Post-Sympathectomy Care in Patients with Incessant Ventricular Tachycardia: A Case Study.

Introduction: Incessant Ventricular Tachycardia is a condition characterized by multiple episodes of Ventricular Tachycardia (VT) in 24 hours, persisting despite efforts to stop the arrhythmia. In this condition, sympathectomy as the surgical procedure is considered a permanent intervention and the last resort when medications prove ineffective. This procedure comprises the cutting or clamping of sympathetic nerves to prevent the transmission of nerve signals. Therefore, this study aims to present a case report of post-sympathectomy nursing management in a patient with Incessant Ventricular Tachycardia. Case Presentation: A 59-year-old female patient was admitted to the high-care unit with a diagnosis of post-sympathectomy, Incessant Ventricular Tachycardia due to Arrhythmogenic Cardiomyopathy. Nursing problems based on NANDA included decreased cardiac output, gas exchange impairment, and activity intolerance. Furthermore, the nursing interventions for the condition included self-care management and collaboration with an anesthesiologist and cardiologist. The interventions encompassed cardiac care, airway management, and activity therapy. Tele-nursing was also conducted through video calls to monitor the patient after hospital care. Results: The planned nursing care was effective in preventing common complications that often occur after the surgical procedure. The most important key aspect is regular maintenance and monitoring. The patient was discharged on the third day after the surgery with no complaints of shortness of breath, palpitations, and gradual resumption of activities. Conclusion: Sympathectomy procedures could successfully be used to treat patients through multidisciplinary collaboration. Furthermore, nurses could emphasize post-operative care management to expedite recovery and improve patient quality of life.

How to undertake a pain assessment for -patients with acute post-operative pain.

RATIONALE AND KEY POINTS: Acute post-operative pain is common among patients in secondary care settings, and the alleviation of this pain is a principal responsibility for all healthcare professionals, including nurses. To achieve this, it is essential to regularly undertake comprehensive pain assessments, using validated pain assessment tools, for all patients who have undergone a surgical procedure. Inadequate pain assessment may lead to ineffective or inappropriate pain management, which can adversely affect the patient's recovery and increase their risk of developing chronic pain. •  Pain is a subjective experience and therefore requires individualised, comprehensive assessment and management interventions. •  The assessment process for patients with acute pain is fundamental to understanding the patient's current status, informing differential diagnoses regarding the underlying cause of the pain, providing appropriate treatment and monitoring, and evaluating the effectiveness of treatment. •  Pain assessment should not be undertaken as a one-off care activity; it should be completed whenever a patient reports pain and repeated following pharmacological and/or non-pharmacological interventions. REFLECTIVE ACTIVITY: 'How to' articles can help you to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: •  How this article might improve your practice when undertaking a comprehensive pain assessment with patients experiencing acute post-operative pain. •  How you could use this information to educate nursing students or colleagues on the appropriate actions to take when undertaking a comprehensive pain assessment with patients experiencing acute post-operative pain.

Excision of a Giant Cell Tumor With Bone Grafting and Bone Cementing of the Proximal Humerus: A Case Report.

Giant cell tumors (GCTs) of the bone are uncommon neoplasms that predominantly affect the metaphysis of long bones, with proximal humerus involvement being less frequent. We present the case of a 58-year-old male who presented with a two-month history of progressive right shoulder pain and difficulty in raising his arm. Clinical examination revealed a palpable swelling on the lateral aspect of the right arm. Radiological investigations, including X-ray and magnetic resonance imaging (MRI), confirmed the presence of a primary osseous neoplasm involving the proximal humerus, suggestive of a GCT. The patient underwent surgical excision of the tumor with bone grafting and bone cementing of the proximal humerus. Post-operative care included prescribed medications and physiotherapy. This case highlights the successful management of GCTs of the proximal humerus through a multidisciplinary approach, emphasizing the importance of meticulous surgical technique, appropriate reconstruction, and comprehensive post-operative care for optimal patient outcomes.

