Lílian Varanda Pereira

Sistematização da assistência de enfermagem ao paciente crítico: proposta de instrumento de coleta de dados

A coleta de dados fundamenta a sistematizacao da assistencia de enfermagem, metodologia que permite ao enfermeiro aplicar os conhecimentos tecnico-cientificos que embasam a profissao. Este estudo objetivou elaborar um instrumento de coleta de dados visando o registro de forma eficiente e valida-lo em sua forma aparente e de conteudo. Investigamos os sinais e sintomas frequentemente encontrados em clientes de um Centro de Terapia Intensiva-Adulto e os categorizamos em Necessidades Humanas Basicas. Posteriormente, o instrumento foi submetido a validacoes aparente e de conteudo. Com relacao a estrutura do instrumento, foi detectada a necessidade de reduzi-lo, tornando-o mais pratico. Quanto ao conteudo, os juizes concordaram que este seria suficiente para o estabelecimento dos diagnosticos de enfermagem, favorecendo o desenvolvimento da sistematizacao da assistencia ao paciente critico, em Centro de Terapia Intensiva.

Consumo de medicamentos por idosos, Goiânia, Brasil

OBJETIVO: Analisar o padrao de consumo de medicamentos entre idosos e sua associacao com aspectos socioeconomicos e autopercepcao de saude. METODOS: Estudo de base populacional e delineamento transversal com 934 idosos de Goiânia, GO, Brasil, entre dezembro de 2009 e abril de 2010. Os dados foram coletados por meio de questionario. As variaveis estudadas foram: numero de medicamentos consumidos, sexo, estado civil, escolaridade, tipo de moradia, idade, renda e autopercepcao de saude. Os medicamentos foram classificados segundo o Anatomical Therapeutic and Chemical Classification. Os medicamentos improprios para idosos foram identificados segundo o Criterio de Beers-Fick. Os testes utilizados foram Qui-quadrado (X2) e exato de Fisher e p foi considerado significativo quando < 0,05. RESULTADOS: Os idosos consumiam 2.846 medicamentos (3,63 medicamentos/idoso). Os mais usuais atuavam no aparelho cardiovascular (38,6%). A prevalencia de polifarmacia foi de 26,4% e da automedicacao de 35,7%. Os medicamentos mais ingeridos por automedicacao foram os analgesicos (30,8%); 24,6% dos idosos consumia medicamento considerado improprio. Mulheres, viuvos, idosos com 80 anos ou mais e com pior autopercepcao de saude praticavam mais a polifarmacia. A maior pratica da automedicacao esteve associada com menor escolaridade e pior autopercepcao de saude. CONCLUSOES: O padrao do consumo de medicamentos por idosos foi semelhante ao encontrado em idosos de outras regioes do Brasil. O numero de medicamentos usados, a prevalencia das praticas da polifarmacia e automedicacao e consumo de medicamentos improprios estiveram dentro da media nacional.OBJECTIVE To analyze the pattern of use of medications use in aged people and associate it with socioeconomic aspects and with the self-rated health. METHODS A population-based cross-sectional design study with 934 elderly people from Goiania, Midwestern Brazil, between December 2009 and April 2010. Data were collected through a questionnaire. The dependent variable was the number of medications consumed and the independent variables were sex, marital status, education, type of residence, age, income, and self-rated health. Drugs were classified according to the Anatomical Therapeutic Chemical Classification. The inappropriate drugs for the elderly were identified according to the Beers-Fick criteria. The tests used were Chi-square and Fishers exact test, p was considered significant when < 0.05. RESULTS The elderly consumed 2,846 medicines (3.63 medications/person). The most commonly consumed were those which act in the cardiovascular system (38.6%). The prevalence of polypharmacy was 26.4% and self-medication was 35.7%. The most used drugs for self-medication were analgesics (30.8%), 24.6% of the elderly consumed drug considered inappropriate. Women, widows, those aged 80 or over and with worse self-rated health were more likely to practiced more polypharmacy. Most self-medication was associated with lower levels of education and worse self-rated health. CONCLUSIONS The pattern of drug use by the elderly was similar to that found in the elderly in other regions of Brazil. The number of drugs used, the prevalence of self-medication and practice of polypharmacy and inappropriate drug use were within the national average.

