Restriction Of Fluid Intake Research Articles

Dasatinib induced penile and scrotal edema a case report

Dermatologist’s opinion is often sought for various types of drug reactions/side effects-specially, if the effects are on skin, mucous membranes or genitals. Updating their knowledge about newer molecules (drugs) and their side effects,thus become a necessity. Dasatinib is a new USFD approved Tyrosine kinase inhibitor for the treatment of those Chronic Myeloid Leukemias patients who cannot tolerate Imatinib or are resistant to imatinib. Dasatinib can cause fluid retention in some patients,which can lead to peripheral edema and pleural effusion. Penile and scrotal edema are unusual manifestation of that fluid retention and very few cases have so far been reported to my knowledge of this side effect. We reporting a case of scrotal and penile edema, who had a transitory relief on stoppage of drug, restricting fluid intake and vitamin E. Recognising this side effect could have prevented many investigations and various specialist consultations and nine months of agony in my case.

Management of treatment-resistant nocturnal enuresis.

Nocturnal enuresis is defined as intermittent urinary incontinence during sleep in children 5 years of age and older, occurring at least once a month for at least 3 months. In Japan, pediatricians who do not specialize in nocturnal enuresis have become more proactive in treating the condition since 2016, when the guidelines for treating it were revised for the first time in 12 years. For monosymptomatic nocturnal enuresis, the first step is lifestyle guidance, with a focus on the restriction of fluid intake at night; however, if lifestyle guidance does not decrease the frequency of nocturnal enuresis, aggressive treatment should be added. The first choice of aggressive treatment is oral desmopressin, an antidiuretic hormone preparation, or alarm therapy. However, there remain patients whose wet nights do not decrease with oral desmopressin or alarm therapy. In such cases, it is necessary to reconfirm the method of desmopressin administration and check for factors that may decrease the efficacy of desmopressin. If alarm therapy does not increase the number of dry nights, it is possible that the patient is fundamentally unsuitable for alarm therapy. If dry nights do not increase with oral desmopressin or alarm therapy, the next treatment strategy should be considered immediately to keep the patient motivated for treatment.

Obstructive and secretory complications of diverting ileostomy

This review aimed to highlight the etiology, diagnosis, treatment, and prevention of obstructive and secretory complications associated with diverting ileostomy (DI). Obstructive complications at the stoma site are termed stoma outlet obstruction (SOO) or stoma-related obstruction (SRO). The incidence of SOO/SRO is 5.4%-27.3%, and the risk factors are multifactorial; however, the configuration of the stoma limb and the thickness of the rectus abdominis muscle (RAM) may be of particular concern. Trans-stomal tube decompression is initially attempted with a success rate of 33%-86%. A thick RAM may carry the risk of recurrence. Surgical refinement, including a wider incision of the anterior sheath and adequate stoma limb length, avoids tension and immobility and may decrease SOO/SRO. Secretory complications of DI are termed high output stoma (HOS). Persistent HOS lead to water and sodium depletion, and secondary hyperaldosteronism, resulting in electrolyte imbalances, such as hypomagnesemia. The incidence of HOS is 14%-24%, with an output of 1000-2000 mL/d lasting up to three days. Treatment of HOS is commenced after excluding postoperative complications or enteritis and includes fluid intake restriction, antimotility and antisecretory drug therapies, and magnesium supplementation. Intensive monitoring and surveillance programs have been successful in decreasing readmissions for dehydration.

Secondary adrenal insufficiency in patient with COVID-19 and head and neck cancer

