTS: Eleven interviews were performed (six males/five females). All patients described the instruction and follow-up care as positive. Barriers were the preparation before the handling, which is more difficult than the catheterisation itself, and the fact that patients felt constrained by the need to plan convenient times to catheterise themselves. CONCLUSION: This study shows that patients who perform catheterisation are satisfied about the instruction and follow-up care. Important barriers in everyday life are the preparation and the need to plan convenient times. RELEVANCE TO CLINICAL PRACTICE: Interviewing patients gave important additional information about dealing with intermittent catheterisation in everyday life. Prescribers and teachers of intermittent catheterisation must realise that they often have to high expectations of patients when it comes to being flexible in frequency of catheterisation. It is important to realise that patients experience barriers of which healthcare workers are not always aware of, such as the preparation before the handling and feeling constrained by the need to plan convenient times to catheterise. The outcome of this study can be used to improve the content of patient information brochures and guidelines for intermittent catheterisation.

Recogida de urocultivo por sondaje vesical en niños: una observación sistemática / Coleta de urocultura por sonda vesical em criança: uma observação sistemática / Collect of uroculture by urinary catheter in child: a systematic observation

La infección urinaria se caracteriza por la invasión de microorganismos en el tracto urinario, siendo una de las patologías más frecuentes en todos los grupos de edad, especialmente en niños. El urocultivo se considera el método estándar-oro para el diagnóstico de laboratorio, ofreciendo un alto valor predictivo positivo, si se garantiza una técnica aséptica durante la recolección. El estudio de tipo evaluativo, prospectivo y cuantitativo, tiene por objeto comparar los resultados de los urocultivos por sondaje vesical recogidos por enfermeras del Ambulatorio y Enfermería de un Hospital Universitario Pediátrico teniendo en cuenta el material y la técnica utilizada en el procedimiento.La población de estudio consistió en 12 enfermeros, 4 residentes y los resultados de 300 muestras de cultivos de orina en el período junio-agosto de 2012. Los datos fueron recolectados a través de la observación sistemática y la documentación técnica. Los resultados mostraron una mayor contaminación del procedimiento en la enfermería (13,3%) que en el Ambulatorio (1,3%), donde se utilizó kit específico de urocultivo (AU)

A infecção urinária se caracteriza pela invasão de microrganismos no trato urinário, sendo uma das patologias mais frequentes em todas as faixas etárias, principalmente, em crianças. A urocultura é considerada o método padrão-ouro de diagnóstico laboratorial por oferecer alto valor preditivo positivo, se garantida uma técnica asséptica durante a coleta da urina. O estudo do tipo avaliativo, prospectivo e quantitativo objetivou comparar os resultados das uroculturas por sonda vesical coletada por enfermeiros do Ambulatório e Enfermaria de um Hospital Universitário Pediátrico, considerando o material e a técnica utilizada no procedimento. A população estudada foi composta por 12 enfermeiros, 4 residentes de enfermagem e pelos resultados das 300 amostras das uroculturas no período de junho a agosto de 2012. Os dados foram coletados mediante observação sistemática e técnica documental. Os resultados apontaram maior contaminação do procedimento na Enfermaria (13,3%) do que no Ambulatório (1,3%), onde se utilizou kit específico de urocultura

Urinary tract infection is characterized by invasion of microorganisms in the urinary tract, one of the most frequent pathologies in all age groups, especially in children. The uroculture is considered the gold standard method of diagnosis for offering high positive predictive value, if guaranteed aseptic technique during the urine collected. The assessment study, prospective and quantitative aimed to compare the results of urine cultures for catheter collected by nurses in the clinic and infirmary of a University Hospital Pediatric, considering the material and the technique used in the procedure. The study population consisted of 12 nurses and 4 nursing home residents and the results of 300 samples of uroculture in the period June-August 2012. Data were collected through systematic observation and technical documentation. Results showed higher contamination procedure Infirmary (13.3%) than in the Clinic (1.3%), which we used urine specific kit (AU)

Management of bladder dysfunction in patients with multiple sclerosis.

Multiple sclerosis is a chronic disease of the central nervous system that often has a disabling effect, resulting in reduced quality of life for patients. Bladder dysfunction is a common and distressing symptom. Nurses can have a key role in the management of this symptom by promoting an integrated approach to care, thereby improving bladder control and reducing patient anxiety. This article explores the core elements of a specialist continence assessment in this patient group, and provides a critical overview of treatments used for managing bladder problems.

Relationship of nursing education and care management inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project.

