Ciencias de la Salud
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Item “Hemofilia tipo A”(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-06-01) Guerrero Casquete, César Andrés; Mejía Ortiz, Ruth Aurelia Dra.Hemophilia is a devastating disease of genetic origin, recessive and linked to the X chromosome, which contains the genes that code for the hemostatic factors VIII and IX. Some specific mutations of these genes cause the appearance of hemophilia A or B. Hemophilia type A is caused by the reduction in the amount or activity of coagulation factor VIII, a failure at this point of the cascade of coagulation. The result is poor fibrin formation, which causes the coagulation to be much longer and the coagulum more unstable. Approximately 1 in every 5000 males is affected. The severity of the clinic correlates with factor levels. The following clinical case analysis is a 4-year-old male patient with a personal pathological head trauma of mild cranial encephalic trauma at 2 years and a personal surgical history of wound cauterization at the level of the lip when he was 2 years 6 months, that presents approximately 3 days of gingivorrhagia evolution after molar extraction, also refers to asthenia, anorexia, marked weakness and generalized pallor, to the physical examination he was: pale skin, at the level of the gingiva, there is an injury in the process of healing, no stigmas or active bleeding on admission, auscultation presents: tachycardia, rhythm regular, normofoneticos heart sounds, ausculta murmur at the level of holosistolico tricuspid focus, has hemoglobin 5.9 g/dl, hematocrit 20.1 %. He´s admitted to the pediatric hospitalization service of Hopital IESS Ambato where complementary tests are performed showing altered values of part time of thromboplastin what leads to perform other complementary tests to arrive the diagnosis of hemophilia type AItem ´´Paciente con sangrado digestivo alto relacionado con los cuidados de enfermería intrahospitalarios´´(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Enfermería, 2018-01-01) Montero Estrella, Giovanna Estefanía; Quishpe Jara, Graciela de las Mercedes Lic. Mg.The present Case Analysis with the topic Upper Digestive Bleeding talks about the high rate in which it occurs in male and elderly people understood as the bleeding that occurs after an injury caused in the upper digestive tract. Whose objective is to analyze the main complications that existed in a patient with High Digestive Bleeding focused on nursing care through the review of the Clinical History and Bibliographic Sources. Using methodologies of descriptive, bibliographic, field and documentary type; the descriptive one prevailing since a nursing guide was realized with the purpose of offering an alternative treatment with the intervention of the nursing personnel for the improvement of the health and the effective recovery of the patient. Having as conclusion the proposal and identification of the most appropriate treatment to be applied in the patient instrument that will help us to the constant recovery of the quality of life of the patient whose nursing care is directed to maintain the health of the individual in all its physical aspects, psychological, spiritual and social to be able to cover the needs of the person, through the promotion of health and the prevention of diseases.Item Placenta Previa Increta como causa de Hemorragia Obstétrica(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Cupueran Limachi, Carolina Estefanía; Remache Cevallos, Héctor Rodrigo Dr. EspecialistaPlacenta previa is defined as the total or partial insertion of the placenta in the lower segment of útero. La incidence is estimated to be 1 in every 200 pregnancies to term and varies throughout the world. It seems to have increased relative to the increasing rate of births cesárea. It is classified as complete, partial and marginal, depending on how the placenta covers the opening endocervical. According to the degree of penetration of abnormal placentation three types are recognized: accreta, increta, percreta. We present the case of female patient of 33 years old that causes pregnancy 22 weeks 5 days with reproductive background of sharp curettage 3 years ago. Go to the emergency room to present in moderate vaginal bleeding, bright red, with clots, accompanied by crampy abdominal pain located in lower abdomen. Enter hemodynamically stable. An ultrasound trace is reported total occlusive placenta previa. It remains hospitalized for about 3 months in the HPDA, at 35.3 weeks outpatient reports crystal clear liquid in small quantities, positive crystallography. Patient with uterine activity sporadic transfer is decided by lack of physical space to IESS in Ambato with a pregnancy of 35.3 weeks LMP + premature rupture of membranes 48 hours of evolution + previa low set + fetal distress, is valued and decide their intervention performing a caesarean surgical segmental abdominal hysterectomy + bilateral + adnexectomy. Post-surgical patient remains in recovery of 35.3 weeks + increta placenta previa, pregnancy patient is discharged in good general condition. Histopathological confirms increta placenta. Early prenatal approach through non-invasive diagnostic imaging provides useful information on the commitment and extension in the evaluation of patients with risk factors for placenta accreta. Ultrasonography is the method of choice, leaving magnetic resonance imaging and the study as a confirmatory histopathology as the gold standard definitive diagnosis and image. The only safe and proper method of delivery for placenta previa is a cesarean delivery. It is essential in all hospitals that treat obstetric patients evaluate and implement strategies