Syndrome of inappropriate antidiuretic hormone (SIADH) secretion is an endocrinological disorder which occurs when there is an evidence of continued antidiuretic hormone (ADH) secretion in the absence of an appropriate osmotic volume stimulus. Most commonly it is caused by different types of cancer or medications (eg. diuretics, antidepressants, antipsychotics...). Secondary adrenal insufficiency is caused by the insufficient adrenocorticotropic hormone (ACTH) secretion and cortisol production. In the hypocortisolism, the inhibitory mechanism on ADH secretion vanishes causing increased ADH secretion and leading to SIADH-like state. Both conditions, SIADH and hypocortisolism, manifest in euvolemic hyponatremia, however, its cause can be misdiagnosed and result in an inadequate treatment and potentially fatal outcome. Our case is about fifty-seven-year-old male patient who was treated with chemoradiotherapy for hematological malignancy of the oropharynx and who presented with severe hyponatremia se-veral times that almost ended fatally. Considering his malignant disease, patient was diagnosed with SIADH as a cause of hypona-tremia and was treated with hypertonic saline fluids and fluid intake restriction. However, after having suffered Covid-19 infection the patient was given glucocorticoids according to the protocol at the time. The sodium levels finally corrected, and the secondary adrenal insufficiency has been declared as the real cause of hyponatremia. SIADH is often thought to be the cause of hyponatremia in patients with malignant disease. However, SIADH represents a diagnosis of exclusion. Before making a final diagnosis, thyroid and secondary adrenal insufficiency must be ruled out. Moreover, secondary adrenal insufficiency imitates SIADH and results in euvolemic hyponatremia but the management and potential outcomes of these two conditions differ significantly. In patients who have been previously treated for malignancies with the treatment options that increase the risk of adrenal insufficiency (chemotherapy, neck or skull base radiotherapy, immunotherapy), adrenal reserve must be evaluated. If introduced, the glucocorticoid therapy should be carefully deescalated in these patients because of the risk of previously unrecognized adrenal insufficiency. This especially applies to conditions that include glucocorticoid therapy in the treatment protocol, such as Covid-19 infection.

OGC P44 Endoscopy-guided Laparoscopic Trans-gastric Resection (ELTGR) of bleeding gastric submucosal lesion, adjacent to the gastro-oesophageal junction

Abstract Background Leiomyomas are rare, benign submucosal tumours originating from smooth muscle cells. Ulcerated lesions could present with Upper Gastrointestinal(UGI) bleeding. Treatment of these lesion could be challenging especially if they are close to the Oesophagogastric Junction(OGJ). In this abstract, we present a novel surgical technique for resection of symptomatic gastric submucosal lesion located near the gastro-oesophageal junction on the lesser curve of the stomach. The Endoscopy guided laparoscopic trans-gastric resection technique is minimally invasive and avoids partial or total gastrectomy. Methods We present a case of 74-year-old male with a body mass index of 32.3 requiring resection of a bleeding gastric submucosal lesion. The patient presented with melaena, and an upper GI endoscopy diagnosed a single 30mm sub mucosal tumour immediately distal to the gastro-oesophageal junction. Stable clinical condition allowed complete preoperative work out including staging CT that showed small lesion at OGJ with no evidence of metastasis. UGI MDT discussion advised surgery without Endoscopic Ultrasound as it was a bleeding lesion. The patient was consulted on the management options and decided on surgical resection for prevention of re-bleeding. Surgical options discussed included local resection, partial and or total gastrectomy. Endoscopy was performed under general anaesthetic at the time of surgery and the tumour was found to be on the upper part of lesser curvature, thus not suitable for wedge or sleeve gastrectomy. A decision was made to try the trans-gastric approach. Results The endoscope was left in the stomach to demonstrate and protect the gastro-oesophageal junction. A gastrotomy was made longitudinally on the anterior surface of the stomach. Careful assessment of the lesion suggested that it could be resected using the trans-gastric approach. The endoscope was used to protect the junction and an endoscopic stapler (Echelon flex 60mm, Gold) was used to resect the tumour. A nasogastric drainage tube (NGT) was placed under vision and the gastrostomy was closed with the Echelon flex stapler 60 mm gold and blue . The NGT left for 72 hours with restricted and controlled fluid intake started the day after surgery and gradually increased to soft diet over three days. Patient was discharged on day 4. Follow up on day 7; WBC 10, CRP 19 and patient was very satisfied that he is at home and eating now normal diet. Using this minimally invasive approach we achieved macroscopic complete resection of the tumour whilst avoiding a total gastrectomy. Pathology report concluded features are of a smooth muscle tumour favouring a benign leiomyoma that is fully excised. Repeat scope after 3 month showed good healing and no recurrence or stricture and patient remains asymptomatic. Conclusions In this abstract we present endoscopic guided laparoscopic trans gastric resection (ELTGR) approach as a novel technique to avoid laparoscopic or open proximal gastrectomy or total gastrectomy in patients with tumours adjacent to the gastro-oesophageal junction and on the lesser curve that do not require radical oncological resection.