OBJECTIVE: To investigate associations of nursing bedside education and care management activities during inpatient rehabilitation with functional, participation, and quality-of-life outcomes for patients with traumatic spinal cord injury (SCI). METHODS: In a prospective observational study, data were obtained by means of systematic recording of nursing activities by registered nurses (RNs), chart review and patient interview. RESULTS: Greater patient participation in nursing activities is associated with better outcomes. More time spent by RNs in coordination with other members of the care team, consultants and specialists, along with participation in physician rounds (team process) is associated with patient report of higher life satisfaction and higher CHART mobility at the one-year injury anniversary; more time providing psychosocial support is associated with higher CHART mobility and occupation scores and with greater likelihood of working or being in school at the anniversary. More time spent providing education about specific care needs is associated with several outcomes but not as consistently as might be expected. CONCLUSION(S): Higher levels of patient participation in nursing care activities is associated with multiple better outcomes, and hence, nurses should promote active patient participation during all aspects of care and interactions between themselves and patients with SCI. Time spent providing psychosocial support of patients and their families should be evaluated to ensure that other necessary education or care management interventions are not minimized. Note: This is the seventh of nine articles in the SCIRehab series.

Caring for bladder dysfunctions in patients with Parkinson's disease.

Parkinson's disease and parkinson-like syndromes are frequently associated with disautonomic disorders, particularly urinary symptoms, with various degrees of severity. Urinary symptoms can represent the debut of an extrapiramidal syndrome and in most cases are urgency and incontinence due to detrusor hyperreflexia. Urodynamic studies allow to understand the causes of urinary symptoms, and thus makes possible a rational nursing and therapeutic approach.

Manejo de los espasmos vesicales en una unidad de enfermería nefrológica / No disponible

No disponible

Diabetes-associated bladder dysfunction in the older adult (CE).

Diabetic cystopathy is a chronic complication of diabetes with a classic triad of symptoms: decreased bladder sensation, increased bladder capacity, and impaired detrusor contractility. This article discusses age- and diabetes-related changes that affect lower urinary tract function. The article also reviews bladder function in the older adult diabetic, explores bladder dysfunction prevention, and suggests management strategies for diabetic cystopathy. Little research has been published to date to guide practice in this area, and opportunities exist for nursing research to fill the gap in knowledge.

How is follow-up after transurethral prostatectomy best performed?

OBJECTIVE: To evaluate the role of the nurse practitioner (NP) in screening patients for potential discharge after routine transurethral prostatectomy (TURP) or bladder neck incision (BNI) where, although urologists continue to follow such patients, the trend is away from clinic attendance. PATIENTS AND METHODS: The NP telephoned 70 patients 4 weeks after surgery; information about expected postoperative problems, change in symptoms and the need to visit their general practitioner (GP) was recorded. A doctor then saw all the patients in a clinic 3 months after TURP or BNI. RESULTS: Complete records were available for 66 patients (TURP 56, BNI 10). Four weeks after their operation, 39 (59%) patients still had one or more significant symptoms but only nine (23%) had consulted their GP. After a telephone interview the NP considered that 38 of the 66 patients were fit to be discharged. At the 3-month outpatient appointment, 37 of these 38 patients were subsequently discharged. Of the remaining 29 patients, 15 (seven with carcinoma of the prostate and eight with significant symptoms) were given follow-up appointments. CONCLUSIONS: The persistence of significant symptoms in 12% of patients 3 months after TURP justifies the follow-up of all patients. A telephone interview by the NP at one month is recommended. This could result in safe discharge of more than half the patients and allow follow-up of those who need specialist input.

Test or trauma? The voiding cystourethrogram experience of young children.

Many diagnostic procedures, while necessary and appropriate, may be experienced by a child as a trauma. Health care professionals often perceive invasive procedures such as surgery and needle biopsies as more painful and threatening to the child than "test" such as voiding cystourethrograms (VCUGs). However, clinical experience indicates that the VCUG is often perceived by children as more highly distressing than other procedures. Success and a sense of competence (or shame and doubt) in mastering challenging life experiences, such as medical procedures, contribute to a child's evolving self-concept (Harter, 1983). These memories and successful behaviors can be applied to future similar situations. Health care professionals are challenged to help the child and the parents through the procedure with minimal distress in an effective and efficient manner. A series of vignettes illustrating parents' and children's experiences with a VCUG procedure highlight the impact of the VCUG on children's coping ability and adjustment. Recommendations for developmentally appropriate clinical practice standards of care related to the VCUG procedure in young children also are presented. Preparation as an ongoing partnership process among children, parents, and health care professionals.

Cistoprostatectomia radical y derivacion urinaria continente tipo Indiana / Radical Cystoprostatectomy and urinary derivation Indiana type

Se presentan dos pacientes portadores de carcinoma de celulas transicionales de vejiga, sometidos a cistoprostatectomia radical y neovejoga continente tipo Indiana.