Karina de Oliveira Azzolin

Effectiveness of nursing interventions in heart failure patients in home care using NANDA-I, NIC, and NOC

OBJECTIVE The objective of the study is to evaluate the effectiveness of nursing interventions (NIC) using nursing outcomes (NOC) and based on NANDA-I nursing diagnoses in patients with heart failure in home care. METHOD In this longitudinal study, 23 patients with heart failure were followed for 6 months, in four home visits. During the visits, nursing diagnoses were established, outcomes assessed, and interventions implemented. RESULTS Of the 11 NIC interventions implemented, eight proved effective, that is, showed significant improvement between the first and the fourth visit, according to scores obtained for six outcomes: knowledge: treatment regimen, knowledge: medication, compliance behavior, symptom control, activity tolerance, and energy conservation. CONCLUSION NIC interventions health education, self-modification assistance, behavior modification, teaching: prescribed medication, teaching: disease process, nutritional counseling, telephone consultation, and energy conservation showed effective outcomes based on NOC scores, suggesting that the NANDA-I, NIC, and NOC linkage is useful in patients with heart failure in home care.

Fatores de risco modificáveis para doença arterial coronariana nos trabalhadores de enfermagem

OBJECTIVE: to identify the modifiable risk factors for coronary artery disease (CAD) among nursing staff of a general hospital. METHODS: the sample consisted of 209 nursing staff. Data included anthropometric and blood pressure measurements, body mass index (BMI), and cholesterol and glucose levels. A questionnaire was also used to measure physical activity and stress level. Risk factors for CAD were identified and quantified. RESULTS: the findings suggest that nursing staff was stressed (19.1%) and had high blood pressure (29.7%) and total cholesterol >200mg/dl (27.7%). Nursing assistants had higher BMI than nursing licensed practical nurses or registered nurses; and licensed practical nurses had the higher level of stress. Sedentary life style was common in more than half of the nursing staff. CONCLUSION: it is important to identify and quantify risk factors for CAD. This epidemiological knowledge might lead to educational interventions to prevent the development of the disease.OBJETIVO: identificar os fatores de risco (FR) modificaveis para doenca arterial coronariana (DAC) nos trabalhadores de enfermagem de um hospital geral. METODOS: estudo com 209 trabalhadores submetidos a exame antropometrico e afericao da pressao arterial. Foram realizadas coletas capilares para verificar os niveis de colesterol total e glicemia para calculo do indice de massa corporal (IMC). Aplicado questionario sobre atividade fisica e estresse. Os FR para DAC foram quantificados e avaliados. RESULTADOS: da amostra, 19,1% eram estressados, 29,7% hipertensos e 27,7% apresentaram CT>200mg/dl. O tabagismo corresponde a 28,8% dos tecnicos. Os auxiliares apresentaram maior indice de IMC e nivel de estresse; os enfermeiros foram os mais hipertensos. Sedentarismo estava presente em mais da metade da amostra. CONCLUSAO: este estudo mostra a identificacao e quantificacao dos diferentes FR para DAC, pois a partir do conhecimento da realidade epidemiologica, e possivel desenvolver acoes e educacao em saude relevantes na intervencao preventiva.

Prevalência de fatores de risco para síndrome coronariana aguda em pacientes atendidos em uma emergência

Objetivou-se caracterizar o perfil do paciente portador de Sindrome Coronaria Aguda (SCA) atendido em um servico de emergencia de Porto Alegre, Rio Grande do Sul, no que se refere aos fatores de risco. Estudo de prevalencia entre agosto de 2007 e fevereiro de 2008. Para coleta de dados, foi utilizado um questionario, consulta ao prontuario e afericao de medidas antropometricas. Foram avaliados 152 pacientes com SCA, 63,8% do sexo masculino, idade media de 61±10,26 anos. Com diagnostico de infarto agudo do miocardio sem supradesnivelamento de ST em 50,7%, infarto agudo do miocardio com supradesnivelamento de ST em 14,5% e angina instavel em 34,9%. Os fatores de risco foram: sedentarismo (86,8%); sobrepeso e obesidade (77%); hipertensao arterial sistemica (75,7%); historia familiar (56,6%); estresse (52,6%); dislipidemia (44,7%); diabete mellitus (40,1%); tabagismo (39,5%); e ingesta de alcool (14,4%). Constatou-se uma alta prevalencia de fatores de risco para SCA, necessitando de programas de educacao em saude, visando reduzir a morbi-mortalidadeOur purpose is to characterize the profile of patients with Acute Coronary Syndrome (ACS) assisted in an emergency service in Porto Alegre. The characterization of the profiles focus on risk factors. This prevalence study was carried out from August, 2007 to February 2008. To collect the data, we developed a questionnaire, checked bedside assessment and measured anthropometric evaluation. 152 patients had their ACS evaluated, of which 63.8% were males, with an average age of 61 +/- 10.26 years. 50.7% had acute myocardial infarction non-ST elevation, 14.5% acute myocardial infarction with-ST elevation, and 34.9% unstable Angina. Risk factors were sedentariness (86.8%); overweightness and obesity (77%); systemic arterial hypertension (75.7%); family history (56.6%); stress (52.6%); dyslipidemia (44.7%); diabetes mellitus (40.1%); tobacco smoking (39.5%); and alcohol consumption (14.4%). A high prevalence of risk factors for ACS was verified, indicating a necessity of health education programs to reduce morbimortality.