Multidimensional pain evaluation scale

Os objetivos deste estudo foram elaborar escala de avaliacao de dor e valida-la para a lingua portuguesa. Elaboracao de inventario - foram pesquisados 308 descritores de dor da literatura mundial e, a partir desses, seis juizes realizaram a validacao aparente e de conteudo. Como resultados foram encontrados 100 descritores de dor aguda e 100 de cronica, os quais foram utilizados na proxima etapa. Validacao estatistica - participaram 493 profissionais da saude e 146 portadores de dor aguda e de cronica. Usou-se, como material, instrucoes aos participantes, descritores de dor e suas definicoes, caneta e trena. Foram utilizados metodos psicofisicos: estimacao de categorias, estimacao de magnitudes e emparelhamento intermodal com modalidade em comprimento de linhas. Os resultados mostram escalonamento dos descritores de maior caracterizacao para a dor aguda e para a dor cronica, tendo sido encontrado expoente igual a 0,99, proximo ao predito (um) ao utilizar comprimentos de linhas e estimativas numericas. Foi validada para a lingua portuguesa a Escala Multidimensional de Avaliacao de Dor (EMADOR).This study developed a pain evaluation scale and validated it for the Portuguese language. Development of the inventory--308 readily available pain descriptors--were searched in international literature and validated by six judges. One hundred descriptors of acute pain and 100 descriptors of chronic pain were found, which were used in the next stage. Statistical validation--493 health professionals and 146 patients experiencing acute and chronic pain participated in the study. Instructions, pain descriptors and respective definitions, pen and measuring tape were provided to participants. Psychophysical methods were used to establish categories, magnitude and cross-modality matching using line-length. Results revealed the ranking of the most frequently used descriptors of acute and chronic pain, with power equal to 0.99, close to the predicted (one), using line-length estimations. The Multidimensional Pain Evaluation Scale is thus validated for the Portuguese language.

Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study

OBJECTIVE: to identify the prevalence and intensity of chronic pain among elderly people of the community and to analyze associations with the self-perceived health status. METHOD: cross-sectional study with a populational sample (n=934), conducted through household interviews in the city of Goiânia, Brazil. The intensity of chronic pain (existing for 6 months or more) was measured using a numerical scale (0-10) and the self-perceived health through a verbal scale (very good, good, fair, poor, very poor). For the statistical analysis, the absolute frequency and percentage, CI (95%), Chi-square test, Odds ratio, and regression analysis were used. Significance of 5%. RESULTS: The prevalence of chronic pain was 52.8% [CI (95%):49.4-56.1]; most frequently located in the lower limbs (34.5%) and lumbar region (29.5%); with high or the worst possible intensity for 54.6% of the elderly people. The occurrence of chronic pain was associated with (p<0.0001) a worse self-perception of health (OR=4.2:2.5-7.0), a greater number of chronic diseases (OR=1.8:1.2-2.7), joint disease (OR=3.5:2.4-5.1) and the female gender (OR=2.3:1.7-3.0). A lower intensity of chronic pain was associated with a better self-perception of health (p<0.0001). CONCLUSION: the majority of the elderly people of the community reported chronic pain, of a severe intensity, and located in areas related to movement activities, thus influencing the morbidity and mortality of this population.OBJETIVO: identificar a prevalencia e a intensidade de dor cronica entre idosos da comunidade e analisar associacoes com a autopercepcao do estado de saude. METODO: estudo transversal, com amostra populacional (n=934), conduzido por meio de entrevista domiciliar, na cidade de Goiânia, Brasil. A intensidade da dor cronica (existente ha 6 meses ou mais) foi mensurada por meio de escala numerica (0-10) e a autopercepcao de saude por meio de escala verbal (muito boa, boa, regular, ruim, muito ruim). Para analise estatistica utilizou-se frequencia absoluta e porcentual, IC (95%), teste do qui-quadrado, Odds ratio e analise de regressao. Significância de 5%. RESULTADOS: a prevalencia de dor cronica foi de 52,8% [IC (95%):49,4-56,1]; localizada com maior frequencia em membros inferiores (34,5%) e regiao lombar (29,5%); de intensidade forte ou pior possivel para 54,6% dos idosos. Ocorrencia de dor cronica associou-se (p<0,0001) a pior autopercepcao de saude (OR=4,2:2,5-7,0), numero de doencas cronicas (OR=1,8:1,2-2,7), doenca articular (OR=3,5:2,4-5,1) e sexo feminino (OR=2,3:1,7-3,0). Menor intensidade de dor cronica associou-se a melhor autopercepcao de saude (p<0,0001). CONCLUSAO: a maioria dos idosos da comunidade relata dor cronica, de elevada intensidade, e localizada em regioes relacionadas as atividades de deslocamento, podendo influenciar na morbimortalidade dessa populacao.

