Ana Rita de Cássia Bettencourt

Educacao de pacientes com asma: atuacao do enfermeiro

Background: Asthma education programs induce better asthma control and are one of main recommendations in guidelines. The programs recommendations should include a nurse in the educational team applying the structured program. The purpose of the intervention is to bring a change in the daily life of the patient and the family in order to improve disease control and quality of life. Aim: To standardize and apply a structured post-consultation model as part of multidisciplinary care in an educational program for asthmatic patients seen at the outpatient clinic of a public hospital, and to monitor the changes in asthma knowledge and quality of life. Methods: A longitudinal prospective study over six months with regular visits at four week intervals (total = 6 visits), conducted at the outpatient department of Unifesp/EPM/HSP, and the patients were included after signing a consent form. The asthma structured educational plan was conducted by a multidisciplinary team and addressed the following issues: what is asthma, relief and prevention medicines, daily report of symptoms and dyspnea score, training of the correct use of inhaled medication, discussion and actions regarding triggering factors and how to avoid them, and tips to recognize the signals of uncontrolled asthma. A standard questionnaire about general knowledge on asthma and a quality of life questionnaire were applied at the beginning, during the course, and at the end of the program. Results: 26 asthmatics were followed over six months and showed a statistically significant improvement in their identification and management of asthma skills as well as better quality of life indices. Conclusion: The model of care and the approach and training techniques were adequate and useful in the development of a structured educational program for socially deprived patients.

Diagnósticos de enfermagem em portadores da Síndrome da Imunodeficiência Adquirida

Os objetivos deste estudo foram identificar os diagnosticos de enfermagem mais frequentes segundo a taxonomia II da NANDA em pacientes adultos portadores de HIV/aids e verificar com que frequencia as caracteristicas definidoras, os fatores relacionados e de risco deram suporte para a elaboracao destes. O levantamento dos dados foi realizado pelos pesquisadores nos 60 pacientes internados com HIV/aids e depois feita a verificacao se os requisitos propostos pela NANDA para realizacao dos DE eram adequados. Foram selecionados 13 dos 38 diagnosticos com frequencia igual ou superior a 80%. Os resultados indicaram concordância e adequacoes para identificacao. Porem, novos estudos serao necessarios tanto para confirmacao dos achados, assim como trazer novos conhecimentos ao assunto e estimular a pesquisa nesta populacao de pacientes.

Avaliação do uso da Escala Modificada de Borg na crise asmática

The dyspnea is the biggest cause of incapacity and reduction of the quality of life for patients with respiratory illnesses as it is the case of the asthma. Being thus, the respiratory difficulty is probably the more important isolated factor in the limitation of the capacity of the individual in the basic functions of day-by-day, making with that this looks the health services. The objective of this study was to verify the degree of dyspnea of the patients in asthmatic crisis for the scored on the Modif Borg Scale and the correlation of improvement of the degree of dyspnea for the same one with the improvement of the pulmonary function verified by Peak expiratory Flow (PEF). A total of 40 asthmatic patients in acute crisis taken care of in the service of Attendance in Pneumologia of the Sao Paulo Hospital, were included, in the period of september to the december of 2003. Before and after the clinical treatment, the subsequent data were colected: cardiac rate (FC), respiratory rate (FR), PEF and peripherical oxygen saturation (SpO2) and the patient was questionado about your perception of the dyspnea for the Modif Borg Scale. The punctuation of this scale varies of 0 the 10 (of none to the dyspnea highest). The results had pointed a trend of the high values of the Modif Scale of Borg to be related to the low values of PEF in the daily pay-treatment, inverting this relation in the post-cure. This scale in them seemed a fast, cheap additional instrument and of easy applicability in the evaluation of asthmatic patients, being able to be used by health professionals who carry through the initial evaluation of the patients in crisis as well as its reply to the treatment.

