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Estandarización de cuidados del síndrome metabólico en diálisis peritoneal Standardising care of metabolic syndrome in peritoneal dialysis  [cached]
Francisco Cirera Segura,Myriam Ruiz Montes,Verónica Rosales Sánchez,Jesús Lucas Martín Espejo
Enfermería Nefrológica , 2012,
Abstract: Introducción. Detectamos una gran prevalencia de factores de riesgo cardiovascular en los pacientes incidentes y prevalentes en diálisis peritoneal. Objetivo. Elaborar un plan de cuidados estandarizado para pacientes en diálisis peritoneal que diera respuesta a los problemas derivados del síndrome metabólico. Material y Método. La población objeto fueron los pacientes en diálisis peritoneal. Se realizó una valoración de las necesidades según Marjory Gordon, y se utilizaron las taxonomías NANDA, NIC y NOC para establecer los diagnósticos, intervenciones y criterios de resultados más frecuentes. Resultados. Los diagnósticos más prevalentes fueron: Conocimientos deficientes, Manejo inefectivo del régimen terapéutico, Desequilibrio nutricional por exceso y Deterioro de la movilidad física. Se elaboraron las intervenciones a realizar en la consulta de Enfermería, así como los criterios de resultados esperados. Las intervenciones se basaron en la educación del paciente sobre la modificación del estilo de vida, manejo adecuado de alimentación, realización de ejercicio físico adecuado a su edad, y en los aspectos relativos a la patología de base y tratamiento, como administración y manejo de los fármacos y líquidos de diálisis peritoneal. Conclusión. Hemos estandarizado mediante un plan de cuidados, la atención a los problemas de salud derivados del síndrome metabólico, en los pacientes en programa de diálisis peritoneal. Introduction: We detected a high prevalence of cardiovascular risk factors in both incidental and prevalent cases in peritoneal dialysis. Aim: To draw up a standardised care plan for patients in peritoneal dialysis to deal with the problems arising from metabolic syndrome. Material and Method: The target population consisted of patients in peritoneal dialysis. A needs assessment was carried out using Marjory Gordon's approach, in which the NANDA, NIC and NOC classifications were used to establish the most frequent diagnoses, interventions and criteria for outcomes. Results: The most prevalent diagnoses were: lack of knowledge, ineffective management of the therapy regime, nutritional imbalance due to excess and deterioration in physical mobility. The interventions to be performed in the nursing consulting room and the criteria for expected outcomes were drawn up. The interventions were based on educating patients about altering their lifestyle, proper management of their diet, doing physical exercise appropriate to their age and in matters concerning their basic pathology and its treatment, such as administering and managing medication and per
Pérdidas Proteicas Peritoneales en Ni os Portadores de Síndrome Nefrótico en Diálisis Peritoneal Peritoneal Protein Loss in Children Suffering from Nephrotic Syndrome Undergoing Peritoneal Dialysis  [cached]
LILY QUIROZ Z,MARTA AZóCAR P,HéCTOR DINAMARCA S,MARCOS EMILFORK S
Revista chilena de pediatría , 2009,
Abstract: El Síndrome Nefrótico primario (SN) responde favorablemente a corticoides en un 80-90% de los casos. Los pacientes cortico resistentes (SNCR) evolucionan, en su gran mayoría, a insuficiencia renal crónica (IRC). De etiología desconocida, se ha reportado la presencia de un factor de permeabilidad (FP) en el suero de estos pacientes, con algunos efectos conocidos a nivel de otras membranas biológicas, incluyendo el peritoneo. Objetivo: Evaluar las pérdidas proteicas vía peritoneo en ni os con SNCR en diálisis peritoneal crónica (DP). Pacientes y Método: Análisis retrospectivo de 4 a os (2003-2007), Se incluyeron 9 pacientes portadores de SNCR (grupo 1), y un grupo control de 10 ni os en DP portadores de IRC por otra etiología (grupo 2). Se evaluó a los 2 grupos al mes 1 y 6 ó 12 de su ingreso. Los grupos fueron comparables respecto a edad, sexo, peso, superficie corporal, tiempo en DP, concentración de dextrosa utilizada, modalidad dialítica y dosis de diálisis. Resultados: No se observó diferencias de los parámetros bioquímicos (creatinina, nitrógeno ureico, calcio, fósforo). La hormona paratiroidea (PTH) fue significativamente mayor en el grupo control (164 ± 144 vs 564 ± 454 pg/dl p < 0,05), y la albúmina fue menor en los pacientes con SN al inicio (2,27 ± 0,63 gr/dl vs 3,62 ± 1,45 gr/dl p < 0,05) y al final de la evaluación (2,8 ± 0,5 gr/dl vs 3,9 ±0,86 gr/dl, p < 0,05). Las pérdidas proteicas peritoneales fueron significativamente mayores en el grupo 1 vs el grupo 2 al ingreso: 3,41 ± 2,01 vs 1,76 ± 1,45 gr/m2/día, y al final de la evaluación: 4,27 ± 3,47 vs 1,66 ±1,31 gr/m2/día, (p < 0,05) respectivamente. Lo mismo ocurrió con las pérdidas urinarias. No hubo diferencias en la ingesta proteica, KtV peritoneal ni KtV total entre los grupos, mientras que el KtV residual fue significativamente menor en los pacientes nefróticos al término del estudio, sugiriendo una caída más precoz de la función renal residual. Tampoco se observó diferencias respecto a las tasas de peritonitis en el período estudiado. Conclusión: Las pérdidas de proteínas por peritoneo en pacientes en DP portadores de SN, son significativamente mayores que en el resto de los pacientes en DP, y son consistentes con un posible efecto sistémico de un FP en estos pacientes. Primary Nephrotic Syndrome (NS) responds favorably to steroids in 80-90% of cases. Most corticoresistant (CR) patients evolve into Chronic Renal Failure (CRF), Of unknown origin, a permeability factor in these patient's serum has been reported, with some known effects in membranes including the peritoneum. Objective: To e
Hidrotórax agudo masivo secundario a diálisis peritoneal aguda en síndrome hemolítico urémico: Caso clínico Massive acute hydrothorax secondary to peritoneal dialysis in a hemolytic uremic syndrome: Report of one case  [cached]
Pablo Cruces R,Jorge Roque E,Ricardo Ronco M,Astrid Valenzuela S
Revista médica de Chile , 2006,
Abstract: Massive acute hydrothorax (MAH) is a severe and unusual noninfectious complication of peritoneal dialysis (PD). It can lead to acute respiratory failure and may diminish the effectiveness of the dialytic therapy. Many therapeutic strategies for this complication are employed, ranging from conservative methods like reduction of the volume of the dialysate and the transitory interruption of the PD, to more aggressive therapies as the closure of diaphragmatic defects by videothoracoscopy with or without pleurodesis. Herein, we report a two years old girl that developed acute renal failure due to an hemolytic uremic syndrome. She underwent PD and developed MAH. PD was temporarily ceased and continuous veno-venous hemofiltration was started. After 8 days, PD was resumed uneventfully. The temporary interruption of the PD was an effective measure to avoid the recurrence of the MAH
Peritoneal Dialysis in Dengue Shock Syndrome May Be Detrimental  [PDF]
Chulananda D. A. Goonasekera,Bhagya G. Thenuwara,Ranjith P. V. Kumarasiri
Journal of Tropical Medicine , 2012, DOI: 10.1155/2012/917947
Abstract: Dengue shock syndrome is the most severe form of Dengue that can be fatal. Nonresponders to standard therapy need intensive care. This paper outlines the clinical features, complications, and outcomes of Dengue Shock Syndrome not responding to standard therapies and needing supportive care in a tertiary referral intensive care unit of a developing country. Nearly one-third die within 3 days of admission to ICU. Peritoneal dialysis predicts the worst outcomes. 1. Introduction Dengue is an important arthropod-borne viral disease of humans [1]. Its presentation varies from a mild viral syndrome to hemorrhagic fever and severe shock. Its severe forms (hemorrhagic fever and shock syndrome) may lead to multiorgan involvement and death. Dengue Shock Syndrome (DSS) is characterized by a massive increase in systemic capillary permeability with consequent hypovolemia [2]. The mortality rate in Dengue Shock Syndrome ranges from 6 to 30 percent, most commonly reported in children. Fluid resuscitation is critical with added support for failing organs [3]. In the recent past, Sri Lanka has experienced a surge of the disease reaching epidemic proportions associated with a probable change in the virus strain to a more virulent form [4, 5]. In this context we have also noted a rise in the number of cases with severe forms of the disease needing intensive care. The Peradeniya ICU is a tertiary referral centre and it attracts a large number of above patients with Dengue Shock Syndrome in the region who do not respond to standard therapy with intravenous fluids, antibiotics, and supportive care including inotropes. 