O que ensinar aos pacientes com insuficiência cardíaca e por quê: o papel dos enfermeiros em clínicas de insuficiência cardíaca

The most important objective of heart failure (HF) treatment is to reach and preserve patients' clinical stability. Several studies have shown that programs aimed at systematic education, developed by multidisciplinary teams, are positive strategies to work with these patients. Nurses active in HF clinics play a fundamental role in the educational process and continuity of patient care. The objectives of these processes are to teach, reinforce, improve and constantly evaluate patients' self-care abilities, which include weight monitoring, sodium and fluid restrictions, physical activities, regular medication use, monitoring signs and symptoms of disease worsening and early search for medical care. Therefore, education to understand HF and the development of self-care abilities are considered key points to improve adherence, avoid decompensation crises and, consequently, to maintain patients clinically stable. This article presents a careful review of the aspects involved in the patient education process by nurses in the context of HF clinics.El principal objetivo del tratamiento de la insuficiencia cardiaca (IC) consiste en obtener y mantener la estabilidad clínica del paciente. Varios estudios demostraron que programas de educación sistemática, desarrollados por equipos multidisciplinares, son estrategias positivas para estos pacientes. Enfermeras que trabajan en clínicas de IC tienen un papel fundamental en la educación y apoyo de los pacientes. Los objetivos del proceso son enseñar, reforzar, mejorar y evaluar constantemente la capacidad de autoayuda, que incluye el control de peso, restricciones al consumo de sodio y líquidos, actividades físicas, el uso adecuado de medicamentos, la observación de señales y síntomas de agravamiento de la enfermedad y la búsqueda precoz de los servicios médicos. Los puntos principales para promover el mejor cumplimiento de la terapia y evitar crisis de descompensación serian entonces la educación para el manejo de la enfermedad y el desarrollo de la capacidad de autoayuda. En este artículo revisaremos en detalle aspectos de la educación para pacientes con insuficiencia cardiaca dada por enfermeros.O principal objetivo do tratamento da insuficiência cardíaca (IC) consiste em alcançar e manter a estabilidade clínica dos pacientes. Vários estudos demonstram que programas multidisciplinares para educação sistemática sobre a doença são estratégias positivas para estes pacientes. Enfermeiros engajados em clínicas de IC desempenham papel fundamental no processo de educação e acompanhamento dos pacientes. Os objetivos deste processo são ensinar, reforçar, melhorar e avaliar constantemente as habilidades dos pacientes para o autocuidado, que incluem a monitorização do peso, a restrição de sódio e de líquidos, a realização de atividade física, o uso regular das medicações, a monitorização de sinais e de sintomas de piora da doença e o contato precoce com a equipe assistencial. Desta forma, a educação para o entendimento da IC, e o desenvolvimento de habilidades para o autocuidado, são considerados chaves para melhorar a adesão, evitar crises de descompensação e conseqüentemente manter a estabilidade clínica dos pacientes. Neste artigo nos revisamos detalhadamente os aspectos envolvidos no processo de educação dispensados aos pacientes por enfermeiros no contexto das clínicas de IC