Wellness Coaching dengan Smile Model terhadap Kepatuhan Pembatasan Intake Cairan dan Fungsi Ginjal pada Pasien Gagal Ginjal Kronik yang Menjalani Hemodialisa

This study aims to determine the effect of wellness coaching with the smiling model on adherence to fluid intake restrictions and kidney function in CRF patients undergoing hemodialysis at the Hemodialysis Installation at Puri Asih Karawang General Hospital. This research is a quasi-experimental study using a pre-test and post-test design with a control group design. The results showed that before the intervention, the abnormal kidney function (urea) group had a higher pre-test, namely 20 respondents (87%), and in the urea control group, there were 18 respondents (78.3%). The creatinine values ​​for the intervention group and the control group were almost comparable to typical values, namely, 17 respondents (73.9) in the intervention group and 18 respondents (82.6%) in the control group. As for after the intervention, it can be seen that after the intervention in the intervention group, most of the kidney function of urea was higher, namely 18 respondents (78.3%), and in the urea control group, there were 13 respondents (56.5%). The creatinine value for the intervention and control groups was dominated by average values, namely 16 respondents (69.6%) and 19 respondents (82.6%). In conclusion, there is an effect of wellness coaching on compliance with fluid intake restrictions and no impact on kidney function. Still, there is no difference in adherence and kidney function between the intervention and control groups.
 
 Keywords: Coaching Wellness, Kidney Function, Compliance, Smile Model

Evaluating Clinical Outcomes and Physiological Perspectives in Studies Investigating Respiratory Support for Babies Born at Term With or at Risk of Transient Tachypnea: A Narrative Review.

Respiratory distress in the first few hours of life is a growing disease burden in otherwise healthy babies born at term (>37 weeks gestation). Babies born by cesarean section without labor (i.e., elective cesarean section) are at greater risk of developing respiratory distress due to elevated airway liquid volumes at birth. These babies are commonly diagnosed with transient tachypnea of the newborn (TTN) and historically treatments have mostly focused on enhancing airway liquid clearance pharmacologically or restricting fluid intake with limited success. Alternatively, a number of clinical studies have investigated the potential benefits of respiratory support in newborns with or at risk of TTN, but there is considerable heterogeneity in study designs and outcome measures. A literature search identified eight clinical studies investigating use of respiratory support on outcomes related to TTN in babies born at term. Study demographics including gestational age, mode of birth, antenatal corticosteroid exposure, TTN diagnosis, timing of intervention (prophylactic/interventional), respiratory support (type/interface/device/pressure), and study outcomes were compared. This narrative review provides an overview of factors within and between studies assessing respiratory support for preventing and/or treating TTN. In addition, we discuss the physiological understanding of how respiratory support aids lung function in newborns with elevated airway liquid volumes at birth. However, many questions remain regarding the timing of onset, pressure delivered, device/interface used and duration, and weaning of support. Future studies are required to address these gaps in knowledge to provide evidenced based recommendations for management of newborns with or at risk of TTN.