2. Methods We collected demographic data of all patients referred for intensive care between January 2009 and June 2010 (18 months) and analyzed their outcomes in relation to the complications of DSS that ensued during their ICU stay and the therapies given. The diagnosis of Dengue has been established upon clinical grounds (WHO guidelines 2009) and treated accordingly by the referring physicians before admission to the ICU. On admission to ICU, all have had fever, vomiting 78%, abdominal pain 21%, cough 5%, and body ache among 3% of cases. Eleven patients have had serological tests and Dengue IgM was found to be positive amongst 72% and IgG in 50% of the tested. They all have had intravenous fluid therapies and antibiotics. During the course of therapy in ICU, 43.6% of cases received fresh frozen plasma, 21.8% cryoprecipitate, 32.7% blood, and 56.4% platelet transfusions. Furthermore, 36.4% of cases were mechanically ventilated for multiple reasons such as
The Frequency of Fibromyalgia Syndrome and the Quality of Life in Patients with Peritoneal Dialysis  [PDF]
Muyesser Okumus, Hulya Parpucu, Seher Kocaoglu, Esma Ceceli, Murat Duranay, P?nar Borman
Open Journal of Rheumatology and Autoimmune Diseases (OJRA) , 2012, DOI: 10.4236/ojra.2012.24017
Abstract: ,b>Objective: The aim of this study was to determine the frequency of fibromyalgia (FM) in patients on Peritoneal Dialysis (PD) and to investigate its impact on the quality of life of that population. Methods: A hundred and twenty four patients with end stage renal disease who had undergone PD, and a control group of 54 age and sex-matched healthy volunteers were included to the study. Demographic characteristics including age, sex, disease and dialysis duration were recorded. Fibromyalgia Impact Questionnaire (FIQ) and Nottingham Health Profile (NHP) were also measured. Results: The mean age of the patients (68 female, 56 male) and control subjects (36 female, 18 male) were 43.5 ± 13.4 and 41.2 ± 9.2 years respectively. The prevalence of FM in the PD patients and controls were determined as 9.7% (12 patients) and 11.1% (6 controls) respectively and were found to be similar (p = 0.983). The mean score of sub- groups of NHP except pain and emotion subgroups, were significantly higher in PD patients than in the control group. The mean FIQ levels, the scores of all the subgroups of NHP except the social subgroup were significantly higher in PD patients with FM than in those without FM. Conclusion: In conclusion although the prevalence of FM appears to be similar in PD patients and control subjects, the functional disability is common and quality of life is worse in PD patients with FM than in patients without FM. Detection and treatment of FM may lead to improvement in the quality of life of PD patients with this syndrome.
Prevalence of Restless Legs Syndrome in Patients Treated with Peritoneal Dialysis: Clinical and Biochemical Characteristics among Patients with and without Restless Legs Syndrome  [PDF]
Selda Korkmaz, Bulent Tokgoz, Sevda Ismailogullari, Ismail Kocyigit, Merva Kocyigit, Ozgur Berkay Aksu, Murat Aksu
Open Journal of Nephrology (OJNeph) , 2013, DOI: 10.4236/ojneph.2013.31008
Abstract: Introduction and Aims:This is a prospective study identifying prevalence of Restless Legs Syndrome (RLS) in patients ongoing peritoneal dialysis (PD) due to end stage renal disease (ESRD) and comparing clinical and biochemical characteristics among patients with and without RLS. Methods: Two hundred ESRD patients who received PD at least six months assessed by neurologist and nephrologist with regards to presence of RLS. Also, clinical and biochemical features of these patients are determined. One hundred and forty four patients were excluded from study because they had other secondary causes of RLS except for ESRD. Results: Thirteen of 56 patients (23.2%) had RLS. The use of vitamin B + folic acid supplements was significantly lower in patients with RLS than in those without RLS (69.2% vs 97.7%; p = 0.008). There was no significant difference between patient groups with and without RLS in terms of age, gender, body mass index, cause of ESRD, peritoneal membrane transport characteristic, smoking, consuming alcohol, use of erythropoietin, duration of PD, hemoglobin, serum calcium, serum phosphorus, serum albumin, levels of serum iron, total iron binding capacity, ferritin, folic acid and vitamin B12, transferrin saturation, weekly Kt/V urea value, and amount of residual urine volume (p > 0.05). Conclusion: RLS is more common among PD patients than general population. Although essential cause is not exactly known, use of folic acid and vitamin B complex decrease the RLS prevalence in this particular patient group.
