Perfil clínico e diagnósticos de enfermagem de pacientes em risco para úlcera por pressão

This cross-sectional study characterizes patients at risk of Pressure Ulcers (PUs) and identifies their corresponding Nursing Diagnoses (NDs). The sample consisted of 219 hospitalizations of adult patients at risk for developing a PU established through the Braden Scale. Data concerning the results of the application of the Braden Scale were retrospectively collected from the patients medical files and statistically analyzed. Most patients were elderly women hospitalized for an average of nine days, affected by cancer, cerebrovascular, lung, cardiovascular and metabolic diseases. The most frequent NDs were Risk for infection, Self-care deficit syndrome, Bathing/hygiene self-care deficit, Impaired physical mobility, Imbalanced nutrition: less than body requirements, Ineffective breathing pattern, Impaired tissue integrity, Acute pain, Impaired urinary elimination, Impaired skin integrity, and Risk for impaired skin integrity. We conclude that most NDs are common in clinical nursing practice.Se trata de un estudio transversal con objetivos de caracterizar a los pacientes en riesgo de contraer úlcera por presión (UP) e identificar sus diagnósticos de enfermería (DEs). La muestra consistió de 219 hospitalizaciones de pacientes adultos en riesgo de contraer UP, determinado por la Escala de Braden. Los datos fueron recolectados retrospectivamente en registros de la Escala de Braden en ficha electrónica y, analizados estadísticamente. La mayoría de los pacientes fueron mujeres, ancianos, con tiempo de internación promedio de nueve días y portadores de enfermedades cerebrovasculares, pulmonares, cardiovasculares, metabólicas y neoplásicas. Los DEs más frecuentes fueron Riesgo de infección, Síndrome de déficit en el autocuidado, Déficit en el Autocuidado: baño/higiene, Movilidad física perjudicada; Nutrición desequilibrada: menos que las necesidades corporales, Estándar respiratorio ineficaz, Integridad tisular perjudicada, Dolor agudo, Alteración en la eliminación urinaria, Integridad de la piel perjudicada, Riesgo para perjuicio de la integridad de la piel. Se concluye que estos DEs, en la mayoría, son comunes a la práctica clínica de enfermería.Estudo transversal, cujos objetivos foram caracterizar os pacientes em risco para úlcera por pressão (UP) e identificar os seus diagnósticos de enfermagem (DEs). A amostra consistiu de 219 hospitalizações de pacientes adultos em risco para UP, determinado pela escala de Braden. Os dados foram coletados, retrospectivamente, em registros da escala de Braden e em prontuário eletrônico e, após, analisados estatisticamente. A maioria dos pacientes era de mulheres, idosos, com tempo de internação mediano de nove dias e portadores de doenças cerebrovasculares, pulmonares, cardiovasculares, metabólicas e neoplásicas. Os DEs mais frequentes foram risco para infecção, síndrome do déficit no autocuidado, déficit no autocuidado: banho/higiene, mobilidade física prejudicada, nutrição desequilibrada: menos do que as necessidades corporais, padrão respiratório ineficaz, integridade tissular prejudicada, dor aguda, alteração na eliminação urinária, integridade da pele prejudicada, risco para prejuízo da integridade da pele. Conclui-se que esses DEs, na maioria, são comuns à prática clínica de enfermagem

Carbapenem stewardship: positive impact on hospital ecology

INTRODUCTION: Excessive group 2 carbapenem use may result in decreased bacterial susceptibility. OBJECTIVE: We evaluated the impact of a carbapenem stewardship program, restricting imipenem and meropenem use. METHODS: Ertapenem was mandated for ESBL-producing Enterobacteriaceae infections in the absence of non-fermenting Gram-negative bacilli (GNB) from April 2006 to March 2008. Group 2 carbapenems were restricted for use against GNB infections susceptible only to carbapenems and suspected GNB infections in unstable patients. Cumulative susceptibility tests were done for nosocomial pathogens before and after restriction using Clinical and Laboratory Standards Institute (CLSI) guide-lines.Vitek System or conventional identification methods were performed and susceptibility testing done by disk diffusion according to CLSI.Antibiotic consumption (t-test) and susceptibilities (McNemar's test) were determined. RESULTS: The defined daily doses (DDD) of group 2 carbapenems declined from 61.1 to 48.7 DDD/1,000 patient-days two years after ertapenem introduction (p = 0.027). Mean ertapenem consumption after restriction was 31.5 DDD/1,000 patient-days. Following ertapenem introduction no significant susceptibility changes were noticed among Gram-positive cocci. The most prevalent GNB were P. aeruginosa, Klebsiella pneumoniae, and Acinetobacter spp. There was no change in P. aeruginosa susceptibility to carbapenems. Significantly improved P. aeruginosa and K. pneumoniae ciprofloxacin susceptibilities were observed, perhaps due to decreased group 2 carbapenem use. K. pneumoniae susceptibility to trimethoprim-sulfamethoxazole improved. CONCLUSION: Preferential use of ertapenem resulted in reduced group 2 carbapenem use, with a positive impact on P. aeruginosa and K. pneumoniae susceptibility

