INTERVENÇÃO EDUCATIVA DE ENFERMAGEM AO CLIENTE SUBMETIDO À CIRURGIA CARDÍACA

Objetivo: analisar se um programa educativo de enfermagem favorece o conhecimento e orienta as condutas adotadas pelos clientes no pós-operatório de cirurgia cardíaca. Método: estudo de intervenção realizado com 51 pacientes. A coleta de dados foi realizada através da aplicação de um formulário estruturado. Análise estatística:  foram usados os testes qui-quadrado, exato de Fisher, Mann-Whitney ou coeficiente de correlação de Spearman, quando apropriados. Resultados: o programa educativo foi considerado importante para garantir tranquilidade, adesão ao tratamento e auxílio na recuperação. Entretanto, os clientes apresentaram compreensão limitada quanto a alguns procedimentos comuns do pós-operatório. As respostas inadequadas foram relacionadas à baixa escolaridade (p < 0,05). Houve correlação moderada e negativa (ρ = -0,314; p < 0,05) entre a coerência das respostas e o tempo entre a orientação e a cirurgia. Conclusão: o programa educativo favoreceu o conhecimento e orientou as condutas adotadas pelos clientes na fase pós-operatória.Descritores: Cirurgia cardíaca. Enfermagem perioperatória. Assistência de Enfermagem. Educação em saúde

Elaboration and validation of an ICNP® terminology subset for patients with acute myocardial infarction

Objective: To elaborate a terminological subset for the International Classification for Nursing Practice (ICNP® ) for patients with acute myocardial infarction using the Activities of Living Model. Method: A methodological study which followed the guidelines of the International Nursing Council and was based on theoretical framework of the Activities of Living Model for its elaboration. Content validation was performed by 22 nursing specialists. Results: Twenty-two (22) diagnoses and 22 nursing outcomes were elaborated. Of these, 17 nursing diagnosis statements and 17 nursing outcome statements presented Content Validity Index (CVI) ≥ 0.80. Of the 113 elaborated nursing interventions, 42 reached a CVI ≥ 0.80, and 51 interventions made up the terminological subset after the expert suggestions. Conclusion: The ICNP® was suitable for use with the Activities of Living Model, having compatible terms with those used in clinical nursing practice, and valid for construction of the terminological subset for patients with acute myocardial infarction and most likely to facilitate clinical nursing judgment

Construção e validação de um instrumento para avaliação do conhecimento dos enfermeiros sobre os medicamentos utilizados no infarto agudo do miocárdio

Introduction: The construction and validation of an instrument to evaluate nurses' knowledge about medication administration in patients with acute myocardial infarction can contribute to a safe and quality nursing care. Objective: To construct and validate a questionnaire to evaluate the knowledge of nurses about medications used for the treatment of ST-segment elevation myocardial infarction (STEMI). Methods: A methodological study that involved the construction and validation of the content of a questionnaire, as well as a semantic and idiomatic review. The degree of agreement among judges was assessed by the Content Validity Index (IVC ≥ 0.8). Results: The validated questionnaire consists of 20 questions divided into 4 sessions: I- Expected action of the medication, II- Adverse effects, III- Nursing care, IV- Route of administration and V- Contraindications. In the evaluation of the judges 19 questions obtained IVC≥0.8; 7 questions were corrected and 1 question was reworked as suggested by the judges. Conclusion: The questionnaire constructed in this study provides a validated and reliable data collection instrument for the evaluation of nurses' knowledge on the topic of medications used to treat STEMI.Introdução: A construção e validação de instrumento para avaliar o conhecimento dos enfermeiros quanto ao tema administração de medicamentos em pacientes acometidos por infarto agudo do miocárdio pode contribuir para a busca de uma assistência de enfermagem segura e de qualidade. Objetivo: Construir e validar um questionário para avaliar o conhecimento de enfermeiros sobre os medicamentos utilizados no tratamento de infarto agudo do miocárdio com supradesnível do segmento ST (IAM CSST). Métodos: Estudo metodológico de construção e validação de conteúdo de um questionário, além de revisão semântica e idiomática. O grau de concordância entre juízes foi avaliado pelo Índice de Validade de Conteúdo e considerado ponto de corte (IVC ≥ 0,8). Resultados: O questionário validado está composto de 20 questões, divididas a cada 4 nas sessões: I- Ação esperada do medicamento, II-Efeitos adversos, III-Cuidados de enfermagem, IV- Via de administração e V-Contraindicações. Na avaliação dos juízes, 19 questões obtiveram IVC ≥ 0,8; 7 questões passaram por correções e 1 questão foi reelaborada conforme sugestões. Conclusão: O questionário construído neste estudo fornece um instrumento metodológico de coleta de dados validado e confiável para avaliação do conhecimento de enfermeiros sobre os medicamentos utilizados para tratamento de IAM CSST

