Compromised end-of-life syndrome in cancer patients: A clinical validation study.

PURPOSE: To identify the prevalence of the nursing diagnosis of compromised end-of-life syndrome in patients in end-of-life care. METHODS: This is a clinical validation based on a cross-sectional epidemiological clinical study conducted at the National Cancer Institute in Rio de Janeiro, Brazil. The defining characteristics of a syndrome diagnosis were identified, defined as a "subset of nursing diagnoses," using sensitivity and specificity measures through the application of latent class statistical methods. FINDINGS: The statistical results revealed seven nursing diagnoses characterizing the syndrome: imbalanced nutrition: less than body requirements, nausea, anxiety, ineffective breathing pattern, disturbed sleep pattern, ineffective thermoregulation, and fatigue. Compromised end-of-life syndrome was present in 76% of the sample. CONCLUSION: The study demonstrated the presence of compromised end-of-life syndrome in most end-of-life patients from the sample. IMPLICATIONS FOR NURSING PRACTICE: Recognizing the presence of the syndrome diagnosis enables nurses to have efficient and effective clinical reasoning for implementing the nursing process in palliative care. CAAE Number: 85415618.0.3001.5274.

OBJETIVO: Identificar a prevalência do diagnóstico de enfermagem Síndrome de fim de vida comprometido em pacientes em cuidados de fim de vida. MÉTODO: Trata-se de uma validação clínica baseada em um estudo clínico epidemiológico transversal, desenvolvido no Instituto Nacional do Câncer no Rio de Janeiro, Brasil. Foram identificadas as características definidoras de um diagnóstico de síndrome, definido como um "subconjunto de diagnósticos de enfermagem" utilizando-se medidas de sensibilidade e especificidade a partir da aplicação do método estatístico de classe latente. RESULTADOS: Os resultados estatísticos identificaram sete diagnósticos de enfermagem caracterizadores da síndrome: nutrição desequilibrada: menor que as necessidades corporais, náusea, ansiedade, padrão respiratório ineficaz, padrão de sono perturbado, termorregulação ineficaz e fadiga. O diagnóstico Síndrome de fim de vida comprometido esteve presente em 76% da amostra. CONCLUSÃO: O estudo demonstrou a presença da Síndrome de fim de vida comprometido na maioria dos pacientes em cuidados de fim de vida da amostra. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: O reconhecimento da presença do diagnóstico de síndrome permite ao enfermeiro um raciocínio clínico eficaz e eficiente para a implantação do processo de enfermagem em cuidados paliativos. Número CAAE: 85415618.0.3001.5274.

Prognostic Indicators of Delayed Surgical Recovery in Patients Undergoing Cardiac Surgery.

PURPOSE: The purpose of this study was to analyze the prognostic capacity of the clinical indicators of a delayed surgical recovery nursing diagnosis throughout the hospital stay of patients having cardiac surgery. DESIGN: A prospective cohort design was adopted. A sample of inpatients undergoing elective cardiac surgery was followed during the immediate preoperative period and hospitalization. This research was conducted in the southeast region of Brazil at a national reference institution that treats highly complex diseases and performs cardiac surgeries. Data were collected from July 2017 to July 2018. METHODS: At the end of 1 year of data collection, 181 patients were followed in this study. The Kaplan-Meier method was used to calculate the survival time related to delayed surgical recovery. In addition, an extended Cox model of time-dependent covariates was adjusted to identify the clinical signs that influenced the change in the nursing diagnosis status. RESULTS: A delayed surgical recovery nursing diagnosis was present in 23.2% of the sample studied. With an expected length of stay of 8 to 10 days, most new cases of delayed surgical recovery were observed on the 10th postoperative day, and the survival rate after this day was decreased until the 29th postoperative day, when the nursing diagnosis no longer appeared. Interrupted healing of the surgical area, loss of appetite, and atrial flutter were indicators related to an increased risk for delayed surgical recovery. CONCLUSIONS: Timely recognition of selected clinical indicators demonstrates a promising prognostic capacity for delayed surgical recovery. CLINICAL RELEVANCE: Accurate identification of prognostic factors allows nurses to identify early signs of postoperative complications. Consequently, the professional can develop an individualized plan of care, aiming at the satisfactory clinical recovery of the patient.

