Rita Simone Lopes Moreira

Hospital discharge plan for patients with congestive heart failure

Trata-se de artigo de revisao integrativa que teve por objetivo identificar como as enfermeiras tem planejado a alta dos pacientes com insuficiencia cardiaca congestiva, pois o inadequado plano de alta e o nao seguimento das orientacoes dadas sao apontados como possiveis fatores de re-hospitalizacao. Atraves da busca nas bases de dados LILACS e MEDLINE, abrangendo o periodo de 2004 a 2008, foram encontrados 24 artigos que, pelo criterio de selecao da amostra, resultaram em 14. Os artigos foram analisados e categorizados em Educacao em Saude e Cuidado de Enfermagem. Com isso, foi possivel sintetizar os resultados e identificar que o plano de alta realizado pelos enfermeiros esta baseado nessas duas categorias, pois as condutas do enfermeiro para promover a educacao em saude podem proporcionar ao paciente com insuficiencia cardiaca congestiva melhora no autocuidado.

Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial

OBJECTIVE To evaluate the lung function and clinical outcome in severe chronic obstructive pulmonary disease in patients undergoing off-pump coronary artery bypass grafting with left internal thoracic artery graft, comparing the pleural drain insertion in the intercostal versus subxyphoid region. METHODS A randomized controlled trial. Chronic obstructive pulmonary disease patients were randomized into two groups according pleural drain site: II group (n=27) - pleural drain in intercostal space; SI group (n=29) - pleural drain in the subxyphoid region. Spirometry values (Forced Vital Capacity - and Forced expiratory volume in 1 second) were obtained on preoperative and 1, 3 and 5 postoperative days. Chest x-ray from preoperative until postoperative day 5 (POD5) was performed for monitoring respiratory events, such as atelectasis and pleural effusion. Pulmonary shunt fraction and pain score was evaluate preoperatively and on postoperative day 1. RESULTS In both groups there was a significant decrease of the spirometry values (Forced Vital Capacity and Forced expiratory volume in 1 second) until POD5 (P<0.05). However, when compared, SI group presented less decrease in these parameters (P<0.05). Pulmonary shunt fraction was significantly lower in SI group (P<0.05). Respiratory events, pain score, orotracheal intubation time and postoperative length of hospital stay were lower in the SI group (P<0.05). CONCLUSION Subxyphoid pleural drainage in severe Chronic obstructive pulmonary disease patients determined better preservation and recovery of pulmonary capacity and volumes with lower pulmonary shunt fraction and better clinical outcomes on early postoperative off-pump coronary artery bypass grafting.

Sub-xyphoid pleural drain as a determinant of functional capacity and clinical results after off-pump coronary artery bypass surgery: a randomized clinical trial

OBJECTIVES The aim of this trial was to compare functional capacity, pulmonary shunt fraction and clinical outcomes between patients undergoing pleurotomy with a pleural drain inserted in the sub-xyphoid position and patients with a pleural drain placed in the intercostal position after off-pump coronary artery bypass surgery. METHODS Patients were randomized into two groups according to the pleural drain site: Group II (n = 33 intercostal pleural drain); and Group SI (n = 35 sub-xyphoid pleural drain). Functional capacity was assessed by the distance covered on the 6-min walking test performed preoperatively and on postoperative day (POD) 5; in addition, pulmonary function test was determined preoperatively and on POD 1 and 5. Pulmonary shunt fraction was evaluated preoperatively and on POD 1, and clinical outcomes were recorded throughout the study. RESULTS Group SI had better preservation of lung volumes and capacities in POD compared with Group II (P <0.05). Pulmonary shunt fraction increased in both groups postoperatively; however, Group SI showed a smaller pulmonary shunt fraction (0.26 ± 0.04 vs 0.21 ± 0.04%; P = 0.0014). Functional capacity was significantly reduced in both groups on POD 5; however, Group SI showed better preservation of functional capacity (P = 0.0001). Group SI had better postoperative clinical results, with lower incidence of atelectasis and pleural effusion (P <0.05), lower pain scores (P <0.0001), and shorter orotracheal intubation and hospitalization lengths (P <0.001). CONCLUSIONS Sub-xyphoid pleural drain determined better functional capacity and exercise tolerance with a smaller pulmonary shunt fraction and improved clinical outcomes compared with intercostal pleural drainage after off-pump coronary artery bypass surgery.