Experiences of middle-aged individuals with lower extremity amputation caused by diabetic foot ulcer after disability in China: A qualitative study.

AIM: To understand the experiences of individuals who undergo LEA due to DFU after disability. DESIGN: A descriptive research design in qualitative research. METHODS: Semi-structured interviews were used in this qualitative descriptive study. Eleven middle-aged patients (45-59 years) who underwent LEA due to DFU were purposively selected and interviewed. Qualitative data were thematically analysed. RESULTS: Three themes and 10 subthemes were identified. The themes were (1) role function confusion, (2) self-concept stress and (3) unreasonable objective support. Subthemes included (1) weakened career role, (2) family role reversal, (3) social role restriction, (4) over-focusing on appearance, (5) immersion in patient experience, (6) living with faith, (7) polarization of independent consciousness, (8) low perceived benefits of peer support, (9) existence of treatment disruption and (10) poor participation in medical decision-making.

Trends in Nutrition-Related Risk Factors Identified Post-Operatively in Patients Treated for a Lower-Extremity Injury.

This study investigated trends within a custom Sports Nutrition Assessment for Consultation (SNAC) survey designed to identify nutrition-related risk factors among post-operative lower-extremity youth athletes. Athletes aged 8-18 years who completed the SNAC at a sports medicine institution after lower-extremity surgery were reviewed for associations between SNAC questions and age/sex differences. Of 477 patients (15.0 ± 2.0 years; 47.8% female), 319 (66.9%) answered 'yes' to at least one question and were identified for a consult, though 216 (64.3%) declined. The most frequent questions to prompt a consult were a desire to better understand nutrition for recovery (41.5%) and regularly skipping at least one meal a day (29.8%). Inter-question responses were often significantly related, especially regarding appetite changes, weight changes, and/or meal-skipping. While consult acceptance was not significantly different between sex/age, males were more likely to report a desire to better understand nutrition (p = 0.004) and a weight change (p = 0.019), and females were more likely to report struggling with dizziness/fatigue (p < 0.001). Additionally, older athletes reported an appetite change (p = 0.022), meal-skipping (p = 0.002), a desire to better understand nutrition (p < 0.001), a weight change (p < 0.001), and an effort/recommendation to change their body composition/weight (p = 0.005). These findings demonstrate a link between risky nutrition behaviors and physical detriments.

Impact of sex on the outcomes of deceased donor liver transplantation.

BACKGROUND: Data examining the impact of sex on liver transplant (LT) outcomes are limited. It is clear that further research into sex-related differences in transplant patients is necessary to identify areas for improvement. Elucidation of these differences may help to identify specific areas of focus to improve on the organ matching process, as well as the peri- and post-operative care of these patients. AIM: To utilize data from a high-volume Eurotransplant center to compare characteristics of male and female patients undergoing liver transplant and assess asso ciation between sex-specific variables with short- and long-term post-transplant outcomes. METHODS: A retrospective review of the University of Essen's transplant database was performed with collection of baseline patient characteristics, transplant-related data, and short-term outcomes. Comparisons of these data were made with Shapiro-Wilk, Mann-Whitney U, χ2 and Bonferroni tests applied where app ropriate. A P value of < 0.05 was accepted as statistically significant. RESULTS: Of the total 779 LT recipients, 261 (33.5%) were female. Female patients suffered higher incidences of acute liver failure and lower incidences of alcohol-related or viremic liver disease (P = 0.001). Female patients were more likely to have received an organ from a female donor with a higher donor risk index score, and as a high urgency offer (all P < 0.05). Baseline characteristics of male and female recipients were also significantly different. In multivariate hazard regression analysis, recipient lab-Model for End-Stage Liver Disease score and donor cause of death were associated with long-term outcomes in females. Pre-operative diagnosis of hepatocellular carcinoma, age at time of listing, duration of surgery, and units transfused during surgery, were associated with long-term outcomes in males. Severity of complications was associated with long-term outcomes in both groups. Overall survival was similar in both males and females; however, when stratified by age, females < 50 years of age had the best survival. CONCLUSION: Female and male LT recipients have different baseline and transplant-related characteristics, with sex-specific variables which are associated with long-term outcomes. Female recipients < 50 years of age demonstrated the best long-term outcomes. Pre- and post-transplant practices should be individualized based on sex-specific variables to optimize long-term outcomes.