Medicine use by the elderly in Goiania, Midwestern Brazil

OBJETIVO: Analisar o padrao de consumo de medicamentos entre idosos e sua associacao com aspectos socioeconomicos e autopercepcao de saude. METODOS: Estudo de base populacional e delineamento transversal com 934 idosos de Goiânia, GO, Brasil, entre dezembro de 2009 e abril de 2010. Os dados foram coletados por meio de questionario. As variaveis estudadas foram: numero de medicamentos consumidos, sexo, estado civil, escolaridade, tipo de moradia, idade, renda e autopercepcao de saude. Os medicamentos foram classificados segundo o Anatomical Therapeutic and Chemical Classification. Os medicamentos improprios para idosos foram identificados segundo o Criterio de Beers-Fick. Os testes utilizados foram Qui-quadrado (X2) e exato de Fisher e p foi considerado significativo quando < 0,05. RESULTADOS: Os idosos consumiam 2.846 medicamentos (3,63 medicamentos/idoso). Os mais usuais atuavam no aparelho cardiovascular (38,6%). A prevalencia de polifarmacia foi de 26,4% e da automedicacao de 35,7%. Os medicamentos mais ingeridos por automedicacao foram os analgesicos (30,8%); 24,6% dos idosos consumia medicamento considerado improprio. Mulheres, viuvos, idosos com 80 anos ou mais e com pior autopercepcao de saude praticavam mais a polifarmacia. A maior pratica da automedicacao esteve associada com menor escolaridade e pior autopercepcao de saude. CONCLUSOES: O padrao do consumo de medicamentos por idosos foi semelhante ao encontrado em idosos de outras regioes do Brasil. O numero de medicamentos usados, a prevalencia das praticas da polifarmacia e automedicacao e consumo de medicamentos improprios estiveram dentro da media nacional.OBJECTIVE To analyze the pattern of use of medications use in aged people and associate it with socioeconomic aspects and with the self-rated health. METHODS A population-based cross-sectional design study with 934 elderly people from Goiania, Midwestern Brazil, between December 2009 and April 2010. Data were collected through a questionnaire. The dependent variable was the number of medications consumed and the independent variables were sex, marital status, education, type of residence, age, income, and self-rated health. Drugs were classified according to the Anatomical Therapeutic Chemical Classification. The inappropriate drugs for the elderly were identified according to the Beers-Fick criteria. The tests used were Chi-square and Fishers exact test, p was considered significant when < 0.05. RESULTS The elderly consumed 2,846 medicines (3.63 medications/person). The most commonly consumed were those which act in the cardiovascular system (38.6%). The prevalence of polypharmacy was 26.4% and self-medication was 35.7%. The most used drugs for self-medication were analgesics (30.8%), 24.6% of the elderly consumed drug considered inappropriate. Women, widows, those aged 80 or over and with worse self-rated health were more likely to practiced more polypharmacy. Most self-medication was associated with lower levels of education and worse self-rated health. CONCLUSIONS The pattern of drug use by the elderly was similar to that found in the elderly in other regions of Brazil. The number of drugs used, the prevalence of self-medication and practice of polypharmacy and inappropriate drug use were within the national average.