Fluid REStriction in Heart Failure vs Liberal Fluid UPtake: Rationale and Design of the Randomized FRESH-UP Study

It is common practice for clinicians to advise fluid restriction in patients with heart failure (HF), but data from clinical trials are lacking. Moreover, fluid restriction is associated with thirst distress and may adversely impact quality of life (QoL). To address this gap in evidence, the Fluid REStriction in Heart failure vs liberal fluid UPtake (FRESH-UP) study was initiated. The FRESH-UP study is a randomized, controlled, open-label, multicenter trial to investigate the effects of a 3-month period of liberal fluid intake vs fluid restriction (1500 mL/day) on QoL in outpatients with chronic HF (New York Heart Association Classes II--III). The primary aim is to assess the effect on QoL after 3 months using the Overall Summary Score of the Kansas City Cardiomyopathy Questionnaire (KCCQ). Thirst distress, as assessed by the Thirst Distress Scale for patients with HF, KCCQ Clinical Summary Score, each of the KCCQ domains and clinically meaningful changes in these scores, the EQ-5D-5L, patient-reported fluid intake and safety (ie, death, HF hospitalizations) are secondary outcomes. The FRESH-UP study is registered at ClinicalTrials.gov (NCT04551729). The results of the FRESH-UP study will add substantially to the level of evidence concerning fluid management in chronic HF and may impact the QoL of these patients.

Association between fluid intake and extubation failure in intensive care unit patients with negative fluid balance: a retrospective observational study

BackgroundNegative fluid balance (NFB) is associated with reduced extubation failure. However, whether achieving more NFB can further improve extubation outcome has not been investigated. This study aimed to investigate whether more NFB and restricted fluid intake were associated with extubation success.MethodsWe performed a retrospective study of adult patients with mechanical ventilation (MV) admitted to Medical Information Mart for Intensive Care (MIMIC-III) from 2001 to 2012. Patients with duration of MV over 24 hours and NFB within 24 hours before extubation were included for analysis. The primary outcome was extubation failure, defined as reintubation within 72 hours after extubation. Association between fluid balance or fluid intake and extubation outcome were investigated with multivariable logistic models.ResultsA total of 3433 extubation events were recorded. 1803 with NFB were included for the final analysis, of which 201(11.1%) were extubation failure. Compared with slight NFB (− 20 to 0 ml/kg), more NFB were not associated improved extubation outcome. Compared with moderate fluid intake (30 to 60 ml/kg), lower (< 30 ml/kg, OR 0.75, 95% CI [0.54, 1.05], p = 0.088) or higher (> 60 ml/kg, OR 1.63, 95% CI [0.73, 3.35], p = 0.206) fluid intake was not associated with extubation outcome. Duration of MV, chronic obstructive pulmonary disease (COPD), hypercapnia, use of diuretics, and SAPSIIscore were associated with extubation failure.ConclusionsMore NFB or restricted fluid intake were not associated with reduced extubation failure in patients with NFB. However, for COPD patients, restricted fluid intake was associated with extubation success.

Tolvaptan versus fluid restriction in acutely hospitalised patients with moderate-profound hyponatraemia (TVFR-HypoNa): design and implementation of an open-label randomised trial

BackgroundCurrent hyponatraemia guidelines are divided on the use of tolvaptan in hospitalised patients with moderate to severe hyponatraemia, due to an uncertain risk-benefit ratio. We will conduct a randomised trial to test the hypothesis that early use of tolvaptan improves the rate of serum sodium correction and clinical outcomes compared with current standard first-line therapy, restriction of fluid intake, without increasing the risk of serum sodium overcorrection.MethodsWe will enrol hospitalised patients with euvolaemic or hypervolaemic hyponatraemia and serum sodium of 115–130 mmol/L at Austin Health, a tertiary care centre in Melbourne, Australia. Participants will be randomised 1:1 to receive either tolvaptan (initial dose 7.5 mg) or fluid restriction (initial limit 1000 ml per 24 h), with titration of therapy based on serum sodium response according to a pre-determined protocol over a 72-h intervention period.The primary endpoint will be the between-group change in serum sodium over time, from study day 1 to day 4. Secondary endpoints include serum sodium increment in the first 24 and 48 h, proportion of participants with normalised serum sodium, length of hospital stay, requirement for serum sodium re-lowering with intravenous dextrose or desmopressin, cognitive and functional measures (Confusion Assessment Method Short form, Timed Up and Go test, hyponatraemia symptom questionnaire), 30-day readmission rate, treatment satisfaction score and serum sodium 30 days after discharge. The trial will be overseen by an independent Data Safety Monitoring Board. Serum sodium will be monitored every 6–12 h throughout the study period, with pre-specified thresholds for commencing intravenous 5% dextrose if serum sodium rise targets are exceeded.DiscussionWe seek to inform future international guidelines with high-quality data regarding the utility and safety of tolvaptan compared to standard therapy fluid restriction in patients with moderate-severe hyponatraemia in hospital. If tolvaptan use in this patient group is endorsed by our findings, we will have established an evidence-based framework for tolvaptan initiation and monitoring to guide its use.Trial registrationAustralia and New Zealand Clinical Trials Registry ACTRN12619001683123. Registered on December 2 2019