Orthogeriatric Care Following Hip Fracture: Improving Post-Operative Outcomes in an Aged Population.

INTRODUCTION: Hip fractures globally are associated with high levels of morbidity, mortality, and significant financial burden. This audit aimed to assess the impact of orthogeriatric liaison care on post-operative outcomes following surgical management of neck or femur fractures. METHODS: Here, 258 patients who underwent hip fracture surgery over 1-year were included. Data were collected as an audit following the transition to an orthogeriatric liaison care model, involving regular orthogeriatric review (thrice weekly ward rounds, daily board rounds), superseding orthogeriatric review as requested. The audit is meant to assess the development of post-operative non-surgical site infection (NSSI) and mortality and duration of inpatient stay. Outcomes were compared to previous data from our hospital site in 2015/2016. RESULTS: Patients with severe cognitive impairment and systemic disease (Abbreviated Mental Test Score (AMTS) < 7 and American Society of Anesthesiologists (ASA) grade ≥ 3) showed significantly elevated NSSI risk, consistent across the study periods. Both periods demonstrated an increased risk of NSSI associated with admission from nursing homes. Despite the 2021/2022 cohort being notably older, NSSI risk decreased from 40.6% to 37.2% after implementing the orthogeriatric care model. NSSI risk was notably reduced for severe cognitive impairment (51.6% vs. 71%), and the p-value was 0.025. Average hospital stay decreased post-intervention (2.4 days shorter), with a notable reduction for NSSI patients (3.4 days shorter). Overall mortality rates were similar, although mortality due to infection was significantly reduced in 2021/2022 (44.4% vs. 93.3%), and the p-value was 0.003. CONCLUSION: The orthogeriatric liaison care model significantly decreased NSSI only in individuals with severe cognitive impairment and infection-associated mortality. This highlights the integral role of orthogeriatricians in the care of elderly hip fracture patients.

Mouse Anesthesia and Analgesia.

Providing anesthesia and analgesia for mouse subjects is a common and critical practice in the laboratory setting. This practice is necessary for performing invasive procedures, achieving prolonged immobility for sensitive imaging modalities (magnetic resonance imaging, for instance), and providing intra- and post-procedural pain relief. In addition to facilitating the procedures performed by the investigator, the provision of anesthesia and analgesia is crucial for the preservation of animal welfare and for humane treatment of animals used in research. Furthermore, anesthesia and analgesia are important components of animal use protocols reviewed by Institutional Animal Care and Use Committees, requiring careful consideration and planning for the particular animal model. In this article, we provide technical guidance for the investigator, covering the provision of anesthesia by two routes (injectable and inhalant), guidelines for monitoring anesthesia, current techniques for recognition of pain, considerations for administering preventative analgesia, and considerations for post-operative care. © 2024 Wiley Periodicals LLC. Basic Protocol 1: Injectable anesthesia Basic Protocol 2: Inhalant anesthesia Basic Protocol 3: Assessing pain.

Decreasing Opioid Addiction and Diversion Using Behavioral Economics Applied Through a Digital Engagement Solution: Protocol for a Randomized Controlled Trial.

