Anafylaxi är en akut, oförutsedd, allergisk reaktion som kan uppkomma när som helst. Alla sjuksköterskor skall ha kunskap om anafylaxi, samt beredskap att ta hand om denna reaktion på ett korrekt sätt. I bakgrunden beskrivs den immunologiska mekanismen vid anafylaxi och allergi, symtom och behandling, samt det omvårdnadsvetenskapliga perspektivet. Syftet med denna litteraturöversikt var att identifiera och beskriva bidragande orsaker som ligger bakom osäkerheten kring anafylaxi och därmed ge en ökad kunskap om anafylaxi i sjuksköterskans professionella omhändertagande. Metoden som vi har använt oss av har varit litteraturstudie och sökning har skett via databaserna Pubmed, Cinahl och Scopus.

ABSTRACTIntroduction: An increasing number of patients undergo surgery under local anesthesia and are thereforeawake during the procedure. Nursing care that is provided to these patients can differ from those thatreceive general anesthesia. Previous research has focused on patients? general experiences of being awakeintraoperative. But there is no research that focuses on patients perceptions of security.

SammanfattningSyftet med studien var att beskriva och sammanställa befintlig forskning om de etiska konflikterna, som ambulanspersonal ställs inför i samband med HLR och att inventera om prehospitala HLR riktlinjer tar hänsyn till etiska aspekter på HLR. En litteraturstudie genomfördes där tretton vetenskapliga artiklar analyserades. Resultatet visade att etiska konflikter uppstod när det gällde ambulanspersonalens beslut om att påbörja HLR eller inte, på patienter som av litteraturen beskrevs som terminalt sjuka eller äldre terminalt sjuka patienter. Ibland kränkte ambulanspersonalen patienternas autonomi genom att påbörja HLR mot patienternas och de anhörigas vilja, trots att det existerade en Ej HLR önskan från patienterna och deras anhöriga. Den huvudsakliga orsaken till att sådana situationer uppstod var oklarheter i lagstiftningen omkring prehospitala HLR riktlinjer i USA och Kanada.

Sahlgrenska Academyat University of GothenburgDepartment of Internal Medicine and Clinical NutritionAbstractTitle: BCAA supplementation in patients undergoing resection for liver cancerAuthor: Mikael Semaan and Viktor SjölingSupervisor: Fredrik BertzExaminer: Frode SlindeProgramme: Dietician study programme, 180/240 ECTSType of paper: Examination paper, 15 hpDate: April 10, 2013BackgroundLiver cancer is the fifth most common cancer worldwide and the third largest to cause death. Protein-energy malnutrition is common in patients with liver disease and they often suffer from changes in the hepatic metabolism of nutrients and other substances. There is a basis for recommending BCAA supplementation in other certain liver diseases. Given the similar clinical picture of liver cancer surgery, it is possible that supplementation of BCAA can be beneficial for these patients as well.ObjectiveThe aim was to study the scientific basis for the effect of branched chain amino acid (BCAA) supplementation in liver cancer patients. Can it improve their recovery in terms of nutritional status and albumin levels, and does it changes the duration of hospital stay, after surgery?Search strategyFive extensive searches were performed on PubMed and Cochrane after appropriate study material.