Avaliação da dor durante a troca de curativo de úlceras de perna

The aim in this study was to assess the pain resulting from leg ulcers during dressing change and to identify the most painful procedures in the opinion of SUS patients. Cross-sectional study with the participation of 76 patients with leg ulcers, 69.8% being male with an average age of 57.8 (sd=13.2) who were admitted at Primary Health Care Units and at the Outpatient Care Centre of Goiania Hospital das Clinicas, in the state of Goias, Brazil. For the assessment of pain, a Numerical Rating Scale (1-10) and the McGill Pain Questionnaire were used. The occurrence of pain during dressing change was 76.3%, with a moderate intensity (Mean=5, Q1=3, Q3+8, Min=1, Max=10). The degree of pain was described as tiring (63.2%) and throbbing (55.3%). The most painful procedures in the opinion of the participants included cleaning the wound and removing the previous dressing. The pain during dressing change for leg ulcers was frequent and increased during wound cleaning and removal of previous dressing DESCRIPTORS: Pain measurement. Leg ulcer. Bandages. Pain. Nursing.

Escala Multidimensional de Avaliação de Dor (EMADOR)

Os objetivos deste estudo foram elaborar escala de avaliacao de dor e valida-la para a lingua portuguesa. Elaboracao de inventario - foram pesquisados 308 descritores de dor da literatura mundial e, a partir desses, seis juizes realizaram a validacao aparente e de conteudo. Como resultados foram encontrados 100 descritores de dor aguda e 100 de cronica, os quais foram utilizados na proxima etapa. Validacao estatistica - participaram 493 profissionais da saude e 146 portadores de dor aguda e de cronica. Usou-se, como material, instrucoes aos participantes, descritores de dor e suas definicoes, caneta e trena. Foram utilizados metodos psicofisicos: estimacao de categorias, estimacao de magnitudes e emparelhamento intermodal com modalidade em comprimento de linhas. Os resultados mostram escalonamento dos descritores de maior caracterizacao para a dor aguda e para a dor cronica, tendo sido encontrado expoente igual a 0,99, proximo ao predito (um) ao utilizar comprimentos de linhas e estimativas numericas. Foi validada para a lingua portuguesa a Escala Multidimensional de Avaliacao de Dor (EMADOR).This study developed a pain evaluation scale and validated it for the Portuguese language. Development of the inventory--308 readily available pain descriptors--were searched in international literature and validated by six judges. One hundred descriptors of acute pain and 100 descriptors of chronic pain were found, which were used in the next stage. Statistical validation--493 health professionals and 146 patients experiencing acute and chronic pain participated in the study. Instructions, pain descriptors and respective definitions, pen and measuring tape were provided to participants. Psychophysical methods were used to establish categories, magnitude and cross-modality matching using line-length. Results revealed the ranking of the most frequently used descriptors of acute and chronic pain, with power equal to 0.99, close to the predicted (one), using line-length estimations. The Multidimensional Pain Evaluation Scale is thus validated for the Portuguese language.

Prevalência, intensidade de dor crônica e autopercepção de saúde entre idosos: estudo de base populacional