USO DE TECNOLOGIAS NO ENSINO DE SEMIOLOGIA E SEMIOTÉCNICA DE ENFERMAGEM

Objetivo: relatar a vivência de discentes, docentes e monitores na utilização de diferentes tecnologias educativas durante ensino teórico-prático de semiologia e semiotécnica de enfermagem. Método: relato de prática de ensino de 2 monitores, 2 docentes e 187 alunos de um curso de graduação em enfermagem de Vitória, Espírito Santo, realizado de 2015 a 2017, com reflexões sustentadas no referencial teórico de Merhy. Resultados: o ensino foi mediado por tecnologias leves associadas às leve-duras e duras, buscando-se o desenvolvimento de competências que pudessem aprimorar a produção de conhecimentos e que possam futuramente ser aplicadas na prática profissional, tendo como horizonte um cuidado de enfermagem humanizado e não restrito ao tecnicismo. Conclusão: a práxis pedagógica relatada favoreceu ao desenvolvimento de competências relacionais e manuais, à autonomia discente e ao pensamento crítico-reflexivo, necessários à articulação teórico-prática, à tomada de decisão clínica e a novos modos de se produzir cuidado em enfermagem.Descritores: Educação em Enfermagem. Inovação. Tecnologia Educacional. Ensino. Enfermage

Nurses’ attitudes toward the nursing process / Atitudes do enfermeiro frente ao Processo de Enfermagem

Objetivo: Avaliar a posição do enfermeiro frente ao processo de enfermagem em um hospital universitário. Método: estudo transversal analítico, com amostra de 141 enfermeiros, a coleta de dados utilizou o instrumento Posições sobre o Processo de Enfermagem, realizou estatística descritiva e associações, por meio do teste Qui-quadrado de Pearson e considerou significante p≤ 0,05. Resultados: Os escores gerais variaram entre 73 e 138. O escore total médio do Posições sobre o Processo de Enfermagem foi de 113,29 (DP=15,33). Os enfermeiros demonstraram atitudes fortemente favoráveis frente ao Processo de Enfermagem. Apresentar satisfação com a carreira e com o setor de trabalho e ter conhecimento prévio de diagnósticos de enfermagem foram variáveis relacionadas às atitudes favoráveis frente ao Processo de Enfermagem. Conclusão: Este estudo permitiu concluir que os enfermeiros da instituição estudada possuem atitudes favoráveis ao Processo de Enfermagem.

Nurses’ attitudes toward the nursing process / Atitudes do enfermeiro frente ao Processo de Enfermagem

Objetivo: Avaliar a posição do enfermeiro frente ao processo de enfermagem em um hospital universitário. Método: estudo transversal analítico, com amostra de 141 enfermeiros, a coleta de dados utilizou o instrumento Posições sobre o Processo de Enfermagem, realizou estatística descritiva e associações, por meio do teste Qui-quadrado de Pearson e considerou significante p≤ 0,05. Resultados: Os escores gerais variaram entre 73 e 138. O escore total médio do Posições sobre o Processo de Enfermagem foi de 113,29 (DP=15,33). Os enfermeiros demonstraram atitudes fortemente favoráveis frente ao Processo de Enfermagem. Apresentar satisfação com a carreira e com o setor de trabalho e ter conhecimento prévio de diagnósticos de enfermagem foram variáveis relacionadas às atitudes favoráveis frente ao Processo de Enfermagem. Conclusão: Este estudo permitiu concluir que os enfermeiros da instituição estudada possuem atitudes favoráveis ao Processo de Enfermagem.