Avaliação do tipo de curativo utilizado em cateter venoso central para hemodiálise

Objectives: To evaluate the efficacy of two types of dressings used on central venous catheter (CVC) in patients undergoing hemodialysis and to determine the rate of local and systemic bacterial infection when using gauze and micropore dressings or transparent film dressings. Methods: This study was a controlled randomized clinical trial with 66 subjects who were equally assigned to two groups (33 subjects per group). Group 1 used gauze and micropore dressings and group 2 used transparent film dressings. Measures consisted of a socio demographic questionnaire, clinical data, and catheter tip and blood culture tests. Subjects remained in the study until removal of the catheter. Results: There were no statistically significant differences regarding the types of dressings. Positioning of CVCs at 90 degrees in relation to the skin had higher rate of infections by S. Aureus. Conclusion: Although the use of transparent film dressings did not reduce infection, qualitative data analysis suggested that this type of dressing was preferred by the patients and by the health care providers from a university hospital.Objectives: To evaluate the efficacy of two types of dressings used on central venous catheter (CVC) in patients undergoing hemodialysis and to determine the rate of local and systemic bacterial infection when using gauze and micropore dressings or transparent film dressings. Methods: This study was a controlled randomized clinical trial with 66 subjects who were equally assigned to two groups (33 subjects per group). Group 1 used gauze and micropore dressings and group 2 used transparent film dressings. Measures consisted of a socio demographic questionnaire, clinical data, and catheter tip and blood culture tests. Subjects remained in the study until removal of the catheter. Results: There were no statistically significant differences regarding the types of dressings. Positioning of CVCs at 90 degrees in relation to the skin had higher rate of infections by S. Aureus. Conclusion: Although the use of transparent film dressings did not reduce infection, qualitative data analysis suggested that this type of dressing was preferred by the patients and by the health care providers from a university hospital.

Comparison of the quality of life among persons with lung cancer, before and after the chemotherapy treatment

OBJECTIVE this prospective study aimed to assess the quality of life related to health (QLRH) of patients with lung cancer after chemotherapy treatment. METHOD The QLRH was assessed using the questionnaires Quality-of-Life Questionnaire-Core 30 (QLQ-C30) and Lung Cancer Module (LC13), version 3.0. RESULTS the sample was made up of 11 women and 19 men, with an average age of 68 years (51-87 years). After the chemotherapy treatment, the authors observed a clinically-relevant improvement in general quality of life, as well as in the symptoms of dyspnea, insomnia, hemoptysis, cough, thoracic pain, pain in the arm/shoulder, and financial difficulty. There was a worsening on the functional scale which assesses role performance and symptoms of fatigue, nausea and vomiting, sensory neuropathy, pain in other parts, constipation, loss of appetite and alopecia. CONCLUSION although the patients have an improvement of their QLRH and symptoms related to the lung cancer after the chemotherapy treatment, there was a worsening of the symptoms which resulted from the toxicity of the chemotherapy medications.OBJETIVO: estudo prospectivo, com o objetivo de avaliar a Qualidade de Vida Relacionada a Saude de pacientes com câncer de pulmao, apos tratamento quimioterapico. METODO: a Qualidade de Vida Relacionada a Saude foi avaliada pelos questionarios Quality-of-Life Questionnaire-Core 30 e Lung Cancer Module, versao 3.0. RESULTADOS: a amostra foi composta por 11 mulheres e 19 homens, com media de idade de 68 anos (51-87 anos). Apos o tratamento quimioterapico, observou-se melhora clinicamente relevante da qualidade de vida geral, assim como dos sintomas de dispneia, insonia, hemoptise, tosse, dor toracica, dor no braco/ombro e dificuldade financeira. Houve piora na escala funcional que avalia o desempenho de papel e dos sintomas de fadiga, nausea e vomito, neuropatia sensorial, dor extratoracica, constipacao, perda de apetite e alopecia. CONCLUSAO: os pacientes apresentaram melhora da Qualidade de Vida Relacionada a Saude e sintomas relacionados ao câncer de pulmao, apos o tratamento quimioterapico; entretanto, houve piora dos sintomas decorrentes da toxicidade dos medicamentos quimioterapicos.