SAMMANFATTNING Bakgrund: Preoperativ fasta har under många år varit en traditionell metod för att minska risken för aspiration medan patienten är under generell anestesi och för att eliminera risken för postoperativ illamående och kräkningar. Studier visar att trots riktlinjer och rekommendationer gällande preoperativ fasta fastar många patienter i onödan i flera dagar än nödvändigt. Detta kan orsaka skador och obehag hos patienten som till exempel: törst, huvudvärk, illamående, svaghet och trötthet.Syfte: Syfte med denna studie var att undersöka hur patienter upplever fasta mer än 12 timmar innan en akutoperation.Metod: Arbetet hade en kvalitativ ansats där 12 patienter som genomgått akut operation inkluderades. Data samlades in genom en semistrukturerad intervju, med hjälp av öppna frågor enligt en intervjuguide och analyserades med hjälp av manifest innehållsanalys enligt Graneheim och Lundman.Resultat: Analyserna resulterade i fyra kategorier: Preoperativ information, upplevelse av fasta, hantering av preoperativ fasta och upplevelse av preoperativ tid och åtta underkategorier: Bristfällig information, tillräcklig information, bristfällig kunskap trots tidigare vårderfarenhet, fysisk påverkan, psykisk påverkan, strategi, väntetid och fastetid.Slutsats: Deltagarna i studien upplevde brist på information och kunskaper om den preoperativa fastans betydelse. Studien visade att patienterna som väntade på akut operation på akutvårdsavdelning fastade längre än nödvändigt trots riktlinjer och rekommendationer gällande preoperativ fasta från Svensk förening för Anestesi och Intensivvård (SFAI).

Previous research and patient complaints to the Swedish Patient Support Committee shows that there is a lack of substance in the patient-nurse relationship. This may suggest that it can be difficult for health care to live up to health-care law which requires it to be of good quality, based on dignity and respect and designed so that the patient is an active participant and can make their own decisions when it comes to their health care. For a better understanding of what a dignified patient-nurse relationship is, this study aims to clarify what the patient values as good patient-nurse relationship and describe how they have experienced the patient-nurse relationship during their stay at an emergency care department. The study is a descriptive cross-sectional study with a quantitative approach, where the population consisted of patients who were cared for at an emergency care department in the County of Västmanland, Sweden during 2007. The sample consisted of 93 patients which were asked to answer a questionnaire.

Background: Surgical complications has been the main cause of medical injuries and deaths worldwide. In 2008 WHO developed the checklist for safe surgery to reduce the number of surgical complications. The objective of the checklist is to strengthen already established safety routines and contribute to better cooperation and communication. Research shows that compliance to the checklist is deficient, which can affect patient safety.Aim: The aim was to study the extent to which theatre nurses participate in the use of the checklist.Method: Observational study was conducted with a descriptive design and quantitative approach. 24 observations were carried out with aid of an observation protocol of two surgical units at a hospital in central Sweden.Result: The results showed that Timeout initiated widely but compliance to all items was considerably lower.

Background: Vacuum assisted closure, VAC, is a method which can benefit wound closure. There are not many reliable studies about the effects of VAC in different types of wounds. Previous studies have shown that patients have experienced pain during dressing changes.Aim: The aim of the study was to survey in what kind of wounds the vascular surgery ward have been using VAC, to study the treatment process of VAC and how it has been documented and also to investigate if patients with VAC experienced pain during dressing changes.Method: The patients were chosen from a ledger, which contained 77 patients that had been treated with VAC on the vascular surgery ward. Data were collected with a journal survey protocol.Results: The result is based on 67 patients with a total of 79 wounds. VAC was shown to have a good effect on wound healing and infected surgical wounds were the most commonly wound category undergoing treatment with VAC.

The main objective of this research was to study how increased arterial oxygenation by the use of Pulsed Inhaled Nitric-Oxide (PiNO) influenced the metabolic and cardiovascular parameters on horses undergoing acute abdominal surgery because of colic. The parameters blood lactate, blood glucose, pH and heart rate were evaluated before and during anesthesia and closely after recovery. The study showed that blood lactate concentrations decreased significantly during anaesthesia in horses treated with PiNO compared to non-treated horses. It was also seen that the lactate concentration decreased most in horses with the highest levels before PiNO treatment. Since enhanced oxygen extraction ratio was evident in the PiNO group, improved oxygen delivery to the tissue may be a possible explanation for the improved situation.