Toxic effects of mercury, lead and gadolinium on vascular reactivity

Heavy metals have been used in a wide variety of human activities that have significantly increased both professional and environmental exposure. Unfortunately, disasters have highlighted the toxic effects of metals on different organs and systems. Over the last 50 years, the adverse effects of chronic lead, mercury and gadolinium exposure have been underscored. Mercury and lead induce hypertension in humans and animals, affecting endothelial function in addition to their other effects. Increased cardiovascular risk after exposure to metals has been reported, but the underlying mechanisms, mainly for short periods of time and at low concentrations, have not been well explored. The presence of other metals such as gadolinium has raised concerns about contrast-induced nephropathy and, interestingly, despite this negative action, gadolinium has not been defined as a toxic agent. The main actions of these metals, demonstrated in animal and human studies, are an increase of free radical production and oxidative stress and stimulation of angiotensin I-converting enzyme activity, among others. Increased vascular reactivity, highlighted in the present review, resulting from these actions might be an important mechanism underlying increased cardiovascular risk. Finally, the results described in this review suggest that mercury, lead and gadolinium, even at low doses or concentrations, affect vascular reactivity. Acting via the endothelium, by continuous exposure followed by their absorption, they can increase the production of free radicals and of angiotensin II, representing a hazard for cardiovascular function. In addition, the actual reference values, considered to pose no risk, need to be reducedResearch supported by CAPES and CNPq/FAPES/ FUNCITEC (#39767531/07), Brazil, and MCINN (#SAF 2009-07201) and ISCIII (Red RECAVA, #RD06/0014/0011), Spai

DOAÇÃO DE ÓRGÃOS E TECIDOS PARA TRANSPLANTES: CONHECIMENTO, ATITUDE E PRÁTICA

RESUMO Objetivo: avaliar o conhecimento, atitude e prática de integrantes de comissões intra-hospitalares de doação de órgãos e tecidos para transplantes quanto ao processo de doação de órgãos e tecidos para transplantes. Método: estudo avaliativo, quantitativo, com aplicação de questionário conhecimento, atitude e prática (CAP) a 34 profissionais de saúde em 2017. Resultados: constatou-se mais adequabilidade dos profissionais quanto à atitude e menos quanto ao conhecimento. Profissionais com especialização na área e os que se sentem preparados obtiveram maiores escores de conhecimento e prática; aqueles com duplo vínculo empregatício apresentaram menores escores de atitude; aqueles com formação para atuar na comissão e os que não tinham empecilhos para a condução do processo alcançaram pontuações superiores de prática. Os escores conhecimento e prática apresentaram correlação positiva moderada. Conclusão: evidenciou-se déficit dos profissionais quanto ao domínio conhecimento do processo de doação e captação de órgãos para transplantes

Home intravenous infusion: educational technologies for the care of people with hemophilia