Estandarización de cuidados del síndrome metabólico en diálisis peritoneal
Cirera Segura,Francisco; Ruiz Montes,Myriam; Rosales Sánchez,Verónica; Martín Espejo,Jesús Lucas;
Enfermería Nefrológica , 2012, DOI: 10.4321/S2254-28842012000200008
Abstract: introduction: we detected a high prevalence of cardiovascular risk factors in both incidental and prevalent cases in peritoneal dialysis. aim: to draw up a standardised care plan for patients in peritoneal dialysis to deal with the problems arising from metabolic syndrome. material and method: the target population consisted of patients in peritoneal dialysis. a needs assessment was carried out using marjory gordon's approach, in which the nanda, nic and noc classifications were used to establish the most frequent diagnoses, interventions and criteria for outcomes. results: the most prevalent diagnoses were: lack of knowledge, ineffective management of the therapy regime, nutritional imbalance due to excess and deterioration in physical mobility. the interventions to be performed in the nursing consulting room and the criteria for expected outcomes were drawn up. the interventions were based on educating patients about altering their lifestyle, proper management of their diet, doing physical exercise appropriate to their age and in matters concerning their basic pathology and its treatment, such as administering and managing medication and peritoneal dialysis liquids. conclusion: through a care plan we standardised care of the health problems arising from metabolic syndrome in patients on a peritoneal dialysis programme.
Síndrome de lisis tumoral: A propósito de un caso tratado con peritoneodiálisis Tumour lysis syndrome: a case treated using peritoneal dialysis
Carlos Saieh A.,Juan Quintana B.
Revista chilena de pediatría , 2001,
Abstract: Se presenta el caso de una escolar de 10 a os de edad tratada con quimioterapia a causa de una leucemia linfoblástica aguda, que a pesar de las medidas preventivas presenta hiperuricemia, hiperfosfemia, hipercalemia y disminución de la diuresis, por lo que se diagnostica síndrome de lisis tumoral y se inicia tratamiento conservador y luego, por falta de respuesta, se realiza peritoneo diálisis, eligiéndose esta modalidad por inestabilidad hemodinámica y trastornos de la coagulación, lo que contraindicaba la hemodiálisis. Al tercer día mejoran los valores plasmáticos del ácido úrico, del calcio, del fósforo, del potasio y comienza a aumentar francamente la diuresis, siendo dado de alta en buenas condiciones. El objetivo de esta presentación, a propósito de un caso clínico, es revisar la patogenia y tratamientos del síndrome de lisis tumoral We present a 10 year old girl with acute lymphoblastic leukaemia who inspite of preventative treatment developed an acute tumour lysis syndrome with the administration of chemotherapy. This syndrome is characterized by hyperuricaemia, hyperkalaemia, hyperphosphataemia and oliguria. Conservative treatment was undertaken but it was necessary to initiate peritoneal dialysis because of deteriorating renal function. We choose peritoneal dialysis because of the patients haemodynamic instability and coagulation disorder. Serum uric acid, phosphate, calcium and potassium levels were effectively controlled and urinary volume increased after 3 days of treatment. The pathogenesis and treatment of tumour lysis syndrome are briefly discussed
Síndrome metabólico en diálisis peritoneal
Cirera Segura,Francisco; Martín Espejo,Jesús Lucas;
Revista de la Sociedad Espa?ola de Enfermería Nefrológica , 2011, DOI: 10.4321/S1139-13752011000400007
Abstract: introduction: metabolic syndrome is a combination of cardiovascular risk factors of metabolic origin. we set out to: ? determine the prevalence of metabolic syndrome in peritoneal dialysis and see how it evolved. ? evaluate its influence on mortality. ? review the nursing interventions aimed at preventing it. material and methods: a 5-year retrospective descriptive study was carried out. the metabolic syndrome diagnostic criteria classification proposed by ncep atp iii, modified by kam-tao li, was used. the other variables were obtained from the clinical history. results: the sample was made up of 53 patients with an average age of 62.02 years. the average time on dialysis was 28.02 months. the factors that describe metabolic syndrome in peritoneal dialysis were studied. they did not differ, except for glucaemia (p=0.012). the patients diagnosed with metabolic syndrome increased, without significance (p=0.18). the survival of patients with metabolic syndrome was lower, although without a significant difference (p=0.990). discussion: the role of nursing in the prevention and treatment of metabolic syndrome is fundamentally, as we can act on all the factors. the "knowledge deficit" should be assessed systematically in order to reinforce the intervention. we found the importance of establishing nursing diagnoses and re-assessing interventions designed to obtain the expected results. we have not managed to improve metabolic syndrome, which forces us to consider more effective actions, because ? we have a high percentage of patients with metabolic syndrome, which increases every year. ? they had lower survival, although the difference was not significant. ? we should correct nursing diagnoses and interventions.