to achieve a significant reduction in maternal morbidity and mortality. The ideal is to have a contingency plan on therapeutic conduct to follow, so that each case must be individualized. However, there are specific conditions of these high-risk pregnancies that require rapid decision-making, which should ideally be carried out in highly complex centers with highly trained professionals’ health to optimize final results thus reducing the maternal risks fetal.Item Hemorragia Subaracnoidea por Ruptura de Aneurisma Sacular(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Chango Cando, Freddy Gustavo; De La Cruz PueblaDra. Esp., Myriam,Subarachnoid hemorrhage is the output of blood into the subarachnoid space, and is considered a neurological emergency because it has a high morbidity and mortality. Its incidence is about 10 cases per 100,000 population per year, hypertension and smoking are the main risk factors. 80% of subarachnoid hemorrhages, are secondary to rupture of cerebral aneurysms, the remaining 20% is due to arteriovenous malformations (AVM), illicit drugs, amyloid angiopathy and superficial siderosis, venous sinus thrombosis, arterial dissection, infections, coagulation disorders, pituitary apoplexy and head trauma. The diagnostic study of choice is computed tomography (CT) without contrast. Treatment should be performed in specialized centers, embolization of unruptured aneurysms is recommended as a minimally invasive treatment as it is associated with low morbidity and mortality. A clinical case of a patient of 69 years with no personal or family history of importance Subcentro entering the health of La Mana because 15 days ago headache presents spontaneous appearance of holocraneana location, high intensity described by scale 9/10 EVA described as the "worst headache of your life" without irradiation does not relieve any position and spontaneous exacerbation and suffers fainting approximately 30 seconds plus classic symptoms of pyelonephritis include fever, it chills, back pain, dysuria and polaquiuria so comes to health Subcentro La Mana where she underwent additional tests the diagnosis is confirmed and transferred to Latacunga IESS Hospital where diagnosed with pyelonephritis is administered antibiotics, hydration and analgesia. On his second day of hospitalization patient referred headache of moderate intensity scale 8/10 as continuous type EVA holocraneana not giving up on painkillers, decided to perform CT brain where there are signs of subarachnoid hemorrhage, so it was decided to perform CT angiography in CT angiography shift awaiting new headache patient has high intensity and fading staying with a 14/15 Glasgow you choose to make new brain CT where volume increase bleeding is observed and decides to transfer to a third level unit. In third level unit angiography shows presence of saccular aneurysm and decided to perform embolization, on the eighth day of hospitalization treatment as expected, suffers new event being in Glasgow 7/15 it was decided to transfer to ICU where patient dies.Item Shock Hipovolémico Secundario a Hemorragia Obstétrica por Inversión Uterina en Sala de Partos(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Toalombo Eugenio, Graciela Estefanía; González Guevara, Laura Catalina Dra. ESP.Postpartum hemorrhage, mostly caused by uterine atony is the most common preventable cause of maternal mortality worldwide, and the second leading cause of maternal death in Ecuador. 4-6 Among the causes of postpartum hemorrhage is uterine inversion, a rare and serious complication that occurs in the third stage of labor, has an incidence of 1: 20,000 -1: 25,000 partos.13 This case is a female patient of 22 years old, born in Santo Domingo and living in Puyo, without personal pathological or family history of importance, is in her second pregnancy of 40.1 weeks last menstrual period (LMP), during his pregnancy was hospitalized for threatened preterm delivery more urinary tract infection. Go to gynecological emergencies present labor decided to send him to proceed to cefalovaginal birth, left in spontaneous evolution, resulting in childbirth at three hours and forty-five minutes, I received newborn anthropometric parameters of a newborn macrosomia with good general condition, in the period lasts more than 30 minutes delivery by retained placenta, is extracted manually incompletely, the vaginal touch incomplete uterine inversion palpating under short general anesthesia review is done and reduced manually uterus with maneuver Johnson, curettage and Bakri balloon placement is done. Patient signs of moderate hypovolemic shock with a loss of approximately 2000 milliliters blood crystalloid solutions so more globular packages are administered and plasma cool to recover blood volume; warrants admission to ICU, hypovolemic shock is persistent, a new uterine inversion, which is determined with the help of relaxation and bleeding, the conditions of the user warrant mechanical ventilatory support invasive, remains under observation without ruling hysterectomy evidence . Remains in ICU for 3 days thereafter to monitor their discharge is decided by the department of gynecology where it is kept under observation without improving clinical symptoms or signs of possible complications and decides high. In its evolution goes for outpatient control being in good general condition.Item “criterios aplicados comparadamente para el manejo de pacientes con shock hipovolémico de origen obstétrico admitidas en la unidad de terapia intensiva del hospital regional docente ambato, durante el periodo enero – agosto 2012”.(Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2016-02-01) Miranda Solís, Edwin Marcelo; Dr. Mera Ramos, Gerardo Vinicio