BACKGROUND: Despite strong and growing interest in ending the ongoing opioid health crisis, there has been limited success in reducing the prevalence of opioid addiction and the number of deaths associated with opioid overdoses. Further, 1 explanation for this is that existing interventions target those who are opiate-dependent but do not prevent opioid-naïve patients from becoming addicted. OBJECTIVE: Leveraging behavioral economics at the patient level could help patients successfully use, discontinue, and dispose of their opioid medications in an acute pain setting. The primary goal of this project is to evaluate the effect of the 3 versions of the Opioid Management for You (OPY) tool on measures of opioid use relative to the standard of care by leveraging a pragmatic randomized controlled trial (RCT). METHODS: A team of researchers from the Center for Learning Health System Sciences (CLHSS) at the University of Minnesota partnered with M Health Fairview to design, build, and test the 3 versions of the OPY tool: social influence, precommitment, and testimonial version. The tool is being built using the Epic Care Companion (Epic Inc) platform and interacts with the patient through their existing MyChart (Epic Systems Corporation) personal health record account, and Epic patient portal, accessed through a phone app or the MyChart website. We have demonstrated feasibility with pilot data of the social influence version of the OPY app by targeting our pilot to a specific cohort of patients undergoing upper-extremity procedures. This study will use a group sequential RCT design to test the impact of this important health system initiative. Patients who meet OPY inclusion criteria will be stratified into low, intermediate, and high risk of opiate use based on their type of surgery. RESULTS: This study is being funded and supported by the CLHSS Rapid Prospective Evaluation and Digital Technology Innovation Programs, and M Health Fairview. Support and coordination provided by CLHSS include the structure of engagement, survey development, data collection, statistical analysis, and dissemination. The project was initially started in August 2022. The pilot was launched in February 2023 and is still running, with the data last counted in August 2023. The actual RCT is planned to start by early 2024. CONCLUSIONS: Through this RCT, we will test our hypothesis that patient opioid use and diverted prescription opioid availability can both be improved by information delivery applied through a behavioral economics lens via sending nudges directly to the opioid users through their personal health record. TRIAL REGISTRATION: ClinicalTrials.gov NCT06124079; https://clinicaltrials.gov/study/NCT06124079. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52882.

Efficacy of Multiple Exercise Therapy after Coronary Artery Bypass Graft: A Systematic Review of Randomized Control Trials.

Background: Coronary artery bypass graft (CABG) is intended to restore myocardial perfusion and alleviate morbidity among patients suffering from coronary artery disease. Due to procedural complexity, and anesthetic medications, post-operative complications are more prevalent, requiring the integration of rehabilitation strategies. This review aimed to determine the effect of single and multiple exercise therapy on rehabilitation after CABG surgery. Methods: We conducted a systematic search of databases (EBSCOhost, Scopus, PubMed, and Web of Science) from 01 January 2000 to 15 September 2022. The protocol of this systematic review is registered to PROSPERO. Results: We found nine randomized control trials composed of 599 CABG patients. In-patient cardiac rehabilitation (CR), a combination of inspiratory muscle training, mobilization, active upper and lower limb exercise, and aerobic exercise as multiple exercise therapy, found significant improvement in 6-minute walking distance (6MWD) than single exercise therapy (breathing exercise) at discharge and follow-up (moderate quality evidence). Contrary, multiple exercises group compared to single exercise groups did not improve the peak volume of oxygen ( VO 2 ) at discharge. Still, significant improvement was found at follow-up (moderate quality of evidence). On the other hand, the out-patient CR made up of high-intensity inspiratory muscle training, upper and lower limbs resistance training, and aerobic exercise as multiple exercise therapy significantly improved 6MWD and peak VO 2 at discharge (High-quality evidence). Conclusions: Our review revealed that multiple exercise therapy significantly improves functional and exercise capacity in in-patient and out-patient cardiac rehabilitation settings than single exercise therapy, but more than double exercise therapy protocol may be inefficient for improvement of quality of life. Inspiratory muscle training and resistance training in exercise therapy protocols significantly supplant the outcome, which requires further investigation.