Objetivo: Elaborar e validar tecnologias educativas para o cuidado domiciliar de pessoas com hemofilia em infusão endovenosa do fator de coagulação. Método: Estudo metodológico, desenvolvido em três etapas: elaboração de tecnologias educativas, avaliação de conteúdo e aparência por juízes e apreciação por pessoas com hemofilia. As tecnologias educativas − cartilha e infográfico − foram elaboradas mediante revisão de literatura. Na etapa de avaliação com juízes, foi utilizada a técnica Delphi em duas rodadas, por meio do Índice de Validade de Conteúdo, concordância superior a 0,80 em relação a clareza de linguagem, pertinência prática e relevância teórica. Na avaliação com o público-alvo, foi considerado o nível de concordância de respostas positivas maior ou igual a 80% nos itens de organização, o estilo de escrita, a aparência e a motivação para a leitura. Resultados: A cartilha apresentou índice de validade de conteúdo global de 0,88 na primeira rodada e 0,98 na segunda; e o infográfico, 0,88 na primeira rodada e 0,97 na segunda. Na apreciação das tecnologias educativas pelo público-alvo, o nível de concordância das respostas positivas foi superior a 80%. Conclusão: Este estudo elaborou tecnologias educativas, cartilha e infográfico, que poderão contribuir com a adesão ao tratamento e promoção do cuidado, por meio de padronização das orientações às pessoas com hemofilia em infusão endovenosa domiciliar.Objective: To develop and validate educational technologies for home care of people with hemophilia on intravenous infusion of clotting factor. Method: This is a methodological study, developed in three stages: development of educational technologies, content and appearance assessment by judges, and appraisal by people with hemophilia. The educational technologies – a booklet and an infographic - were developed through a literature review. In the assessment stage with judges, the Delphi technique was used in two rounds, through Content Validity Index, agreement greater than 0.80 in regarding clarity of language, practical relevance, and theoretical relevance. In the assessment with the target audience, the level of agreement of positive responses greater than or equal to 80% in the items of organization, writing style, appearance and motivation for reading was considered. Results: The booklet presented a global content validity index of 0.88 in the first round and 0.98 in the second; and the infographic, 0.88 in the first round and 0.97 in the second. In the assessment of educational technologies by the target audience, the level of agreement of positive responses was higher than 80%. Conclusion: This study developed educational technologies, a booklet and an infographic, which could contribute to adherence to treatment and promotion of care, by standardizing the guidelines for people with hemophilia in intravenous infusion at homeinfo:eu-repo/semantics/publishedVersio

