Gestación con éxito en paciente en programa de hemodiálisis. Revisión y recomendaciones / Succesful pregnancy in patients on hemodialysis. Review and recommendations

La gestación a término en una Unidad de Hemodiálisis es un proceso poco frecuente. Muchos factores colaboran a su baja incidencia; trastornos hormonales, psicológicos, complicaciones maternas y fetales. Hasta hace poco se ha desaconsejado e incluso contraindicado la gestación en estas fases de la Enfermedad Renal Crónica. En los últimos años se han dado recomendaciones para el manejo de esta situación de riesgo provocando controversia sobre el consejo que debemos de dar al respecto. Presentamos un caso de una gestación a término en una paciente asiática de 27 años en nuestra Unidad de Hemodiálisis en la que el seguimiento de las recomendaciones condujo a un éxito en el desarrollo de la gestación y ausencia de complicaciones materno-infantiles. Estas pautas consistieron en un control estricto consistente en un incremento drástico de las horas de hemodiálisis semanal, uso de filtros de alta permeabilidad, control del peso y ganancia interdiálisis, tensión arterial, control ecográfico más frecuente, seguimiento multidisciplinar (nefrólogo, obstetra, enfermería) y dieta individualizada. Esta conducta puede cambiar significativamente el concepto de esta situación en nuestras mujeres en hemodiálisis en edad susceptible de gestación. Nuestra experiencia en este caso ha sido positiva no presentando ninguna complicación tanto el recién nacido como la madre. En principio no se debería de descartar la lactancia materna (AU)

Successful pregnancy in a hemodialysis unit is a rare process. Many factors contribute to the low incidence; hormonal and psychological disorders, maternal and fetal complications. Until recently, pregnancy in these stages of chronic kidney disease has been discouraged and even contraindicated. In recent years there have been recommendations for the management of this risk provoking controversy about what the health professional must advise. We report a case of a successful pregnancy in an 27-years Asian patient in our hemodialysis unit in which the monitoring of the recommendations led to a successful pregnancy and absence of maternal and child complications. These recommendations consisted of strict control leading in a drastic increase in hours of weekly hemodialysis, use of filters with high permeability, weight control and interdialysis gain, blood pressure, more frequent ultrasound control, multidisciplinary monitoring (nephrologist, obstetrician and nurse) and individualized diet. This behavior can significantly change the concept of this situation on women in hemodialysis with a susceptible gestational age. Our experience in this case has been positive, without complications in both the mother and newborn. In principle, breastfeeding should not be ruled out (AU)

Herbal remedies in a Nicaraguan barrio.

To become more culturally competent, nurses need to increase their knowledge of the health practices of their immigrant clients. With the growing Latino immigrant community, it is imperative that nurses learn more about the cultures from which the immigrants come. This article examines the use of herbal remedies in treating common illnesses in a barrio in Managua, Nicaragua. Data were collected in a random sample of households in an impoverished community of more than 1,600 persons. The use of herbal remedies occurred in 78% of the households. Herbal remedies were used for a variety of symptoms. There was no difference in herbal remedy use based on age or education. The discussion focuses on the availability and functionality of these herbal remedies for this vulnerable population. Implications are addressed for incorporating this information into nursing practice with Central American immigrants, thereby increasing cultural competence.