Agueda Maria Ruiz Zimmer Cavalcante

Nursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit

OBJECTIVE To describe the nursing clinical judgment as a basis for ND identification and development of a NIC treatment plan for a child after cardiac surgery under intensive care. METHOD A case study with data retrospectively collected from charts. RESULTS Three nurses identified NANDA-I diagnoses and NIC interventions. A 6-month-old child submitted to cardiac surgery, requiring extracorporeal membrane oxygenation in the postoperative period. Four main nursing diagnoses were identified, towards which ten interventions were directed. The proposal of interventions to respond to the priority human responses of the child was optimized by the use of standard terminologies. Every nursing diagnosis was supported by diagnostic indicators; every intervention was scientifically supported. CONCLUSION There must be an expectation that nurses address not only physiological responses, but also those within psychosocial domains.

Factors associated with excessive bleeding after cardiac surgery: A prospective cohort study

OBJECTIVE To identify factors associated with excessive bleeding (ExB) after cardiac surgery in adults. BACKGROUND Excessive bleeding after cardiac surgery must be anticipated for implementation of timely interventions. METHODS A prospective cohort study with 323 adults requiring open-chest cardiac surgery. Potential factors associated with ExB were investigated through univariate analysis and logistic regression. The accuracy of the relationship between the independent variables and the outcome was depicted through the receiver-operating characteristic (ROC) curve. RESULTS The factors associated with ExB included gender, body mass index (BMI), preoperative platelet count, intraoperative heparin doses and intraoperative platelet transfusion. The ROC curve cut-off points were 26.35 for the BMI; 214,000 for the preoperative platelet count, and 6.25 for intraoperative heparin dose. This model had an accuracy = 77.3%, a sensitivity = 81%, and a specificity = 62%. CONCLUSIONS Male gender, BMI, preoperative platelet count, dose of intraoperative heparin >312.5 mg without subsequent platelet transfusion, are factors associated with ExB.

Association of cardiovascular risk factors with the different presentations of acute coronary syndrome

Objetivo: identificar la relacion de las diferentes presentaciones del sindrome coronario agudo con factores de riesgo cardiovasculares entre individuos hospitalizados. Metodo: estudio transversal realizado en un hospital escuela de Sao Paulo-SP. Los datos sociodemograficos, clinicos y antropometricos de 150 individuos hospitalizados por sindrome coronario agudo fueron recolectados por medio de entrevista y revision de fichas medicas. Fue verificada la asociacion de esos datos con la presentacion del sindrome. Resultados: hubo predominio de infarto agudo del miocardio con deflexion positiva del segmento ST; hubo asociacion significativa de hipertension arterial sistemica con angina inestable y altos valores de lipoproteina de baja densidad con infarto, sin influencia de caracteristicas sociodemograficas. Conclusion: la hipertension arterial y los niveles de lipoproteina de baja densidad elevados se asociaron a diferentes presentaciones del sindrome coronario. Los resultados pueden ofrecer subsidios a los profesionales de salud para planificar programas de prevencion secundaria que objetiven el cambio de comportamiento.OBJECTIVE: to identify the relationship between different presentations of acute coronary syndrome and cardiovascular risk factors among hospitalized individuals. METHOD: cross-sectional study performed in a teaching hospital in São Paulo, in the State of São Paulo (SP). Socio-demographic, clinical and anthropometric data of 150 individuals hospitalized due to acute coronary syndrome were collected through interviews and review of clinical charts. Association between these data and the presentation of the syndrome were investigated. RESULTS: there was a predominance of ST segment elevation acute myocardial infarction. There was significant association of systemic hypertension with unstable angina and high values of low density lipoprotein with infarction, without influence from socio-demographic characteristics. CONCLUSION: arterial hypertension and high levels of low-density lipoprotein were associated with different presentations of coronary syndrome. The results can provide support for health professionals for secondary prevention programs aimed at behavioural changing.