Nutritional Deficits In Children With Cancer: A Situation-Specific Theory.

PURPOSE: To construct a situation-specific theory (SST) to represent nutritional deficits for assessing children with cancer. DATA SOURCES: Literature review. DATA SYNTHESIS: The SST included the definition of key concepts, a pictorial scheme, propositions, causal relationships, and evidence for nursing practice. CONCLUSIONS: It was possible to characterize the elements as antecedent and consequent clinical factors to allow for an understanding of the existing relationships between them and their temporality. These elements differed considerably from those included in NANDA International. IMPLICATIONS FOR NURSING PRACTICE: This study provides additional information so that nurses in clinical practice can infer the presence of nutritional deficits in children with cancer early, given the risk already inherent in the diagnosis of cancer and treatment.

Hierarchical analysis of factors associated with hospital readmissions for coronary heart disease: A case-control study.

AIMS AND OBJECTIVES: To analyse, hierarchically, factors associated with hospital readmissions for acute coronary syndrome. BACKGROUND: Hospital readmissions have risen, especially in patients with multiple comorbidities, which are most often chronic. The leading causes of hospital readmission include acute coronary syndrome, which is costly and often preventable. Determining clinical and nonclinical variables that increase the chances of readmission is important to assess and evaluate patients hospitalised for coronary heart diseases. DESIGN: A case-control study whose dependent variable was hospital readmission for acute coronary syndrome. METHODS: The study included 277 inpatients, of whom 132 were in their first hospitalisation and 145 had already been hospitalised for acute coronary syndrome. The independent variables for this hierarchical model were sociodemographic conditions, life habits, access to health services and physical health measures. Data were obtained by interviews, anthropometric measurements and patient records. Logistic regression analysis was performed using the stepwise technique, with Microsoft Excel and R version 3.2.3. The research was reported via strengthening the reporting of observational studies in epidemiology (STROBE). RESULTS: In the final hierarchical logistic model, the following risk factors were associated with readmission for acute coronary syndrome: inadequate drug therapy adherence, stress, history of smoking for 30 years or more, and the lack of use of primary healthcare services. CONCLUSIONS: Clinical and nonclinical variables are related to hospital readmission for acute coronary syndrome and can increase the chance of readmission by up to six times. RELEVANCE TO CLINICAL PRACTICE: The predictive model can be used to avoid readmission for acute coronary syndrome, and it represents an advance in the prediction of the occurrence of the outcome. This implies the need for a reorientation of the network for postdischarge care in the first hospitalisation for acute coronary syndrome.

Nursing Diagnosis Risk for Delayed Surgical Recovery (00246) in Adult and Elderly: A Case-Control Study.

PURPOSE: The study's objective was the clinical validation of the nursing diagnosis Risk for delayed surgical recovery (00246). METHOD: Case control study was conducted in a university hospital; the charts of 239 patient, 71 cases and 168 controls. Odds ratio was calculated for the association between each risk factor and the outcome of delayed surgical recovery. RESULTS: Risk factors with higher odds of association were malnutrition, pain, and postoperative emotional response. The associated conditions were perioperative surgical site infection, psychological disorder in the postoperative period, and surgical site contamination. CONCLUSION: Risk factors have different impact on the postoperative recovery. IMPLICATIONS FOR NURSING PRACTICE: Knowing the magnitude of the risk factors allows a decision making best interventions for a fast surgical recovery.

Impaired Gas Exchange: Prognostic Clinical Indicators of Short-Term Survival in Children with Acute Respiratory Infection.

PURPOSE: To establish prognostic indicators of survival for impaired gas exchange (IGE) (00030). METHODS: Secondary analysis of data from an open prospective cohort developed with a group of 136 children with acute respiratory infection (ARI). FINDINGS: On Day 1, IGE (00030) was present in 42.6% of the sample. New cases arose until the last day of evaluation. With regards to defining characteristics, only hypoxemia and abnormal skin color were associated with a higher risk of developing diagnosis. CONCLUSIONS: Children with ARI who exhibit hypoxemia and abnormal skin color had a worse prognosis for IGE (00030). IMPLICATIONS FOR NURSE PRACTICE: Nurses can use the research findings as a predictive marker of the evolution of the patient's health status.