Perfil de los diagnósticos de enfermería en pacientes cardiópatas estables

Objective. To identify the nursing diagnoses through reports in the medical records of patients monitored in a specialized ischemic heart disease outpatient clinic. Methods. Cross-sectional study with retrospective data collection in the medical records. From the data collected, the nursing diagnoses were proposed by the researchers and submitted for validation by specialist cardiology nurses. Results. A total of 13 nursing diagnoses were evaluated from the medical records of 50 outpatients with the following validation agreements among the specialists: Ineffective health management (100%), Noncompliance (100%), Sedentary lifestyle (100%), Activity intolerance (100%), Decreased cardiac output (88%), Risk of decreased cardiac tissue perfusion (65%), Risk of intolerance to activity (65%), Acute pain (76%), Ineffective health maintenance (65%), Risk-prone health behavior (65%), Risk for decreased cardiac output (65%), Risk for intolerance to activity (65%), Ineffective respiratory pattern (53%), Impaired memory (29%). Conclusion. In this study, the nursing diagnoses validated for stable heart disease patients were linked to adherence to treatment and to the cardiovascular responses of the patients, reinforcing the importance of early intervention. These results allow the multidisciplinary team to individualize the goals and interventions proposed for ischemic heart disease patients.Objetivo. Identificar os diagnósticos de enfermagem através dos registros no seguimento dos pacientes que vão a um centro ambulatório especializado em cardiopatia isquêmica na cidade de Porto Alegre, Brasil. Métodos. Estudo transversal com toma de informação retrospectiva da história clínica. A partir dos dados recolhido, os diagnósticos de enfermagem identificados pelos investigadores foram submetidos a valoração de enfermeiros especialistas em cardiologia. Resultados. Foram identificados 13 diagnósticos de enfermagem nas histórias clínicas de 50 pacientes ambulatórios, com a seguinte concordância de validação entre os especialistas: controle ineficaz da saúde (100%), falta de aderência (100%), estilo de vida sedentário (100%), Intolerância à atividade (100%), Débito cardíaco diminuído (88%), irrigação de perfusão tissular cardíaca diminuída (76%), Dor agudo (76%), Manutenção ineficaz da saúde (65%), Comportamento de saúde propenso a risco (65%), Risco de débito cardíaco diminuído (65%), Risco de intolerância à atividade (65%), Padrão respiratório ineficaz (53%), Memória prejudicada (29%). Conclusão. Neste estudo os diagnósticos de enfermagem validados para os pacientes cardiopatas estáveis estão relacionados com a aderência ao tratamento e à resposta cardiovascular às intervenções dos pacientes, reforçando a importância de intervenção precoce. Esses resultados permitem em equipes multiprofissionais individualizar as metas e intervenções para os pacientes com cardiopatia isquêmica.Objetivo. Identificar los diagnósticos de enfermería a partir de los registros en el seguimiento de los pacientes que acuden a un centro ambulatorio especializado en cardiopatía isquémica en la ciudad de Porto Alegre, Brasil. Métodos. Estudio transversal con toma de información retrospectiva de la historia clínica. A partir de los datos recolectados, los diagnósticos de enfermería identificados por los investigadores se sometieron a valoración de enfermeros especialistas en cardiología. Resultados. Se identificaron 13 diagnósticos de enfermería en las historias clínicas de 50 pacientes ambulatorios, con la siguiente concordancia de validación entre los especialistas: control ineficaz de la salud (100%), falta de adherencia (100%), estilo de vida sedentario (100%), Intolerancia a la actividad (100%), Débito cardíaco disminuido (88%), Riego de perfusión tisular cardíaca disminuida (76%), Dolor agudo (76%), Mantenimiento ineficaz de la salud (65%), Comportamiento de salud propenso a riesgo (65%), Riesgo de débito cardíaco disminuido (65%), Riesgo de intolerancia a la actividad (65%), Patrón respiratorio ineficaz (53%), Memoria perjudicada (29%). Conclusión. En este estudio los diagnósticos de enfermería validados para los pacientes cardiópatas estables están relacionados con la adherencia al tratamiento y a la respuesta cardiovascular a las intervenciones, reforzando la importancia de intervención precoz. Esos resultados permiten, en equipos multiprofesionales, individualizar las metas e intervenciones para los pacientes con cardiopatía isquémica

Visita domiciliar melhora conhecimento, autocuidado e adesão na insuficiência cardíaca: ensaio clínico randomizado HELEN-I

