Direct costs of integrated procedures of conventional hemodialysis performed by nursing professionals.

OBJECTIVE: to analyze the mean direct cost of the constituent procedures of conventional hemodialysis, performed in three public teaching and research hospitals. METHOD: quantitative, exploratory-descriptive study, of the multiple case study type. The mean direct cost was calculated by multiplying the time (timed) spent by nursing professionals, on the execution of procedures, by the unit cost of direct labor, added to the cost of materials and solutions/medications. RESULTS: the total mean direct cost, in patients with an arteriovenous fistula corresponded to US$25.10 in hospital A, US$37.34 in hospital B and US$25.01 in hospital C, and in patients with a dual lumen catheter, US$32.07 in hospital A, US$40.58 in hospital B and US$30.35 in hospital C. The weighted mean values obtained were US$26.59 for hospital A, US$38.96 for hospital B and US$27.68 for hospital C. It was noted that the "installation and removal of hemodialysis fistula access" caused a significantly lower economic impact compared to "installation and removal of hemodialysis catheter access". CONCLUSION: with the knowledge developed it will be possible to support hospital managers, technical managers and nursing professionals in the decision making process, with a view to the rational allocation of the necessary inputs for the performance of conventional hemodialysis.

Validation of the nursing interventions and activities for patients on hemodialytic therapy. / Validação de intervenções e atividades de enfermagem para pacientes em terapia hemodialítica.

OBJECTIVE: To validate interventions and nursing activities proposed by the Nursing Interventions Classification for patients with acute renal failure or acute chronic renal disease in hemodialysis therapy with the Excess Fluid Volume and Risk for Imbalanced Fluid Volume nursing diagnoses. METHODS: Validation of content with 19 expert nurses from a university hospital. The data collection was made from September to November 2011 through instruments that contained the interventions and nursing activities in study. The data analysis considered the average of scores obtained in the validation process. RESULTS: The Fluid Management was validated as a priority intervention (mean ≥ 0.8), with eight main activities for the Excess Fluid Volume nursing diagnosis and eight for the Risk for Imbalanced Fluid Volume nursing diagnosis. CONCLUSION: The validated intervation of the Fluid Management enables the monitoring of the hydric balance and facilitates the prevention of complications, which are important activities in the nursing care of the patients in hemodialysis therapy.

Diagnosis, results, and nursing interventions for patients with acute renal injury / Diagnósticos, resultados e intervenções de enfermagem em pacientes com lesão renal aguda

Objective: To identify prevalence and correlate diagnosis, results, and nursing interventions in patients with acute renal injury (ARI) who were hospitalized in an intensive care unit (ICU). Methods: This was a cross-sectional study including 98 patients older than 18 years old with ARI who were undergoing hemodialysis treatment in the ICU . The study was carried out in an ICU a large public hospital located in the city of São Paulo, Brazil. For statistics analysis we used the SPSS v21.0 to estimate prevalence, the 95% of confidence interval and sample error of 0.05. Data were collected from March to July 2016 using structured interviews, anamnesis and physical exam of patients using an instrument designed by this study researchers. The main instrument was completed by the principal researcher. Nursing consultation lasted for approximately 30 minutes. Of the total sample, 10% was selected and checked randomly in order to evaluate data quality and atypical values. Two patients previously did a pilot test to verify whether information in the instrument achieved the objective of the study. Results: The 98 participatns were aged ≥60 years (33%), men (60%), and classified as pre-renal injury (54%). Prevalent diagnosis was (100%) risk of infection, risk of inefficient gastrointestinal perfusion, risk of ineffective renal perfusion, risk of electrolyte imbalance, excessive fluid volume, and risk of imbalanced fluid volume. Results (100%) were: severity of infection, access for hemodialysis, tissue perfusion - abdominal organs, hydric balance, mobility, removal of toxins and renal function. Prevalent nursing interventions (100%) were: promotion against infection, control of infection, maintenance of access for dialysis, hydroeletrolitic control, urinary elimination control, acid-base control, electrolytic control, hypervolemia control, hydric control, hydric monitoring, respiratory physiotherapy, respiratory and positioning monitoring. Correlations were significant (p< 0.001) between diagnosis and nursing interventions and between nursing interventions and results. Conclusion: Main diagnosis, results and nursing interventions related with loss of renal function originated from changes of renal perfusion, volemia, hydroelectrolytic dysfunctions, and risk of infection. The number of diagnosis showed to be correlated with number of nursing interventions and nursing interventions was correlated with results.