Tensão do papel de cuidador principal diante do cuidado prestado a crianças com câncer / del cuidador principal frente al cuidado de niños con cáncer / The main caregiver role in the care given to children with cancer

Introdução: a luta contra o câncer não é um processo fácil e não se limita só ao paciente, mas se estende àqueles mais próximos a ele e que exercem o papel de cuidador. Objetivo: avaliar o diagnóstico de enfermagem Tensão do papel de cuidador em cuidadores de crianças internadas com câncer. Métodos: trata-se de um estudo exploratório com abordagem quantitativa, realizado de janeiro a março de 2012 em um hospital de referência para o tratamento do câncer infantil na capital do estado de Pernambuco, Brasil. A amostra foi constituída por 46 cuidadores principais de crianças com câncer. Os dados foram coletados pela técnica de entrevista uma entrevista estruturada com perguntas referentes às características definidoras do diagnóstico "Tensão do papel de cuidador". Os dados das características definidoras estão organizados em porcentagens de acordo com a frequência de ocorrência. Resultados: apresentaram o diagnóstico "ensão do papel de cuidador 44 cuidadores (95,65 porcento). A característica definidora enfrentamento individual prejudicado foi a mais frequente (84,7 porcento), seguido pelo estresse com 82,6 porcento e a preocupação coma rotina de cuidados (78,2 porcento). As patologias cardiovasculares foram a menos frequente (2,1 porcento), e a diabete não foi citado por nenhum cuidador. Verificou-se não haver relação entre o número de características definidoras com o tempo de tratamento. Conclusão: os cuidadores das crianças apresentam características definidoras que são pertinentes para sinalizar a presença do diagnóstico Tensão do papel de cuidador, demonstrado pelos mais diferentes aspectos físicos, emocionais e sociais resultantes dessa atividade(AU)

Introducción: la lucha contra el cáncer no es un proceso fácil y no se limita sólo al paciente sino que se extiende a aquellos que son más cercanos a ejercer el papel de cuidador. Objetivo: evaluar el diagnóstico Tensión del Rol de Cuidador para los cuidadores de los niños hospitalizados con cáncer. Métodos: estudio exploratorio con abordaje cuantitativo, realizado de enero a marzo de 2012 en un hospital de referencia en el tratamiento del cáncer infantil, la capital del estado de Pernambuco, Brasil. El universo quedó constituido por 46 cuidadores principales de niños con cáncer. Los datos fueron recolectados a través de una entrevista estructurada, con preguntas que contienen las características definidoras del diagnóstico Tensión del Rol de Cuidador. Los datos de las características definidoras estaban organizados en percentiles de acuerdo a la frecuencia de ocurrencia. Resultados: tuvieron diagnóstico de Tensión del Rol de cuidador"44 pacientes (95,65 por ciento). Las variables de estudio: individuo para hacer frente perjudicado fue la más frecuente (84,7 por ciento), seguido por el estrés (82,6 por ciento), y la preocupación con la atención habitual (78,2 por ciento). Las enfermedades cardiovasculares fue la de menor frecuencia (2,1 por ciento), mientras que la diabetes"no fue mencionada por ningún cuidador. No existe una correlación entre el número de definición de características del tiempo de tratamiento. Conclusiones: los cuidadores de niños con cáncer definen las características pertinentes para señalar la presencia del diagnóstico de enfermería destacar el papel de cuidador, demostrado por los distintos niveles de desarrollo físico, emocional y social resultante de las actividades laborales(AU)

The fight against cancer is not an easy process and it is not limited only to the patient but extends to those who are nearest and performing the role of caregiver. This study aimed to assess the diagnosis Caregiver Role Tension for caregivers of hospitalized children with cancer. This is an exploratory study with a quantitative approach, performed in a referral hospital in the treatment of childhood cancer the state capital of Pernambuco, Brazil. All primary caregivers of children who fell into our inclusion criteria were part of our study and they are addressed in the range from January to March 2012, scoring a total of 46 primary caregivers of children with cancer. Data were collected through interviews following a structured interview, which included questions containing the defining characteristics of the diagnosis Caregiver Role Tension. Of the total, 44 (95,65 percent) subjects had a diagnosis of Caregiver Role Tension. Features individual coping harmed was the most frequent (84.7 percent), followed by stress (82.6 percent), and concern with routine care (78,2 percent). Cardiovascular diseases mentioned was less (2,1 percent), while the diabetes has not been mentioned by any caregiver. There is no correlation between the number of defining characteristics of the treatment time. The study showed that caregivers of children with cancer have defining characteristics relevant to point out the presence of the nursing diagnosis Stress the role of caregiver, demonstrated by various levels of physical, emotional and social development resulting from work activities . It is up to the nurse to identify the signs that point to the emergence of the diagnosis Stress the role of caregiver, and insert the caregiver within your care plan(AU)