OBJECTIVE: to identify the prevalence and intensity of chronic pain among elderly people of the community and to analyze associations with the self-perceived health status. METHOD: cross-sectional study with a populational sample (n=934), conducted through household interviews in the city of Goiânia, Brazil. The intensity of chronic pain (existing for 6 months or more) was measured using a numerical scale (0-10) and the self-perceived health through a verbal scale (very good, good, fair, poor, very poor). For the statistical analysis, the absolute frequency and percentage, CI (95%), Chi-square test, Odds ratio, and regression analysis were used. Significance of 5%. RESULTS: The prevalence of chronic pain was 52.8% [CI (95%):49.4-56.1]; most frequently located in the lower limbs (34.5%) and lumbar region (29.5%); with high or the worst possible intensity for 54.6% of the elderly people. The occurrence of chronic pain was associated with (p<0.0001) a worse self-perception of health (OR=4.2:2.5-7.0), a greater number of chronic diseases (OR=1.8:1.2-2.7), joint disease (OR=3.5:2.4-5.1) and the female gender (OR=2.3:1.7-3.0). A lower intensity of chronic pain was associated with a better self-perception of health (p<0.0001). CONCLUSION: the majority of the elderly people of the community reported chronic pain, of a severe intensity, and located in areas related to movement activities, thus influencing the morbidity and mortality of this population.OBJETIVO: identificar a prevalencia e a intensidade de dor cronica entre idosos da comunidade e analisar associacoes com a autopercepcao do estado de saude. METODO: estudo transversal, com amostra populacional (n=934), conduzido por meio de entrevista domiciliar, na cidade de Goiânia, Brasil. A intensidade da dor cronica (existente ha 6 meses ou mais) foi mensurada por meio de escala numerica (0-10) e a autopercepcao de saude por meio de escala verbal (muito boa, boa, regular, ruim, muito ruim). Para analise estatistica utilizou-se frequencia absoluta e porcentual, IC (95%), teste do qui-quadrado, Odds ratio e analise de regressao. Significância de 5%. RESULTADOS: a prevalencia de dor cronica foi de 52,8% [IC (95%):49,4-56,1]; localizada com maior frequencia em membros inferiores (34,5%) e regiao lombar (29,5%); de intensidade forte ou pior possivel para 54,6% dos idosos. Ocorrencia de dor cronica associou-se (p<0,0001) a pior autopercepcao de saude (OR=4,2:2,5-7,0), numero de doencas cronicas (OR=1,8:1,2-2,7), doenca articular (OR=3,5:2,4-5,1) e sexo feminino (OR=2,3:1,7-3,0). Menor intensidade de dor cronica associou-se a melhor autopercepcao de saude (p<0,0001). CONCLUSAO: a maioria dos idosos da comunidade relata dor cronica, de elevada intensidade, e localizada em regioes relacionadas as atividades de deslocamento, podendo influenciar na morbimortalidade dessa populacao.

Versão brasileira do Instrumento de Avaliação da Dor em Paciente Não Comunicativo (NOPPAIN): equivalência conceitual, de itens e semântica

The evaluation and measurement of pain in individuals with dementia and unable to communicate verbally has been a challenging experience. The Non-communicative Patients Pain Assessment Instrument (NOPPAIN) is an instrument that evaluates this phenomenon by observing behaviors that express pain. Considering the lack of instruments for this purpose in Brazil, the current study was designed to translate the NOPPAIN instrument into Brazilian Portuguese and culturally adapt it to the Brazilian reality. This was a methodological study, with Guillemin et al. as the theoretical reference. The study included four steps: translation; obtaining a consensus version; back-translation; and evaluation of the translation and back-translation by an expert panel. In this initial approach, the NOPPAIN-Br showed semantic equivalence to the original instrument and is now available in Brazilian Portuguese for further validation.

Nonpharmacologic therapies in diabetic neuropathic pain: a review

Painful diabetic neuropathy is characterized by intense pain. The objective was to conduct a literature review regarding the pharmacologic therapies used to relieve that pain. A literature search was conducted of six (6) data sources, in the last 12 years (1998 to 2010) using the keywords: diabetes, diabetes, painful neuropathy, neuropathic pain, treatment, and other similar terms. Thirteen articles were selected that addressed the use of acupuncture, reiki, photic stimulation, electromagnetic stimulation of neural electrical stimulation, laser therapy. The non-pharmacological therapies are being used to alleviate diabetic neuropathic pain, however, there is no consensus about the effectiveness of such treatment in reducing this pain. The knowledge base on the subject is scarce, especially in Brazil.