Self-Efficacy and Compliance Fluid Intake Restriction as a Determinant of The Interdialytic Weight Gain (IDWG) Level

Higher interdialytic Weight Gain (IDWG) is commonly experienced by patients with chronic kidney disease (CKD). Increased IDWG can cause various complications that result in risk of death. CKD patients who had undergoing hemodialysis in the Public Regional Hospital of Indramayu would have different weight gain, but it is not known what factors affect the increase in IDWG. The purpose of this study was to determine the factors that were significantly related to the IDWG level in CKD patients in the Public Regional Hospital of Indramayu. This research design is descriptive-analytic. The number of samples was 86 respondents who were selected by consecutive sampling technique. Data collection tools are questionnaires and the data analysis technique is the Pearson chi-square test. From the result from 86 respondents, it is known that 44 (51.2%) respondents experienced an increase in IDWG level at the mild category (&lt;4%). It is known that the factor influencing to level of IDWG are self-efficacy (p-value = 0.000; 95% CI) and fluid intake compliance (p-value = 0.042; 95% CI). Meanwhile, age, sex, education level, family support, and duration of hemodialysis are not influencing the IDWG level (p-value &gt; 0,05; 95% CI). Self-efficacy and fluid intake compliance are the most significant factor on the IDWG level in CKD patients who had hemodialization. Patients with high self-efficacy can reduce the IDWG level accompanied by compliance with fluid restriction. Recommendation for hemodialysis nurses needs to increase the patient’s self-efficacy in limiting fluid so that can be controlled at the IDWG level.

A Randomized Trial Evaluating the Use of a Smart Water Bottle to Increase Fluid Intake in Stone Formers

The aim of this study is to evaluate if the use of a smart water bottle improves urine volume in stone forming patients. Adults with nephrolithiasis and low urine volume (<1.5L) documented on a 24-hour urinalysis (24hr U) were randomized to receive either standard dietary recommendations to increase fluid intake (DR arm), or DR and a smart water bottle (HidrateSpark®; Hydrate Inc., Minneapolis, MN) that recorded fluid intake, synced to the user's smartphone, and provided reminders to drink (SBarm). Participants completed baseline surveys assessing barriers to hydration. They then repeated a 24hr U and survey at 6 and 12weeks, respectively. Eighty-five subjects (44 DR, 41 SB) were enrolled. The main baseline factor limiting fluid intake was not remembering to drink (60%). Follow-up 24hr Us were available for 51 patients. The mean increase in volume was greater in the SB arm (1.37L, 95% confidence interval -0.51 to 3.25) than the DR arm (0.79L, 95% confidence interval -1.15 to 2.73) (P=.04). A smaller percentage of subjects in the SB arm reported not remembering to drink as the main factor limiting fluid intake in the follow-up questionnaire compared to baseline (45.4% vs. 68.4%, P<.05). This was not true for the DR arm (40.0% vs. 51.2%, P=.13). Difficulty remembering to drink is a barrier to achieving sufficient fluid intake in stone formers. The use of a smart bottle was associated with greater increases in 24hr U volumes and less difficulty remembering to drink.