Quality of nursing records related to cardiopulmonary resuscitation compared to the Utstein model

Objective: To assess the quality of nursing records related to cardiopulmonary resuscitation, comparing them to the validated Utstein protocol, in a university hospital. Methods: Retrospective, exploratory and descriptive study, with quantitative approach, performed by means of consultation records of patients that suffered cardiorespiratory arrest (CRA) followed by death. The data collection was carried out in the period of May 1st to June 30 th , in 2009. Results: Of the 144 medical records surveyed, 74 were dismissed for not having any recorded information on the items to be studied and, 70 constituted the study sample. In these there were no entries on: the immediate cause of CRA (92%); the interventions seeking to recover the cardiorespiratoy arrest (RCA) (71%); on the initial rate of CRA (59%); on the time of events (16%); on drugs used (50%); and, on the professionals involved in RCA (88%). Conclusions: The notes were scarce and often not realized. The use of the Utstein model favors the annotation sequence of events, avoiding data loss.OBJECTIVE: To assess the quality of nursing records related to cardiopulmonary resuscitation, comparing them to the validated Utstein protocol, in a university hospital. METHODS: Retrospective, exploratory and descriptive study, with quantitative approach, performed by means of consultation records of patients that suffered cardiorespiratory arrest (CRA) followed by death. The data collection was carried out in the period of May 1st to June 30th, in 2009. RESULTS: Of the 144 medical records surveyed, 74 were dismissed for not having any recorded information on the items to be studied and, 70 constituted the study sample. In these there were no entries on: the immediate cause of CRA (92%); the interventions seeking to recover the cardiorespiratoy arrest (RCA) (71%); on the initial rate of CRA (59%); on the time of events (16%); on drugs used (50%); and, on the professionals involved in RCA (88%). CONCLUSIONS: The notes were scarce and often not realized. The use of the Utstein model favors the annotation sequence of events, avoiding data loss.

Neuromuscular electrical stimulation improves exercise tolerance in patients with advanced heart failure on continuous intravenous inotropic support use—randomized controlled trial:

Objective: To evaluate the impact of a short-term neuromuscular electrical stimulation program on exercise tolerance in hospitalized patients with advanced heart failure who have suffered an acute decompensation and are under continuous intravenous inotropic support. Design: A randomized controlled study. Subjects: Initially, 195 patients hospitalized for decompensated heart failure were recruited, but 70 were randomized. Intervention: Patients were randomized into two groups: control group subject to the usual care (n = 35); neuromuscular electrical stimulation group (n = 35) received daily training sessions to both lower extremities for around two weeks. Main measures: The baseline 6-minute walk test to determine functional capacity was performed 24 hours after hospital admission, and intravenous inotropic support dose was daily checked in all patients. The outcomes were measured in two weeks or at the discharge if the patients were sent back home earlier than two weeks. Results: After losses of follow-up, a total of 49 patients were included and considered for final analysis (control group, n = 25 and neuromuscular electrical stimulation group, n = 24). The neuromuscular electrical stimulation group presented with a higher 6-minute walk test distance compared to the control group after the study protocol (293 ± 34.78 m vs. 265.8 ± 48.53 m, P < 0.001, respectively). Neuromuscular electrical stimulation group also demonstrated a significantly higher dose reduction of dobutamine compared to control group after the study protocol (2.72 ± 1.72 µg/kg/min vs. 3.86 ± 1.61 µg/kg/min, P = 0.001, respectively). Conclusion: A short-term inpatient neuromuscular electrical stimulation rehabilitation protocol improved exercise tolerance and reduced intravenous inotropic support necessity in patients with advanced heart failure suffering a decompensation episode.

