Camilla Christina Rodrigues

Older adults hospitalized in a teaching hospital: clinical characteristics and outcomes

Objective: to investigate the causes of older adult hospitalizations, demographic and clinical profiles, and patient outcome. Method: quantitative cross-sectional study conducted with 14,892 electronic medical records during 12 months. We carried out a descriptive analysis of the variables of the sample characterization, and an associative test using chi-square statistics. Results: most patients assessed were male, had primary education, lived with a partner, were white and Catholics, and had cardiovascular diseases, followed by neoplasms and gastrointestinal diseases in both sexes. The average age of the patients was 72.1 years, and the average length of hospital stay was 5.9 days. There was a significant association between diagnosed diseases, sex (p <0.001), and ethnicity (p = 0.023) of the patients. The most common outcome was hospital discharge. Conclusion: chronic diseases were the main causes of older adult hospitalizations and led to increased length of hospital stay. The assessment of these factors provides subsidies for identifying problems and performing best nursing interventions. Descriptors: Older Adult; Hospitalization; Clinical Evolution. RESUMO Objetivo: investigar as causas de internação dos idosos hospitalizados, o perfil demográfico, o perfil clínico e o desfecho. Método: estudo quantitativo, transversal de análise de 14.892 prontuários eletrônicos, no período de 12 meses. Foi realizada uma análise descritiva das variáveis de caracterização amostral e aplicação do teste associativo pela estatística qui-quadrado. Resultados: a maioria dos pacientes avaliados era do sexo masculino, com grau de instrução fundamental, com companheiro, do lar, brancos, católicos e com doenças cardiovasculares, seguidas de neoplasias e doenças gastrointestinais em ambos os sexos. A idade dos pacientes apresentou média de 72,1 anos e a média da permanência hospitalar foi de 5,9 dias. Houve associação significativa entre as doenças diagnosticadas, o sexo (p <0,001) e a etnia (p = 0,023) dos pacientes. O desfecho mais comum foi a alta dos pacientes. Conclusão: as doenças crônicas foram as principais causas de hospitalização dos idosos, acarretando mais tempo na hospitalização. A investigação destes fatores fornece subsídios para identificação dos problemas e realizar melhores ações de enfermagem. Descritores: Idoso; Hospitalização; Evolução Clínica. RESUMEN Objetivo: investigar las causas de hospitalización de adultos mayores, perfil demográfico, perfil clínico y desenlaces. Método: estudio cuantitativo transversal con análisis de 14.892 registros médicos electrónicos de un período de 12 meses. Se realizó un análisis descriptivo de las variables de caracterización de la muestra y se aplicó la prueba chi-cuadrado. Resultados: la mayoría de los pacientes evaluados eran hombres, con educación primaria, vivían en pareja, eran blancos, católicos y tenían enfermedades cardiovasculares, seguidas de neoplasias y enfermedades gastrointestinales en ambos sexos. El promedio de edad de los pacientes fue de 72,1 años y de la estancia hospitalaria fue de 5,9 días. Hubo una asociación significativa entre enfermedades diagnosticadas, sexo (p <0.001) y etnia (p = 0.023) de los pacientes. El resultado más común fue el alta hospitalaria. Conclusión: las enfermedades crónicas fueron las principales causas de hospitalización de los adultos mayores, llevando a un tiempo más prolongado de internación. La investigación de estos factores proporciona subsidios para identificación de problemas y realizar mejores intervenciones de enfermería. Descritores: Adulto Mayor; Hospitalización; Evolución Clínica. Nurse, Master’s Degree in Nursing, São José do Rio Preto School of Medicine (FAMERP). São José do Rio Preto, SP, Brazil. E-mails: ca.c.rodrigues@hotmail.com; samaris.enf@hotmail.com; Nurse, Ph.D., Professor at the Department of General Nursing and the Nursing Graduate Program, São José do Rio Preto School of Medicine (FAMERP). São José do Rio Preto, SP, Brazil. E-mails: ricardo.rita@terra.com.br; claudiacesarino@famerp.br; Nurse, Ph.D., Professor at the União das Faculdades dos Grandes Lagos University (UNILAGO) and the Nursing Graduate Program, São José do Rio Preto School of Medicine (FAMERP). São José do Rio Preto, SP, Brazil. Email: danielacomelisbertolin@gmail.com; Nurse, Master’s Degree candidate in Nursing, São José do Rio Preto School of Medicine (FAMERP). São José do Rio Preto, SP, Brazil. E-mail: rib_renato@hotmail.com; Nurse, Ph.D., Professor at the São José do Rio Preto School of Medicine (FAMERP), University of São Paulo (USP). Ribeirão Preto, SP, Brazil. E-mails: mariliapilotto@yahoo.com.br; kusumota@eerp.usp.br ORIGINAL ARTICLE Rodrigues CC, Ribeiro RCHM, Cesarino CB et al. Older adults hospitalized in a teaching...

