Pielęgnacja pacjenta z nieepileptycznymi napadami — opis przypadku

Introduction. Differentiation of epileptic seizures from psychogenic nonepileptic seizures (PNES) is problematic andleads to wrong diagnosis. It is estimated that among patients diagnosed with epilepsy, as many as 20–40% sufferedfrom pseudo-epileptic seizures. Misdiagnosis is associated with a delay in the implementation of appropriate treatment,complications following unnecessary treatment, worse functioning of the patient, high costs of care and unemployment.Aim. The aim of the study was to familiarise neuroscience nurses with the causes, symptoms, treatment and nursingcare for a patient with PNES on the basis of the described case.Case Report. Case study of a female patient with psychogenic non-epileptic seizures repeatedly treated in a psychiatricward. Based on an interview with the patient, analysis of the medical documentation, direct and indirect observationof the patient, problems with nursing were identified and a care plan was established.Results. The depicted patient was admitted to a psychiatric ward due to suicidal intentions, decreased mood andepileptic attacks of unknown aetiology. The patient was struggling with numerous psychosocial problems, whichrequired high professional and ethical competences. The patient has been diagnosed with the following care problems:reluctance to undergo video EEG examination, abdominal pain, isolation of the patient in the ward, risk of suicide,risk of injury.Conclusions. The nursing interventions undertaken with respect to the patient turned out to be effective. Improvementin psychosocial functioning was achieved and the patient did not attempt suicide during the crisis. Thanks to theinterdisciplinary cooperation, it was possible to confirm the non-epileptic nature of the seizures, and the patient wasdischarged with therapeutic recommendations (pharmacotherapy, psychotherapy, visits to a mental health clinic).(JNNN 2021;10(1):35–41)Wstęp. Różnicowanie napadów padaczkowych od psychogennych niepadaczkowych napadów (PNES psychogenic nonepileptic seizures) jest problematyczne i prowadzi do postawienia złej diagnozy. Szacuje się, że wśród chorych z rozpoznaną epilepsją, aż 20–40% miało w rzeczywistości napady rzekomopadaczkowe. Błędna diagnoza wiąże się z opóźnieniem wdrożenia właściwego leczenia, powikłaniami zbędnego leczenia, gorszym funkcjonowaniem chorego, wysokimi kosztami opieki i bezrobotności.Cel. Celem pracy było zapoznanie pielęgniarek neurologicznych z przyczynami, objawami, leczeniem i opieką pielęgniarską nad chorą z PNES na podstawie opisanego przypadku.Opis przypadku. Studium przypadku pacjentki z psychogennymi napadami niepadaczkowymi leczonej wielokrotnie na oddziale psychiatrycznym. Na podstawie wywiadu z chorą, analizy dokumentacji medycznej, obserwacji pośredniej i bezpośredniej chorej rozpoznano problemy pielęgnacyjne i ustalono plan opieki.Wyniki. Opisaną pacjentkę przyjęto na oddział psychiatryczny z powodu zamiarów samobójczych, obniżonego nastroju i ataków epileptycznych o nieznanej etiologii. Pacjentka borykała się z wieloma problemami natury psychospołecznej, których rozwiązanie wymagało wysokich kompetencji zawodowych i etycznych. U chorej rozpoznano następujące problemy pielęgniarskie: niechęć do poddania się badaniu wideo EEG, bóle brzucha, izolacja chorego na oddziale, ryzyko samobójstwa, ryzyko urazu.Wnioski. Interwencje pielęgniarskie podjęte wobec chorej okazały się skuteczne. Uzyskano poprawę w zakresie funkcjonowania psychospołecznego, chora nie podjęła próby samobójczej w czasie kryzysu. Dzięki współpracy interdyscyplinarnej udało się potwierdzić nieepileptyczny charakter napadów, a chorą wypisano z zaleceniami terapeutycznymi (farmakoterapia, psychoterapia, wizyty w poradni zdrowia psychicznego) do domu. (PNN 2021; 10(1):35–41)