Effects of hypohydration and fluid balance in athletes’ cognitive performance: a systematic review

Background: The effects of progressive body fluid loss on athletic and cognitive performance are known to result from exposure to environmental heat stress, morphologic factors, and limited fluid replenishment. Athletes need to restore lost body water. However, athletes may fail to maintain euhydration during exercise. This systematic review investigated hypohydration and fluid balance effects on an athlete’s cognitive function.&#x0D; Methods: The PubMed, Sports Discuss, and Ebsco databases were searched for studies reporting on hypohydration, fluid balance and heat on cognitive performance in sport. Multiple phrases including hydration, dehydration, fluid balance, mood, cognition, vigilance, decision making, and brain were explored. Participants in the studies did either receive fluid or did not receive fluid during exercise.&#x0D; Results: Twenty-four trials (n=493 participants) from 24 articles met the inclusion criteria. Significant hypohydration, &gt;2% body mass loss was reported consistently in 16 publications. Five articles where hypohydration was associated with heat stress and limited fluid intake (3-5% body mass loss) impaired cognitive performance. Mood disturbance, fatigue, and ratings of perceived exertion constantly complemented hypohydration impairment on cognition.&#x0D; Conclusion: Findings show that hypohydration impairs cognitive performance and mood at higher levels of 3-5% body mass loss. However, sport-specific cognitive protocols of accessing hypohydration and fluid balance in individual and team sports remain equivocal.&#x0D; Keywords: Hypohydration; cognition; mood; fluid replenishment.

A CASE STUDY OF A 54-YEAR-OLD MAN WITH NYHA CLASS III, STAGE 2 HYPERTENSION, AND TYPE II DIABETES MELLITUS

Background: Heart failure is when the heart cannot pump enough blood to fulfill the body's needs. This disease is dangerous and can lead to death. The most common risk factors are hypertension, diabetes mellitus, and metabolic syndrome.Case Presentation: A 54-year-old man complained of shortness of breath for the last one month, which worsened during light activities and decreased when he was in a semi-sitting position. The patient had a history of hypertension and type-II diabetes mellitus for the last five years. On physical examination, the patient's blood pressure was 140/100 mmHg, respiratory rate was 25 bpm. There were paroxysmal nocturnal dyspnea, orthopnea, rales on both basal lung fields, dyspnea on exertion, ankle edema, a pansystolic murmur heard in the apex, ascites and ankle edema. Blood laboratory examination showed HbA1c 6%, chest X-ray and ECG showed cardiomegaly.Conclusion: The patient was diagnosed with NYHA Class III Heart Failure with stage 2 hypertension and type-2 diabetes mellitus and was treated with fluids, diuretics, ACE inhibitors, beta-blockers, low salt diet, restriction of fluid intake, and oral antidiabetics.

The Fluid Management Experience in Patients with Chronic Kidney Disease Undergoing Hemodialysis in Indonesia: A Qualitative Study

Background: Fluid management can reduce mortality, severe comorbidities, and debilitating symptoms in patients on hemodialysis. Therefore, a restricted fluid intake plan is crucial for patients with chronic kidney disease (CKD). Little evidence has been found to date on exploring the experience in fluid management of CKD patients in Indonesia.Purpose: This study aimed to explore the fluid management experience of adults with chronic kidney disease participating in hemodialysis treatment in Indonesia.Methods: A qualitative study with a phenomenological approach was conducted. Purposive sampling was used to recruit 14 adults patients with chronic kidney disease undergoing hemodialysis in a tertiary hospital in Padang between July and September 2020. Manual content analysis using the Colaizzi approach was used to identify themes.Results: Data analysis revealed four themes with 12 sub-themes. The four major themes include the challenge of thirst control, fluid/diet restriction management, inadequate information, and the support system.Conclusions: The result showed the severe suffering and sadness experienced by CKD patients who conform to fluid restrictions. It is important to provide clear information on the fluid prescription or the exact consumable amount per day. Structured education with a personal approach is recommended to ensure detailed information regarding "fluid prescribing". The support obtained from family, friends, and dialysis staff is a significant factor in promoting acceptance and adherence.