OBJECTIVE: To verify the effect of an educative nursing intervention composed of home visits and phone calls on patients' knowledge about the disease, self-care and adhesion to the treatment. METHODS: Randomized clinical trial with patients with recent hospitalization caused by decompensated heart failure. There were two groups: the intervention group, which has received four home visits and four phone calls to reinforce the guidelines during six months of follow up; and the control group, which has received conventional follow up with no visits or phone calls. RESULTS: Two hundred patients were randomized (101 in the intervention group and 99 in the control group). After six months, a significant improvement was observed in self-care and knowledge about the disease in the intervention group (P=0.001 and POBJETIVO: Verificar el efecto de una intervención educativa de enfermería combinada de visita domiciliaria y contacto telefónico en pacientes con internación reciente por insuficiencia cardiaca descompensada, en el conocimiento de la enfermedad, las habilidades para el autocuidado y la adhesión al tratamiento comparado con el acompañamiento convencional de pacientes en el período de seis meses. MÉTODOS: Ensayo Clínico Aleatorizado en pacientes que fueron ingresados recientemente por insuficiencia cardiaca descompensada. El grupo intervención recibió cuatro visitas domiciliarias y cuatro contactos telefónicos para reforzar las orientaciones en seis meses de acompañamiento; el grupo control recibió acompañamiento convencional sin visitas y sin contactos telefónicos. RESULTADOS: Fueron aleatorizados doscientos pacientes (101: intervención y 99: control). Tras seis meses, se observó una mejoría significativa en el conocimiento y el autocuidado para el grupo intervención (P=0,001 y POBJETIVO: verificar o efeito de uma intervenção educativa de enfermagem combinada, caracterizada por visita domiciliar e contato telefônico, em pacientes com internação recente por insuficiência cardíaca descompensada, no conhecimento da doença, nas habilidades para o autocuidado e na adesão ao tratamento, comparado ao acompanhamento convencional de pacientes no período de seis meses. MÉTODOS: nsaio línico randomizado com pacientes que tiveram internação recente por insuficiência cardíaca descompensada. O grupo-intervenção recebeu quatro visitas domiciliares e quatro contatos telefônicos para reforço das orientações, em seis meses de acompanhamento; o grupo-controle recebeu acompanhamento convencional sem visitas e sem contatos telefônicos. RESULTADOS: duzentos pacientes foram randomizados (101: intervenção e 99: controle). Após seis meses, observou-se melhora significativa no conhecimento e autocuidado para o grupo-intervenção (p=0,001 e

Lean Healthcare applied toward turning a Pharmacy Service Patient Centered

Pharmaceutical service optimization requires a comprehensive understanding of resource usage. The aim of the study is to analyze how Lean Healthcare principles can contribute toward turning a pharmacy service patient-centered and value oriented. Understand how clinical pharmacists’ resources are effectively used by patients in an academic hospital using lean tools, such as value stream mapping and activity designation matrix, determine the amount of time each professional is involved in specific activities, and identify activities that add value. The data were mainly obtained through interviews with professionals, time-motion observational studies, chronoanalysis and meetings with the head of the unit. A process flow map is designed for clinical pharmacy services, and it considers the relationship between the activities and their added value base. An exploration of the map shows that the activity “clinical rounds” is the most time consuming (27%) and not necessarily considered value-added by both parties (pharmacists staff and head of service). It is notable the opportunity the service has to prioritize the high-risk patients and to make a good time management; furthermore, activities that are of high value to patients are being performed and monitored by interns. The role of pharmacists should evolve from now on to be congruent with the new realities of healthcare. When value is questioned, we are encouraged to reflect on the activities engaged in by professional pharmacists in a clinical/surgical unit of a hospital. Through these tools, we could infer how the system is engaged and how it can be transformed toward added value.Introduction. Pharmaceutical service optimization requires a comprehensive understanding of resource usage. The aim of the study is to analyze how Lean Healthcare principles can contribute toward turning a pharmacy service patient-centered and value oriented. Methods. Understand how clinical pharmacists’ resources are effectively used by patients in an academic hospital using lean tools, such as value stream mapping and activity designation matrix, determine the amount of time each professional is involved in specific activities, and identify activities that add value. The data were mainly obtained through interviews with professionals, time-motion observational studies, chronoanalysis and meetings with the head of the unit. Results. A process flow map is designed for clinical pharmacy services, and it considers the relationship between the activities and their added value base. An exploration of the map shows that the activity “clinical rounds” is the most time consuming (27%) and not necessarily considered value-added by both parties (pharmacists staff and head of service). It is notable the opportunity the service has to prioritize the high-risk patients and to make a good time management; furthermore, activities that are of high value to patients are being performed and monitored by interns. Conclusions. The role of pharmacists should evolve from now on to be congruent with the new realities of healthcare. When value is questioned, we are encouraged to reflect on the activities engaged in by professional pharmacists in a clinical/surgical unit of a hospital. Through these tools, we could infer how the system is engaged and how it can be transformed toward added value

Effectiveness of nursing interventions in heart failure patients in home care using NANDA-I, NIC, and NOC