Efeito de um programa de treinamento funcional no equilíbrio postural de idosas da comunidade

Functional training programs may help reduce elderly disabilities, falls, and emotional and social problems. The aim of this study was to assess the impact of an eight-week functional exercise program on aged women's instrumental activities of daily living (IADL) and one-foot stance balance. Irrespective of race and/or social condition, 7 community-dwelling elderly women (aged 71±8.1) were selected, being excluded those with cognitive impairment, acute or neurological diseases, spine or joint pain, labyrinth inflammatory disease, visual impairment, fractures in the previous year, and use of gait aid. All subjects were assessed by the Lawton IADL scale and the one-foot stance balance test, before and after the program. Exercises were performed three times a week and consisted of gait exercises in plantar flexion, dorsiflexion, alternation of sustained one-foot stance, sideways gait, gait with increased hip flexion, and tandem gait. Results show a functional improvement in IADL (p=0.042) as measured by the Lawton scale, and a trend towards better static one-foot stance balance, though not significant (p>;0.105). The proposed program of functional exercises may thus be said to bring about improvement in older women's functional performance and a trend towards improvement on static balance, suggesting its relevance to increase elderly women's autonomy.Programas de treino funcional podem colaborar na redução de incapacidades, quedas, problemas emocionais e sociais em idosos. O objetivo do estudo foi verificar o efeito de um programa de oito semanas de exercícios funcionais em idosas da comunidade, avaliando o impacto nas atividades instrumentais de vida diária (AIVD) e no equilíbrio unipodálico. Deste estudo quasi-experimental participaram sete idosas da comunidade (71±8,1 anos), sem distinção de raça e/ ou condição social, excluindo-se aquelas com alterações cognitivas, doenças agudizadas ou neurológicas, quadro álgico na coluna ou articulações, labirintite, distúrbios visuais não-compensados, fratura prévia no último ano e utilização de apoio para a marcha. Todas responderam ao questionário de Lawton e se submeteram ao teste de apoio unipodálico antes e depois do programa, administrado três vezes por semana. O programa consistia em exercícios de marcha em flexão plantar, dorsiflexão, permanência em alternância de apoio unipodálico, marcha lateral com flexão de quadril aumentada e marcha tandem. Os resultados indicam melhora (p=0,042) no nível funcional (índice de Lawton) após o programa e uma tendência à melhora no equilíbrio unipodálico, embora não-significante (p>;0,105). O programa de exercícios proposto produziu pois melhora no desempenho das AIVD e uma tendência à melhora do equilíbrio estático, sugerindo ser relevante para aprimorar a autonomia das idosas

