Rita de Cássia Helú Mendonça Ribeiro

Caracterização e etiologia da insuficiência renal crônica em unidade de nefrologia do interior do Estado de São Paulo

OBJETIVOS: Caracterizar a los pacientes con insuficiencia renal cronica (IRC) que participan en un programa dialitico; verificar las causas de la IRC; identificar las enfermedades asociadas a la IRC; levantar el tipo de tratamiento y el acceso actual de esos pacientes. METODOS: Se trata de un estudio descriptivo epidemiologico, realizado en una Unidad de Nefrologia en el que fueron incluidos todos los pacientes registrados en el Programa Nefro Data. RESULTADOS: De los 217 pacientes registrados en la Unidad en estudio, observamos que el 68,2% tenian edad superior a 40 anos y el 59,4% eran del sexo masculino. En cuanto a la enfermedad de base, el 31,3% de los pacientes presentan Nefroesclerosis Hipertensiva y el 25,3% Diabetes Mellitus (DM), seguido de la Glomerulonefritis con el 24,5%. Respecto a las enfermedades asociadas, el 42,4% de los pacientes poseen Hipertension Arterial Sistemica (HAS), el 24,9% no poseen comorbidades, el 19,8% HAS y DM. En relacion al tipo de acceso vascular el 70,5% poseen fistula arteriovenosa, siendo la utilizacion del cateter de Tenckhoff exclusivo de la dialisis peritoneal en el 13,3%. CONCLUSION: los resultados permiten una mejor planificacion frente a las necesidades reales de los pacientes.Objectives: Characterize the pacients with chronic renal failure (CRF) in dialythical program; verify the causes of the CRF; identify the associated diseases to CRF; measure the type of treatment and the actual access of the pacients to them. Methods: This is a epidemiological descriptive research performed in a nephrology unit, and all pacients registered in the Nefro Data program were included. Results: Of the group of 217 patients registered in the studied unit, 68,2% have age of 40 or greater and 59,4% are male. Regarding the base disease, 31,3% of the pacients have Hipertensive Nephrosclerosis, 25,3% have Diabetes Mellitus (DM) and 24,5% have Glomerulonephritis. Regarding the associated diseases, 42,4% of the pacients have Systemic Arterial Hipertension (SAH) 24,9% don’t have comorbities, 19,8% have both SAH and DM. Regarding the type of vascular acess, 70,5% have arteriovenous fistula, being the utilization of the Tenckhoff catheter exclusive of peritoneal dialysis in 13,3% of the studied cases. Conclusion: The results allow a better planning with regard to the patients real needs.

Functional independence in patients with chronic kidney disease being treated with haemodialysis

PURPOSE This study has described and analysed the functional independence of the patients served in the haemodialysis services of a countryside town in the State of São Paulo, Brazil, using the Functional Independence Measure (FIM). METHOD The population considered was that of 214 patients being treated with haemodialysis, assessed in 2011, by means of a social, demographic and clinical report, a Mini-Mental State Examination (MMSE) and also the FIM. RESULTS The mean age of the population under study was 58.01 years, while the mean FIM point score was 118.38 points, showing a level of complete or modified independence within this population. Even though the level of dependence found has been low, this can be highlighted, within the locomotion domain, in the activity of going up and down stairs (10.28%). Age, complications arising from haemodialysis, and comorbidities show a negative correlation with FIM. CONCLUSION Awareness of the level of functional independence of the patients being subjected to treatment with haemodialysis is essential in order to back up intervention for the improvement of nursing assistance provided to this population.OBJETIVO: este estudo teve como objetivo descrever e analisar a independencia funcional dos pacientes atendidos nos servicos de hemodialise, de uma cidade do interior paulista, segundo a Medida de Independencia Funcional (MIF). METODO: a populacao foi de 214 pacientes em tratamento hemodialitico, avaliados em 2011, por meio de um questionario sociodemografico e clinico, Miniexame do Estado Mental e MIF. RESULTADOS: a idade media da populacao do estudo foi de 58,01 anos e a media da MIF foi de 118,38 pontos, evidenciando nivel de independencia completa ou modificada dessa populacao. Mesmo tendo sido baixo o nivel de dependencia encontrado, essa dependencia destacou-se no dominio locomocao, na atividade subir e descer escadas (10,28%). A idade, complicacoes relacionadas a hemodialise e comorbidades apresentaram correlacao negativa com a MIF. CONCLUSAO: conhecer o nivel de independencia funcional dos pacientes em tratamento hemodialitico e primordial para subsidiar intervencoes para a melhoria da assistencia de enfermagem prestada a essa populacao.