Objetivo: Identificar prevalência de diagnósticos (DE), resultados (RE) e intervenções de enfermagem (IE) em pacientes com lesão renal aguda (LRA) internados em unidade de terapia intensiva (UTI). Correlacionar DE, RE e IE identificados. Métodos: Estudo transversal, conduzido em Unidades de Terapia Intensiva de um hospital público de grande porte da cidade de São Paulo. Foram incluídos, numa amostra intencional, 98 pacientes com LRA em tratamento hemodialítico internados em UTI, maiores de 18 anos. Foi utilizado software SPSS v21.0 para estimação da prevalência, fixando a estimativa no intervalo de confiança (IC) de 95% e erro amostral de 0,05. A coleta de dados foi realizada por meio da consulta de enfermagem, composta de entrevista estruturada, anamnese e exame físico dos pacientes, utilizando instrumento elaborado pelos pesquisadores. A coleta de dados foi realizada no período de março a julho de 2016, e o instrumento de coleta de dados foi preenchido pela pesquisadora principal. A consulta de enfermagem teve duração de aproximadamente 30 minutos. Do total da amostra, 10% foi selecionada aleatoriamente e checada, com o propósito de avaliar a qualidade dos dados e valores atípicos. Foi também realizado teste piloto em dois pacientes, previamente, para verificar se as informações contidas no instrumento atingiriam os objetivos da pesquisa. Resultados: Participaram 98 pacientes, predominantemente com idade ≥60 anos (33%), sexo masculino (60%) e classificados com lesão pré-renal (54%). DE prevalentes (100%): risco de infecção, risco de perfusão gastrointestinal ineficaz, risco de perfusão renal ineficaz, risco de desequilíbrio eletrolítico, volume de líquidos excessivos e risco de volume de líquidos desequilibrados. RE prevalentes (100%): gravidade da infecção, acesso para hemodiálise, perfusão tissular: órgãos abdominais, equilíbrio hídrico, mobilidade, remoção de toxinas e função renal. IE prevalentes (100%): promoção contra infecção, controle de infecção, manutenção de acesso para diálise, controle hidroeletrolítico, controle de eliminação urinária, controle ácido-básico, controle de eletrólitos, controle de hipervolemia, controle hídrico, monitorização hídrica, fisioterapia respiratória, monitorização respiratória e posicionamento. Correlações foram significativas (p< 0,001) entre DE e IE e entre IE e RE. Conclusão: Os principais DE, RE e IE foram relacionados à perda da função renal, origem das alterações na perfusão renal, volemia, distúrbios hidroletroliticos e risco para infecção. O número de DE atribuídos mostrou-se relacionado ao número de IE, assim como, das IE aos RE.

Validação de intervenções e atividades de enfermagem para pacientes em terapia hemodialítica / Validación de intervenciones y actividades de enfermería para pacientes en terapia hemodialítica / Validation of the nursing interventions and activities for patients on hemodialytic therapy

