Nursing Guide to Management of Major Symptoms in Patients with Malignant Glioma.

OBJECTIVES: To provide an overview of the symptoms commonly experienced by patients with malignant glioma, and discuss the pathophysiology and interventions associated with those. DATA SOURCES: A review of published scientific literature and clinical literature, and online information from National Comprehensive Cancer Network, Oncology Nursing Society, Epilepsy Foundation of America, and the American Brain Tumor Association. CONCLUSION: The unique symptom burden associated with a malignant glioma diagnosis often disrupts the lives of patients and their caregivers. Clinical support and interventions addressing malignant glioma-related focal deficits, seizures, headaches, venous thromboembolism, mood disturbances, fatigue, and sleep-wake disturbance can positively impact patient and caregiver experiences while living with malignant glioma. IMPLICATIONS FOR NURSING PRACTICE: Understanding the pathophysiology of these symptoms and reviewing nursing-led and supported interventions will empower the nurse in providing comprehensive care to patients with malignant glioma and their caregivers.

CE: Atrial Fibrillation: Updated Management Guidelines and Nursing Implications.

OVERVIEW: Atrial fibrillation, the most common chronic cardiac arrhythmia, adversely affects the quality of life of millions of people. The condition is frequently associated with advancing age, structural cardiac dysfunction, and preexisting comorbidities. The most common complications, stroke and heart failure, result in significant morbidity and mortality. Indeed, atrial fibrillation is responsible for over 450,000 hospitalizations and 99,000 deaths annually and adds up to $26 billion to U.S. health care costs each year. Given the aging of the U.S. population, the incidence of atrial fibrillation is expected to double within the next 50 years. There is evidence that nursing intervention in patient education and transition of care coordination can improve adherence to treatment plans and patient outcomes.This article reviews the recently updated guideline for the management of atrial fibrillation, issued jointly by the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society. It focuses on the prevention of thromboembolism and on symptom control, and stresses the importance of patient adherence to treatment plans in order to ensure better outcomes.

Pacientes con tratamiento anticoagulante oral. ¿qué saben sobre su tratamiento? / Profile of women with breast disease wich does self-exploration. Which are the factors associated with this practice?

Introducción. Los pacientes anticoagulados con tratamiento oral (ACO) deben tener unos conocimientos de los riesgos que dicho tratamiento conlleva. Para ello el personal sanitario debe formar tanto al paciente como a su familia. Objetivos. Determinar el nivel de adhesión terapéutica que tienen los pacientes tratados con ACO en una consulta de atención primaria (AP) y en un área de salud urbana, como Plasencia. Material y método. Se realizó un estudio observacional descriptivo retrospectivo con 34 pacientes con tratamiento ACO. Se recogen datos de patologías, parámetros biométricos de las historias clínicas y entrevistas a los sujetos que acuden a la consulta de enfermería. Resultados. Una vez analizados los datos, el número de pacientes –según el sexo– estaba igualado; no sucedía lo mismo por edades donde la población entre 80-90 años constituía el 26,5 % del total; dentro de las patologías de las que se deriva el tratamiento, la fibrilación auricular (FA) es la más frecuente, con un 50%, siguiéndole el tromboembolismo pulmonar, con un 23%. El control de los resultados se distribuía de la siguiente manera: los más jóvenes se controlaban en atención especializada (AE), en su hospital de referencia; los de mayor edad en AP. En relación con la adhesión al tratamiento y la patología principal, quienes padecían FA y portaban una prótesis valvular cumplían el tratamiento en mayor número. Discusión. Para el profesional sanitario es necesario conocer el perfil del paciente con ACO, y si este sabe los riesgos que conlleva el tratamiento. Los enfermos jóvenes con patología cardiovasculares son controlados en el hospital por sus mayores oscilaciones en los resultados; la población mayor es vigilada en la consulta de atención primaria (AP), y los residentes en zonas rurales cuentan con una mayor adherencia y un mejor control. Con una completa información el personal sanitario puede efectuar intervenciones que ayuden a la adhesión, seguimiento del control y tratamiento, así como a la colaboración de familiares(AU)