Hematological Adaptations to Post-Exercise Sauna Bathing with No Fluid Intake: A Randomized Cross-Over Study

ABSTRACT Purpose: Sauna bathing is recommended to improve the sports training process, yet empirical evidence confirming its effectiveness is still inconclusive. We examined the effects of post-exercise sauna bathing on hematological adaptations and exercise capacity in healthy men. Methods: Thirteen physical education students participated in randomized cross-over study: two, 4-week interventions, with 10-week washout. The interventions involved 3 times per week 60-min stationary cycling either with 30-min of post-exercise sauna bathing (89 ± 3°C, 10 ± 2% RH) or without; no fluid was ingested during both exercise and sauna sessions. Before and after both interventions, participants were tested for total hemoglobin mass (tHb-mass), intravascular volumes, erythropoietin, ferritin, red blood cell parameters with reticulocyte fractions, along with maximal/peak and submaximal variables in a graded exercise test (GXT). Results: Regardless of intervention type, tHb-mass increased (p = .014) whereas ferritin concentration decreased (p = .027); however, changes in tHb-mass were within the range of typical error (<1.8%). Absolute and relative values of maximal power and power at gas exchange threshold, as well as peak oxygen uptake (all p < .010), also increased irrespective of intervention type. Conclusions: The use of post-exercise sauna bathing with fluid intake restrictions does not provide any additional benefits in tested variables over endurance training alone. Thus, further evidence is required before recommendations to utilize this post-exercise conditioning strategy are deemed valid.

Factors Associated With Adherence to Fluid Restriction in Patients Undergoing Hemodialysis in Indonesia.

The factors related to fluid intake adherence among patients undergoing hemodialysis have been explored in many studies. However, most of these were conducted in Western countries and have produced inconsistent results. A study of this issue in Indonesia, a tropical country with strong herbal medicine traditions, may show different results. In addition to demographic characteristics, self-efficacy is a standard measurement used in chronic care management activities such as hemodialysis treatment. Understanding the reasons behind patient nonadherence in Indonesia may help nurses better manage the fluid intake of patients. This study was designed to determine the factors that predict patient adherence to fluid intake restrictions. A cross-sectional study was conducted on 153 patients undergoing hemodialysis at two hospitals. Intradialytic weight gain over a 1-month period was recorded to assess the participants' adherence to fluid intake restrictions. Intradialytic weight gains of more than 2 kg was considered to be nonadherent. A daily urine output and level of thirst were also recorded. The participants completed an adapted self-efficacy questionnaire, Swedish Fluid Intake Appraisal Inventory, and the data were analyzed together with demographic characteristic and clinical parameters using hierarchical multiple regression. The results revealed that most of the respondents did not adequately adhere to fluid intake restrictions (59.5%). Intradialytic weight gain was shown to strongly correlate with self-efficacy (p < .05, β = -.201), gender (p < .05, β = -.179), educational background (p = .05, β = .159), and urine output (p < .05, β = -.168). Demographic characteristic explained 10.6% and self-efficacy explained 3.9% of the variance in fluid adherence. Female participants with higher self-efficacy scores reported the lowest average level of intradialytic weight gain, indicating better adherence to fluid intake restrictions. Several demographic factors as well as self-efficacy were identified as potential predictors of fluid intake restriction adherence. Therefore, measuring self-efficacy periodically is a good initial step toward detecting those patients who are at higher risk of noncompliance with fluid intake restrictions.

Hubungan Pengetahuan dan Dukungan Keluarga Dalam Kepatuhan Pembatasan Asupan Cairan Pasien Hemodialisa Di RSBT Pangkalpinang

Compliance with fluid intake restriction is one of the problems in chronic kodney failure patients undergoing hemodialisysis. The difficulty of limiting fluid intake in patiens undergoing hemodialysis is due orance and lack of support from the family so that fluid intake is not controlled in patients with chronic kidney failure. This of course will worsen the patient’s health condition. Purpose of this research is to know the related factors towards the obedience in limiting fluid intake on the patients receiving hemodialysis at Bakti Timah Hospital Pangkalpinang. Method This research employs a Cross-sectional design. The sample of this research is the entire kidney failure patients receiving hemodialysis therapy with the total number of 66. The data are collected using questionnaire and measuring body weights based on Inter Dialytic Weight Gain. The data are then analyzed using Chi Square Test. Result The result of this research shows that there are relation factors toward the obedience in limiting fluid intake on the patients receiving hemodialysis are knowledge (p=0.034), and family support (p=0.027).The most dominant factor is the family support with the score of (POR=3.571). Conclusion There is a significant relationship between knowledge and family support in limiting fluid intake, so very important to improve education and counseling in hemodialysis patient

Antipsychotic-Induced Constipation: A Review of the Pathogenesis, Clinical Diagnosis, and Treatment.