RESUMO Objetivo Validar intervenções e atividades de enfermagem propostas pela Nursing Interventions Classification, para pacientes com insuficiência renal aguda ou doença renal crônica agudizada, em terapia hemodialítica com os diagnósticos de enfermagem Volume de Líquidos Excessivo e Risco de Volume de Líquidos Desequilibrado. Métodos Validação de conteúdo com 19 enfermeiros peritos de um hospital universitário. A coleta de dados ocorreu de setembro a novembro de 2011, por meio de instrumentos que continham as intervenções e atividades de enfermagem em estudo. A análise considerou a média dos escores obtidos na validação. Resultados O Controle Hídrico foi validado como intervenção prioritária (média ≥ 0.8), com oito atividades principais para o diagnóstico Volume de Líquidos Excessivo e oito para o diagnóstico Risco de Volume de Líquidos Desequilibrado. Conclusão A intervenção validada de Controle Hídrico possibilita o monitoramento do equilíbrio hídrico e facilita a prevenção de complicações, consideradas importantes atividades do cuidado ao paciente em terapia hemodialítica.

RESUMEN Objectivo Validar intervenciones y actividades de enfermería propuestas por la Nursing Interventions Classification, para pacientes con insuficiencia renal aguda o enfermedad renal crónica agudizada, en terapia hemodialítica con los diagnósticos de enfermería Volumen de Líquidos Excesivo y Riesgo de Desequilibrio de Volumen de Líquidos. Métodos Validación de contenido con 19 enfermeros expertos de un hospital universitario. La recolección de datos fue realizada de septiembre a noviembre de 2011 con instrumentos que contenían las intervenciones y actividades de enfermería en estudio. El análisis consideró el promedio de los puntajes obtenidos en la validación. Resultados El Manejo de Líquidos fue validado como intervención prioritaria (media >0.8), con ocho actividades principales para el diagnóstico Volumen de Líquidos Excesivo y ocho para el diagnóstico Riesgo de Desequilibrio de Volumen de Líquidos. Conclusión La intervención validada de Manejo de Líquidos posibilita el monitoreo del balance hídrico y facilita la prevención de complicaciones, consideradas importantes actividades del cuidado al paciente en terapia hemodialítica.

ABSTRACT Objective To validate interventions and nursing activities proposed by the Nursing Interventions Classification for patients with acute renal failure or acute chronic renal disease in hemodialysis therapy with the Excess Fluid Volume and Risk for Imbalanced Fluid Volume nursing diagnoses. Methods Validation of content with 19 expert nurses from a university hospital. The data collection was made from September to November 2011 through instruments that contained the interventions and nursing activities in study. The data analysis considered the average of scores obtained in the validation process. Results The Fluid Management was validated as a priority intervention (mean ≥ 0.8), with eight main activities for the Excess Fluid Volume nursing diagnosis and eight for the Risk for Imbalanced Fluid Volume nursing diagnosis. Conclusion The validated intervation of the Fluid Management enables the monitoring of the hydric balance and facilitates the prevention of complications, which are important activities in the nursing care of the patients in hemodialysis therapy.

Terapias de reemplazo renal lentas continuas / Slow continuous renal replacement therapies (CRRT)", "_i": "

Las terapias de reemplazo renal continuas (TRRC) representanuna alternativa terapéutica cada vez más utilizada a nivel mundialpara el tratamiento de la insuficiencia renal aguda, sus distintasmodalidades ofrecen la posibilidad de corregir complicacionesmédicas que se pueden presentar en el postoperatorio de cirugíacardíaca; es una opción que ha demostrado ser mejor tolerada porlos pacientes inestables hemodinámicamente y con falla cardíaca.El personal de enfermería que labora en áreas de cuidados críticosdebe adquirir los conocimientos necesarios y desarrollar habilidadespara su manejo; esto incluye los mecanismos físico-químicosimplicados, indicaciones de cada una de las terapias, las modalidadesterapéuticas y cuidados específicos al paciente.

The Continuous Renal Replacement Therapy represent an alternativetherapy is increasingly used worldwide for the treatmentof acute renal failure, and its different modalities offer thepossibility of correcting medical complications that can occurin postoperative cardiac surgery, is an option that has provento be better tolerated by instable patients and with heart failure.Nursing staff that working in an intensive care unit, mustacquire the necessary knowledge, and develop skills for its use,including physical and chemicals mechanisms, indication foreach therapies, modalities and specific nursing care that the patientneeds.