Venous ulcer: risk factors and the Nursing Outcomes Classification.

OBJECTIVE: To explore the relationship between the risk factors for the development of venous ulcers and the indicators of tissue integrity from the Nursing Outcomes Classification. METHODOLOGY: A cross-sectional study conducted in 2013 in a university hospital in Natal/RN (Brazil). Fifty individuals selected by consecutive sampling participated in an interview and physical examination. RESULTS: The most important risk factors were: 44% presented with arterial hypertension, 26% allergy, 20% diabetes mellitus, 4% participated in some physical activity, 6% were smokers and 14% drank alcohol. There was a statistically significant association between diabetes mellitus and the texture of the lesion (p=0.015) and tissue perfusion (p=0.026); allergy and texture (p=0.034); physical activity and hydration (p = 0.034); smoking and thickness (p = 0.018); and alcoholism and exudate of the ulcer (p=0.045). CONCLUSION: . The relationship between risk factors and the nursing outcome indicators generated information relevant to the development of guidelines for the monitoring and treatment of venous ulcer information.

[Systematic review and meta-analysis of the accuracy of "impaired gas exchange" defining characteristics]. / Meta-analisi dell'accuratezza delle caratteristiche definenti di "Compromissione degli scambi gassosi"

INTRODUCTION: Nursing diagnoses share some common defining characteristics. OBJECTIVE: To identify key defining characteristics for the nursing diagnosis "Impaired gas exchange". METHOD: Systematic review with meta-analysis of three studies in samples with different clinical profiles. The relevance and quality of the studies were assessed according the QUADAS protocol. RESULTS: Two studies were on children with acute respiratory infection and one on adults with mechanical ventilation. The heterogeneity statistic test suggested that the studies are homogeneous. The defining characteristics with higher accuracy were: headaches upon waking, irritability and tachycardia. DISCUSSION: The clinical indicators headache, irritability and tachycardia are signals secondary to hypoxia. Although of different magnitudes according to the age, they are the body's physiological responses. CONCLUSIONS: A comparison of the defining characteristics of "Impaired gas exchange" showed their accuracy. Obtaining measures can contribute to a better identification of this nursing diagnosis.

Diagnósticos de enfermería en individuos ingresados en unidad de cuidados intensivos / Nursing diagnose in individuals admitted to the intensive therapy unit

Objetivo: Identificar los diagnósticos de enfermería presentados por pacientes ingresados en Unidad Terapia Intensiva (UCI), según la taxonomía de la NANDA Internacional. Metodología: Se trata de un estudio descriptivo con la aplicación de un instrumento estructurado para la recolección de datos. Incluye aspectos referentes a: datos de identificación, funciones fisiológicas, el cual fue aplicado a 35 pacientes ingresados en la UCI de un hospital privado de la ciudad de Fortaleza / Brasil. Los datos se presentan en tablas y se discuten los diagnósticos, factores relacionados y de riesgo más frecuentes. Resultados: Los principales diagnósticos de enfermería identificados fueron: déficit del autocuidado: alimentación (85,7%), deterioro de la movilidad física (85,7%), riesgo de aspiración (85,7%), Perfusión tisular inefectiva (80%) y riesgo de infección (80%). Estos hallazgos son compatibles con estudios anteriores desarrollados con pacientes que ingresaron en unidad de cuidados intensivos. Conclusiones: Se concluyó que los pacientes evaluados presentan diagnósticos relacionados con alteraciones fisiológicas los cuales incluyen la necesidad de cuidados específicos.