Elaboração de um instrumento da assistência de enfermagem na unidade de hemodiálise

This study aimed at developing an instrument to record nursing assistance systematization in a hemodialysis unit. For this development, we used the instrument formulated from literature on nursing diagnosis in nephropathic patients. The record instrument has been analyzed according to: layout and process facilitation. The process relied on the Basic Human Needs Theory and the taxonomy of the North American Nursing Diagnosis Association. The instrument has been facilitating the implementation of the nursing process in the hemodialysis unit. It was possible to record the data in a organized and concise fashion and use key information to plan and evaluate the assistance offered.ABSTRACT This study aimed at developing an instrument to record nursing assistance systematization in a hemodialysis unit. For this deve lopment, weused the instrument formulated from literature on nursing diagnosis in nephropathic patients. The record instrument has been analyzedaccording to: layout and process facilitation. The process relied on the Basic Human Needs Theory and the taxonomy of the North AmericanNursing Diagnosis Association. The instrument has been facilitating the implementation of the nursing process in the hemodialysis unit. Itwas possible to record the data in a organized and concise fashion and use key information to plan and evaluate the assistance offered. Keywords : Hemodialysis units, hospital; Renal dialysis/nursing; Nursing care; Nursing diagnosis RESUMO O objetivo deste estudo O relatar a experiŒncia de construcao de um instrumento para registro da sistematizacao da assistŒncia de enfermagemem uma unidade de tratamento dialitico. Para esta construcao, utilizou-se o instrumento formulado com base na literatura sobre diagnosticosde enfermagem em pacientes nefropatas. O instrumento de registr o foi analisado conforme: diagramacao e facilitacao do processo. O processoteve como norteador a teoria das Necessidades Humanas BAEsicas e a taxonomia da North American Nursing Diagnosis Association. Oinstrumento tem facilitado a implantacao do processo de enfermagem na unidade de hemodiAElise. Com o seu uso, foi possivel o registroorganizado e conciso dos dados e uso de informacies importantes para o planejamento e avaliacao da assistŒncia prestada.

Modos de enfrentamento dos estressores de pessoas em tratamento hemodiálitico: revisão integrativa da literatura

An integrative literature review was performed with the purpose to synthesize the contribution brought by research on the ways that people on hemodialysis deal with the treatment. Through a bibliographic review, 12 articles were identified, which composed the study sample. The results point out that problem-focused coping are the most used and that depression was positively correlated with the forms of emotionfocused coping for people on hemodialysis. The identification of the forms of dealing with the treatment is valuable information to plan treatments individually so as to control the stressors inherent to the disease and to hemodialysis, thus supporting the patient toward a betterAn integrative literature review was performed with the purpose to synthesize the contribution brought by research on the ways that people on hemodialysis deal with the treatment. Through a bibliographic review, 12 articles were identified, which composed the study sample. The results point out that problem-focused coping are the most used and that depression was positively correlated with the forms of emotionfocused coping for people on hemodialysis. The identification of the forms of dealing with the treatment is valuable information to plan treatments individually so as to control the stressors inherent to the disease and to hemodialysis, thus supporting the patient toward a better adaptation to the therapeutic regimen.

Trabalho e qualidade de vida relacionada à saúde de pacientes em diálise peritoneal

Objective: To describe and compare Health Related Quality of Life (HRQoL) of patients on peritoneal dialysis (PD) who had and who did not have paid work. Methods: A cross-sectional and populational study with 82 patients from the two PD services in Ribeirão Preto (SP), Brazil. Data collection was conducted by interviews between December/2009 and March/2010. The questionnaires for the characterization of patients, the Mini Mental State Examination and the Kidney Disease and Quality of Life-Short Form were used. Analyses were performed using exploratory univariate and bivariate statistics, and the confirmatory bivariate among the independent variables and the dimensions of HRQoL. Results: Patients with paid work presented higher mean scores reflecting better HRQoL for the majority of the dimensions of the instrument used. Conclusion: Work is an important facet of life for these patients and merits the attention of health professionals in the search for strategies that promote and incentivize its maintenance and the reintegration of patients into the labor market.

Depressão em idosos portadores de insuficiência renal crônica em tratamento hemodialítico

Objectives: This study aimed to characterize the elderly on hemodialysis for chronic renal failure in a teaching hospital and to describe their levels of depression. Methods: This is a descriptive exploratory study with 61 patients. A socio-demographic questionnaire and the geriatric depression scale (GDS) were used to collect the data. Data analysis consisted of descriptive statistics and Spearman rho correlations. Results: The mean age of patients was 69.97±7.51. The majority was white (79%), married (72%), and male (57%). Approximate a quarter of the patients (26%) were illiterate. The mean depression score was 10.43±4.37, suggesting the presence of normal to slightly depressive symptoms. Conclusions: There were statistically significant correlation coefficients between family monthly income and education (p value=0.004) and between depressive symptoms and illiteracy (p=0.028). This last finding indicates that the illiterate patients had more depressive symptoms, suggesting they have less adaptation capacity or resilience to cope with the disease and its implications.Objectives: This study aimed to characterize the elderly on hemodialysis for chronic renal failure in a teaching hospital and to describe their levels of depression. Methods: This is a descriptive exploratory study with 61 patients. A socio-demographic questionnaire and the geriatric depression scale (GDS) were used to collect the data. Data analysis consisted of descriptive statistics and Spearman rho correlations. Results: The mean age of patients was 69.97±7.51. The majority was white (79%), married (72%), and male (57%). Approximate a quarter of the patients (26%) were illiterate. The mean depression score was 10.43±4.37, suggesting the presence of normal to slightly depressive symptoms. Conclusions: There were statistically significant correlation coefficients between family monthly income and education (p value=0.004) and between depressive symptoms and illiteracy (p=0.028). This last finding indicates that the illiterate patients had more depressive symptoms, suggesting they have less adaptation capacity or resilience to cope with the disease and its implications.