ABSTRACTAim. To describe intensive care nurses´ experiences of caring for patients with postoperative delirium after heart surgery.Background. Delirium is a common condition after heart surgery. Previous research has focused more on pathophysiology, incidence, etiology, prevention, detection and management, and less on how nurses caring for patients with delirium experience it.Design. A qualitative interview study.Method.

Bakgrund: ERAS (Enhanced Recovery After Surgery) är ett standardiserat multimodalt vårdprogram vid elektiv kolorektalkirurgi, som syftar till snabbare återhämtning och kortare vårdtider genom ett tvärprofessionellt samarbete.  En vecka innan planerad operation träffar sjuksköterskan patienten för ett samtal om vårdförloppet. Syfte: Att identifiera och beskriva patientens upplevelse av sjuksköterskans ERAS- samtal och dess betydelse för patientens delaktighet i sin vård.   Metod: Datainsamlingen skedde genom kvalitativa intervjuer. Tolv patienter, nio män och tre kvinnor har intervjuats. De ljudinspelade samtalen har transkriberats ordagrant och analyserats med hjälp av tolkande fenomenologisk analys (Interpretative Phenomenological Analysis). Resultat: Analysarbetet resulterade i fem olika teman; bli sedd, trygghet, tillit, ansvar samt delaktighet. Alla teman relaterar till varandra och illustrerar en positiv och en negativ sida av den upplevda erfarenheten. Tillsammans bildar en helhet av upplevelsen; ERAS- samtalet och dess betydelse för patientens delaktighet. Konklusion: Resultatet visar att patienterna känner sig sedda under informationssamtalet.

The aim was to identify if the veterinary nurse is as competent as the veterinaian in placing a nasoesophageal feeding tube. The aim was also to identify the complications with malnutrition and the advantage and disadvantage of the procedure. This essay is based on several interviews with both veterinary nurses and veterinaries. 16 persons were asked 4 short questions in conjunction with an intensive care/emergency and surgery congress in Gothenburg in February 2013. In addition 4 major hospitals that provided intensive care were asked to answer 5 more detailed questions, one answer from a veterinary and one answer from a veterinary nurse was requested.

Previous research and patient complaints to the Swedish Patient Support Committee shows that there is a lack of substance in the patient-nurse relationship. This may suggest that it can be difficult for health care to live up to health-care law which requires it to be of good quality, based on dignity and respect and designed so that the patient is an active participant and can make their own decisions when it comes to their health care. For a better understanding of what a dignified patient-nurse relationship is, this study aims to clarify what the patient values as good patient-nurse relationship and describe how they have experienced the patient-nurse relationship during their stay at an emergency care department. The study is a descriptive cross-sectional study with a quantitative approach, where the population consisted of patients who were cared for at an emergency care department in the County of Västmanland, Sweden during 2007. The sample consisted of 93 patients which were asked to answer a questionnaire.

Bakgrund. På akutmottagningen är flödet av patienter stort och möten mellan sjuksköterskor och patienter är korta och tidspressade. Det primära för patienter på en akutmottagning är att sjuksköterskan vet vad som ska göras. Omvårdnad kan delas upp i två kategorier: instrumentell omvårdnad och emotionell omvårdnad. För att agera med omvårdnad, måste sjuksköterskan dels ha ett omhändertagande med teknisk kompetens och samtidigt stödja patientens emotionella behov.

ABSTRACTBackground: As a nurse it is a part of your work description to precepting students. A good relationship between preceptor and student is important for a successful precepting witch can be rewarding for both parties. There are many studies on how nurses in hospital departments experience precepting students, however it is not as explored in the prehospital care.Objective: To describe ambulance nurses' experience of precepting nursing students in the third and final year of university-level nursing school.Method: A qualitative study was conducted. Nine respondents at two ambulance stations in central Sweden were selected with the help of strategic convenience sample. The informants were nurses with specialist education in ambulance/prehospital care who had experience of working in the ambulance unit for at least a year.Result: The majority of participants were positive to precepting students and the time seemed adequate.