Percepções de pacientes sobre recuperação cirúrgica retardada: validação do diagnóstico de enfermagem / Percepciones de pacientes sobre recuperación quirúrgica retardada: validación del diagnóstico de enfermería / Perceptions of patients on delayed surgical recovery: validation of the nursing diagnosis

RESUMO Objetivo: validar qualitativamente o diagnóstico de enfermagem Recuperação Cirúrgica Retardada, a partir das percepções de pacientes. Método: estudo qualitativo, realizado com 20 pacientes de hospital de referência com seis dias ou mais de pós-operatório. Realizou-se entrevista semiestruturada como técnica de coleta de dados e, para análise de dados, procedeu-se ao método da análise de conteúdo temática. Resultados: obtiveram três categorias: Descrição das características definidoras e fatores relacionados a partir do relato dos pacientes; Percepção sobre a recuperação cirúrgica; e Repercussões do retardo da recuperação cirúrgica na vida, na saúde e no bem-estar dos pacientes. Considerações finais: as percepções dos pacientes estiveram intimamente ligadas ao tempo de pós-operatório e prolongamento da internação, o que corrobora a definição do diagnóstico Recuperação Cirúrgica Retardada. Investigações qualitativas auxiliam na compreensão da experiência do paciente quanto ao fenômeno do diagnóstico e situa o cuidado centrado na pessoa. Pode, ainda, auxiliar no delineamento de intervenções de enfermagem assertivas para o alcance da recuperação plena.

RESUMEN Objetivo: validar cualitativamente el diagnóstico de enfermería Recuperación Quirúrgica Retardada, a partir de las percepciones de pacientes. Método: estudio cualitativo, realizado con 20 pacientes de hospital de referencia con seis días o más de postoperatorio. Se realizó entrevista semiestructurada como técnica de recolección de datos y, para análisis de datos, se procedió al método del análisis de contenido temático. Resultados: obtuvieron tres categorías: Descripción de las características definitorias y factores relacionados a partir del relato de los pacientes; Percepción sobre la recuperación quirúrgica; y Repercusiones del retardo de la recuperación quirúrgica en la vida, en la salud y en el bienestar de los pacientes. Consideraciones finales: las percepciones de los pacientes estuvieron íntimamente conectadas al tiempo de postoperatorio y la prolongación de la internación, lo que corrobora la definición del diagnóstico Recuperación Quirúrgica Retardada. Investigaciones cualitativas ayudan en la comprensión de la experiencia del paciente en cuanto al fenómeno del diagnóstico y ubican el cuidado centrado en la persona. Pueden, además, ayudar en la definición de intervenciones de enfermería asertivas para el alcance de la recuperación plena.

ABSTRACT Objective: to qualitatively validate the nursing diagnosis Delayed surgical recovery based on patients' perceptions. Method: a qualitative study was conducted with 20 patients from a reference hospital six days or more after surgery. A semi-structured interview was conducted as the data collection technique, and the thematic content analysis method was used for data analysis. Results: three categories were obtained: Description of the defining characteristics and related factors based on the patients' statements, Perception of surgical recovery, and Repercussions of delayed surgical recovery on the patients' lives, health, and well-being. Final considerations: the patients' perceptions were closely linked to the postoperative period and length of stay, which corroborates the definition of Delayed surgical recovery. Qualitative investigations help to understand the patient's experience regarding the diagnosis phenomenon and situate person-centered care. It can also help design assertive nursing interventions to achieve full recovery.

Translation into portuguese of a set of questionnaires designed to evaluate the impact of using a telepresence robot during postoperative ward rounds / Tradução para a língua portuguesa de um conjunto de questionários destinados à avaliação do impacto da utilização de um robô de telepresença em visitas hospitalares pós-cirúrgicas

ABSTRACT Introduction: the use of telepresence grows with the advancement of technology integration into medical practice. Regarding surgery, effective distance communication can translate into better perioperative care. Though, the patients' perception about this modality needs to be critically evaluated. Structured questionnaires using objective scales are the instruments of choice for measuring subjective aspects. However, there are no such questionnaires available in Portuguese. Our objective was, thus, translate and adapt into Portuguese a specific questionnaire evaluating the use of telepresence robots during post-operatory ward rounds. Methods: search on PubMed and selection of a set of validated questionnaires in English, translation into Portuguese according to the principles of good practice for the translation and cultural adaptation process for patient-reported outcomes measures. The original author approved the final version. Results: three questionnaires that assess ward rounds assisted by a telepresence robot were translated. Questionnaires are directed to the patient who receives the visit via telepresence or face-to-face visit and to the medical team accompanying the visit. The questionnaires use the Likert scale and contain thirteen questions that address 5 spheres: Communication; Dignity and Confidentiality; Contents; Time; General Impressions. Conclusions: this is the first instrument in Portuguese designed to assess the impression of patients and professionals involved in ward rounds using a telepresence robot. It has the potential to be used in clinical studies involving the use of this technology in care.

