Ana Karina Marques Salge

Diagnósticos de enfermagem da NANDA no período pós-parto imediato e tardio

By returning to the community, at the postpartum period, the woman needs systematic nursing care. The goal in this investigation was to analyze the occurring of 22 diagnosis of nursing interests into the puerperium immediate and late. In this descriptive study participated 40 puerperal. Data collecting was made during the February-May 2008 period, at the participants residence, by a meeting, utilizing interview, physical examination and observation. The clinic judgment of the diagnoses was based in NANDA Taxonomy II. Among the diagnosis identified, have been remarked: knowledge deficit, risk for infection, impaired tissue integrity, breastfeeding effective, anxiety, altered nutrition, less than body requirements, disposition about better family processes, risk for impaired integrity skin and insomnia. Evidence has been found that suggest possible new diagnosis: risk of breastfeeding interrupted, risk of breastfeeding ineffective. The results indicate areas for the aiming of the nursing actions at pre-birth and puerperium and the accomplishment necessity nearest of the puerperal preview the politics of the health.Ao retornar a comunidade, no periodo pos-parto, a mulher necessita de atendimento de enfermagem sistematizado. Objetivou-se nesta pesquisa analisar a ocorrencia de 22 diagnosticos de enfermagem de interesse no puerperio imediato e tardio. Trata-se de estudo descritivo, do qual participaram 40 puerperas. Realizou-se a coleta de dados no periodo de fevereiro a maio de 2008, no domicilio das participantes, mediante um encontro com entrevista, exame fisico e observacao. O julgamento clinico dos diagnosticos foi baseado na Taxonomia II da NANDA. Entre os diagnosticos identificados, destacaram-se: conhecimento deficiente; risco para infeccao; integridade tissular prejudicada; amamentacao eficaz; ansiedade; nutricao desequilibrada, menos do que as necessidades corporais; disposicao para processos familiares melhorados; risco de integridade da pele prejudicada; e insonia. Foram encontrados indicios de novos diagnosticos: risco de amamentacao interrompida, risco de amamentacao ineficaz. Os resultados indicam areas para o direcionamento das acoes de enfermagem no pre-natal e puerperio e a necessidade de acompanhamento mais proximo da puerpera do que o previsto nas politicas de saude.A su regreso a la comunidad despues del parto, las mujeres necesitan cuidados de enfermeria de forma sistematica El objetivo de esta investigacion fue analizar con que frecuencia se presentaron 22 diagnosticos de enfermeria durante las etapas de puerperio inmediato y tardio. Este es un estudio descriptivo, en el que participaron 40 madres. Los datos fueron recopilados de febrero a mayo de 2008, en el hogar de los participantes, a traves de una reunion en donde se realizaron entrevistas, examenes fisicos y observacion. El juicio critico del diagnostico esta basado en la taxonomia II de la North American Nursing Diagnosis Association (NANDA). Entre los diagnosticos identificados, destacaron los siguientes: Conocimientos deficientes, Riesgo de infeccion, Deterioro de la integridad tisular, Lactancia materna eficaz, Ansiedad, Desequilibrio Nutricional, Disposicion para mejorar el afrontamiento familiar, Riesgo de deterioro de la integridad cutanea y Deprivacion de sueno. Fueron encontrados indicios que sugieren posibles diagnosticos nuevos: Riesgo de interrupcion de la lactancia materna y Riesgo de lactancia materna ineficaz. Los resultados ayudaron a identificar areas en las que la enfermeria debe enfocarse durante el periodo prenatal y posparto y a subrayar la necesidad de brindar una vigilancia mas estrecha- de lo que esta previsto en las politicas de salud - a las mujeres despues del parto.

Alterações anatomopatológicas da placenta e variações do índice de Apgar

OBJETIVOS: descrever possiveis alteracoes anatomopatologicas placentarias associadas a hipoxia fetal, avaliada pelo indice de Apgar. METODOS: foram estudadas 167 placentas de partos realizados no Hospital Escola da Universidade Federal do Triângulo Mineiro, em Uberaba, atraves da analise macroscopica e microscopica, e de informacoes clinicas obtidas de prontuarios. O indice de Apgar menor que sete foi o parâmetro utilizado para se diagnosticar hipoxia fetal. RESULTADOS: foram encontradas alteracoes placentarias compativeis com hipertensao e infiltrado inflamatorio. As placentas com alteracoes compativeis com baixo fluxo sanguineo cursaram mais frequentemente com fetos com indice de Apgar <7 no 5o minuto (p=0,017). CONCLUSOES: pode existir uma relacao entre alteracoes placentarias e hipoxia fetal evidenciada pelo indice de Apgar. Portanto, o exame anatomopatologico da placenta poderia ser utilizado para esclarecer causas de hipoxia perinatal nao evidenciadas na clinica.