Przeciwdziałanie stygmatyzacji chorych psychicznie w praktyce pielęgniarskiej

StreszczenieSłowa kluczowe: stygmatyzacja choroba psychiczna, chory psychicznie, wykluczenie społeczne, pielęgniarka  Stygmatyzacja jest jedną z przeszkód w leczeniu i odzyskiwaniu zdrowia psychicznego osób chorych psychicznie.  W artykule przedstawiono przyczyny, mechanizmy stygmatyzacji i następstwa dla osób napiętnowanych. Główną cześć artykułu stanowi opis działania pielęgniarskiego podejmowanego w celu poprawy wizerunku osób z kryzysem psychicznym w społeczeństwie. Działania edukacyjne skierowane do wybranych grup docelowych powinny poprawić wiedzę społeczeństwa na temat symptomatologii, przyczyn i opcji leczenia chorób psychicznych. Większa świadomość powinna z kolei znieść uprzedzenia i negatywne postrzeganie oraz ułatwić reintegrację społeczną osób cierpiących na choroby psychiczne

The absence of fetal nasal bones in ultrasound examination between 11 + 0 and 13 + 6 weeks of gestation versus the occurrence of trisomies 21, 18, and 13

Objectives: One part of the ultrasound examination of fetuses in the first trimester of gestation is visualization of the nasal bones. Numerous studies have demonstrated a correlation between the absence of nasal bones and abnormal fetal karyotype. Aim: To assess the utility of ultrasound visualization of nasal bones during the first trimester of pregnancy as a marker of the most common chromosomal trisomies. Material and methods: Ultrasound visualization of nasal bones was carried out in 941 fetuses from a high-risk group between 11 + 0 and 13 + 6 weeks of gestation. Amniocentesis was performed to determine karyotype in all 941 cases. Results: Normal fetal karyotype was observed in 847 cases, trisomy 21 in 45 cases, trisomy 18 in 16 cases and trisomy 13 in 10 cases. Other abnormal karyotypes were detected in the remaining 23 cases. The absence of nasal bones demonstrated 27% sensitivity, 97% specificity and a positive predictive value of 35% as an indicator of trisomy 21 in the study group, and 12% sensitivity, 97% specificity and 12% positive predictive value for trisomies 18 and 13. Conclusions: The absence of nasal bones in ultrasound examination in the first trimester of pregnancy is characterized by low sensitivity and high specificity as a marker of the most common trisomies. Visualization of fetal nasal bone is a poor marker of aneuploidy and should not be taken into account in risk calculation algorithms

Usefulness of saline infusion sonohysterography and feeding artery imaging in endometrial polyp diagnosis

Objectives: The aim of this study was to assess the usefulness of sonohysterography with feeding artery visualization using transvaginal sonography to diagnose endometrial polyps. Material and methods: We conducted an observational study of 60 perimenopausal patients referred to the Department of Fetal Medicine and Gynaecology, Medical University of Lodz with abnormal uterine bleeding or suspicion of endometrial pathology based on sonography scan. In all 60 patients transvaginal sonography scan showed a possibility of an endometrial polyp. Of these, 46 underwent saline infusion sonohysterography with sonography visualization of a feeding artery. Pathological examination was performed on material collected during hysteroscopy. Results: Sonography detection of endometrial polyp based on feeding artery visualization had a 40% sensitivity, whereas sonohysterographic polyp detection had a sensitivity of 75% and a specificity of 100%. The positive and negative predictive values of saline infusion sonohysterography in diagnosing endometrial polyps were estimated at 75% and 72% (95% CI: 52–86%), respectively. The combination of sonohysterography and feeding artery imaging in transvaginal sonography was 84% sensitive and 95% specific in detecting endometrial polyps. The positive and negative predictive values were: PPV = 96% and NPV = 89%. Conclusion: Saline infusion sonohysterography with feeding artery visualization may become a standard method in the diagnostics of endometrial polyps in perimenopausal women

Wspieranie osób głuchoniewidomych w komunikowaniu się i przewodnictwie w świetle polskich rozwiązań prawnych i nowych propozycji

