Vania Regina Goveia

Artroplastia do quadril: prevenção de infecção do sítio cirúrgico

Objective: To investigate preventive measures of the surgical site infection in patients undergoing hip arthroplasty. Method: Retrospective and descriptive study of procedures performed in a teaching hospital, from May 2010 to June 2012. Results: A total of 78 hip arthroplasties were conducted, with predominance of elderly and women. The main diagnosis was head femoral fracture. Half of the revision surgeries were performed due to infection. The mean preoperative hospital stay was 13.6 days and 94.9% of the patients were discharged. The preoperative bath was done by 86% of the participants; 23.1% had no hair removed; 80.8 and 83.3% had their skin prepared by scrubbing and antisepsis respectively; and antimicrobial prophylaxis was administered in 97% of them. Conclusion: Lack of registration of preventive measures in patients’ records was the main limitation of this study. Preventive measures of the surgical site infection have been partially adopted, so it is necessary to train healthcare workers and investig ate the causes of low compliance to preventive measures.

Transplantados cardíacos em pós‑operatório mediato: diagnósticos de Enfermagem segundo pressupostos de Horta

Objective: To identify the profile of Nursing diagnoses in heart‑transplanted patients in the postoperative period from the Taxonomy II of the North‑American Nursing Diagnosis Association, and to discuss them using Horta’s assumptions and scientific literature. Method: A retrospective, descriptive, exploratory study performed in Belo Horizonte, Minas Gerais State, Brazil, in a large‑sized general hospital. The sample consisted of 49 adult patients, aged ≥18 and <60 years, of both genders, heart‑transplanted subjects in the postoperative period. Data were collected from patient records. Results: We identified 12 Nursing diagnoses, divided into 10 real and two potential ones, 100% belonging to the psychobiological basic human need. Conclusion: There was not a diagnostic identification for psychosocial and psychospiritual needs. According to Horta, the biologicist paradigm moves Nursing career to the patient’s fragmentation, keeps nurse in alienation, and is opposed to the pragmatic focused on holism.

A CONTRIBUIÇÃO DE IMRE LAKATOS PARA A ANÁLISE EPISTEMOLÓGICA DO PROGRAMA BRASILEIRO DE PÓS-GRADUAÇÃO EM ENFERMAGEM

Objective: to present the theoretical perspective of Imre Lakatos, from its Methodology of Scientific Research Programs, and its epistemological evaluation of the Brazilian Postgraduate Nursing Program. Method: It is a reflexive analysis, organized into three sections, with the following question: Can the theoretical-philosophical proposition by Imre Lakatos contribute to assess to the Brazilian Postgraduate Nursing Program? Discussion: It is assumed that nursing care as a theoretical hypothesis; it presents the basic elements of lakatosian program: the hard core, the protective belt, negative and positive heuristics and its application for evaluation of Brazilian Postgraduate Nursing Program. Program researchers must define and establish the lakatosian basic elements. After 43 years of the creation of the stricto sensu postgraduate programs in Brazil, a critical analysis of its epistemological foundation is necessary. Conclusion: the amplification of the evaluation process from the link between quantitative and philosophical in order to judge the Nursing Science is recommended.

LA CONTRIBUCIÓN DE IMRE LAKATOS PARA EL ANÁLISIS EPISTEMOLÓGICO DEL PROGRAMA DE POST-GRADO EN ENFERMERÍA DE BRASIL

Objective: to present the theoretical perspective of Imre Lakatos, from its Methodology of Scientific Research Programs, and its epistemological evaluation of the Brazilian Postgraduate Nursing Program. Method: It is a reflexive analysis, organized into three sections, with the following question: Can the theoretical-philosophical proposition by Imre Lakatos contribute to assess to the Brazilian Postgraduate Nursing Program? Discussion: It is assumed that nursing care as a theoretical hypothesis; it presents the basic elements of lakatosian program: the hard core, the protective belt, negative and positive heuristics and its application for evaluation of Brazilian Postgraduate Nursing Program. Program researchers must define and establish the lakatosian basic elements. After 43 years of the creation of the stricto sensu postgraduate programs in Brazil, a critical analysis of its epistemological foundation is necessary. Conclusion: the amplification of the evaluation process from the link between quantitative and philosophical in order to judge the Nursing Science is recommended.

THE CONTRIBUTION OF IMRE LAKATOS FOR EPISTEMOLOGICAL ANALYSIS OF THE BRASÍLIAN NURSING POSTGRADUATE PROGRAM

Objective: to present the theoretical perspective of Imre Lakatos, from its Methodology of Scientific Research Programs, and its epistemological evaluation of the Brazilian Postgraduate Nursing Program. Method: It is a reflexive analysis, organized into three sections, with the following question: Can the theoretical-philosophical proposition by Imre Lakatos contribute to assess to the Brazilian Postgraduate Nursing Program? Discussion: It is assumed that nursing care as a theoretical hypothesis; it presents the basic elements of lakatosian program: the hard core, the protective belt, negative and positive heuristics and its application for evaluation of Brazilian Postgraduate Nursing Program. Program researchers must define and establish the lakatosian basic elements. After 43 years of the creation of the stricto sensu postgraduate programs in Brazil, a critical analysis of its epistemological foundation is necessary. Conclusion: the amplification of the evaluation process from the link between quantitative and philosophical in order to judge the Nursing Science is recommended.