Objective: to identify the nursing diagnoses found in patient put into hospital in the first 24 hours at Intensive Therapy Unit, independently of their disease. Methodology: It is a descriptive study that used a structured instrument for data collection, including parts referring to identification and physiologic functions data, being applied to 35 patients put into hospital in ITU of a particular hospital. The data were presented in tables and it was discussed the diagnoses, related and risk factors more frequent. Results: The main diagnoses were identified: self-care deficit: feeding (85.7%), impaired physical mobility (85.7%), risk for aspiration (85.7%), ineffective tissue perfusion (80%) and risk for infection (80%). These findings are consistent with previous studies developed with individuals admitted to intensive care unit. These findings are compatibles with previous studies developed with patients of Intensive Care Unit. Conclusions: It was concluded that the evaluated patients, present nursing diagnosis related to physiologic alterations which include the need of specific cares.

Objetivo: identificar os diagnósticos de enfermagem encontrados em pacientes ingressados na Unidade de Terapia Intensiva, de acordo com a taxonomia da NANDA Internacional. Metodologia: Trata-se de um estudo descritivo que utilizou um instrumento estruturado para coleta de dados, incluindo aspectos referentes aos dados de identificação e as funções fisiológicas, sendo aplicado a 35 pacientes internados na UCI de um hospital privado da Cidade de Fortaleza, Brasil. Os dados são apresentados em tabelas e os diagnósticos, fatores relacionados e de risco mais frequentes são discutidos. Resultados: Os principais diagnósticos de enfermagem identificados foram: déficit de autocuidado, alimentação (85,7%), mobilidade física prejudicada (85,7%), risco de aspiração (85,7%), perfusão tecidual ineficaz (80%) e risco de infecção (80%). Estes resultados são consistentes com estudos anteriores desenvolvidos com indivíduos internados em unidade de terapia intensiva. Estes resultados são compatíveis com estudos anteriores desenvolvidos com pacientes de Unidade de Terapia Intensiva. Conclusões: Concluiu-se que os pacientes avaliados apresentaram diagnósticos relacionados com alterações fisiológicas que precisam de cuidados específicos.

Clinical indicators of ineffective airway clearance for patients in the cardiac postoperative period.

BACKGROUND: The accuracy of an indicator determines the direct relationship between a defining characteristic and the presence or absence of a specific nursing diagnosis. AIMS: To analyse the accuracy of the clinical indicators of ineffective airway clearance in patients during the postoperative period of cardiac surgery. METHODS: A total of 98 patients recruited from a postoperative unit were included in the study. An analysis of sensitivity, specificity, predictive value, likelihood ratio, diagnostic odds ratio, accuracy, and area under the ROC curve was used to determine the accuracy of these clinical indicators. RESULTS: Four clinical indicators showed the highest levels of accuracy by statistical measure: dyspnoea, adventitious breath sounds, ineffective cough, and retained secretions. The indicators retained secretions and ineffective cough showed high diagnostic odds ratios (62.8 and 28.1, respectively). CONCLUSION: The results suggest that there are differences between the ineffective airway clearance indicators as accuracy measures.

Adesão ao tratamento de crianças soropositivas ao HIV: uma análise conceituai / Adherence to the Treatment of Children Living with HIV: A Conceptual Analysis / Adherencia al tratamiento de niños que viven con el VIH: un análisis conceptual

Objetivo: Objetivou-se analisar o conceito de adesão ao tratamento de crianças soropositivas ao HIV, expresso pela literatura da área de saúde, identificando seus atributos essenciais, antecedentes e consequentes. Método: Seguiu-se o Método Evolucionário de análise de conceito, proposto por Rodgers, para avaliar 17 artigos que focalizaram a temática do estudo. Resultados: Como atributos essenciais identificados que caracterizam o conceito constaram: seguimento da prescrição médica pelo binômio criança-família, disponibilidade de formulações pediátricas, acompanhamento clínico-laboratorial regular, adequação de hábitos e compartilhamento de decisões entre cuidador e criança. Conclusões: A partir dos elementos identificados, elaborou-se uma definição consensual, na qual adesão ao tratamento de crianças soropositivas é compreendida como um processo colaborativo, que vai além da ingestão de medicamentos, considerando-se o dinamismo, aspectos familiares, o cotidiano das crianças, os determinantes sociais, econômicos e estruturais que integram o fenômeno em estudo. Os achados permitem uma compreensão mais abrangente do conceito e fornecem subsídios para a prestação de uma assistência integral, direcionada ao controle da doença e a uma melhor qualidade de vida. Sugere-se a formação de grupos multiprofissionais dedicados a realização de trabalhos educativos sobre as dificuldades na adesão, promovendo um espaço para trocas de experiências e para o desenvolvimento de estratégias de enfrentamento.