Toxic Effects of Mercury on the Cardiovascular and Central Nervous Systems

Environmental contamination has exposed humans to various metal agents, including mercury. This exposure is more common than expected, and the health consequences of such exposure remain unclear. For many years, mercury was used in a wide variety of human activities, and now, exposure to this metal from both natural and artificial sources is significantly increasing. Many studies show that high exposure to mercury induces changes in the central nervous system, potentially resulting in irritability, fatigue, behavioral changes, tremors, headaches, hearing and cognitive loss, dysarthria, incoordination, hallucinations, and death. In the cardiovascular system, mercury induces hypertension in humans and animals that has wide-ranging consequences, including alterations in endothelial function. The results described in this paper indicate that mercury exposure, even at low doses, affects endothelial and cardiovascular function. As a result, the reference values defining the limits for the absence of danger should be reduced. History More than 2500 A.C., the prehistoric man used the cinabrio (mercury sulfide), due to its red-gold color, to draw on cave walls and perform face painting. Subsequently, mercury has been used in the amalgamation (direct burning of metallic mercury on the gravel, promoting the separation of gold), in photography and as an antiseptic in the treatment of syphilis Exposure to mercury brought harmful effects to health of humans, but changes resulting from human exposure to mercury only called the attention of the scientific society after the accidents in Japan and Iraq Mercury Characteristics Mercury is characterized as a highly malleable liquid at normal temperature and pressure Inorganic Mercury Compounds Elemental Mercury or Metalic Mercury Compounds. In its liquid form, the elemental mercury (Hg 0 ) is poorly absorbed and presents little health risk. However, in the vapor form, metallic mercury is readily absorbed through the lungs and can produce body damage Elemental mercury is used in thermometers and sphygmomanometers because of its uniform volumetric expansion, high surface tension, and lack of vitreous adherence to surfaces. Low electrical resistance and high thermal conductivity allow metallic mercury to be used in electrical and electronic materials. Because of its high oxidation power, metallic mercury is used in electrochemical operations in the chlorine and soda industries. Metallic mercury is also used in metallurgy, mining, and dentistry because of the easy amalgam formation with other metals. In addition, gold extraction with archaic and dangerous methods predispose miners to mercury poisoning. The burning of metallic mercury on the gravel promotes the separation of gold, a process called amalgamation, which causes emission of large amounts of mercury vapor that is inhaled immediately by the miner, since they do not use appropriate personal protective equipment Mercurous Mercury and Mercuric Mercury Compounds. The mercurous mercury in the form of mercurous chloride (Hg 2 Cl 2 ) is little absorbed in the body. It is believed that in the body the form of metallic mercury is changed to elemental mercury and mercuric mercury Mercuric mercury compounds, such as mercury salts, result from the combination of mercury with chlorine, sulfur, or oxygen. Mercuric mercury can be found in different states when combined with other chemical elements, including mercuric chloride (HgCl 2 ), which is highly toxic and corrosive; mercury sulfide (HgS), which is often used as a pigment in paints due to its red color; mercury fulminate (Hg(CNO) 2 ), which is used as an explosive detonator In the cardiovascular system, acute inorganic mercury exposition in vivo promotes reduction of myocardial force development Organic Mercury. Organic mercury compounds, also called organometallic, result from a covalent bond between mercury and the carbon [8] atom of an organic functional group such as a methyl, ethyl, or phenyl group. Methylmercury (CH 3 Hg + ) is by far the most common form of organic Hg to which humans and animals are exposed. CH 3 Hg + in the environment is predominantly formed by methylation of inorganic mercuric ions by microorganisms present in soil and water Journal of Biomedicine and Biotechnology 3 The organomercury antiseptics still used are Merthiolate, Bacteran, and Thimerosal [40]. Thimerosal is an organomercurial compound that since 1930 has been widely used as a preservative in biological material such as vaccines and serums used to prevent microbiological growth Forms of Mercury Exposure Mercury is now considered an environmental pollutant of high risk to public health because of its high toxicity and mobility in ecosystems More natural sources of mercury include volcanic activity, earthquakes, erosion, and the volatilization of mercury present in the marine environment and vegetation Mercury contaminates the environment through a cycle involving the initial emission, the subsequent atmospheric circulation of the vapor form, and the eventual return of mercury to the land and water via precipitation ( Mercury present in seas and rivers after methylation can contaminate fish Transport and Elimination of Mercury Inhaled elemental mercury vapor, for example, is readily absorbed through mucous membranes and the lung and is rapidly oxidized but not as quickly as to prevent the deposition of considerable amount in the brain Then, toxicity for man varies depending on the form of mercury, dose, and rate of exposure. The target organ for inhalted mercury vapor is primarily the brain Oxidized mercury binds strongly to SH groups; this reaction can inactivate enzymes, lead to tissue damage and interfere with various metabolic processes Doses of Mercury and Safety Legislation The chemical form of mercury in the air affects its time of permanence and its dispersion in the atmosphere. The elemental mercury form can persist