Associação de fatores de risco cardiovasculares com as diferentes apresentações da síndrome coronariana aguda

Objetivo: identificar la relacion de las diferentes presentaciones del sindrome coronario agudo con factores de riesgo cardiovasculares entre individuos hospitalizados. Metodo: estudio transversal realizado en un hospital escuela de Sao Paulo-SP. Los datos sociodemograficos, clinicos y antropometricos de 150 individuos hospitalizados por sindrome coronario agudo fueron recolectados por medio de entrevista y revision de fichas medicas. Fue verificada la asociacion de esos datos con la presentacion del sindrome. Resultados: hubo predominio de infarto agudo del miocardio con deflexion positiva del segmento ST; hubo asociacion significativa de hipertension arterial sistemica con angina inestable y altos valores de lipoproteina de baja densidad con infarto, sin influencia de caracteristicas sociodemograficas. Conclusion: la hipertension arterial y los niveles de lipoproteina de baja densidad elevados se asociaron a diferentes presentaciones del sindrome coronario. Los resultados pueden ofrecer subsidios a los profesionales de salud para planificar programas de prevencion secundaria que objetiven el cambio de comportamiento.OBJECTIVE: to identify the relationship between different presentations of acute coronary syndrome and cardiovascular risk factors among hospitalized individuals. METHOD: cross-sectional study performed in a teaching hospital in São Paulo, in the State of São Paulo (SP). Socio-demographic, clinical and anthropometric data of 150 individuals hospitalized due to acute coronary syndrome were collected through interviews and review of clinical charts. Association between these data and the presentation of the syndrome were investigated. RESULTS: there was a predominance of ST segment elevation acute myocardial infarction. There was significant association of systemic hypertension with unstable angina and high values of low density lipoprotein with infarction, without influence from socio-demographic characteristics. CONCLUSION: arterial hypertension and high levels of low-density lipoprotein were associated with different presentations of coronary syndrome. The results can provide support for health professionals for secondary prevention programs aimed at behavioural changing.

Self-Care Behaviors in Heart Failure: Self-Care Management in Heart Failure

OBJECTIVE To identify self-care behaviors, instruments, techniques, parameters for the assessment of self-care behaviors in people with heart failure, compare these behaviors with the indicators of the Nursing Outcomes Classification outcome, Self Management: Cardiac Disease. METHOD Integrative literature review performed in Lilacs, Medline, CINAHL, and Cochrane, including publications from 2009 to 2015. One thousand six hundred ninety-one articles were retrieved from the search, of which 165 were selected for analysis. RESULTS Ten self-care behaviors and several different assessment instruments, techniques, and parameters were identified. The addition and removal of some indicators are proposed, based on this review. The data provide substrate for the development of conceptual and operational definitions of the indicators, making the outcome more applicable for use in clinical practice.OBJECTIVE To identify self-care behaviors, instruments, techniques, parameters for the assessment of self-care behaviors in people with heart failure, compare these behaviors with the indicators of the Nursing Outcomes Classification outcome, Self Management: Cardiac Disease. METHOD Integrative literature review performed in Lilacs, Medline, CINAHL, and Cochrane, including publications from 2009 to 2015. One thousand six hundred ninety-one articles were retrieved from the search, of which 165 were selected for analysis. RESULTS Ten self-care behaviors and several different assessment instruments, techniques, and parameters were identified. The addition and removal of some indicators are proposed, based on this review. The data provide substrate for the development of conceptual and operational definitions of the indicators, making the outcome more applicable for use in clinical practice.