EL CUIDADO DE ENFERMERÍA AL PACIENTE ONCOLÓGICO SIN POSIBILIDAD DE CURA: PERCEPCIÓN DE UN GRUPO DE PROFESIONALES

Esta pesquisa investigou a experiência do profissional da enfermagem no cuidado ao paciente oncológico fora de possibilidade de cura; trata-se de um estudo de abordagem qualitativa, com participação de 13 profissionais da equipe de enfermagem de um hospital de ensino do interior paulista. Os dados foram coletados entre agosto e outubro/2009, por meio de entrevista. A análise de conteúdo de Bardin possibilitou a categorização dos dados em: O cotidiano da enfermagem com o paciente oncológico fora de possibilidade de cura; O enfrentamento do trabalho com paciente em fase terminal; e Dificuldades no trabalho com o paciente fora de possibilidade de cura. Os resultados apontaram que a assistência aos pacientes restringiu-se aos cuidados físicos e o enfrentamento se deu com estratégias individuais, podendo colocar em risco a segurança do paciente. O despreparo dos profissionais para o cuidado emocional foi a principal dificuldade relatada, com evidências de necessidade de sua capacitação.This study investigated the experience of professional nurses involved in the care of cancer patients whose cancer was beyond treatment. The study had a qualitative approach and was undertaken with the participation of thirteen professionals from a nursing team in a teaching hospital in the countryside in Sao Paulo state. The data was collected through interviews between August and October 2009. By applying Bardin’s content analysis, the data was categorized in three groups; nursing routines with patients with incurable cancer, facing work with patients in the terminal phase, and difficulties in working with patients beyond cure. The results indicated that patient care was limited to physical care, and that facing work with these patients was accomplished with individual strategies, putting patient safety at risk. The health care professionals’ lack of preparedness for emotional care was the main difficulty related, with evidence for the need for training in this matter.Esta investigación analizó la experiencia del profesional de enfermería en el cuidado al paciente oncológico sin posibilidad de cura. Se trata de un estudio de abordaje cualitativo, con participación de 13 profesionales del equipo de enfermería de un hospital de enseñanza del interior paulista. Los datos fueron recogidos entre agosto y octubre/2009, por medio de entrevista. El análisis de contenido de Bardin posibilitó la categorización de los datos en: El cotidiano de la enfermería con el paciente oncológico sin posibilidad de cura; El afrontamiento del trabajo con paciente en fase terminal; y Dificultades en el trabajo con el paciente sin posibilidad de cura. Los resultados apuntaron que la asistencia a los pacientes se restringió a los cuidados físicos y el afrontamiento se dió con estrategias individuales, siendo posible poner en riesgo la seguridad del paciente. La falta de preparación de los profesionales para el cuidado emocional fue la principal dificultad relatada, con evidencias de necesidad de su capacitación

Avaliação física e química da desidratação osmótica, em abacaxi pérola seco e irradiado

A tecnologia de métodos combinados baseia-se na atuação sinérgica dos diferentes métodos de conservação para manter a qualidade dos alimentos. O objetivo deste trabalho foi avaliar os efeitos de doses de radiação (0,75 e 1,5 kGy) nas características físicas e químicas do abacaxi tratado com desidratação osmótica e seco, durante o armazenamento (0, 14, 28 e 56 dias). Foram avaliados umidade, atividade de água, teor de sólidos solúveis, acidez total, pH, cor e textura. Os níveis de radiação não afetaram a umidade nem a atividade de água, porém o tempo de armazenamento alterou os valores. O teor de sólidos solúveis, acidez total e pH mantiveram-se praticamente constantes durante o tempo de armazenamento. As doses de radiação afetaram a cor das amostras, reduzindo os parâmetros L e b*. A textura, tanto para a força de ruptura quanto para o trabalho de ruptura, no decorrer do tempo, e nas doses de radiação, foi afetada, a dureza e a crocância do abacaxi desidratado diminuíram em ambos. A irradiação foi um excelente método combinado para prolongar o armazenamento do abacaxi tratado com desidratação osmótica e seco

Assessment of Physical-Chemical Characteristics of Water and Sediments from a Brazilian Tropical Estuary: Status and Environmental Implications

The environmental quality of the Jacuípe River's estuary (very important in northeastern Brazil) was assessed during 2007 and 2008. In water, concentrations (mg L−1) of NO2− (<0.004 to 0.016), NO3− (0.01 to 0.33), soluble PO43− (<0.02 to 0.22), dissolved oxygen (3.9 to 9.6), total contents (mg L−1) of Cd (<0.001), Cu (<0.01), Pb (<0.01), and Zn (<0.1), pH (5.60 to 8.00), and electrical conductivity (0.12 to 48.60 mS cm−1) agreed with environmental standards. In sediments, clay and total organic matter (%, m/m) varied, respectively, from 8.8 to 12.0 and from 1.1 to 8.8, while infrared, thermogravimetric profile, electronic micrograph, as well as X-Ray analyses showed desirable adsorptive characteristics. However, maximum exchangeable levels (mg kg−1) of Cd (1.3), Cu (44.6), Pb (35.7), and Zn (43.7) and their respective maximum pseudototal concentrations (mg kg−1): 19.4, 95.1, 68.2, and 30.3 were below the recommended limits. In this sense, it was possible to demonstrate good environmental preservation even with the growing number of industries and touristic activities in the evaluated estuarine area

Efeitos da etcc sobre o aprendizado motor em pessoas com doença de Parkinson / Effects of cts on motor learning in people with parkinson's disease

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