for more than four years in the air, while its compounds are deposited in a short time at locations near their origin. In the northern hemisphere, their average concentration in the atmosphere is estimated at 2 ng/m 3 and in the southern hemisphere is less than 1 ng/m 3 . In urban areas, there is a great variability of these concentrations being found up to 67 ng/m 3 with a mean of 11 ng/m 3 in Japan In 2004, the Joint FAO (Food and Agriculture Organization of the United National)/WHO Expert Committee on Food Additives (JECFA) established that the safe concentration of methylmercury intake, without the appearance of neurological disorders, is 1.6 mg/kg of body weight. However, in 2006, JECFA stated that this concentration is not safe for intrauterine exposure, because fetuses are more sensitive to the onset of neurological disorders after exposure to methylmercury Currently, the general population is exposed to mercury by the following main sources: the consumption of contaminated fish, the use and manipulation of dental amalgam, thimerosal contained in vaccines, workers in industries of chlorine, caustic soda, miners, and workers in industries of fluorescent lamps In Brazil, the rules for vaccination of the Ministry of Health, published in June 2001, shows that thimerosal is used in many vaccines. These vaccines prevent flu (influenza vaccine), rabies (rabies vaccine), infection with meningococcus serogroup b, and hepatitis B The US Environmental Protection Agency's recommended a reference blood concentration of mercury to be 5.8 ng/mL; concentrations below this level are considered to be safe In the following sections, we will describe results obtained from animals with chronic and acute exposure to mercury. Some of these studies were performed with mercury exposure protocols that led to blood concentrations slightly above the reference values. Nevertheless, these concentrations could be easily found in exposed populations and may even be considered low when compared with concentrations in humans who consume large amounts of fish or who live in areas contaminated with mercury. Effect of Mercury on the Central Nervous System (CNS) Among the compounds of mercury, the methylmercury is primarily responsible for the neurological alterations present in humans and experimental animals. It is believed that the mechanisms are related to the toxic increase in reactive oxygen species (ROS). Oxidative stress is associated with the etiology of neurodegenerative diseases such as amyotrophic lateral sclerosis, Parkinson's disease, and Alzheimer's disease Reinforcing the hypothesis that the majority of injuries caused by methylmercury (MeHg) in the central nervous system are related to its ability to increase reactive oxygen species, Studies also demonstrate that mercury has the ability to reduce the number of neuron and cytoarchitecture in individuals with prenatal exposure to mercury In addition, because of its high affinity for sulfhydryl groups in tubulin, methylmercury inhibits the organization of microtubules that are important in CNS development Corroborating these findings, the study conducted by Halbach et al. [90] studied a correlation in Iraqi children between the level of maternal exposure to methylmercury during pregnancy and psychomotor retardation. SandborghEnglund et al. Effect of Mercury on the Cardiovascular System For decades, the toxic effects of mercury were associated mainly with the central nervous system; however, inorganic mercury also produces profound cardiotoxicity The mechanism by which mercury produces toxic effects on the cardiovascular system is not fully elucidated, but this mechanism is believed to involve an increase in oxidative stress. Exposure to mercury increases the production of free radicals, potentially because of the role of mercury in the Fenton reaction The reduction in glutathione peroxidase with seleniumdependent activity is the result of the decreased bioavailability of selenium, a molecule that is required for enzymatic activity Cardiovascular changes resulting from mercury poisoning are also described in animal models. However, the mechanism involved in the effects of mercury on the cardiovascular system is not fully understood but seems to be dependent on both the dose and time of exposure. Raymond and Ralston [123] studied the hemodynamic effects of an intravenous injection of HgCl 2 (5 mg/kg) in rats and observed that mercury produced cardiac diastolic failure and pulmonary hypertension. Moreover, Naganuma et al. Our group has found that chronic exposure to low doses of mercury (1st dose 4.6 μg/kg followed by 0.07 μg/kg/day for 30 days, im) attained a blood mercury concentration of approximately 8 ng/mL, a concentration similar to the levels found in exposed humans. This exposure produced a negative inotropic effect in perfused hearts, although increasing myosin ATPase activity. Invivo, arterial or ventricular pressures did not change The chronic exposure to low concentrations of mercury was also able to induce endothelial dysfunction in resistance and conductance vessels, most likely because of the decreased nitric oxide (NO) bioavailability due to the increased superoxide anion (O 2 •− ) production from NADPH oxidase Taken together, these data show that chronic low doses of mercury have an important and deleterious effect on vascular function by reducing NO bioavailability. The degree of severity of mercury exposure is comparable to traditional cardiovascular risk factors, such as hypertension diabetes or hypercholesterolemia. Therefore, mercury could be considered an important risk factor for cardiovascular disease that could play a role in the development of cardiovascular events. The association between mercury exposure and an increased risk of developing cardiovascular and neurological diseases is apparent. Thus, continuous exposure to mercury can be dangerous, and current reference values, once considered to be without risk, should be reevaluated and reduced