RESUMO Introdução: O uso da telepresença cresce com o avanço da integração de tecnologias à prática médica. No que tange a cirurgia, a comunicação à distância efetiva pode traduzir-se em um melhor cuidado perioperatório. No entanto, a percepção das partes acerca desta modalidade carece de avaliação científica. Questionários estruturados através de escalas são os instrumentos de escolha na mensuração de aspectos subjetivos. Entretanto, não há uma ferramenta validada neste molde em língua portuguesa. Nosso objetivo foi traduzir e adaptar para língua portuguesa um questionário específico de percepção sobre o uso de robôs de telepresença em visita hospitalar pós-cirúrgica. Métodos: foi realizada busca no PubMed e selecionado um conjunto de questionários validados em língua inglesa. Após, realizada a tradução para a língua portuguesa conforme as boas práticas para o processo de tradução e adaptação cultural. A autora original avaliou e aprovou a versão traduzida. Resultados: foram traduzidos três questionários autoaplicáveis e direcionados para os pacientes que recebem a visita por telepresença ou presencial e à equipe médica que acompanha as visitas com o objetivo de avaliar a visita hospitalar assistida por robô de telepresença. O conjunto utiliza a escala de Likert e contêm treze perguntas que abordam as esferas Comunicação; Dignidade e Confidencialidade; Conteúdo; Tempo; Impressões Gerais. Conclusões: este é o primeiro instrumento em língua portuguesa desenhado para avaliar a impressão de pacientes e profissionais envolvidos em rounds utilizando um robô de telepresença, tendo potencial para ser utilizado em estudos clínicos que envolvam a utilização desta tecnologia na assistência.

Recomendaciones pre- y posquirúrgicas en pacientes reumáticos / Pre and post-surgical recommendations in rheumatic patients

El acto quirúrgico constituye un elemento de estrés, principalmente en pacientes con enfermedades reumáticas en los que la actividad quirúrgica presenta características distintivas. Mantener un adecuado control de la actividad clínica de los pacientes con enfermedad reumática constituye un pilar fundamental para la recuperación posquirúrgica de las personas sometidas a cirugía electiva. Para ello es necesario orientar correctamente a los pacientes reumáticos tanto en el preoperatorio como en el posoperatorio. Solo de esta forma se logrará una adecuada recuperación quirúrgica sin poner en riesgo el control de la enfermedad reumática. El siguiente reporte tiene como objetivo describir las recomendaciones pre- y posquirúrgicas de la cirugía electiva en pacientes con enfermedades reumáticas, lo que permitirá orientar correctamente a las personas y disminuir la morbilidad relacionada con la realización de procedimientos quirúrgicos en los pacientes diagnosticados con enfermedades reumáticas(AU)

The surgical act constitutes an element of stress, mainly in patients with rheumatic diseases in whom the surgical activity presents distinctive characteristics. Maintaining adequate control of the clinical activity of patients with rheumatic disease constitutes a fundamental pillar for the post-surgical recovery of people undergoing elective surgery. For this, it is necessary to correctly guide rheumatic patients both preoperatively and postoperatively. Only from this will an adequate surgical recovery be achieved without jeopardizing the control of the rheumatic disease. The objective of the following report is to describe the pre and post-surgical recommendations for elective surgery in patients with rheumatic diseases, which will allow people to be correctly oriented and reduce the morbidity related to the performance of surgical procedures in patients diagnosed with rheumatic diseases(AU)