Survival and Risk Factors Among Dialytic Acute Kidney Injury PatientsAfter Cardiovascular Surgery

Objective Acute kidney injury (AKI) is a frequent postoperative complication after cardiovascular surgery. It has been described as a predictor of decreased survival rates, but how dialysis decreases survival when initiated on the postoperative period has yet to be determined. To analyze the survival of patients who presented postoperative AKI requiring dialysis up to 30 days after cardiovascular surgery and its risk factors is the aim of this study. Methods Of the 5,189 cardiovascular surgeries performed in a 4-year period, 157 patients developed AKI requiring dialysis in the postoperative period. The Kaplan-Meier survival curve and log-rank test were used in the statistical analysis to compare the curves of categorical variables. P-value< 0.05 was considered significant. Results Patient average survival was 546 days and mortality was 70.7%. The need for dialysis on the postoperative period decreased late survival. Risk factors for decreased survival included age (P<0.001) and postoperative complications (P<0.0003). Conclusion The average survival was approximately one year among dialytic patients. Age and postoperative complications were risk factors that determined decreased survival.

Nursing in cardiology: state of the art and frontiers of knowledge

Heart diseases lead the group of clinical disorders with higher rates of hospitalization and mortality and present a progressive increase in incidence due to population ageing, simultaneously to the development of new health therapies and technology. DATASUS(1) estimated a cost of nearly 700 million Reais1 for the country’s health care system in 2015, only for people with heart failure and acute myocardial infarction. Generally, people diagnosed with heart diseases have their functional capacity and quality of life impaired. When in children, these diseases can lead to an impaired development, since they can cause systemic injuries and result in disabilities. Given this situation, nurses have been facing several challenges and, as a consequence, achieved results that place them in a prominent role in different dimensions of care. An example is national and international guidelines that credit the nurses with the benefits brought to the patients during follow-up in disease management and educational programs. The development and validation of scales and measurement instruments helps nurses to establish actions and to make decisions that aim at improving the health care process for the patient. Recent advances in cardiology also stand out, since nurses’ appropriation of knowledge through researches and understanding of diseases, treatments and clinical manifestations lead to empowerment in debates and clinical discussions with the healthcare team. Despite the wide possibilities and the necessity of nurses’ work, health care environments are marked by challenging variables such as shortage of workforce, physical structure, equipment and material; inadequate salaries; double working hours; constant physical effort; and the risk of accidents. These situations indicate gaps in the quality of care, often revealing a pattern of decline in health outcomes. Considering this situation, possibly similar in different parts of the world, how can we create a promising future for cardiac nursing? We observed that there is a lack of nursing interventions that could consolidate the path of the profession, leading to a mastery of evidence-based nursing, focused on previously established objectives. There is a need for the implementation of actions that will demonstrate a nursing performance aware of its role, centered in the patient and in the family; actions performed through coherent judgment, contesting results obtained. Considering the constant updates in cardiology, there is still a need for technological improvement for the safe handling of devices and equipment, also addressing their risks and benefits. The appropriation of nursing phenomena elements should address actions to search for knowledge and development of the subject, avoiding the hegemony of the biomedical model, necessary for the good conduct of the nursing professional(2). However, the predominance or exclusive use of this model misrepresents the professional, impairing the progress of nursing science. In a visionary process of professional growth in cardiology, studies addressing nursing diagnoses and the best interventions, allow nurses the appropriation of the knowledge and the development of the nursing science Nursing in cardiology: state of the art and frontiers of knowledge

Self‐Care Behaviors in Heart Failure

OBJECTIVE To identify self-care behaviors, instruments, techniques, parameters for the assessment of self-care behaviors in people with heart failure, compare these behaviors with the indicators of the Nursing Outcomes Classification outcome, Self Management: Cardiac Disease. METHOD Integrative literature review performed in Lilacs, Medline, CINAHL, and Cochrane, including publications from 2009 to 2015. One thousand six hundred ninety-one articles were retrieved from the search, of which 165 were selected for analysis. RESULTS Ten self-care behaviors and several different assessment instruments, techniques, and parameters were identified. The addition and removal of some indicators are proposed, based on this review. The data provide substrate for the development of conceptual and operational definitions of the indicators, making the outcome more applicable for use in clinical practice.OBJECTIVE To identify self-care behaviors, instruments, techniques, parameters for the assessment of self-care behaviors in people with heart failure, compare these behaviors with the indicators of the Nursing Outcomes Classification outcome, Self Management: Cardiac Disease. METHOD Integrative literature review performed in Lilacs, Medline, CINAHL, and Cochrane, including publications from 2009 to 2015. One thousand six hundred ninety-one articles were retrieved from the search, of which 165 were selected for analysis. RESULTS Ten self-care behaviors and several different assessment instruments, techniques, and parameters were identified. The addition and removal of some indicators are proposed, based on this review. The data provide substrate for the development of conceptual and operational definitions of the indicators, making the outcome more applicable for use in clinical practice.