Objective The objective of the study is to evaluate the effectiveness of nursing interventions (NIC) using nursing outcomes (NOC) and based on NANDA-I nursing diagnoses in patients with heart failure in home care. Method In this longitudinal study, 23 patients with heart failure were followed for 6 months, in four home visits. During the visits, nursing diagnoses were established, outcomes assessed, and interventions implemented. Results Of the 11 NIC interventions implemented, eight proved effective, that is, showed significant improvement between the first and the fourth visit, according to scores obtained for six outcomes: knowledge: treatment regimen, knowledge: medication, compliance behavior, symptom control, activity tolerance, and energy conservation. Conclusion NIC interventions health education, self-modification assistance, behavior modification, teaching: prescribed medication, teaching: disease process, nutritional counseling, telephone consultation, and energy conservation showed effective outcomes based on NOC scores, suggesting that the NANDA-I, NIC, and NOC linkage is useful in patients with heart failure in home care

Detection and quantification of Campylobacter spp. in Brazilian poultry processing plants

Introduction: Campylobacteriosis is considered the most common bacteria-caused human gastroenteritis in the world. Poultry is a major reservoir of Campylobacter. Human infection may occur by consumption of raw and undercooked poultry or by contamination of other foods by these items. The aim of this study was to assess the prevalence of Campylobacter spp. in poultry processing plants with conventional culture method and real-time PCR. Methodology: A total of 108 poultry processing plant samples were collected to test with conventional microbiology and qPCR. Sampling included cloacal swabs, swabs of transport crates (before and after the cleaning and disinfection process) and carcasses (after the chiller, cooled at 4°C and frozen at −12°C). Results: Positivity in cloacal swabs indicated that poultry arrived contaminated at the slaughterhouse. Contamination in transport cages was substantially increased after the cleaning process, indicating that the process was ineffective. The detection of Campylobacter on carcasses was higher than that on cloacal swabs, which could indicate cross-contamination during the slaughtering process. Conventional microbiology and molecular methods revealed a prevalence of 69.4% and 43.5%, respectively. Lower detection by qPCR can be attributed to the high specificity of the kit and to biological components that could inhibit PCR reactions. Conclusions: Our results indicate that poultry arrive contaminated at the slaughterhouse and that contamination can increase during the slaughtering process due to cross-contamination. The isolation of Campylobacter in cooled and frozen carcasses corroborates the bacterial survival even at temperatures considered limiting to bacterial growth which are routinely used for food preservation

Detection of virulence genes in Salmonella Heidelberg isolated from chicken carcasses

During the last years, Brazilian government control programs have detected an increase of Salmonella Heidelberg in poultry slaughterhouses a condition that poses a threat to human health However, the reasons remain unclear. Differences in genetic virulence profiles may be a possible justification. In addition, effective control of Salmonella is related to an efficient epidemiological surveillance system through genotyping techniques. In this context, the aim of this study was the detection of 24 virulence-associated genes in 126 S. Heidelberg isolates. We classified the isolates into 56 different genetic profiles. None of the isolates presented all the virulence genes. The prevalence of these genes was high in all tested samples as the lowest number of genes detected in one isolate was 10/24. The lpfA and csgA (fimbriae), invA and sivH (TTSS), and msgA and tolC (intracellular survival) genes were present in 100% of the isolates analyzed. Genes encoding effector proteins were detected in the majority of SH isolates. No single isolate had the sefA gene. The pefA gene was found in only four isolates. We have also performed a screening of genes associated with iron metabolism: 88.9% of isolates had the iroN gene and 79.4% the sitC gene. Although all the isolates belong to the same serotype, several genotypic profiles were observed. These findings suggest that there is a diversity of S. Heidelberg isolates in poultry products. The fact that a single predominant profile was not found in this study indicates the presence of variable sources of contamination caused by SH. The detection of genetic profiles of Salmonella strains can be used to determine the virulence patterns of SH isolates

Detection of virulence genes in Salmonella Heidelberg isolated from chicken carcasses