This article discusses a little-known in Poland issue related to supporting deaf-blind persons with concomitant hearing and visual impairments in communication and guidance. The reflections refer to current legal solutions. The authors verify and confirm them or propose new recommendations for the future. They do not cut themselves off from the past, recalling major events in the history of supporting deaf-blind people.  The starting point for the discussion is the Sign Language and Other Means of Communication Act 2011 (hereinafter referred to as Act 2011) which is of groundbreaking importance for deaf-blind people and whose provisions pertain to this target community. Related to a larger or smaller extent to Act 2011, other legal acts are also confronted with this law. Important sources of reflection include the results of the work of the Polish Sign Language Council pursued during its first and second term of office, especially the Report submitted by the members serving the former one.  The considerations undertaken in the article are aimed at revising the three central concepts contained in Act 2011: deaf-blind person, modes of communication of the deaf-blind people, and the guide-interpreter. The authors are convinced that if they are properly understood and defined in Act 2011, the legal and, consequently, social interests of deaf-blind people will be duly safeguarded. Hence, where necessary, the authors redefine them, emphasising the importance of guidance in supporting deaf-blind people or the existence of new modes of communication. In the article, they also underline the significance of new technological solutions. All this does not escape the authors’ attention, as they themselves come from the communities that Act 2011 would legally support.  These several remarks on supporting deaf-blind people may significantly and very positively influence the level of the functioning of deaf-blind people if they are noticed and taken into account in the envisaged amendment to Act 2011 as well as other legal acts.Rozważania są poświęcone mało znanej w Polsce problematyce odnoszącej się do wspierania w komunikowaniu się i przewodnictwie osób głuchoniewidomych doświadczających jednoczesnej dysfunkcji słuchu i wzroku. Autorzy opierają się głównie na analizie i interpretacji aktów prawnych, m.in. Ustawy o języku migowym i innych środkach porozumiewania się z 2011 roku. Celem artykułu jest dokonanie rewizji trzech centralnych pojęć zawartych w ustawie: osoba głuchoniewidoma, sposoby komunikowania się osób głuchoniewidomych (SKOGN), tłumacz-przewodnik. Właściwe rozumienie, względnie redefinicja i realne ich wprowadzenie do obiegu prawnego mogą istotnie wpłynąć na prawne i społeczne funkcjonowanie osób głuchoniewidomych

Web services for spatial data exchange, schema transformation and validation as a prototypical implementation for the LPIS Quality Assurance

This article presents an SDI-based approach to implement selected web services within the Land Parcel Identification System (LPIS) Quality Assurance framework, according to the Commission Regulation 1122/2009. The Test Bed uses OGC conforming web services allowing for: (1) agricultural data transformation from national data schemas to the common LPIS Core Model, (2) transferring, validating and storing spatial and non-spatial observations of the quality inspections. The OGC Web Processing Service (WPS) interface specification is used as a basis to allow for interoperable accessing the schema transformation and content validation functionalities of the realised services. The implemented solutions demonstrate the feasibility of the proposed concepts and fit in with current INSPIRE activities

Prenatal karyotype results from 2169 invasive tests

Objectives: Foetal karyotyping is a basic tool used to diagnose the most common genetic syndromes. Although new molecular methods such as FISH, MLPA or QF-PCR allow rapid prenatal testing, they are of limited value when diagnosing less frequent chromosomal abnormalities. Chromosomal microarray analysis offers higher test resolution than traditional karyotyping and has been recommended as first-line genetic testing in prenatal diagnosis. The aim of the study was to confirm whether foetal karyotyping remains a valid approach to prenatal diagnosis by analysing its performance in a large population of pregnant women with a high risk of chromosomal aberration. Material and methods: An analysis was performed of 2169 foetal karyotypes from two referral university centres for prenatal diagnostics in Lodz, Poland. Results: Amniocentesis and foetal karyotyping were performed when screening methods had indicated a high risk of chromosomal aberration, or when prenatal ultrasound had proved foetal abnormality. The study group included 205 (9.4%) abnormal foetal karyotypes. Rare aberrations were observed in 34 cases (e.g., translocations, inversions, deletions and duplication). A marker chromosome was present in five cases. Conclusions: One third of the chromosomal abnormalities observed in the prenatal tests were rarer aberrations (i.e., not trisomy 21, 18 or 13). As many of these could not be detected by the new molecular methods, foetal karyotyping remains an important component of prenatal diagnosis

Nursing care of a Muslim person with mental disorders

Abstract       In the era of globalization and mass migratory movements, nursing ought to address patients' needs which are determined by culture and religion. The knowledge of cultural and religious principles allows the provision of suitable care, facilitates work, minimizes potential conflicts and speeds up patients' recovery process. It is emphasized that culture underlies the risk of developing a disease, its course, as well as the patient's willingness to start the treatment and the acceptance of therapeutic methods. Therefore, taking into account the cultural aspects facilitates having an impact over a patient with mental problems.     Islam is one of the biggest monotheistic religions worldwide, the second largest in Europe, and the fastest growing one in the world.  The number of Muslim refugees and Poles converting to Islam keeps increasing year by year. Thus, it seems highly probable that a Polish nurse will have to look after a Muslim. The provision of care by the medical personnel in the transcultural approach remains inadequate and shaped by deficient knowledge, stereotypes and the sense of superiority of the Western health care model.Key words: Muslims, culture care ,  nursing intervention , mental disorder