Nursing Diagnosis for People With Heart Failure Based on the Hemodynamic Profiles

OBJECTIVE To investigate the association of nursing diagnoses (NDs) identified for patients with heart failure (HF) based on their hemodynamic profiles. METHOD Analytical, cross-sectional study conducted in the emergency room of a public hospital in a large cardiology center in Brazil. One hundred medical records of patients with HF whose hemodynamic profile had been established were analyzed. RESULTS The main NDs identified were risk of infection, bathing self-care deficit, risk for decreased cardiac output, risk for falls, and excess fluid volume. There was no statistically significant difference (p > .05) between the different hemodynamic profiles and the ND found. CONCLUSION AND IMPLICATIONS Nurses need to develop skills for improving their diagnostic abilities to ensure implementation of consistent interventions.To investigate the association of nursing diagnoses (NDs) identified for patients with heart failure (HF) based on their hemodynamic profiles.Analytical, cross-sectional study conducted in the emergency room of a public hospital in a large cardiology center in Brazil. One hundred medical records of patients with HF whose hemodynamic profile had been established were analyzed.The main NDs identified were risk of infection, bathing self-care deficit, risk for decreased cardiac output, risk for falls, and excess fluid volume. There was no statistically significant difference (p > .05) between the different hemodynamic profiles and the ND found.Nurses need to develop skills for improving their diagnostic abilities to ensure implementation of consistent interventions.OBJECTIVE To investigate the association of nursing diagnoses (NDs) identified for patients with heart failure (HF) based on their hemodynamic profiles. METHOD Analytical, cross-sectional study conducted in the emergency room of a public hospital in a large cardiology center in Brazil. One hundred medical records of patients with HF whose hemodynamic profile had been established were analyzed. RESULTS The main NDs identified were risk of infection, bathing self-care deficit, risk for decreased cardiac output, risk for falls, and excess fluid volume. There was no statistically significant difference (p > .05) between the different hemodynamic profiles and the ND found. CONCLUSION AND IMPLICATIONS Nurses need to develop skills for improving their diagnostic abilities to ensure implementation of consistent interventions.OBJECTIVE To investigate the association of nursing diagnoses (NDs) identified for patients with heart failure (HF) based on their hemodynamic profiles. METHOD Analytical, cross-sectional study conducted in the emergency room of a public hospital in a large cardiology center in Brazil. One hundred medical records of patients with HF whose hemodynamic profile had been established were analyzed. RESULTS The main NDs identified were risk of infection, bathing self-care deficit, risk for decreased cardiac output, risk for falls, and excess fluid volume. There was no statistically significant difference (p > .05) between the different hemodynamic profiles and the ND found. CONCLUSION AND IMPLICATIONS Nurses need to develop skills for improving their diagnostic abilities to ensure implementation of consistent interventions.

Fatores preditores de transfusão de concentrado de hemácias após cirurgia cardíaca: um estudo coorte prospectivo

OBJECTIVE To identify predictors of red blood cell transfusion (RBCT) after cardiac surgery. METHOD A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. RESULTS The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10 3/mm3, lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. CONCLUSION Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.OBJECTIVE To identify predictors of red blood cell transfusion (RBCT) after cardiac surgery. METHOD A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. RESULTS The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10(3)/mm (3), lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. CONCLUSION Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.