Background/Aims: In recent decades the fight against breast cancer has focused primarily on the treatment and secondary prevention (early detection mainly). In the case of breast self-examination, althought it has not been prove to reduce mortality, it is important in cases detected by women themselves (it is estimated 90% of total), mainly in the interval cancers. Objectives: To identify within women with breast cancer, how many do self-examination and identify associated factors. Describe the clinical and pathological features of cancers in women who do perform self-examination. Methodology: In women diagnosed with breast cancer during 2007 in a hospital in the province of Cadiz, Spain, is reconstructed in retrospect the story related the cancer process: symptoms, psychosocial factors that determine the contact with the health system, preventive practices (self-examination, mammography screening). A description of the pathological tumor: presenting symptom, tumor size, node negative, grade of differentiation… Results: We studied 149 women with breast cancer, from whom 52% did self-exploration. Women who performed self-examination were younger (54.78 years) against the women who did not (65.63 years), married (66.2%), active workers and have a higher educational level. The assessment of the first symptoms in these women as «important» is positively correlated with those women who practice self-examination. For other preventive practices, women who does self-examination are also the most actives in early detection programs (74.4% against 29.5% which didn’t do self-examination). For the pathologic characteristics of tumor in women who did self-examination: the tumor size was 2.5 cm, 50.7 / are well differentiated, and 59.1% of cases the nodes are negative. Conclusions: Women who does self-examination are younger, have higher educational level, are married, are active workers and are often involved in other preventive practices. On them, the tumors diagnosed have a smaller size, are diagnosed at earlier stages and usually present better degree of differentiation (AU)

Prevención del tromboembolismo en cirugía bariátrica / Prevention of thromboembolism in bariatric surgery

La enfermedad tromboembólica (ETEV) es una de las complicaciones más importantes que pueden aparecer tras cualquier cirugía, y constituye la primera causa de muerte en el postoperatorio de cirugía bariátrica. Entre otros factores, se debe tener en cuenta que estos pacientes presentan un riesgo adicional de ETEV debido a la propia obesidad (IMC>30). Tras la cirugía bariátrica el riesgo de padecer eventos tromboembólicos varía según las series consultadas. En líneas generales, se estima que el peligro de EP (embolia pulmonar) es del 0,8% y el de TVP (trombosis venosa profunda) de 1,7%. La mortalidad global por ETEV se estima del 0,1 al 2%(AU)

Disease thromboembolic (ETEV) is one of the major complications that can occur after surgery, and is the leading cause of death in the postoperative period of Bariatric Surgery. Among other factors, should be aware that these patients are at additional risk of ETEV due to own obesity (IMC>30). After Bariatric Surgery the risk of thromboembolic events varies according to the surveyed series. In general, it is estimated that danger EP (pulmonary embolism) is 0.8% and DVT (deep vein thrombosis) of 1.7%. ETEV global mortality estimates of 0.1 to 2%(AU)

El tratamiento anticoagulante oral / Oral anticoagulant treatment

La anticoagulación oral supone un tratamiento preventivo contra la enfermedad tromboembólica, muy beneficioso pero no exento de cierto riesgo ya que tiene unas características peculiares, como la posibilidad de originar hemorragias. El creciente número de pacientes anticoagulados hace que Enfermería pueda tener que prestarles cuidados en cualquiera de sus ámbitos de actuación y necesite conocer las particularidades de este tratamiento. Este artículo realiza un repaso por las generalidades del tratamiento anticoagulante oral y la función de enfermería en su control(AU)

Oral anticoagulant treatment is a preventive measure against thrombo-embolic disease; while this measure has very beneficial aspects, it is not exempt from risks since it has a few peculiar characteristics such as possible hemorrhages. The increasing number of patients who require anticoagulant medicine means that nurses may have to treat these patients in any forum where nurses work and therefore nurses need to know the traits this treatment measure entails. This article reviews the general characteristics of anticoagulant treatment and nurses’ role in controlling this treatment(AU)

Application of the theory of planned behavior to oral anticoagulant therapy.