Antipsychotic-induced gastrointestinal hypomotility and, in particular, its manifestation of constipation are common adverse effects in patients with schizophrenia in clinical practice. Serious complications of antipsychotic-induced constipation include ileus, ischaemic bowel disease, colon perforation, aspiration pneumonia, and bacterial septicaemia, which can be life threatening if left untreated, especially in patients prescribed clozapine. The aim of this paper is to review the latest research on the epidemiology, clinical examination methods, pathophysiology, and treatment options and preventive measures for antipsychotic-induced constipation. While clinicians are normally aware of the overall side effects caused by antipsychotics, constipation is often an under-recognized condition despite its relatively high incidence and its impact on daily living. The incidence of constipation differs among individual antipsychotics, but more than 50% of patients prescribed antipsychotics suffer from constipation. Limited fluid intake, poor dietary habits, and a sedentary lifestyle can also worsen constipation. The mechanisms of antipsychotic-induced constipation may be antagonism of cholinergic, histaminergic, and serotonergic receptors, with both parent drug and metabolite(s) contributing to the effects on gastrointestinal motility. Numerous methods, mainly divided into scale evaluations and objective examinations, are applied to evaluate antipsychotic-induced constipation; however, objective examinations have a greater ability to identify cases of gastrointestinal hypomotility since there is often an under-reporting of symptoms in subjective reporting and scale evaluation due to a higher pain threshold, an inability to express pain sensations, and a lack of symptom awareness in these patients. Antipsychotic drug-induced constipation should be closely monitored in patients receiving these medications, with timely intervention to avoid serious gastrointestinal consequences. There is currently no consensus on the efficacy of laxatives in these patients. Further in-depth studies should explore the underlying mechanisms and devise optimal therapeutic approaches to minimize constipation during antipsychotic treatment.

A Qualitative Study to Assess the Psychosocial Stressors among Chronic Kidney Disease Patients under Hemodialysis in Selected Dialysis Unit, New Delhi

Patient with chronic kidney disease (CKD) often have to suffer physical, psychological, social and financial problems and undertake a lot of stress and challenge while carrying themselves with the disease. Therefore, in order to understand the lived experiences and stressors faced by CKD patients undergoing hemodialysis, a qualitative study was conducted to assess the psychosocial stressors among CKD patients undergoing hemodialysis under 4 domains: Physical, Psychological Social and Financial. The research questions assessed were: How the disease condition and treatment regimen affected your physical well being? What are the psychological experiences faced by you as a patient of CKD under hemodialysis? How the disease condition and treatment regime affected your social life? How the disease condition and treatment regimen affected your financial status? Methods: A Qualitative approach with phenomenological design was implemented. Participants were selected through purposive sampling technique and data was collected using semi-structured in-depth interview schedule. Result and Conclusion: Data was analyzed using thematic analysis and subsequent themes, subthemes and categories emerged, which were: Physical struggles, Lack of knowledge of disease condition, Disturbed family life, Distorted personal life, psychological break down, Fear and anxiety, Anger and frustration, social isolation, financial burden. The participants expressed fear of death and hospital re-admission related to deterioration disease condition. Anger and frustration related to restricted food and fluid intake. The major stressors they confronted that is financial burden, disturbed personal life and distorted occupational life and low social support. The participants in this study had limited resources at hand, including treatment modalities, either hemodialysis or kidney transplantation. Patients with CKD experiences considerable levels of stressors which has direct and indirect impact not only their lives as well as to their family life. Thus, it showed that patient with CKD not leading good quality of life, everyday they face new challenges for spending trouble free life.