Factors influencing on cardiopulmonary resuscitation and prognosis in a neonatal icu

Objective: to verify the main factors influencing on cardiopulmonary resuscitation and prognosis in a neonatal intensive care unit (NICU). Method: cross-sectional study with a retrospective nature, quantitative and descriptive, conducted in a NICU in July and August 2012, with data collection from medical records of neonates who suffered cardiorespiratory arrest and were reanimated within the period from January to March 2012, after study approval by the Research Ethics Committee of the School of Medicine of São José do Rio Preto (FAMERP), under the Opinion 32,509. Results: out of the 61 neonates at the NICU within the period, 58 medical records were accessed; 9 (15.5%) were selected for the survey. There were 77.8% of neonates born premature. As for the etiology of cardiorespiratory arrest, 89% had a respiratory origin. Conclusion: the main factors influencing on cardiopulmonary resuscitation and prognosis of neonates at a NICU are: prematurity, prior comorbidities (especially with a respiratory origin), and early intervention by the health team. Descriptors: Cardiopulmonary Resuscitation; Neonatal Period; Neonatal Intensive Care Units. RESUMO Objetivo: verificar os principais fatores que influenciam a ressuscitação cardiopulmonar e o prognóstico em uma unidade de terapia intensiva neonatal (UTIN). Método: estudo transversal de caráter retrospectivo, quantitativo e descritivo, realizado em UTIN em julho e agosto de 2012, com coleta de dados em prontuários de neonatos que apresentaram parada cardiorrespiratória e foram reanimados no período de janeiro a março de 2012, após a aprovação do estudo pelo Comitê de Ética em Pesquisa da Faculdade de Medicina de São José do Rio Preto (Famerp), sob o Parecer n. 32.509. Resultados: dos 61 neonatos internados na UTIN no período, foram acessados 58 prontuários; 9 (15,5%) foram selecionados para a pesquisa. Nasceram prematuros 77,8% dos neonatos. Quanto à etiologia da parada cardiorrespiratória, 89% foram de caráter respiratório. Conclusão: os principais fatores que influenciam a ressuscitação cardiopulmonar e o prognóstico de neonatos internados em uma UTIN são: prematuridade, comorbidades prévias (principalmente de origem respiratória) e intervenção precoce da equipe de saúde. Descritores: Ressuscitação Cardiopulmonar; Período Neonatal; Unidades De Terapia Intensiva Neonatal. RESUMEN Objetivo: verificar los principales factores que influyen en la resucitación cardiopulmonar y el pronóstico en una unidad de cuidados intensivos neonatales (UCIN). Método: estudio transversal con carácter retrospectivo, cuantitativo y descriptivo, realizado en una UCIN en julio y agosto de 2012, con recogida de datos en prontuarios de neonatos que sufrieron parada cardiorrespiratoria y fueron reanimados en el período de enero a marzo de 2012, después de la aprobación del estudio por el Comité de Ética en Investigación de la Facultad de Medicina de São José do Rio Preto (Famerp), bajo la Opinión 32.509. Resultados: de los 61 neonatos internados en la UCIN en el período, se tuvo acceso a 58 prontuarios; 9 (15,5%) fueron seleccionados para la encuesta. Hubo 77,8% de neonatos nacidos prematuros. En cuanto a la etiología de la parada cardiorrespiratoria, 89% tenían un carácter respiratorio. Conclusión: los principales factores que influyen en la resucitación cardiopulmonar y el pronóstico de neonatos en la UCIN son: prematuridad, comorbilidades previas (especialmente con un origen respiratorio) e intervención precoz del equipo de salud. Descriptores: resucitación cardiopulmonar; período neonatal; unidades de cuidados intensivos neonatales. Nurse graduated from the School of Medicine of São José do Rio Preto (FAMERP). São José do Rio Preto (SP), Brazil. Email: bia_lamana@hotmail.com; Nurse. PhD in Nursing. Professor at FAMERP. São José do Rio Preto (SP), Brazil. Email: ricardo.rita@hotmail.com; Clinical nurse at the Base Hospital of São José do Rio Preto. São José do Rio Preto (SP), Brazil. Email: osvaldo.lsilvajr@gmail.com; Nurse. Nursing Supervisor of the Emergency Room at the Base Hospital of São José do Rio Preto. São José do Rio Preto (SP), Brazil. Email: joseli.angelini@gmail.com; Clinical nurse at the Base Hospital of São José do Rio Preto. São José do Rio Preto (SP), Brazil. Email: ca.c.rodrigues@hotmail.com; Nurse. Professor at the Federal University of Mato Grosso (UFMT). Cuiabá (MT), Brazil. Email: jocanova@bol.com.br ORIGINAL ARTICLE Lamana BSN, Ribeiro RCH, Silva Junior OL da et al. Factors influencing on cardiopulmonary resuscitation... English/Portuguese J Nurs UFPE on line., Recife, 8(11):3833-8, Nov., 2014 3834 ISSN: 1981-8963 DOI: 10.5205/reuol.6679-58323-1-ED.0811201403 In Brazil, about 3 million children are born every year, and 300 thousand of them need support to initiate and sustain adequate breathing. Worldwide, from 4 to 7 million need some kind of assistance at birth, per year, and 359 thousand neonatal deaths are avoided by