Processo de cuidar do idoso em Diálise Peritoneal Ambulatorial Contínua no domicílio

Objectives: To describe the elders with end stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD), their caregivers, and the care the caregivers provide to the elders. Methods: This was a qualitative study with 9 caregivers. Data were collected through oral history. Data analysis consisted of thematic content analysis. Results: The sample consisted of 5 male and 4 female elders and all them were dependent on caregivers to change the dialysis collection bag. The mean age of the participants was 70 years. Among the caregivers, 8 of them were female with a mean age of 41.5 years and they provided 8 hours of care to the elders daily. The main theme emerging from the content analysis was “home care for the elderly undergoing continuous ambulatory peritoneal dialysis.” Conclusion: Caregivers need support for the development of knowledge and skills to deal with the elders’ demand of care, particularly in regard to the management of CAPD.

Avaliação do grau de satisfação de pacientes renais crônicos em hemodiálise

Objective: To identify the level of satisfaction in patients with chronic renal disease on hemodialysis regarding their care and the physical structure of the hemodialysis unit of the Hospital “de Base” of Sao Jose do Rio Preto, SP. Methods: This descriptive study used a Likettype scale to collect data from 81 patients from the nephrology department. Results: Almost all patients were very satisfied (53 %) or satisfied (47%) regarding their care and the physical structure of the hemodialysis unit. A few limitations of the service were also reported. Conclusion: Patients’ satisfaction with the service led to reflection among health care providers regarding their practice and served as an indicator for continuous improvement of the hemodialysis service.

Avaliação do risco cardiovascular de pacientes renais crônicos segundo critérios de Framingham

OBJETIVO: Identificar o perfil do paciente com doenca renal cronica em um servico de hemodialise, e a probabilidade do risco de futuros eventos cardiovascular no periodo de dez anos. METODOS: Estudo transversal com amostra de 242 pacientes com doenca renal cronica. A avaliacao do risco cardiovascular foi atraves do Escore de Risco de Framingham. RESULTADOS: Os fatores de risco para doencas cardiovasculares mais prevalentes foram: hipertensao arterial (90,49%), sedentarismo (80,16%), tabagismo (51,23%). O risco cardiovascular em relacao as variaveis genero e renda familiar apresentou diferenca estatistica (p<0,05). Apenas 0,8% dos pacientes apresentaram alto risco de doenca cardiovascular, 28,8% medio risco e 70,2% baixo risco cardiovascular. CONCLUSAO: Os dados apontaram para baixo risco cardiovascular nos pacientes renais cronicos.

Necessidades de aprendizagem de profissionais de enfermagem na assistência aos pacientes com fístula arteriovenosa

Objectives: To identify the learning needs of professional nurses to provide quality care for patients with arteriovenous fistula (AV Fistula) for hemodialysis. Methods: This cross-sectional descriptive study was conducted with 36 professional nurses from the hemodialysis unit of a hospital in the State of Sao Paulo. A semi-structured questionnaire was used to collect the data. Initially, questionnaires were distributed to 43 nurses, but only 36 (83.7%) responded and returned the questionnaires. Results: A great number of nurses (44.9 %) reported to have difficulties in providing quality care for patients with AV Fistula. Difficulties were related to the access of AV Fistula for hemodialysis (47.2%), hemostasis of the site when withdrawing the needle after hemodialysis (19.4%) and lack of competency for the management of hematoma (13.9%), and patient’s instructions and education (19.4%). Conclusions: Nurses had many learning needs to prepare them to care for patients with arteriovenous AV Fistula. This finding led to the development of a protocol to facilitated quality care nursing care.OBJECTIVES: To identify the learning needs of professional nurses to provide quality care for patients with arteriovenous fistula (AV Fistula) for hemodialysis. METHODS: This cross-sectional descriptive study was conducted with 36 professional nurses from the hemodialysis unit of a hospital in the State of Sao Paulo. A semi-structured questionnaire was used to collect the data. Initially, questionnaires were distributed to 43 nurses, but only 36 (83.7%) responded and returned the questionnaires. RESULTS: A great number of nurses (44.9 %) reported to have difficulties in providing quality care for patients with AV Fistula. Difficulties were related to the access of AV Fistula for hemodialysis (47.2%), hemostasis of the site when withdrawing the needle after hemodialysis (19.4%) and lack of competency for the management of hematoma (13.9%), and patients instructions and education (19.4%). CONCLUSIONS: Nurses had many learning needs to prepare them to care for patients with arteriovenous AV Fistula. This finding led to the development of a protocol to facilitated quality care nursing care.