Quality of life and burden in carers for persons with Chronic Obstructive Pulmonary Disease receiving oxygen therapy

1 Articulo parte de la disertacion de maestria: “Qualidade de vida do paciente portador de DPOC em uso de oxigenoterapia domiciliar e seu cuidador”, apresentada a la Escola Paulista de Enfermagem, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brasil. Apoyo financiero de la Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES). 2 Estudiantes de maestria, Escola Paulista de Enfermagem, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brasil. 3 PhD, Profesor Adjuncto, Escola Paulista de Enfermagem, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brasil. 4 PhD, Medica, Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brasil. Objetivo: evaluar la calidad de vida y la sobrecarga de cuidados experimentada por cuidadores de portadores de la Enfermedad Pulmonar Obstructiva Cronica en uso de Oxigenoterapia Domiciliar Prolongada e investigar los factores que influencian esa sobrecarga. Metodo: se trata de estudio transversal analitico, con 80 portadores de la Enfermedad Pulmonar Obstructiva Cronica en uso de Oxigenoterapia Domiciliar en el ambulatorio especializado de la Universidad Federal de Sao Paulo y de sus respectivos cuidadores, aplicando los instrumentos: Medical Outcomes Studies 36 (SF-36), Caregiver Burden Scale (CBS), indice de Katz y variables sociodemograficas y clinicas. Resultados: los puntajes del cuestionario de calidad de vida de los cuidadores mas comprometidos fueron la Vitalidad y la Salud Mental. El Ambiente fue el dominio del Caregiver Burden Scale que genero mayor sobrecarga de cuidados. Con excepcion del Envolvimiento Emocional, todos los dominios de calidad de vida fueron influenciados de forma negativa por los dominios de sobrecarga de cuidados. Conclusion: se demostro que la calidad de vida y la sobrecarga de cuidados, de los cuidadores, estaban comprometidos, confirmando que cuidar a los portadores de Enfermedad Pulmonar Obstructiva Cronica, es un importante interviniente en la calidad de vida del cuidador.

Interference of nail polish on the peripheral oxygen saturation in patients with lung problems during exercise

1 Articulo parte de la thesis de doctorado “Interferencia do esmalte de unha na leitura da saturacao periferica de oxigenio em DPOC no repouso e no exercicio”, presented to Escola Paulista de Enfermagem, Universidade Federal de Sao Paulo, Brasil. 2 Estudiante de Doctorado, Escola Paulista de Enfermagem, Universidade Federal de Sao Paulo, Brasil. 3 Medico, PhD, Universidade Federal de Sao Paulo, Brasil. 4 PhD, Profesor Asociado, Escola Paulista de Enfermagem, Universidade Federal de Sao Paulo, Brasil. 5 PhD, Profesor Adjuncto, Escola Paulista de Enfermagem, Universidade Federal de Sao Paulo, Brasil. Objetivo: Evaluar la interferencia del esmalte de unas en la lectura de la saturacion periferica deAIM To assess the interference of nail polish on the reading of peripheral oxygen saturation in patients with chronic obstructive pulmonary disease on the step exercise. METHODS In this study, there was the inclusion of patients with chronic obstructive pulmonary disease, current non-smokers, of both sexes. Four different colours of nail polish were used in the present study (base, light pink, red and brown), randomly distributed among the fingers of the right hand, with the corresponding fingers on the opposite hand being controls. Saturation was measured at rest, with and without the polish, and also during the 4th, 5th and 6th minutes of the exercise programme. RESULTS The experimental universe included 42 patients with ages of 62.9±8.7 years. In the exercise considered, the red colour reduced it in the fourth minute of the exercise (p=0.047). In contrast, the brown colour reduced saturation at rest and also during the course of exercise (p=0.01). CONCLUSION In patients with chronic obstructive pulmonary disease, the red and brown colours interfered with the reading of the peripheral oxygen saturation during exercise. This study is registered at the Brazilian Register of Clinical Trials (Registro Brasileiro de Ensaios Clínicos) under No. RBR-9vc722.