Macroscopic placental changes associated with fetal and maternal events in diabetes mellitus

OBJECTIVES: The current study sought to identify macroscopic placental changes associated with clinical conditions in women with or without diabetes and their newborns. METHODS: The study population consisted of 62 pregnant women clinically diagnosed with diabetes and 62 healthy women (control group). RESULTS: Among the subjects with diabetes, 43 women (69.3%) were diagnosed with gestational diabetes mellitus, 15 had diabetes mellitus I (24.2%), and four had diabetes mellitus II (6.5%). The mean age of the women studied was 28.5±5.71 years, and the mean gestational age of the diabetic women was 38.51 weeks. Of the 62 placentas from diabetic pregnancies, 49 (79%) maternal surfaces and 59 (95.2%) fetal surfaces showed abnormalities, including calcium and fibrin deposits, placental infarction, hematoma, and fibrosis. A statistical association was found between newborn gender and fetal and maternal placental changes (p = 0.002). The mean weight of the newborns studied was 3,287±563 g for women with diabetes mellitus, 3,205±544 g for those with gestational diabetes mellitus, 3,563±696 g for those with diabetes mellitus II, and 3,095±451 g for those with diabetes mellitus I. CONCLUSIONS: Infarction, hematoma, calcification, and fibrin were found on the maternal and fetal placental surfaces in women with diabetes. Women with gestational diabetes and post-term infants had more calcium deposits on the maternal placental surface as compared to those with type I and type II diabetes.

Morphological characterization of the false vocal cords as larynx-associated lymphoid tissue.

The lymphoid follicles (LF) found in the false vocal cords (FVC) protect the upper air tracts, similar to the lymphoid tissue associated to the respiratory mucosas. However, studies that characterize the phenotype of cells like larynx-associated lymphoid tissue (LALT) are lacking. We analyzed the FVC of autopsied adults according to morphometric and immunohistochemical criteria and defined their possible role as LALT. We analyzed 249 FVC. Primary antibodies, CD68+ macrophages, CD20+, CD3+, and FDC+ were used for the evaluation of inflammatory cell phenotypes. In 40.6% of the cases, there was an inflammatory reaction. In 42.2% of the cases, LF were identified in the submucosa. In 17.3% of the cases, neither LF nor mononuclear cells were identified in the FVC, and these patients were from an older age group (p=0.013). A significant increase in the number of all LF cell phenotypes was observed in patients with pulmonary inflammation; the difference in both T- and B-lymphocytes was statistically significant (p=0.010). The morphological findings of LF suggest a probable participation of the FVC in the protection of the larynx and lungs, and similarity to LALT.

Relationship between the morphologic alterations of vocal cords from adult autopsies and the cause of death

PURPOSE The purpose of this study was to identify the possible alteration in the thickness of the epithelium basal membrane of the vocal cords and correlate it with the cause of death. METHOD Larynxes collected from adult autopsies during the period of 1993 to 2001 were utilized. We used the hematoxylin-eosin and periodic acid-Schiff staining methods for the morphological and morphometric analysis. RESULTS Sixty-six vocal cords were analysed; increased thickness was identified in 14 cases (21.2%), with equal proportions between the genders. Increased vocal-cord thickness was more frequent in patients of the white ethnicity (12 cases, 85.7%). Respiratory alterations were found in 10 (71.4%) of the cases with increased vocal-cord thickness. Of the patients that were maintained with mechanical ventilation before death, 7 (18.4%) had thickening of the basal membrane. Among the smokers, 9 (19.63%) had basal membrane thickening. CONCLUSION No statistically significant differences were found between the cases in which the cause of death was related to respiratory diseases as compared to non-respiratory diseases and the thickening of the basal membrane of the vocal cords. However, new studies are needed in order to verify the etiopathogenesis of this thickening.

Avaliação imunológica nas pregas vestibulares de pacientes autopsiados com a Síndrome da Imunodeficiência Adquirida

Em pacientes com Sindrome da Imunodeficiencia Adquirida ha uma diminuicao das celulas envolvidas na resposta imune, o que influencia na populacao celular dos foliculos linfoides encontrados nas pregas vestibulares, favorecendo o aparecimento de infeccoes nas vias aereas destes pacientes. Estas infeccoes sao a principal causa de mortalidade e morbidade nestes pacientes. OBJETIVO: Caracterizar a populacao de celulas nos foliculos linfoides localizados nas pregas vestibulares de adultos autopsiados com Sindrome da Imunodeficiencia Adquirida, com e sem infeccoes respiratorias associadas. MATERIAIS E METODOS: Foi realizado um estudo retrospectivo transversal em 64 laringes de adultos coletadas na rotina das autopsias. Para a imunohistoquimica foram utilizados os anticorpos: Anti-B cells, Anti-CD3, Anti-CD68 e Anti-follicular dendritic cells. RESULTADOS: 46 (71,87%) dos pacientes estudados tinham diagnostico de Sindrome da Imunodeficiencia Adquirida. Nestes pacientes, a celularidade dos foliculos linfoides foi estatisticamente menor em relacao ao grupo controle em todos os fenotipos estudados. Nos pacientes imunodeprimidos com infeccao respiratoria associada, o numero de celulas estava diminuido, sendo significante no caso dos linfocitos T (p=0,024). CONCLUSAO: Em nosso estudo demonstramos que os foliculos linfoides das pregas vestibulares sao afetados pela infeccao viral e representam com fidedignidade o estado imunologico de imunodepressao destes pacientes.

