PURPOSE: The purpose of this case report is to describe the surgical procedure of pylorus preserving gastrectomy and treatment methods, and the nursing process for postoperative complications namely delayed gastric emptying. METHODS: This case study describes the treatment methods and nursing process for a patient who visited the emergency room because of delayed gastric emptying after a pylorus preserving gastrectomy. RESULTS: The symptoms of this patient were resolved by botox-injection, none per oral, total parenteral nutrition, nutrition education after diagnosis by using abdominal x-ray, gastric emptying study, upper gastrointestinal series, and esophagogastroduodenoscopy. CONCLUSION: According to the result of this case study, nurses should be informed about delayed gastric emptying and how to apply the correct nursing process to the patient.
Diagnosis ; Education ; Emergency Service, Hospital ; Endoscopy, Digestive System ; Gastrectomy* ; Gastric Emptying* ; Humans ; Nursing Process ; Nursing* ; Parenteral Nutrition, Total ; Postgastrectomy Syndromes ; Postoperative Complications ; Pylorus ; Stomach Neoplasms*

OBJECTIVETo compare the effects of enteral nutrition (EN) and parenteral nutrition (PN) on gastric motility and gastroenteric hormones after subtotal gastrectomy. Try to find the possible prognosticating marks for the postoperative gastroparesis.

METHODSForty-one patients after gastrectomy were randomly divided into EN group (n = 20) and PN group (n = 21). From the first day after operation (POD + 1) to the seventh day (POD + 7), patients received either EN (EN group) or PN (PN group) with isocaloric and isonitrogenous intake. Serum gastrin (GAS), plasma motilin (MTL) and plasma cholecystokinin (CCK) were measured on preoperative day, POD + 1 and POD + 7. Electrogastrography (EGG) was measured on preoperative day, and POD + 7.

RESULTSOn the seventh day after gastrectomy, plasma MTL and CCK levels in EN group are higher than those in PN group. There is no difference in GAS between two groups. EGG in EN group is better than that in PN group postoperatively.

CONCLUSIONSThe level of gastroenteric hormones and the gastric motility are decreased significantly after subtotal gastrectomy. In contrast with PN, EN could accelerate the recovery of some gastroenteric hormones and the gastric motility after subtotal gastrectomy. GAS, MTL, CCK and EGG are not accurate enough as the marks for prognosticating the postoperative gastroparesis.

Adolescent ; Adult ; Aged ; Enteral Nutrition ; Female ; Gastrectomy ; methods ; nursing ; Gastric Emptying ; physiology ; Gastrointestinal Hormones ; blood ; Gastroparesis ; etiology ; Humans ; Male ; Middle Aged ; Parenteral Nutrition ; Postoperative Care ; Postoperative Complications ; etiology ; Prospective Studies

OBJECTIVENosocomial infections (NIs) have become a matter of major concern in neonatal intensive care units (NICU). The objectives of this study were to investigate the incidence of nosocomial infections of newborn infants in NICU and to explore the risk factors and strategies of infection control.

METHODSThe study enrolled 638 hospitalized newborn infants from Apr 2003 to Dec 2004. The clinical data, such as the clinical manifestation, the condition of colonized bacteria, were collected and analyzed by using SPSS software.

RESULTThere were 88 times of nosocomial infections in 74 newborn infants. The overall incidence of nosocomial infections was 11.6%. The mean duration from admission to first episode of NI was 7.98 +/- 4.58 days. The incidence density was 14.9 per 1000 NICU patient-days. Catheter-correlated hematogenous infection rate was 18 per 1000 umbilical or central line-days; the ventilator-associated nosocomial pneumonia rate was 63.3 per 1000 ventilator days. The smaller the gestational age and the lower the birth weight, the higher the incidences of nosocomial infection. The duration of hospitalization was longer in these infected infants than those non-infected infants. Univariate analysis indicated that gestational age < or = 32 W, the parenteral nutrition, birth weight < or = 1500 g and mechanical ventilation, apnea, small for gestational age infant, central venous catheter (P < 0.05) were risk factors for NIs. Multivariate analysis identified 3 independent risk factions: the parenteral nutrition ([OR] = 7.185 [95% CI, 3.399 - 15.188]), birth weight < or = 1500 g ([OR] = 3.310 [95% CI, 1.100 - 9.963]) and mechanical ventilation ([OR] = 2.527 [95% CI, 1.092 - 5.850]). The most common infection was pneumonia (45.4%). The mortality rate of nosocomial infections was 4.1%. Bacterial surveillance was examined by nasopharyngeal and rectal swab culture immediately on hospital admission and then once a week. The incidence rate of NIs was 24.8% in patients whose nasopharyngeal and rectal swab culture indicated bacterial colonization, and 1.9% in patients without bacterial colonization (chi(2) = 79.7, P < 0.001).

CONCLUSIONIt is important to identify the high risk factors for nosocomial infections in newborn infants in NICU. Reducing the duration of the parenteral nutrition and the virulence manipulation as far as possible and getting the message of individual bacterial colonization in NICU may be conducive to decrease of the incidence of nosocomial infections and provide reference for rational clinical drug administration.

Birth Weight ; immunology ; physiology ; Catheterization ; adverse effects ; Child ; Cross Infection ; epidemiology ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infection Control ; Intensive Care Units, Neonatal ; Parenteral Nutrition ; nursing ; Pneumonia ; epidemiology ; Respiration, Artificial ; adverse effects ; Risk Factors

Nocardia farcinica is an emerging pathogen in immunocompromised hosts. Even though several species of Nocardia have been reported as causative pathogens of catheter-related blood stream infections (CRBSI), CRBSI caused by N. farcinica has not been reported. A 70-yr-old man with a tunneled central venous catheter (CVC) for home parenteral nutrition was admitted with fever for two days. Norcardia species was isolated from the blood through CVC and peripheral bloods and identified to N. farcinica by 16S rRNA and rpoB gene sequence analyses. This report emphasizes the rapid and correct identification of causative agents in infectious diseases in the selection of antimicrobial agents and the consideration of catheter removal.
Aged ; Bacterial Proteins/genetics/metabolism ; Blood/microbiology ; Catheter-Related Infections/*diagnosis/microbiology/nursing ; Catheterization, Central Venous/*adverse effects ; Humans ; Immunocompromised Host ; Male ; Nocardia/classification/genetics/*isolation & purification ; Nocardia Infections/*diagnosis ; Parenteral Nutrition/nursing ; Polymerase Chain Reaction ; RNA, Ribosomal, 16S/genetics/metabolism ; Sequence Analysis, DNA