Mapeamento dos diagnósticos de enfermagem em uma unidade de pneumologia

Objectives: To identify the most frequent nursing diagnoses according to NANDA Internationals Taxonomy II; the defining characteristics, related factors and risk factors, in patients with respiratory disorders. Methods: Cross-sectional study in a university hospital in Sao Paulo. The nursing diagnoses were determined by the researcher, and subjected to consensual validation by three experts. Results are based on absolute frequency and percentage. Results: Thirty-four patients were evaluated and 35 nursing diagnoses were identified that achieved consensus across the researcher and the experts. Conclusion: Epidemiological studies that report on the frequency of nursing diagnoses in a population contribute to organizing the knowledge base of nursing and the appropriate provision of nursing care required by a specific population.

Calidad de vida y sobrecarga de los cuidadores de portadores de la Enfermedad Pulmonar Obstructiva Crónica en oxigenoterapia

1 Articulo parte de la disertacion de maestria: “Qualidade de vida do paciente portador de DPOC em uso de oxigenoterapia domiciliar e seu cuidador”, apresentada a la Escola Paulista de Enfermagem, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brasil. Apoyo financiero de la Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES). 2 Estudiantes de maestria, Escola Paulista de Enfermagem, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brasil. 3 PhD, Profesor Adjuncto, Escola Paulista de Enfermagem, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brasil. 4 PhD, Medica, Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, SP, Brasil. Objetivo: evaluar la calidad de vida y la sobrecarga de cuidados experimentada por cuidadores de portadores de la Enfermedad Pulmonar Obstructiva Cronica en uso de Oxigenoterapia Domiciliar Prolongada e investigar los factores que influencian esa sobrecarga. Metodo: se trata de estudio transversal analitico, con 80 portadores de la Enfermedad Pulmonar Obstructiva Cronica en uso de Oxigenoterapia Domiciliar en el ambulatorio especializado de la Universidad Federal de Sao Paulo y de sus respectivos cuidadores, aplicando los instrumentos: Medical Outcomes Studies 36 (SF-36), Caregiver Burden Scale (CBS), indice de Katz y variables sociodemograficas y clinicas. Resultados: los puntajes del cuestionario de calidad de vida de los cuidadores mas comprometidos fueron la Vitalidad y la Salud Mental. El Ambiente fue el dominio del Caregiver Burden Scale que genero mayor sobrecarga de cuidados. Con excepcion del Envolvimiento Emocional, todos los dominios de calidad de vida fueron influenciados de forma negativa por los dominios de sobrecarga de cuidados. Conclusion: se demostro que la calidad de vida y la sobrecarga de cuidados, de los cuidadores, estaban comprometidos, confirmando que cuidar a los portadores de Enfermedad Pulmonar Obstructiva Cronica, es un importante interviniente en la calidad de vida del cuidador.

Evaluation of pulse oximetry measurements in healthy subjects with nail polish

OBJETIVO: Evaluar las alteraciones en las medidas de la oximetria de pulso en individuos sanos con esmalte de una. METODOS: Estudio transversal realizado con 80 voluntarias sanas. Los colores de esmalte utilizados para evaluar la saturacion periferica de oxigeno (SpO2) fueron: cafe con leche, cafe, chocolate, rojo y ciruela. Estos colores fueron distribuidos entre las unas de los dedos de la mano izquierda. Los dedos de la mano derecha fueron los controles. RESULTADOS: Los colores rojo (p=0,047) y cafe (p=0,024) mostraron valores menores en la SpO2 cuando fueron comparados al control. Los otros colores no alteraron la medida del SpO2. CONCLUSION: Los colores rojo y cafe causaron reduccion en la medida del SpO2, sin embargo la relevancia clinica de este hallazgo es cuestionable, pues los valores estaban dentro del intervalo de normalidad.