[Complications of the hemodialysis procedure in acute renal failure patients: nursing interventions]. / Complicações do procedimento hemodialítico em pacientes com insuficiência renal aguda: intervenções de enfermagem.

This retrospective study has identified both the prevalence of complications during hemodialitic treatment in patients carrying acute renal failure (ARF) in an intensive care unit of a university hospital and the nursing conduct performed during those episodes. We have assessed sixty-five (282 sessions) records of ARF patients who underwent renal replacement therapy and presented complications during hemodialysis sessions. We have noticed that the most prevalent intradialitic complications were: arterial hypotension (35%), hypothermia (29%), and lack of flow in the vascular access (24.1%). The nursing interventions prioritized during episodes of clinical complications involved clinical assessment (66.8%) and evaluation of patients' consciousness level (59.9%). The search for nursing procedures that are suitable to different situations experienced by patients during hemodialysis, as well as the continuing education of the nursing team are actions that may minimize the intercurrence rate.

Insuficiencia renal aguda / Acute renal failure

El presente artículo hace referencia a la fisiología renal; describe las fases de la insuficiencia renal aguda y detalla el plan de cuidados de un paciente afectado por esta enfermedad (AU)

Insuficiencia renal aguda / Acute renal failure

El presente artículo hace referencia a la fisiología renal; describe las fases de la insuficiencia renal aguda y detalla el plan de cuidados de un paciente afectado por esta enfermedad

Insuficiencia renal aguda secundaria a rabdomiolisis no traumática: presentación de dos casos / Acute renal failure secondary a rhabdomyolysis non-traumatic: presentation of two cases

La rabdomiolisis además de complicar muchas enfermedades críticas, puede requerir manejo intensivo debido a su frecuente asociación a complicaciones que amenazan la vida. La insuficiencia renal aguda (IRA) es una complicación frecuente de rabdomiolisis y puede presentarse después de daño muscular de origen traumático o no traumático y es una complicación frecuente del uso de cocaína. Nosotros presentamos dos casos de rabdomiolisis no traumática con IRA, uno de ellos secundaria a la ingestión compulsiva de alcohol y cocaína dentro de las 12 horas antes de su admisión a la UCI, el otro fue presumiblemente secundaria a una infección viral tipo influenza. Ambos casos sobrevivieron y requirieron diálisis

Síndrome hemolítico urémico

En el presente estudio se analiza la forma de presentación clínica de síndrome hemolítico urémico (SHU) en nuestro medio. Se revisaron 22 historias clínicas con diagnóstico de SHU en un período de seis años, en el Hospital Pediátrico de La Misericordia, 19 incluidos con criterios clínico-paraclínicos y tres confirmados con estudio anatomo-patológico de autopsia. El cuadro se presentó con mayor frecuencia en lactantes mayores y en el sexo femenino. Palidez, oligoanuria e hipertensión arterial fueron las manifestaciones iniciales y la complicación más frecuente fue encefalopatía. A diferencia de otros reportes, no encontramos correlación entre leucocitosis e hiponatremia y complicaciones, mientras que hipocalcemia se correlacionó con encefalopatía en 60 por ciento de los casos. Asimismo la duración de oligoanuria mayor de 3 días fue un indicador de pobre pronóstico.

Insuficiencia renal aguda / Acute renal insufficiency

Dadas las graves alteraciones fisiopatológicas producidas por la Insuficiencia Renal Aguda (I.R.A.), y siendo ésta una enfermedad en alto porcentaje prevenible, se trata de ilustrar como en toda persona en estado crítico una buena observación de la función renal y un adecuado manejo de la alteración primaria, por parte del profesional de enfermería, disminuye los riesgos de desarrollar una insuficiencia renal y los daños que tal síndrome produce