Gravidade de pacientes em pós-operatório de cirurgia cardíaca: uma análise evolutiva segundo o TISS-28

This study verified the daily TISS-28 score in the postoperative period of cardiac surgery at a cardiology intensive care unit. This cohort study included 55 postoperative cardiac surgery patients, who were sent to the intensive care unit to recover. Data were collected from patients records with daily application of the TISS-28. The obtained data revealed that the average age of the population was 61.47 years+/-12.12 years, 78.2% were male, 51.43% underwent valve repair surgery and 48.57% myocardial revascularization surgery. The severity index in the immediate postoperative period was 41.33+/-5.01. The follow-up of patients using the TISS-28 evidenced a significant decrease in the index values up to the patients discharge, averaging at 13.19+/-2.59. The results indicate that immediate postoperative cardiac surgery patients are in severe conditions, hemodynamically unstable and classified in class III according to the TISS-28, though scores gradually decrease over time.O objetivo deste estudo foi verificar o escore diario do TISS-28 no pos-operatorio de cirurgia cardiaca, em uma unidade de terapia intensiva cardiologica. Como metodo foi usado o estudo de coorte, que incluiu 55 pacientes, em pos-operatorio de cirurgia cardiaca, com indicacao de recuperacao em unidade de terapia intensiva (UTI). Os dados foram coletados em prontuario, com aplicacao diaria do TISS-28. Os dados obtidos mostraram que a media de idade da populacao era de 61,47±12,12, 78,2% do sexo masculino, 51,43% realizaram cirurgia de correcao valvar e 48,57% realizaram cirurgia de revascularizacao do miocardio. Ainda, o indice de gravidade no pos-operatorio imediato foi 41,33±5,01. O acompanhamento dos pacientes pelo TISS-28 demonstrou que ha queda significativa nos valores do indice ate a alta, com media de 13,19±2,59. Pode-se concluir que os resultados indicam que os pacientes em pos-operatorio imediato de cirurgia cardiaca sao graves e hemodinamicamente instaveis, classificados em classe III pelo TISS-28, porem, a pontuacao reduz gradualmente com o passar do pos-operatorio.

[Consensus on nursing diagnoses, interventions and outcomes for home care of patients with heart failure].

Estudo de consenso realizado entre seis enfermeiras especialistas da area de cardiologia, com o objetivo de selecionar diagnosticos, intervencoes e resultados de enfermagem descritos pela NANDA Internacional (NANDA-I), Nursing Outcomes Classification (NOC), Nursing Intervention Classification (NIC), para pacientes com insuficiencia cardiaca em cuidado domiciliar. Inicialmente, foram pre-selecionados oito diagnosticos de enfermagem, conforme a NANDA-I e, a partir deles, realizado um consenso, em tres etapas, para a selecao das intervencoes/atividades NIC e os resultados/ indicadores NOC. Consideraram-se selecionados os que obtiveram entre 70% e 100% de consenso. Os resultados apontaram seis diagnosticos de enfermagem selecionados, 11 intervencoes de um total de 96 e sete resultados de um total de 71. O consenso entre os enfermeiros especialistas permitiu identificar e selecionar diagnosticos, intervencoes e resultados de enfermagem para aplicacao na pratica clinica, com vistas a subsidiar o processo de cuidado e o conhecimento das taxonomias de enfermagem.This was a consensus study with six cardiology nurses with the objective of selecting nursing diagnoses, outcomes and interventions described by NANDA International (NANDA-I), Nursing Outcomes Classification (NOC), Nursing Intervention Classification (NIC), for home care of patients with heart failure (HF). Eight nursing diagnoses (NDs) were pre-selected and a consensus was achieved in three stages, during which interventions/activities and outcomes/indicators of each NDs were validated and those considered valid obtained 70% to 100% consensus. From the eight pre-selected NDs, two were excluded due to the lack of consensus on appropriate interventions for the clinical home care scenario. Eleven interventions were selected from a total of 96 pre-selected ones and seven outcomes were validated out of 71. The practice of consensus among expert nurses provides assistance to the qualifications of the care process and deepens the knowledge about the use of tazonomies in nursing clinical practice.