During the last years, Brazilian government control programs have detected an increase of Salmonella Heidelberg in poultry slaughterhouses a condition that poses a threat to human health However, the reasons remain unclear. Differences in genetic virulence profiles may be a possible justification. In addition, effective control of Salmonella is related to an efficient epidemiological surveillance system through genotyping techniques. In this context, the aim of this study was the detection of 24 virulence-associated genes in 126 S. Heidelberg isolates. We classified the isolates into 56 different genetic profiles. None of the isolates presented all the virulence genes. The prevalence of these genes was high in all tested samples as the lowest number of genes detected in one isolate was 10/24. The lpfA and csgA (fimbriae), invA and sivH (TTSS), and msgA and tolC (intracellular survival) genes were present in 100% of the isolates analyzed. Genes encoding effector proteins were detected in the majority of SH isolates. No single isolate had the sefA gene. The pefA gene was found in only four isolates. We have also performed a screening of genes associated with iron metabolism: 88.9% of isolates had the iroN geneand 79.4% the sitC gene. Although all the isolates belong to the same serotype, several genotypic profiles were observed. These findings suggest that there is a diversity of S. Heidelberg isolates in poultry products. The fact that a single predominant profile was not found in this study indicates the presence of variable sources of contamination caused by SH. The detection of genetic profiles of Salmonella strains can be used to determine the virulence patterns of SH isolates

Wooden breast e white striping : ocorrência em três empresas avícolas

To increase the amount of meat produced, researchers have promoted intensive genetic selection for growth rate and muscling and have improved nutrition and management conditions. However, there has been an increase in the number of reports of breast muscle myopathies observed in poultry processing plants, including white striping (WS) and wooden breast (WB). This study aimed to evaluate and to compare the occurrence of WS and WB myopathies in three poultry processing plants and to perform an anatomopathological characterization, including macroscopic and microscopic analyses. A total of 408,334 carcasses were condemned or downgraded due to the presence of WB or WS, which represents 0.73% of the total number of slaughtered animals during the evaluated period. WB was more frequent than WS, but the occurrence of each myopathy varied significantly according to each establishment. WB was more frequent in the establishment which includes only male flocks, an average age of 45 days, and an average live weight of 2775g (B). WS was more frequent in establishment with male, female and mixed flocks, average ages ranging from 41 to 44 days, and average live weight 1731g-2830g (A). It is probably related with specific condition of each poultry company, including genetics, age, nutrition and management conditions. Macroscopically, WB and WS lesions are characterized by hypertrophy and stiffness of the pectoralis major muscle. Under microscopy, the myopathies showed similarities regarding the detected histological abnormalities, characterized by a process of myodegeneration, although the connective tissue infiltrate was more severe in the breasts with WB than in those with WS myopathy. The results found in this study demonstrate that the rates of condemnation for these myopathies are high, vary significantly among the analyzed companies and may cause major economic losses for the productive sector in the region.Para melhorar a quantidadede carne produzida, os pesquisadores têm promovido ao longo dos anos uma seleção genética intensiva para a taxa de crescimento e desenvolvimento de músculos, além de melhorias nas condições nutricionais, sanitárias e de manejo. No entanto, houve um aumento no número de relatos de miopatias dos músculos do peito observados em abatedouros-frigoríficos de aves, incluindo white striping (WS) e wooden breast (WB). O objetivo deste estudo foi avaliar a ocorrência de WB e WS em três abatedouros-frigoríficos de aves e realizar uma caracterização anatomopatológica, incluindo análises macroscópicas e microscópicas. Um total de 408.334 carcaças foi condenado (total ou parcialmente) devido à presença WB ou WS, o que representou 0,73% do número total de animais abatidos durante o período avaliado. Apesar de a ocorrência de WB ter sido maior do que a de WS, a frequência de cada uma variou significativamente de acordo com o estabelecimento. WB foi mais frequente no estabelecimento que incluía apenas lotes de machos, com média de 45 dias de idade e peso médio ao abate de 2775g (B). WS foi mais frequente no estabelecimento com lotes de machos, fêmeas e mistos, com idade entre 41 e 44 dias e peso médio ao abate entre 1731g-2830g (A). Isto pode ser justificado por condições específicas de cada empresa, incluindo genética, idade das aves, nutrição e condições de manejo. Macroscopicamente, as lesões de WB e de WS foram caracterizadas principalmente por hipertrofia e rigidez do músculo pectoralis major. À microscopia, ambas as miopatias mostraram semelhanças em relação às anormalidades histológicas detectadas, caracterizadas principalmente por um processo de miodegeneração. Nos músculos apresentando WB, o infiltrado de tecido conjuntivo foi mais intenso quando comparado àqueles com WS. Os resultados encontrados neste trabalho demonstram que os índices de condenação por essas miopatias são altos, variam significativamente entre as empresas analisadas e podem causar grandes perdas econômicas para o setor produtivo da região