Objective: This study aims to determine the predictive power of the Norton, Braden and Waterlow scales in determining risk of pressure injury (PI) in surgical patients. Method: This prospective study was carried out in the surgery clinic of a training and research hospital in Istanbul, Turkey between January and April 2017. The study sample consisted of adult patients aged ≥18 years and who did not have PI on admission to the clinic, had abdominal surgery under general anaesthesia and who stayed in the clinic for at least 48 hours. The data were collected using the Turkish versions of the Norton, Braden and Waterlow risk assessment scales. The predictive validity of PI risk assessment tools was assessed based on their sensitivity, specificity, positive and negative predictive values and the area under the receiver operating characteristic (ROC) curve. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals (CI). Results: The study sample included 250 patients, and the incidence of PI was 12%. The sensitivity, specificity, positive predictive value and negative predictive value were: 83.3%, 45.4%, 17.2% and 95.2%, respectively, for the Norton scale (a cut-off point of 14); 100%, 40.4%, 18.6% and 100%, respectively, for the Braden scale (a cut-off point of 16); and 100%, 48.1%, 20.8% and 100%, respectively, for the Waterlow scale (a cut-off point of 10). The areas under the ROC curve were 0.749 for the Norton, 0.771 for the Braden and 0.971 for the Waterlow scales. This study's findings produced the following predictive capacity indicators: Norton (RR=3.62; 95%CI=1.43–9.14), Braden (RR=33.88; 95%CI=2.09–547.66); and Waterlow (RR=45.01; 95%CI=2.78–727.97). Conclusion: In this study, the Waterlow scale demonstrated the best values of predictive validity among the three scales in the assessment of PI risk. However, all three scales had low specificity despite high sensitivity in terms of a good risk prediction. No definitive decision could be reached on the predictive capacities of the scales because of wide CIs.
Objective:To determine the precautions that nurses take for avoiding hospital-acquired infections in intensive care units of a State University Medical Faculty Hospital in Istanbul.Methods:The research data were collected by a questionnaire developed by the authors. The study was conducted in intensive care units of a medical faculty hospital of a state university in Istanbul province. 85 nurses working in different various intensive care units and providing informed consent participated in the study.Results:Intravenous catheterization, urinary catheterization, ventilator-associated infections and surgical site infections were assessed. The questionnaire was scored by applying a conversion of 100 to the total scores obtained, with the highest score being 100 and lowest score being 0. The percentage of nurses that practised all of the approaches about preventing hospital-acquired infections was estimated to be 8.2% for catheter-related bloodstream infections, 67.1% for surgical site infections, 72.9% for catheter-associated urinary tract infections, 27.1% for ventilator-associated infections, 29.4% for isolation preventions and 62.5% for attempts related to sterilization/disinfection of the medical devices.Conclusion:It was seen that nurses use most of the effective measures in order to prevent hospital-acquired infections. The guidelines generated for intensive care units should be updated according to international standards as needed. These guidelines should be used effectively; the differences between intensive care units should be resolved and all nurses should be trained at certain intervals.
Hepatorenal syndrome is one of the most common complications seen in patients with liver failure. Azotemia, oliguria, decreased glomerular filtration rate, and renal failure manifested by increased persistent acidity. There is no structural problem in the kidneys. Portal hypertension and splenic arterial vasodilation cause the formation of hepatorenal syndrome. As a result, renal vasoconstriction causes of renal hypoperfusion. Acute tubular necrosis due to inadequate perfusion during surgery, postoperative hypovolemia, and drug-induced nephrotoxicity in patients with liver transplantation are other important causes of renal failure after liver transplantation. To correct splenic and systemic vasoconstriction, to provide vasodilatation of the kidneys, and to provide normovolemia with sodium balance are the treatment aims. In nursing care; In the clinic, the patient's hemodynamics should be stabilized, laboratory findings should be monitored and the patient's condition should be evaluated frequently. Also, the patient should be monitored in terms of fluid-electrolyte imbalances. Sudden changes in critical values such as the patient's urine output, mean arterial pressure, creatinine clearance and serum creatinine due to hepatorenal syndrome, edema due to water and salt retention cause the patient's hemodynamics to be negatively affected. Monitoring of patients is important, especially in intensive care units.
Transversus abdominis plan bloğu, ameliyat sonrası dönem ağrı kontrolünde, kullanılmaya başlanan güncel bir bölgesel anestezi yöntemidir. Yapılan çalışmalarda, abdominal cerrahi girişimler sonrası uygulanan transversus abdominis plan bloğunun, analjezi sağlamada etkili olduğu bulunmuştur. Bu uygulama, ultrasonografi eşliğinde ya da kör teknikle, karın duvarının anterolateral bölgesindeki boşluğa lokal anestezik madde enjeksiyonu yapılarak gerçekleştirilir. İşlem sırası ve sonrasında abdominal organ yaralanması, yüksek doz lokal anestetik madde uygulaması sonucu ilaç toksisitesi gibi komplikasyonlar açısından dikkatli olunmalıdır. Transversus abdominis plan blok uygulaması, özellikle ameliyat sonrası akut dönemde ağrı oluşumunu engellediği için hasta konforunu sağlayan önemli ve güncel bir girişimdir. Hemşirelik bakımında uygulanan girişimler ise eğitim, tanılama, izlem, kayıt tutma, katater bakımı, pansumanların yapılması ve kontrolü olarak sıralanabilmektedir. Yapılan hemşirelik girişimleri ile uygulanan transversus abdominis plan bloğunun değerlendirilmesi, izlenmesi ve dökümantasyonu kurumlar arasında farklılık gösterebilmektedir. Bu derlemede, cerrahi girişim sonrası olası ağrının etkili yönetiminde bilinen bir yaklaşım olarak transversus abdominis plan bloğu uygulaması ve bu uygulamanın öncesi, sırası ve sonrası dönemlerinde bireyin hemşirelik bakımının aşamaları ve önemi vurgulanmıştır.
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