Analysis of placenta vascularization in patients with uterine altered artery Doppler flow velocity exams

Background:  One of the frequent questions in obstetric practice is to determine placental vascular changes that may account for abnormal Doppler flow velocity alterations in maternal uterine vessels from women and fetuses without pregnancy pathology.

Description of microscopic lesions of vestibular folds of autopsied adults and their relationship with cause of death and underlying disease

UNLABELLED The increase in invasive methods currently applied to diagnosis airway upper tract infection leads to a possible increase in vestibular folds (VF) lesions. Besides, VF importance in the prevention of the organism against infection pathogens had been stressed and few studies had addressed the microscopic lesions of the VF in autopsied patients because there is no routine VF examination in the postmortem exam. AIM The aim of this study is morphological microscopic analyses of the VF from autopsied patients and its correlation with basic disease and cause of death. STUDY DESIGN Transversal cohort. MATERIAL AND METHOD We studied 82 larynges collected during the autopsy exam and performed the Hematoxylin -eosin method for morphological analyses. RESULTS From the 82 vestibular folds analyzed we observe that 42 (51%) showed an inflammatory reaction. In fifteen (18.3%) vestibular folds we found lymphoid follicular hyperplasia, in eleven (13.4%) diffuse inflammatory infiltrate and in sixteen (19.5%) acute inflammatory reactions. Circulatory diseases were the most frequently underlying diseases found, 31 (37.8%) and from these 20 (67.8%) presented associated vestibular folds inflammatory reaction. The infection diseases were the most frequently cause of death among the patients with inflammatory reaction of the VF. CONCLUSION Besides the anatomic function, VF seem to have a immunological function preventing lower airway infections. Our study demonstrated inflammatory PV reactions in patients with infections diseases as cause of death; this finding could be a consequence of the sepsis that leads the patient to death or a different way used by the organism to prevent infection.

Descrição das lesões microscópicas das pregas vestibulares de adultos autopsiados e sua relação com as causas de óbito e doença de base

The increase in invasive methods currently applied to diagnosis airway upper tract infection leads to a possible increase in vestibular folds (VF) lesions. Besides, VF importance in the prevention of the organism against infection pathogens had been stressed and few studies had addressed the microscopic lesions of the VF in autopsied patients because there is no routine VF examination in the postmortem exam. AIM: The aim of this study is morphological microscopic analyses of the VF from autopsied patients and its correlation with basic disease and cause of death. STUDY DESIGN: transversal cohort. MATERIAL AND METHOD: We studied 82 larynges collected during the autopsy exam and performed the Hematoxylin -eosin method for morphological analyses. RESULTS: From the 82 vestibular folds analyzed we observe that 42 (51%) showed an inflammatory reaction. In fifteen (18.3%) vestibular folds we found lymphoid follicular hyperplasia, in eleven (13.4%) diffuse inflammatory infiltrate and in sixteen (19.5%) acute inflammatory reactions. Circulatory diseases were the most frequently underlying diseases found, 31 (37.8%) and from these 20 (67.8%) presented associated vestibular folds inflammatory reaction. The infection diseases were the most frequently cause of death among the patients with inflammatory reaction of the VF. CONCLUSION: Besides the anatomic function, VF seem to have a immunological function preventing lower airway infections. Our study demonstrated inflammatory PV reactions in patients with infections diseases as cause of death; this finding could be a consequence of the sepses that leads the patient to death or a different way used by the organism to prevent infection.

CÁNCER DE MAMA EN MUJERES: RECURRENCIA Y SUPERVIVENCIA EN CINCO AÑOS

RESUMENLas mujeres que realizan tratamiento de cancer de mama todavia presentan un riesgo de recurrencia de la enfermedad. Este estudio tiene como objetivo verificar a asociacion entre sobrevivencia e recurencia del cancer de mama en las mujeres atendidas en un hospital de referencia en Goiânia-GO cinco anos despues de del diagnostico en 2008. Este es un estudio de cohorte, retrospectivo, descriptivo constituido por los expedientes de 460 mujeres. Los datos fueron analizados utilizando la Prueba Exacta de Fisher y la Curva de Kaplan Meier. Del total, la tasa de mortalidad, recurrencia regional/local y metastasis fue de 14.1%, 6.5% y 25.2%, respectivamente. Hubo una mejoria en la supervivencia de las mujeres con cancer de mama, pero todavia existe un numero considerable de mujeres que son diagnosticadas en estadios avanzados y que presentan recurrencia de la enfermedad, demostrando la necesidad de la deteccion precoz del cancer en estadios iniciales y de casos de recurrencia.