Anticoagulation control is imperative for individuals who are prescribed long-term oral anticoagulation therapy. Therapeutic international normalized ratios decrease the risk of the thromboembolic complications that are associated with oral anticoagulation therapy. Individuals on oral anticoagulation therapy are often asked to make lifestyle modifications that can become barriers to medication adherence. The application of the theory of planned behavior to oral anticoagulation therapy can be used to assist advanced practice nurses in assessing individuals for the perceived barriers or obstacles that might interfere with the behavioral changes necessary to successfully comply with the recommended treatment plan.

The assessment and management of venous thromboembolism.

This article examines venous thromboembolism (VTE) and offers guidance on its prevention. VTE is a potentially fatal condition, which can be prevented using both pharmacological and mechanical methods. Nursing staff should be aware of the risk factors that predispose patients to venous thromboembolism and ensure that high-risk patients receive the prophylaxis they require.

Venous thromboembolism in patients with cancer. Part I. Survey of oncology nurses' attitudes and treatment practices for ambulatory settings.

Patients with cancer have a higher incidence of venous thromboembolism (VTE). Little information currently exists on VTE and the understanding and beliefs of oncology nurses. Therefore, the attitudes and treatment practices of ambulatory oncology nurses were surveyed to determine the current knowledge base of VTE in patients with cancer. Survey results are presented along with a thorough literature review of thromboembolism and the unique risk factors for this frequent complication in patients with cancer. The causes of VTE in this patient population often are multifactorial and include hypercoagulability, stasis, and vascular endothelial damage from procedures or the neoplastic process itself. In particular, chemotherapy administration can increase the risk of thrombosis considerably. New therapies, including thalidomide, require oncology nurses caring for these patients to have heightened awareness of the potential for thrombogenic complications. This is the first of two articles that address the problem of thromboembolism in patients with cancer, including the survey results. (See part II on page 465.) Oncology nurses are essential in the care of VTE in patients with cancer and can help with patient identification, treatment, and compliance for improved patient outcomes.

Thromboembolic disorders in cancer.

Complex factors, including substances in cancer cells, cancer treatment effects, and venous stasis associated with chronic illness, blood vessel wall injury, and immobility, interact to place patients with cancer at risk for thrombosis. This article describes the etiology, clinical manifestations, diagnostic tests, and treatments for venous and pulmonary emboli associated with cancer. It explores the nurse's role in assessing patients who are at risk, managing symptomatic thrombosis and primary and secondary prevention of emboli, and administering anticoagulant therapy. As growing numbers of patients are treated in outpatient settings, oncology nurses play a critical role in the coordination of care for patients at risk for thrombosis. A nursing care plan summarizes key nursing strategies for assessment and intervention.

Factor V Leiden mutation in pregnancy.

Normal maternal adaptation to pregnancy significantly increases the risk for thrombus formation. Inherited thrombophilias further increase risk for deep venous thrombosis and adverse outcome in pregnancy. Factor V Leiden mutation is the most common inherited thrombophilia, occurring in approximately 5% of the White and 1% of the Black populations. Nurses should be knowledgeable about screening for and diagnosis of factor V Leiden mutation, risk reduction counseling, recommended care of the affected patient, and implications of anticoagulant therapy during the perinatal period.

Factor V Leiden: a review of the literature.

Factor V Leiden, formed by a genetic mutation, disrupts the body's anticoagulation defense system. It was isolated as recently as 1994 as a risk factor for venous thromboembolism. Factor V Leiden has also been linked to preeclampsia, pregnancy loss, and fetal growth restriction. In addition, factor V Leiden has implications for women who are not pregnant. The most effective screening tool is a thorough personal and family history related to thrombosis. For women with a positive factor V Leiden screen, counseling regarding the risks of thrombosis is essential.

Low molecular weight heparins in special populations.

Low molecular weight heparins (LMWH) are replacing unfractionated heparin (UH) as safe and effective agents for the prevention and treatment of thromboembolism. Although LMWH offer many advantages over UH, usage is less clearly defined in certain special populations, including renal dysfunction, obesity and pregnancy. This article will briefly review the pharmacology of LMWH and discuss usage in these special populations.

Venous thromboembolism: prevention & treatment.

Venous thromboembolism still threatens the lives of hundreds of thousands of people in the United States--and some of them are your patients. Here's how to put the latest research and technology to good use in the fight against thromboembolic disease.