A Patient Perception as a Nursing Care in Emergency Sector

The work process by nurses in the emergency sector is comprised of two complementary dimensions, managing and caring. Therefore,the aim of this study was Know the perception of patients to the support of the nursing assistance in Emergency sector. This is a field research, exploratory, descriptive qualitative approach. The survey was conducted in Dr. Luiz Milton Arêa Leão Hospital - Satélite, located in the city of Teresina - PI, Brazil, which caters exclusively by the Unified Health System, and reference in its coverage area.We interviewed thirteen (13) patients who remained in observation in the emergency sector in that hospital. For this study was used as a criterion for inclusion of service users who entered the emergency sector in the periodMarch-April 2014 and who remained in the sector at the time of the interview.  A pilot test was conducted with the instrument to validate and suitability for the target audience, which is excluded from the sample. Ethical aspects were respected, as provided for in Resolution 466/2012 of the National Health Council, Brazil (2013). In this sense, we observed through the reports of the participants carrying out a qualified nursing care, where it identified a good conduct of professionals to provide the necessary assistance. A nursing care and systematic termination  during the stay of patients in hospital was evidenced. It is perceived  that there is a satisfaction from patients and the care of thenursing team, which is performed through actions inherent to these professionals, such as goodwill, the act of providing a welcoming atmosphere, with technical scientific background, and ability in dealing with conflict situations and ethical

Abcessos cerebrais múltiplos â Uma complicação rara de bronquiectasias

Resumo: Introdução: O abcesso cerebral (AC) pode surgir como complicação de uma grande variedade de infecções, traumatismos ou cirurgias. Os microrganismos podem atingir o cérebro por contiguidade ou por disseminação hematogénea. Os AC estão descritos como uma complicação rara de bronquiectasias (BQ). Caso clínico: Mulher de 44 anos com história de tuberculose pulmonar na infância e com diagnóstico de BQ bilaterais extensas que apresentou alterações do comportamento e posteriormente paresia do 6.° nervo craniano esquerdo, tendo sido diagnosticados AC múltiplos. O estudo microbiológico exaustivo foi negativo. A pesquisa de focos de infecção primária revelou apenas a presença de BQ infectadas. Efectuou tratamento antibiótico empírico e antiedematoso, com melhoria clínica progressiva. Contudo, por persistência das lesões cerebrais, foi submetida a excisão cirúrgica dos AC. Teve alta com diplopia, sem outras alterações neurológicas. Conclusão: No presente caso clínico, as BQ foram o único foco de infecção detectado, motivo pelo qual, nos doentes com esta patologia e com alterações neurológicas de novo, deverá ser pesquisada a existência de lesões infecciosas do sistema nervoso central. Abstract: Background: Brain abscess can arise as a complication of a variety of infections, trauma or surgery. Bacteria can invade the brain by direct spread or through haematogenous seeding. Brain abscesses are described as a rare complication of bronchiectasis. Case description: A 44-year-old woman with pulmonary tuberculosis in childhood and with the diagnosis of bilateral extensive bronchiectasis who presented behaviour alterations and later, paresis of the sixth cranial nerve, was diagnosed multiple brain abscesses. The microbiological exams were negative. The study of the primary focus of infection could only identify infected bronchiectasis. Empiric antibiotics and anti-oedematous treatment were prescribed with progressive clinical improvement. Because of inadequate response she was submitted to surgery. She was discharged with diplopia, without any other neurological alterations. Conclusion: In the present clinical case, the infected bronchiectasis were the only focal infection detected, so in patients with this disease and with new neurological manifestations, infected lesions in the central nervous system should be excluded. Palavras-chave: Bronquiectasias, abcesso cerebral, Key-words: Bronchiectasis, brain absces

Biópsia pulmonar cirúrgica em doentes sob ventilação invasiva e com suspeita de doença difusa do parênquima pulmonar