Objective: The objective was to analyze the concept of adherence to treatment of children living with HIV, expressed in the health literature, identifying its essential attributes, antecedents and consequences. Method: The Evolutionary Method of concept analysis proposed by Rodgers was followed to evaluate 17 articles that focused on the study theme. Results: As essential attributes identified by characterizing the concept are included: Following the prescription by the child-family binomial, availability of pediatric formulations, regular clinical and laboratory follow-up, habits adequacy and shared decision making between caregiver and child. Conclusions: Based on the identified elements, a consensual definition was elaborated, in which the treatment compliance by positive-HIV children is understood as a collaborative process, which goes beyond taking medications, considering the dynamism, family aspects, the daily lives of children, the social, economic and structural determinant that integrate the phenomenon under study. The findings allow a more comprehensive understanding of the concept and provide subsidies for the provision of comprehensive care, targeted to disease control and improved life quality. It is suggested the formation of multidisciplinary groups dedicated to conducting educational works about the difficulties in compliance, promoting a space for exchange of experiences and development of coping strategies.

Objetivo: Analizar el concepto de la adherencia al tratamiento de los niños que viven con el VIH, expresado en la literatura de la salud, haciendo la identificación de sus atributos esenciales, antecedentes y consecuencias. Método: método evolutivo de análisis de concepto propuesto por Rodgers para evaluar los 17 artículos que se centraron en el tema del estudio. Resultados: identificado como atributos esenciales que caracterizan el concepto. A raíz de la prescripción por el binomio niño-familia, la disponibilidad de formulaciones pediátricas, acompañamiento clínico y de laboratorio regulares, adecuación de los hábitos y toma de decisiones compartida entre el cuidador y el niño. Conclusiones: con base en los elementos identificados, se elaboró una definición consensuada en que se entiende la adherencia al tratamiento de los niños VIH positivos como un proceso de colaboración que va más allá de tomar los medicamentos, teniendo en cuenta el dinamismo, los aspectos de la familia, la vida cotidiana de los niños, la parte social, económica y estructural del fenómeno en estudio. Los hallazgos permiten una comprensión más amplia del concepto y ofrecer subsidios para la prestación de la atención integral dirigida a controlar la enfermedad y mejorar la calidad de vida. Se sugiere la formación de grupos multidisciplinarios dedicados a la realización de trabajos educativos sobre las dificultades en el cumplimiento, la promoción de un espacio de intercambio de experiencias y el desarrollo de estrategias de afrontamiento.

A escala de Waterlow aplicada em pessoas com lesão medular / The Waterlow scale applied in people with spinal cord injury

Objetivos: Avaliar os fatores de risco para úlceras por pressão em pessoas hospitalizadas por lesão medular, utilizando a Escala de Waterlow e as orientações prestadas para os pacientes antes e depois do aparecimento das úlceras. Método: Estudo transversal, com 60 pacientes, realizado em um hospital da cidade de Fortaleza (Ceará-Brasil). A coleta de dados efetuou-se de maio a outubro de 2008 por meio da utilização da escala de Waterlow. Para a análise foram utilizados: Teste de Kolmogorov-Smirnov, Coeficiente de correlação de Pearson e Coeficiente de correlação de Spearman. Resultados: O fator de risco mais significante para o desenvolvimento da úlcera por pressão foi a mobilidade física prejudicada associada ao longo tempo de internação. A presença de acompanhante foi outro achado importante, pois dos 19 pacientes que não desenvolveram úlcera por pressão todos tinham acompanhantes. Foi constatado também que 90% dos pacientes não receberam nenhum tipo de orientação antes do advento da úlcera por pressão, e que apenas 31% receberam orientações depois do aparecimento da mesma. Conclusões: A variável mais significativa em relação ao risco para desenvolver úlcera por pressão foi a mobilidade física prejudicada, visto que os pacientes eram dependentes de cadeira de rodas ou inertes no leito. A maioria não recebeu orientação antes do aparecimento da úlcera por pressão e somente alguns receberam orientação. Assim o estudo revelou-se eficaz na avaliação dos fatores de risco bem como para o conhecimento das orientações de enfermagem recebidas.