Validation of a novel sleep-quality questionnaire to assess sleep in the coronary care unit: a polysomnography study

INTRODUCTION The sleep of patients admitted to coronary care unit (CCU) may be compromised. A feasible and cost-effective tool to evaluate sleep in this scenario could provide important data. The aim of this study was to evaluate sleep with a questionnaire developed specifically for the CCU and to validate it with polysomnography (PSG). METHODS Ninety-nine patients (68% male; 56 ± 10 years old) with acute coronary syndrome were included. PSG was performed within 36 h of admission. A specific 18-question questionnaire (CCU questionnaire) was developed and applied after the PSG. Cronbachs alpha test was used to validate the questionnaire. The Spearman test was used to analyze the correlation between the PSG variables and the questionnaire, and the Kruskal-Wallis test was used to compare the PSG variables among patients with good, regular, or poor sleep. RESULTS The total sleep time was 265 ± 81 min, sleep efficiency 62 ± 18%, REM sleep 10 ± 7%, apnea/hypopnea index 15 ± 23, and the arousal index 24 ± 15. Cronbachs alpha test was 0.69. The CCU questionnaire showed correlation with the sleep efficiency evaluated by PSG (r: 0.52; p < 0.001). Sleep quality was divided into three categories according to the CCU questionnaire: patients with good sleep had a sleep efficiency of 72 ± 9%, better than those with a regular or poor sleep (60 ± 16% and 53 ± 20%, respectively; p < 0.01). CONCLUSION The CCU questionnaire is a feasible and reliable tool to evaluate sleep in the CCU, showing correlation with the PSG sleep efficiency.

Plano de alta hospitalar a pacientes com insuficiência cardíaca congestiva

Trata-se de artigo de revisao integrativa que teve por objetivo identificar como as enfermeiras tem planejado a alta dos pacientes com insuficiencia cardiaca congestiva, pois o inadequado plano de alta e o nao seguimento das orientacoes dadas sao apontados como possiveis fatores de re-hospitalizacao. Atraves da busca nas bases de dados LILACS e MEDLINE, abrangendo o periodo de 2004 a 2008, foram encontrados 24 artigos que, pelo criterio de selecao da amostra, resultaram em 14. Os artigos foram analisados e categorizados em Educacao em Saude e Cuidado de Enfermagem. Com isso, foi possivel sintetizar os resultados e identificar que o plano de alta realizado pelos enfermeiros esta baseado nessas duas categorias, pois as condutas do enfermeiro para promover a educacao em saude podem proporcionar ao paciente com insuficiencia cardiaca congestiva melhora no autocuidado.

Percepção da doença: uma avaliação a ser realizada pelos enfermeiros

Illness perception is understood as the way individuals understand and cope with their disease. The objective of this paper was to identify articles in literature developed by nurses on disease perception, and the instruments available to assess it. An integrative literature review was performed, which identified nine papers that related to the perception of the disease with Health Education, Coping, Treatment adherence and quality of life. Ways of assessing this phenomenon were also identified. It was concluded that nurses should periodically assess the perception of illness by validated instruments, along with the use of nursing diagnoses reported by NANDA International (NANDA-I).Percepcao da doenca e a maneira como os individuos entendem e lidam com sua patologia. O objetivo deste estudo foi identificar, na literatura, artigos desenvolvidos por enfermeiros a respeito da percepcao da doenca e os instrumentos disponiveis para a avaliacao da mesma. Foi realizada uma revisao integrativa da literatura, que possibilitou a identificacao de nove artigos que relacionavam a percepcao da doenca a Educacao em saude, Enfrentamento, Adesao ao tratamento e Qualidade de vida. Tambem foram identificadas formas de avaliacao deste fenomeno. Concluiu-se que os enfermeiros devem avaliar periodicamente a percepcao da doenca por meio de instrumentos validados e, preferencialmente, em conjunto com o uso dos diagnosticos de enfermagem descritos pela NANDA Internacional (NANDA-I).