means of resuscitation techniques at birth. The neonatal period, from 0 to 28 days, is characterized by weakness of the human being, with high risk of sequelae and high rates of morbidity and mortality. Neonatal mortality accounts for about 60 to 70% of infant mortality. And it is the first day of life that gathers most of the infant deaths in Brazil, about 25%. So, we notice that there is a relation between intrauterine health conditions, at birth and within the neonatal period, with chronic degenerative problems in adulthood, and improving neonatal care can reduce mortality due to preventable causes and reduce individual’s neurological sequelae, which affect the quality of life of children and their families, besides generating expenditures for society. There is a need, therefore, for early intervention, preventing the occurrence of cardiorespiratory arrest (CRA) among neonates. To do this, it is of great importance identifying the main factors that lead to this condition. ● Verify which are the main factors influencing on cardiopulmonary resuscitation and prognosis of neonates in a neonatal intensive care unit. This is a cross-sectional study with a retrospective nature, besides a quantitative and descriptive approach, conducted in the neonatal intensive care unit (NICU) of a school hospital in São José do Rio Preto, São Paulo, Brazil. This is a large hospital, at the tertiary and quaternary level, with a capacity to provide 720 beds. The sample consisted of 61 medical records of neonates hospitalized at the NICU within the period from January 1 to March 31, 2012, and those who had only cardiac arrest/respiratory arrest or those with a “closed prognosis” were excluded. The medical record contained 23 questions which referred from time of birth to the characteristics of the pre-, intraand postCRA period. The database was filled in a spreadsheet of the software Microsoft Excel, and the results, analyzed by simple frequency and average, are expressed in figures. The survey was conducted after approval by the Research Ethics Committee of the School of Medicine of São José do Rio Preto (FAMERP), under the Opinion 32,509, according to Resolution CNS 196/96. Within the proposed period 61 neonates were admitted to the NICU, but it was possible to access 58 records. Out of these, 9 (15.5%) were used in the survey, because they met the inclusion criteria. Figure 1 points out that neonates had, on average, 37 hours of life at the time of CRA. Figure 1. Percentile of age at the time of cardiorespiratory arrest. According to gestational age at birth, 22.2% were born at term and 77.8% were preterm, ≤ 37 weeks. The average weight at birth was 1,957 g and the proportion of neonates per 500 g is illustrated by Figure 2. RESULTS METHOD OBJECTIVE INTRODUCTION Lamana BSN, Ribeiro RCH, Silva Junior OL da et al. Factors influencing on cardiopulmonary resuscitation... English/Portuguese J Nurs UFPE on line., Recife, 8(11):3833-8, Nov., 2014 3835 ISSN: 1981-8963 DOI: 10.5205/reuol.6679-58323-1-ED.0811201403 Figure 2. Percent by weight at birth. Each neonate had, on average, 2.55 comorbidities, mainly pneumothorax (33.3%), neonatal respiratory distress syndrome/hyaline membrane disease (33.3%), and neonatal anoxia (22.2%). Figure 3 shows the neonate’s length of stay in the hospital unit. Figure 3. Percentile of hospital stay for 24 hours. Regarding the etiology of CRA, 89% of cases had a respiratory origin and 11% had a nonspecific cause. As for the techniques used during cardiopulmonary resuscitation (CPR), it was found that: all umbilical cord ligations were performed immediately after birth; the polyethylene plastic bag was not used, because the neonates were housed in heated incubators; therapeutic hypothermia was performed in 11% of cases; volume expansion, with crystalloid and plasma solutions, was performed in 55.5% of neonates; in all cases, airways and trachea were aspirated, by using oxygen therapy and chest compressions. All infants were intubated, ventilated within the CRA period using positive pressure and, at some time, they used the mechanical ventilator. During labor, bag and face mask were used in 11% of them. Neonates already using orotracheal tube (OTT) and ventilated with manual balloon (44%) had a better response to this technique than to the mechanical ventilator. Adrenaline was administered in 78% of cases, out of which 43% with continuous dosing up to 0.5 mcg/kg/min and 57% with a continuous dose of 0.5-1 mg/kg/min (Figure 4). Lamana BSN, Ribeiro RCH, Silva Junior OL da et al. Factors influencing on cardiopulmonary resuscitation... English/Portuguese J Nurs UFPE on line., Recife, 8(11):3833-8, Nov., 2014 3836 ISSN: 1981-8963 DOI: 10.5205/reuol.6679-58323-1-ED.0811201403 Figure 4. Percentile of the techniques used during cardiopulmonary resuscitation. At birth, 11% of neonates were in the meconium amniotic fluid. Regarding neurological sequelae, data were insufficient for proper evaluation, since 89% of neonates progressed to death and the 11% who w