Objetivos: Evaluar los factores de riesgo de úlceras por presión en personas hospitalizadas por lesión medular, utilizando la Escala de Waterlow y las instrucciones dadas a los pacientes antes y después de la aparición de las úlceras. Método: Estudio transversal, con 60 pacientes, realizado en un hospital de la ciudad de Fortaleza (Ceará-Brasil). La recolección de datos se efectuó de mayo a octubre de 2008 a través del uso de la escala de Waterlow. Para el análisis se utilizó el Test de Kolmogorov-Smirnov, el Coeficiente de correlación de Pearson y el Coeficiente de correlación de Spearman. Resultados: El factor de riesgo más significativo para el desarrollo de la úlcera por presión fue una movilidad física afectada asociada con un largo tiempo de hospitalización. Se consideró importante la presencia de un acompañante, ya que de los 19 pacientes que no desarrollaron úlcera por presión todos tenían acompañantes. Se constató también que el 90% de los pacientes no recibieron ningún tipo de orientación antes del advenimiento de la úlcera por presión, y que sólo 31% recibió instrucciones después de su aparición. Conclusiones: La variable más significativa con respecto al riesgo de desarrollar úlcera por presión fue la movilidad física afectada, dados que los pacientes dependían de sillas de ruedas o permanecían inmóviles en su cama. La mayoría no recibió orientación antes de la aparición de la úlcera por presión y sólo algunos recibieron orientación. De esta forma, el estudio demostró ser eficaz en la evaluación de los factores de riesgo y también para conocer las orientaciones de enfermería recibidas.

Objectives: Assessing risk factors for pressure ulcers in people hospitalized with spinal cord injury, using the Waterlow scale and instructions given to patients before and after onset of ulcers Method: Cross-sectional study with 60 patients, conducted in a hospital in the city of Fortaleza (Ceará, Brazil). Data was collected from May to October 2008 through the use of the Waterlow scale. The Kolmogorov-Smirnov test, the Pearson correlation coefficient and Spearman correlation coefficient were used for analysis. Results: The most significant risk factor for the development of pressure ulcers was affected physical mobility associated with a long hospitalization. The presence of a companion was considered important, because the 19 patients who did not develop pressure ulcers had companions. It also was found that 90% of patients did not receive any guidance before the onset of pressure ulcers, and only 31% received instructions after their appearance. Conclusions: The most significant variable in the risk of developing pressure ulcers was affected physical mobility, given that patients were limited to wheelchairs or lay motionless in bed. Most did not receive guidance before the onset pressure ulcers; only some of them were advised. Thus, the study proved to be effective in the evaluation of risk factors and also to gather information on nursing guidance received by patients.

Adaptaçao psicossocial do adolescente pós-trasplante renal segundo a teoria de Roy / Psicosocial adaptation of post-renal traplanted adolescents according to Roy theory

É um estudo descriptivo, com análise cualitativo. O objetivo deste trabalho foi conhecer as repercussoes psicossociais do adolescente após o traplante renale os mecanismos adaptativos utilizados por estes na sua nova condiçao de vida. foram entrevistados dezenove adolescentes que estavam em acompanhamento ambulatorio em dois hospitais públicos do Ceará-Brasil, após aprovaçao do projeto pelo comite de Ética das instituiçoes e obtençao do consentimento livre e esclarecido. Os resultado foram analisados conforme a teoria da adaptaçao de Roy. Foram identificados problemas de adaptaçao, como: limitaçao fisica, vergonha, medo de rejeiçao e impotencia. contudo, esses adolescentes puderam superar tal situaçao e melhorar a adaptaçao à sua nova condiçao. cocluímos que a teoria de Roy permitiu uma análise mais aprofundada desses adolescentes, permitindo lhes um tratamento mais eficaz e, conseqüentemente, uma melhor qualidade de vida.