Proceso de cuidado enfermero aplicado en un paciente con cáncer testicular en un hospital de EsSalud

Objetivo: Dar intervenciones de enfermería que desarrollen el buen estado de salud del usuario. Caso clínico: Paciente adulto de 45 años, de sexo masculino, con los antecedentes de líquidos ascítico y con derrame pleural bilateral; con sospecha de cáncer testicular hace 5 meses, refiere sudoración y que bajó 20 kilos de peso. El usuario ingresó al hospital el 7/4/2022 con dificultad para respirar, con abdomen distendido, con dolor de columna. Se le realizó exámenes TEM (tomografía multicorte) de abdomen, tórax y cerebro; fue operado el 4 de mayo del testículo derecho; según los resultados, el candidato recibió quimioterapia. Salió de alta el 22 de mayo del 2022, con indicaciones farmacológicas para el dolor, con dieta blanda. El paciente permanece en espera de llamado para que continúe su tratamiento de quimioterapia. Métodos: La manera de un estudio de caso único de enfoque cualitativo. Se aplicó como instrumento de valoración la teoría de 11 patrones funcionales de Marjory Gordon. Para el plan de datos se utilizaron las nomenclaturas taxonómicas internacionales de diagnósticos enfermeros 2021 - 2023 de Nanda, Noc y Nic. Resultados: El proceso del usuario fue intermedio debido a la causa de la enfermedad, se dieron los cuidados basados en planes de cuidado clasificado. Conclusión: En el diagnóstico priorizado patrón respiratorio ineficaz, la puntuación de cambio con base en los indicadores frecuencia respiratoria es (+2)

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research