Consenso de diagnósticos, resultados e intervenções de enfermagem para pacientes com insuficiência cardíaca em domicílio

Estudo de consenso realizado entre seis enfermeiras especialistas da area de cardiologia, com o objetivo de selecionar diagnosticos, intervencoes e resultados de enfermagem descritos pela NANDA Internacional (NANDA-I), Nursing Outcomes Classification (NOC), Nursing Intervention Classification (NIC), para pacientes com insuficiencia cardiaca em cuidado domiciliar. Inicialmente, foram pre-selecionados oito diagnosticos de enfermagem, conforme a NANDA-I e, a partir deles, realizado um consenso, em tres etapas, para a selecao das intervencoes/atividades NIC e os resultados/ indicadores NOC. Consideraram-se selecionados os que obtiveram entre 70% e 100% de consenso. Os resultados apontaram seis diagnosticos de enfermagem selecionados, 11 intervencoes de um total de 96 e sete resultados de um total de 71. O consenso entre os enfermeiros especialistas permitiu identificar e selecionar diagnosticos, intervencoes e resultados de enfermagem para aplicacao na pratica clinica, com vistas a subsidiar o processo de cuidado e o conhecimento das taxonomias de enfermagem.This was a consensus study with six cardiology nurses with the objective of selecting nursing diagnoses, outcomes and interventions described by NANDA International (NANDA-I), Nursing Outcomes Classification (NOC), Nursing Intervention Classification (NIC), for home care of patients with heart failure (HF). Eight nursing diagnoses (NDs) were pre-selected and a consensus was achieved in three stages, during which interventions/activities and outcomes/indicators of each NDs were validated and those considered valid obtained 70% to 100% consensus. From the eight pre-selected NDs, two were excluded due to the lack of consensus on appropriate interventions for the clinical home care scenario. Eleven interventions were selected from a total of 96 pre-selected ones and seven outcomes were validated out of 71. The practice of consensus among expert nurses provides assistance to the qualifications of the care process and deepens the knowledge about the use of tazonomies in nursing clinical practice.

Delay factors on the administration of thrombolytic therapy in patients diagnosed with acute myocardial infarction in a general hospital

OBJECTIVE To identify factors that delay the onset of thrombolysis in patients with acute myocardial infarction (AMI). METHODS A cohort study was carried out with 146 patients, each diagnosed with AMI and subjected to thrombolytic therapy. The data was extracted from medical records between January 2002 and December 2004. RESULTS The average age of the studied population was 57.5 +/- 9 years, 64.4% were male. The average time between the onset of pain and arrival at the hospital was 254.7 +/- 126.6 minutes, 28.1% used an ambulance for the trip to the hospital, the door-to-electrocardiogram time averaged 19.4 +/- 7.3 minutes and the door-to-needle time was 51.1 +/- 14.9 minutes. There was no significant difference between the time of arrival to the hospital and the method of transportation used (P= 0.81), and those seen by cardiologists and during the nightshift had a reduction in the door-to-needle time, respectively (P=0.014) and (P=0.034). CONCLUSIONS Study results show that the delay in the search for medical service, and the long time taken from door-to-electrocardiogram and to reach the AMI diagnosis were the factors involved in the delay of thrombolytic treatment.OBJECTIVE: To identify factors that delay the onset of thrombolysis in patients with acute myocardial infarction (AMI). METHODS: A cohort study was carried out with 146 patients, each diagnosed with AMI and subjected to thrombolytic therapy. The data was extracted from medical records between January 2002 and December 2004. RESULTS: The average age of the studied population was 57.5 ± 9 years, 64.4% were male. The average time between the onset of pain and arrival at the hospital was 254.7 ± 126.6 minutes, 28.1% used an ambulance for the trip to the hospital, the door-to-electrocardiogram time averaged 19.4 ± 7.3 minutes and the door-to-needle time was 51.1 ± 14.9 minutes. There was no significant difference between the time of arrival to the hospital and the method of transportation used (P= 0.81), and those seen by cardiologists and during the nightshift had a reduction in the door-to-needle time, respectively (P=0.014) and (P=0.034). CONCLUSIONS: Study results show that the delay in the search for medical service, and the long time taken from door-to-electrocardiogram and to reach the AMI diagnosis were the factors involved in the delay of thrombolytic treatment.

