Colostomy.
Undergoing surgery for a colostomy and coming to terms with the resulting change in body image can be a traumatic time for patients. This update examines the pre- and postoperative care that nurses should provide.
Body Image↗
Biomedical subjects
P K Black
Publications and source records attributed to P K Black.
Pharmacodynamics of torsemide administered as an intravenous injection and as a continuous infusion to patients with congestive heart failure.
The natriuretic and diuretic effects of a 100-mg dose of torsemide administered as a continuous infusion of torsemide and as a single bolus were compared in a group of patients with stable mild-to-moderate congestive heart failure (CHF). Patients received in random order 100 mg of torsemide as an intravenous bolus and as a 75-mg infusion over 24 hours started simultaneously with a 25-mg loading bolus. Administration of torsemide to patients with CHF as a continuous infusion was an effective dosing regimen, resulting in 24-hour diuresis and natriuresis that was numerically but not statistically greater than that observed with bolus administration. The response with continuous infusion occurred with less torsemide in the urine, resulting in a significantly greater efficiency of torsemide with this regimen. The effectiveness of torsemide as a continuous infusion does not mean that this mode of administration should be used in all patients. The response to 100 mg of torsemide in patients with mild-to-moderate CHF is the same whether administered as an intravenous bolus, a continuous intravenous infusion, or by mouth. This is consistent with the high bioavailability demonstrated in previous studies. The mode of therapy used should be dictated by each individual patient's needs. This study shows that continuous infusion is a viable option for administration of torsemide, and dosing guidelines for use of such a strategy are presented.
Adult↗
Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide and furosemide in patients with congestive heart failure.
The bioavailability, pharmacokinetics, and pharmacodynamics of torsemide (10 mg orally and intravenously) and furosemide (40 mg orally and 20 mg intravenously) were determined in a randomized crossover clinical trial in 16 patients with compensated congestive heart failure. Torsemide (time to reach maximum concentration [tmax], 1.1 +/- 0.9 hour) was more rapidly absorbed than furosemide (tmax, 2.4 +/- 2.5 hours), the absorption of which was delayed compared with that in healthy volunteers. Bioavailability of torsemide was also greater and less variable than that of furosemide. All four treatments yielded comparable changes from baseline in 24-hour electrolyte excretion. Based on the relationships between sodium excretion rate and fractional sodium and urinary drug excretion rate, response to both diuretic agents at the level of the nephron was decreased compared with previous studies with healthy subjects. Assessment of the clinical relevance, if any, of the difference in the variability of absorption warrants further study.
Administration, Oral↗
Acute and chronic effects of nonsteroidal antiinflammatory drugs on glomerular filtration rate in elderly patients.
To assess the effects of nonsteroidal antiinflammatory drugs (NSAIDs) on glomerular filtration rate (GFR) in elderly patients with and without renal insufficiency, we conducted an open-label, randomized, prospective three-period cross-over study. Twenty-nine patients at least 65 years old were assigned to groups with preserved GFR (> 1.16 mL/s [70 mL/min]) or with renal insufficiency (GFR 0.50-1.16 mL/s [30-70 mL/min]). Patients received 800 mg ibuprofen three times daily, 20 mg piroxicam daily, or 200 mg sulindac twice daily for 1 month. Three-hour inulin and two-day creatinine clearances were measured before and after the first and last doses of NSAIDs. Ibuprofen, piroxicam, and sulindac decreased inulin clearance after single-doses in both groups of patients. In patients with renal insufficiency, creatinine clearance did not change after administration of ibuprofen for 1 month (0 +/- 0.06 mL/s, mean +/- standard error), but was decreased similarly with administration of either piroxicam or sulindac (-0.12 +/- 0.06 mL/s [-7.2 +/- 3.6 mL/min], P < 0.02). One patient with preserved GFR, but with other risk factors for NSAID-associated renal impairment, met our criteria for withdrawal by experiencing at least a 40 mumol/L (0.5 mg/dL) increase in serum creatinine above their baseline value. Our data indicate that NSAIDs do not adversely affect GFR in patients with preserved renal function unless they have another risk factor for NSAID-associated renal impairment. In contrast, patients with renal insufficiency may have significant chronic decrements in GFR with long-acting NSAIDs such as piroxicam and sulindac, but not with short-acting ibuprofen. Such patients should have renal function monitored while being treated with long-acting NSAIDs.
Age Factors↗
Caring for large wounds and fistulas.
Explore the source record for details and available documents.
Bandages↗
The pharmacodynamics of torsemide in patients with congestive heart failure.