Noninvasive Ventilation After Coronary Artery Bypass Grafting in Subjects With Left-Ventricular Dysfunction

BACKGROUND: The use of noninvasive ventilation in patients with left-ventricular dysfunction may increase cardiac performance by decreasing inspiratory effort and left-ventricular afterload. The aim of the present study was to evaluate the acute effects of noninvasive ventilation on central-venous oxygen saturation (Scv̄O2) and blood lactate in subjects with left-ventricular dysfunction during the early postoperative phase of coronary artery bypass grafting. METHODS: This study included 100 subjects during the postoperative phase of elective coronary artery bypass grafting. Blood samples, at 5 time points, were collected to assess tissue perfusion markers (ie, Scv̄O2 and blood lactate) as follows: (1) the intraoperative period (after anesthesia induction); (2) 20 min after ICU arrival, under intermittent mandatory ventilation; (3) 20 min after extubation with spontaneous breathing; (4) after 1 h of noninvasive ventilation; and (5) 20 min after discontinuation of noninvasive ventilation. RESULTS: A significant increase in the blood lactate and a drop in the Scv̄O2 were observed on arrival to the ICU compared with intraoperative values (P < .001). After extubation, during spontaneous breathing, the Scv̄O2 significantly decreased (P = .02), whereas the blood lactate increased, although not significantly (P = .21) compared with intermittent mandatory ventilation on arrival to the ICU. During the application of noninvasive ventilation, the Scv̄O2 significantly increased (P = .048) and the blood lactate significantly decreased (P = .008) compared with spontaneous breathing values after extubation. After noninvasive ventilation discontinuation, the Scv̄O2 and blood lactate did not change compared with measures taken during noninvasive ventilation; higher values of Scv̄O2 were maintained compared with those obtained after extubation (P < .001). CONCLUSIONS: The acute application of noninvasive ventilation improved Scv̄O2 and decreased the blood lactate in subjects with left-ventricular dysfunction during the early postoperative phase after coronary artery bypass grafting. (ClinicalTrials.gov registration NCT02767687.)

Adaptação transcultural do Myocardial Infarction Dimensional Assessment Scale (MIDAS) para a língua portuguesa brasileira

Resumo A partir da avaliacao dos fatores que incidem na qualidade de vida (QV) e possivel planejar as intervencoes que proporcionam melhoria do bem-estar dos pacientes. Realizar a adaptacao transcultural do questionario Miocardial Infarction Dimensional Assessment Scale (MIDAS) para lingua portuguesa, buscando as equivalencias semântica, idiomatica, conceitual e cultural. Foi utilizado o referencial teorico de Guillemin, Bombardier e Beaton, cumprindo as seguintes etapas: traducao, retrotraducao, avaliacao dos autores, banca de juizes e pre-teste. Apos todas as avaliacoes, foram alcancadas as equivalencias semântica, conceitual, idiomatica e cultural. A escala mostrou-se de facil aplicacao e importância clinica. O MIDAS encontra-se validado no que se refere as equivalencias semânticas, idiomaticas, conceituais e culturais. Posteriormente, sera avaliada a equivalencia de mensuracao, para verificar as propriedades psicometricas.From the evaluation of the factors that affect quality of life (QOL) it is possible to plan interventions that lead to the improved well-being of patients. The scope of this study was to conduct the cross-cultural adaptation of the Myocardial Infarction Dimensional Assessment Scale (MIDAS) questionnaire to the Portuguese language, seeking the necessary semantic, idiomatic, conceptual and cultural equivalence. The theoretical framework of Guillemin, Bombardier and Beaton was used, fulfilling the following steps: translation, back translation, evaluation of the authors, peer review and pre-testing. After all the tests, the semantic, idiomatic, conceptual and cultural equivalence was achieved. The scale proved to be easy to use and was clinically important. MIDAS was validated in terms of its semantic, idiomatic, conceptual and cultural equivalences. Subsequently, the measurement equivalence will be evaluated to verify the psychometric properties.