Resumo: Introdução: A realização de biópsia pulmonar cirúrgica (BPC) em doentes sob ventilação invasiva (VI) no contexto de doenças difusas do pulmão (DPD) poderá revelar-se necessária em circunstâncias em que se torne fundamental a precisão diagnóstica, devendo obviamente ser ponderado o risco associado.Objectivo: Avaliação da rentabilidade diagnóstica, alterações da orientação terapêutica, complicações e mortalidade em doentes com DPD sob VI, submetidos a BPC.Material e métodos: Estudo retrospectivo de 19 doentes admitidos no Hospital de S. João, num período de 8,5 anos (Janeiro 1999 â Julho 2007). Foram analisados os dados demográficos, as variáveis ventilatórias antes e após a BPC, a rentabilidade diagnóstica e o seu efeito na mudança terapêutica e as complicações da BPC. Análise estatística efectuada com SPSS 14.0.Resultados: A idade média dos doentes foi de 58±16,3 anos, e 53% eram do sexo masculino. A média de dias de internamento em unidade de cuidados intensivos (UCI) antes da realização da BPC foi de 13±7 dias. Todas as biópsias foram efectuadas por toracotomia. A rentabilidade diagnóstica foi de 95%. Apenas 4 doentes (21%) apresentaram complicações deste procedimento (fuga aérea prolongada). A razão pressão parcial do oxigénio arterial/fracção de oxigénio inspirada (PaO2/FiO2) e a pressão expiratória final positiva (PEEP) antes e após a BPC não mostraram diferenças significativas. Em 14 doentes (74%) o resultado histológico obtido levou à alteração da suspeita de diagnóstico inicial, condicionando em 8 deles (42%) uma mudança da orientação terapêutica. A mortalidade global foi de 47% (9 doentes), não se tendo observado em nenhum deles relação com o procedimento.Conclusão: A análise desta amostra sugere que a BPC poderá ser um procedimento de extrema utilidade em situações de diagnóstico indeterminado no contexto de doentes com DPD sob VI, para o que contribui a alta rentabilidade diagnóstica e a baixa incidência de complicações reveladas. Contudo, a realização mais precoce de BPC poderia, em alguns casos, originar resultados ainda mais significativos.Rev Port Pneumol 2009; XV (4): 597-611 Abstract: Background: While open lung biopsy (OLB) performed in patients on mechanical ventilation (MV) with diffuse lung diseases (DLD) can be extremely important in establishing the diagnosis, the associated risk of this procedure should be taken into account.Aim: To determine the diagnostic yield, therapeutic changes, complications and mortality in patients with DLD on MV submitted to OLB.Methods: Retrospective study of 19 patients admitted to S. João Hospital between January 1999 and July 2007 (8.5 years). Data analysed included demographic data, ventilation variables before and after biopsy, diagnostic yield, effect on subsequent treatment changes and complications of OLB. Statistical analysis was performed using SPSS 14.0.Results: The mean age of patients was 58±16.3 years old and 53% were male. The mean duration of hospital stay in Intensive Care Unit before performing OLB was 13±7 days. All biopsies were performed by thoracotomy. The diagnostic yield was 95%. There were no significant differences in partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/ FiO2) ratio and the positive end expiratory pressure (PEEP) before and after OLB. Postoperative complications occurred in 4 patients (21%; persistent air leak). Alteration in the diagnosis occurred in 14 patients (74%) and in 8 patients (42%) there was a modification in the treatment regimen. Global mortality was 47% (9 patients) but there were no biopsyrelated deaths.Conclusion: The high diagnostic yield and the low incidence of complications make OLB a useful procedure in patients on MV with DLD of unknown aetiology. However, early OLB may lead to even better results in some patients.Rev Port Pneumol 2009; XV (4): 597-611 Palavras-chave: Biópsia pulmonar cirúrgica, ventilação invasiva, infiltrados pulmonares difusos, Key-words: Open lung biopsy, mechanical ventilation, diffuse lung infiltrate

Endodontic and Surgical Management of an Invasive Cervical Resorption in a Maxillary Central Incisor: A Case Report: Invasive cervical resorption

The current study aims to report a case of invasive cervical resorption in a maxillary left central incisor with a history of dental trauma. After thorough clinical and tomographic evaluations, cervical cavitation, an irregularity in the gingival contour and crown discoloration were observed. Furthermore, presence of an extensive and well-defined area of invasive cervical resorption with pulp communication was discovered. The suggested diagnosis was asymptomatic irreversible pulpitis. The resorption area was treated with the complete removal of granulation tissue, sealed with light-curing glass ionomer cement. Then, the chemo-mechanical preparation and obturation of the root canal were performed. After two years of clinical follow-up and cone-beam computed tomography examination, there were no clinical signs and symptoms, the filling of the resorption area remained intact, and no hypodense image in the cervical region of tooth #21 could be detected. The management reported in this case presented a possible viable treatment for invasive cervical resorption, provided that correct diagnosis is made