Incidence of vascular complications in patients submitted to percutaneous transluminal coronary angioplasty by transradial and transfemoral arterial approach

OBJECTIVE: To describe the vascular complications of transradial and transfemoral artery punctures in patients submitted to percutaneous transluminal coronary angioplasty (PTCA). METHODS: Prospective cohort study including patients submitted to PTCA. An interview was performed and an instrument applied to collect risk factors/predictors of complications. After the procedure, a physical examination was performed, vital signs were measured and the puncture site was assessed. RESULTS: 199 patients were included, age 64±10 years. Complications found for the radial and femoral approach were respectively: ecchymosis (18.29%), (17.14%); bruising (17.66%), (14.27%); urinary retention (2.43%), (25.71%); loss of vessel permeability (8.53%), (0%). CONCLUSION: The complications found were considered minor or secondary, depending on the classification found in literature. A higher rate of vascular complications related to transradial artery punctures compared to the interventions performed by transfemoral approach.

Cross-Cultural Adaptation of the Quality of Diagnoses, Interventions and Outcomes (Q-DIO) Instrument into Brazilian Portuguese

PURPOSE   To describe the cross-cultural adaptation of the Quality of Diagnoses, Interventions and Outcomes instrument into Brazilian Portuguese. METHOD   This process entailed translation, synthesis, back-translation, expert committee review, and pretesting. FINDINGS   Six items were altered in the Brazilian version, and the scoring system was changed from a five-point to a three-point Likert-type scale. Pretesting was conducted on a sample of 40 randomly selected nursing records. Overall reliability as measured by Cronbachs alpha was 0.96. CONCLUSIONS   Adaptation resulted in a preliminary version of the instrument. IMPLICATIONS FOR NURSING PRACTICE   Assessment of the psychometric properties of the instrument in a larger sample of nursing records is required, and such a study is underway.PURPOSE:  To describe the cross-cultural adaptation of the Quality of Diagnoses, Interventions and Outcomes instrument into Brazilian Portuguese. METHOD:  This process entailed translation, synthesis, back-translation, expert committee review, and pretesting. FINDINGS:  Six items were altered in the Brazilian version, and the scoring system was changed from a five-point to a three-point Likert-type scale. Pretesting was conducted on a sample of 40 randomly selected nursing records. Overall reliability as measured by Cronbachs alpha was 0.96. CONCLUSIONS:  Adaptation resulted in a preliminary version of the instrument. IMPLICATIONS FOR NURSING PRACTICE:  Assessment of the psychometric properties of the instrument in a larger sample of nursing records is required, and such a study is underway.

Prevalence of risk factors for acute Coronary Syndrome in patients treated in an emergency

Objetivou-se caracterizar o perfil do paciente portador de Sindrome Coronaria Aguda (SCA) atendido em um servico de emergencia de Porto Alegre, Rio Grande do Sul, no que se refere aos fatores de risco. Estudo de prevalencia entre agosto de 2007 e fevereiro de 2008. Para coleta de dados, foi utilizado um questionario, consulta ao prontuario e afericao de medidas antropometricas. Foram avaliados 152 pacientes com SCA, 63,8% do sexo masculino, idade media de 61±10,26 anos. Com diagnostico de infarto agudo do miocardio sem supradesnivelamento de ST em 50,7%, infarto agudo do miocardio com supradesnivelamento de ST em 14,5% e angina instavel em 34,9%. Os fatores de risco foram: sedentarismo (86,8%); sobrepeso e obesidade (77%); hipertensao arterial sistemica (75,7%); historia familiar (56,6%); estresse (52,6%); dislipidemia (44,7%); diabete mellitus (40,1%); tabagismo (39,5%); e ingesta de alcool (14,4%). Constatou-se uma alta prevalencia de fatores de risco para SCA, necessitando de programas de educacao em saude, visando reduzir a morbi-mortalidadeOur purpose is to characterize the profile of patients with Acute Coronary Syndrome (ACS) assisted in an emergency service in Porto Alegre. The characterization of the profiles focus on risk factors. This prevalence study was carried out from August, 2007 to February 2008. To collect the data, we developed a questionnaire, checked bedside assessment and measured anthropometric evaluation. 152 patients had their ACS evaluated, of which 63.8% were males, with an average age of 61 +/- 10.26 years. 50.7% had acute myocardial infarction non-ST elevation, 14.5% acute myocardial infarction with-ST elevation, and 34.9% unstable Angina. Risk factors were sedentariness (86.8%); overweightness and obesity (77%); systemic arterial hypertension (75.7%); family history (56.6%); stress (52.6%); dyslipidemia (44.7%); diabetes mellitus (40.1%); tobacco smoking (39.5%); and alcohol consumption (14.4%). A high prevalence of risk factors for ACS was verified, indicating a necessity of health education programs to reduce morbimortality.