The pharmacodynamics of torsemide (a new loop diuretic of the pyridine sulfonylurea class) was studied in 16 subjects who had compensated congestive heart failure and had been receiving stable diuretic therapy. Oral doses of 50, 100, and 200 mg were studied by use of a randomized crossover design. The results of this study show that the pharmacokinetics of torsemide is linear up to at least a dose of 200 mg in patients with congestive heart failure. Approximately 20% of each of the three doses was excreted unchanged, consistent with previous findings in healthy volunteers. A hyperbolic relationship between diuretic effect and drug excretion rate was defined. The maximum urinary sodium excretion rate attained was about 0.6 mEq/min, which is about 20% of that in healthy subjects, indicating diuretic resistance in these patients. Although there was no saturation of the urinary excretory pathway with doses as high as 200 mg, the upper plateau of the dose-response curve was reached with doses of 50 mg, indicating that this dose represents a ceiling dose in patients with New York Heart Association class II and III congestive heart failure.
Administration, Oral↗
History and evolution of stomas.
This article, describes the evolution of stoma formation from earliest times to current innovative procedures. Surgeons are continually trying to develop new procedures so that they can offer less socially incapacitating alternatives to the abdominal stoma.
Enterostomy↗
Choosing the correct stoma appliance.
There is a bewildering supply of stoma appliances on the market that are available on the Drug Tarriff, IX part C, so how does the health professional make an objective choice? A new stoma patient, with no previous experience of stoma appliances, has to rely on the advice of ward staff or the stoma care nurse. It is therefore necessary for nurses to be aware of the choices that are available.
Adhesives↗
Hidden problems of stoma care.
Sexual function: Understand the degree of excision that has taken place. Make sure that the patient fully understands the outcome of surgery. Be confident with your own sexuality. Be prepared to refer the patient if you cannot help. Do not wait for the patient to tell you about their sexual activity-they will not. Know what type of contraception would be best for the patient. Understand the possible problems of the homosexual patient after surgery. Ethnic minorities: Know where the patient comes from and which religion they follow. Understand how major religious fasts or feasts may affect the patient. Appreciate the patient's need for prayer at set times, which may be disruptive to ward routine. Understand dietary considerations. Be aware that translation may be needed and, if so, make sure that translator is acceptable to the patient. Find out about the patient's ethnic, cultural and religious background.
Colostomy↗
Management of patients undergoing stoma surgery.
The formation of a stoma causes great anxiety and the patient may have difficulty in accepting his/her altered body image. This article describes how good preoperative counselling, sitting and postoperative care can help allay patients' fears of rejection, mutilation and degradation.
Enterostomy↗
Common problems following stoma surgery.
Although counselling and preoperative siting of the stoma help to eliminate problems following stomal surgery, certain problems may still arise, often when the patient has returned home. Early recognition of these problems and intervention can help to maintain a good quality of life for patients and prevent the condition worsening.
Enterostomy↗
Stoma care: finding the most appropriate appliance.
Over the last 25 years a wide range of stoma appliances have become available via the Drug Tarriff because of the post-war development of plastics. Before deciding which is the most appropriate appliance for the stoma patient to use, it is important to carry out an holistic assessment and understand which type of stoma bag is correct for the appropriate stoma.
Drainage↗
Variable furosemide absorption and poor predictability of response in elderly patients.
STUDY OBJECTIVES: To determine the between- and within-patient variability of furosemide bioavailability and natriuretic response, and whether four marketed products differ in bioavailability and response. DESIGN: Open-label, crossover study. SETTING: General clinical research center at an academic medical center. PATIENTS: Convenience sample of 17 patients age 65 +/- 6 years receiving diuretics for the treatment of hypertension or congestive heart failure. INTERVENTION: Each patient received each of five furosemide products (one intravenous and four oral tablet formulations) twice in random order for a total of 10 treatments. MEASUREMENTS AND MAIN RESULTS: Measurements included absolute bioavailability using cumulative amounts of urinary furosemide collected over 8 hours after oral versus intravenous dosing, and cumulative amounts of urinary sodium. Extensive between- and within-patient variability in all measured values rendered any differences among the products neither clinically nor statistically significant. Mean (+/-SD) bioavailability was 49 +/- 17% (range 12-112%) and coefficients of variation with different products were from 25-43%. Coefficients of variation for urinary furosemide excretion and urinary sodium excretion were also large, 25-42% and 23-51%, respectively. Multivariate analyses that incorporated between- and within-patient effects failed to reveal differences among the products for bioavailability (F = 1.04, p = 0.403), urinary furosemide excretion (F = 1.09, p = 0.371), or urinary sodium excretion (F = 0.97, p = 0.448). Correlation coefficients were 0.81-0.85 for the rates of sodium and furosemide excretion, and half-maximum response using a sigmoid Emax model did not differ among products. CONCLUSION: Although furosemide concentration in urinary and natriuretic responses showed good correlation, variability in bioavailability considerably affects the drug's excretion into urine. Variability in absorption both among patients and within an individual patient is great and overwhelms any differences in bioavailability among approved furosemide products. Switching from one formulation to another will not likely result in any predictable change in patient response.
Administration, Oral↗