Temperatura corporal do paciente idoso no período pós‑operatório

Objective: To identify fever in elderly patients submitted to orthopedic surgery during the postoperative period. Method: This is a retrospective cohort study. Two hundred and sixty-two medical records of elderly people submitted to orthopedic surgery in the period from January 2013 to December 2015 were analyzed. Medical records from 60-year-old patients or older, with complete registration of their body temperature between the first and fifth postoperative days, were included. Results: We found that only 1% of the patients had fever during the postoperative period (38.7°C), and most of them were female patients (58%), aged around 74 years; 52% underwent osteosynthesis of the proximal third of the femur – an orthopedic surgical procedure that had as its main cause the proximal femur fracture (52%). Conclusion: The results found in the research indicate a necessary care, by means of which temperature is controlled after surgical procedures.

Endotoxins in surgical instruments of hip arthroplasty

OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method) was used. RESULT There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. CONCLUSION Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested. OBJETIVO Investigar endotoxinas em instrumentais cirúrgicos esterilizados empregados em artroplastias do quadril. MÉTODO Estudo exploratório, descritivo, desenvolvido em um hospital público de ensino. Foram selecionados seis tipos de instrumentais, a saber: raspa acetabular, raspa femural, saca-cabeça de fêmur, formão box, fresa de fêmur e cabeça de prova de fêmur. A seleção foi feita a partir da análise da dificuldade para a remoção de resíduos de sangue e osso durante a limpeza. A amostra foi constituída por 60 instrumentais cirúrgicos, que foram testados para endotoxinas em três momentos distintos. Foi utilizado o método de gel-clot pelo Limulus Amebócito Lisado (LAL) Endosafe(tm). RESULTADO Houve formação de gel consistente com análise positiva em oito instrumentais, o que corresponde a 13,3%, sendo quatro raspas de fêmur e quatro fresas de fêmur. CONCLUSÃO Foram detectadas endotoxinas em quantidade ≥0,125 UE/mL em 13,3% dos instrumentais testados.OBJETIVO Investigar endotoxinas em instrumentais cirurgicos esterilizados empregados em artroplastias do quadril. METODO Estudo exploratorio, descritivo, desenvolvido em um hospital publico de ensino. Foram selecionados seis tipos de instrumentais, a saber: raspa acetabular, raspa femural, saca-cabeca de femur, formao box, fresa de femur e cabeca de prova de femur. A selecao foi feita a partir da analise da dificuldade para a remocao de residuos de sangue e osso durante a limpeza. A amostra foi constituida por 60 instrumentais cirurgicos, que foram testados para endotoxinas em tres momentos distintos. Foi utilizado o metodo de gel-clot pelo Limulus Amebocito Lisado (LAL) Endosafe(tm). RESULTADO Houve formacao de gel consistente com analise positiva em oito instrumentais, o que corresponde a 13,3%, sendo quatro raspas de femur e quatro fresas de femur. CONCLUSAO Foram detectadas endotoxinas em quantidade ≥0,125 UE/mL em 13,3% dos instrumentais testados.

Profile of hip arthroplasty patients in a teaching hospital

OBJECTIVE to characterize the epidemiological profile of patients undergoing hip replacement, primary or revisional. METHODS we conducted a retrospective, descriptive study, including hip arthroplasties performed from January 2009 to June 2012 in a Belo Horizonte teaching hospital, Minas Gerais State - MG, Brazil. Data were analyzed using descriptive statistics. RESULTS orthopedic procedures represented 45% of the operations at the hospital in the period, 1.4% hip arthroplasties. There were 125 hip replacements, 85 total, 27 partial and 13 reviews. Among the patients, 40% were male and 60% were female. Age ranged between 20 and 102 years, mean and median of 73 and 76 years, respectively. The most frequent diagnosis (82%) was femoral neck fracture by low-energy trauma caused by falling form standing position. In 13 revision operations, 12 required removal of the prosthesis. The infectious complication led to revision in 54% of the time, followed by dislocation (15%), peri-prosthetic fracture (15%) and aseptic loosening (15%). The infection etiologic agent was identified in 43% of occasions. The average length of the prosthesis to a revision operation was eight months. CONCLUSION patients undergoing hip arthroplasty are elderly, with femoral neck fracture caused by falling form standing position, affecting more women. The incidence of hip prosthesis loosening was 10%. The main cause of the infection was loosening. The incidence of revisional hip arthroplasty was 10% and the incidence of hospital mortality in patients undergoing hip arthroplasty was 7.2%.

Como estruturar um isolamento respiratório com pressão negativa do ar, em instituições hospitalares com alto risco ocupacional, para tuberculose pulmonar?

A transmissao intra-hospitalar da tuberculose consiste em um problema de saude ocupacional e as medidas de controle efetivas incluem os controles ambientais que visam prevenir a disseminacao e reduzir as particulas infecciosas aereas. Esse estudo foi realizado com o objetivo de descrever a estrutura necessaria para implantar e operacionalizar uma unidade de isolamento para tuberculose com pressao negativa. Foi realizado em um hospital de ensino, com 640 leitos, localizado em Sao Paulo com admissao anual de 100 pacientes com tuberculose pulmonar. O isolamento respiratorio foi projetado com um sistema de climatizacao com controle de temperatura de 22±2 oC, recirculacao do ar, filtragem HEPA, vinte trocas de ar por hora e pressao negativa. Apos reforma da unidade e implantacao dos controles ambientais, o funcionamento do isolamento respiratorio foi monitorizado por doze meses, tanto para os controles ambientais como para os pacientes admitidos. As ocasioes em que a pressao negativa tornou-se neutra foram identificadas pelos manometros nos quartos e nos filtros, indicando a saturacao dos mesmos e sua substituicao. Apos isso a pressao negativa foi restabelecida. Foram admitidos 131 pacientes, sendo 51 com tuberculose pulmonar. O investimento para a implantacao do isolamento foi de US

The core values of modern nursing in the light of Dilthey and Scheler

75,000.00 e o custo mensal de manutencao US