Evaluación longitudinal de la capacidad de transporte del peritoneo en diálisis peritoneal pediátrica A longitudinal study of the peritoneal transport capacity in paedriatríc peritoneal dialysis
Ana María Lillo D.,Marta Azócar P.,Angela Delucchi B.,Nelly Mazuela M.
Revista chilena de pediatría , 2000,
Abstract: El paciente pediátrico en diálisis peritoneal debe ser periódicamente evaluado para adecuar el procedimiento. Objetivo: Evaluar la evolución de los parámetros de adecuación dialítica en pacientes pediátricos urémicos en diálisis peritoneal crónica. Se estudiaron a 24 pacientes de la Unidad de Nefrología del Hospital Luis Calvo Mackenna, Universidad de Chile, ingresados al programa de diálisis peritoneal crónica entre enero 1995 y octubre 1999. Se evaluó la dosis de diálisis (Kt/V) peritoneal y residual, a los 3, 6 y 12 meses de iniciado el procedimiento, y el test de equilibrio peritoneal (PET) en los mismos tiempos. Se midió el crecimiento a través del puntaje Z talla/edad al ingreso y a los 12 meses de diálisis. Resultados: El valor promedio del Kt/V peritoneal y residual fue de 1,77 (DE = 1,08) y 1,04 (DE = 0,66) al inicio del procedimiento, y a los 12 meses los valores fueron 2,34 (DE = 0,89) y 0,35 (DE = 0,37) respectivamente. El cambio en el Kt/V residual mostró un p < 0,05. El PET promedio de glucosa y creatinina hora 4 fue de 0,72 (DE = 0,16) y 0,31 (DE = 0,12) al inicio, variando a 0,73 (DE = 0,2) y 0,40 (DE = 0,19) a los 12 meses de evolución, sin significancia estadística. El crecimiento expresado como Z talla/edad mostró al inicio del estudio un valor de -1,86 (DE = 1,06) y a los 12 meses de -2,05 (DE = 0,9). En el grupo de pacientes que ingresaron antes de los 12 meses de vida el Z talla/edad inicial vs el control a 1 a o después fue de -2,5 y -1,65 respectivamente. Conclusión: Los resultados muestran una estabilidad de la membrana peritoneal a lo largo del período estudiado, una pérdida de talla progresiva durante la terapia, y un crecimiento positivo en el grupo que inició la diálisis antes de los 12 meses The paedriatric patient treated with peritoneal dialysis must be periodically controlled in order to evaluate the adequacy of dialysis. Objective: To evaluate the change in the dialysis parameters in uraemic paedriatric patients under chronic peritoneal dialysis. 24 patients attending the Nephrology Unit in the Luis Calvo Mackenna Hospital, University of Chile, who entered the chronic peritoneal dialysis programme between January 1995 and October 1999 were enrolled. Peritoneal and residual dialysis dose (KTIV) were measured at 3, 6 and 12 months after starting dialysis as well as the peritoneal equilíbrium test. Growth was measured using the Z point height/age at the beginning of dialysis and after 12 months. Results: Average Kt/V peritoneal and residual dose was 1.77 (SD 1.05) and 1.04 (SD 0.64) at the beginning and 2.34 (SD 0.89) and
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