Beneficios del ácido tranexámico en pacientes intervenidos de artroplastia de rodilla unilateral / Benefits of tranexamic acid in patients undergoing unilateral knee arthroplasty

Objetivo: analizar los beneficios clínicos del uso de ácido tranexámico (TXA) en pacientes intervenidos de artroplastia de rodilla unilateral.Método: se realizó un estudio analítico transversal en las áreas quirúrgicas de dos hospitales en Sevilla (España) en pacientes intervenidos de artroplastia de rodilla con uso de TXA y sin él. Se recogieron variables sociodemográficas, clínicas intra y post-operatorias (dolor, sangrado, autotransfusión, constantes vitales) y tiempo de estancia en la unidad de reanimación post-operatoria y en la unidad de hospitalización. La recogida de datos se llevó a cabo a través de la historia clínica, hojas de constantes vitales y a través de observación directa en el seguimiento. Se utilizaron pruebas de contraste de hipótesis no paramétricas con una significación de p≤ 0,05.Resultados: participaron 72 pacientes: 35 recibieron TXA y 37 no. La mayoría de los participantes era mujer de entre 70 y 79 años. En ambos grupos la lateralidad de la rodilla intervenida fue similar, predominando la izquierda (60% en los que recibieron TXA y 51,4% en los que no). Se halló una menor proporción de personas con hipertensión (p= 0,011) y con necesidad de autotransfusión (p< 0,001) que habían recibido TXA. En este grupo disminuyeron también los tiempos de estancia en las unidades de reanimación y hospitalización, el sangrado y el dolor, y aumentó la saturación de oxígeno (todo p< 0,05).Conclusiones: la administración de TXA produce mejoras significativas en la clínica y recuperación postquirúrgica y reduce la estancia en el hospital, lo que podría implicar mejoras en el flujo de trabajo y en los costes asociados.(AU)

Objective: to analyse the clinical benefits of the use of tranexamic acid (TXA) in patients undergoing unilateral knee arthroplasty.Method: a cross-sectional analytical study was conducted at the surgical areas of two hospitals in Seville (Spain), in patients who had undergone knee arthroplasty using TXA and without it. Sociodemographic variables were collected, as well as clinical variables during and after surgery (pain, bleeding, self-transfusion, vital signs), and time of stay at the post-operative Resuscitation Unit and the Hospitalization Unit. Data collection was conducted through clinical records, vital sign sheets, and direct observation during follow-up. Non-parametric hypothesis contrast tests were used, with a p≤ 0.05 significance.Results: the study included 72 patients: 35 received TXA and 37 did not. Most participants were 70-to-79-year-old women. In both arms, there was similar laterality of the operated knee, with prevalence of the left one (60% in those receiving TXA and 51.4% in those who did not). A lower proportion of persons with hypertension (p= 0.011) and who required self-transfusion (p< 0.001) was found among those receiving TXA. This arm also showed a reduction in the times of stay in the Resuscitation and Hospitalization Units, bleeding and pain, and an increase in oxygen saturation (everything p< 0.05).Conclusions: TXA administration causes significant improvements in clinical signs and post-surgical recovery, and reduces the hospital stay, which could result in improvements in the workflow and associated costs.(AU)

Cuidados intensivos sistematizados ao paciente em pós-operatório cardíaco / Patient systematic intensive care in post-operative cardiac / Patient systematic intensive care in post-operatório cardiac

Objetivo: conhecer o estado da arte atual a respeito da Sistematização da Assistência de Enfermagem nos cuidados intensivos ao paciente em Pós-operatório Cardíaco. Métodos: revisão integrativa de dados indexados a partir de 2012 em conformidade com o Protocolo Reporting of Qualitative Research Studies. Resultados: elegíveis 08 artigos de 40 pré-selecionados com adensamento de evidências capazes de responder ao objetivo de investigação. Discussão: perceber o paciente cirúrgico no escopo de suas necessidades físicas, emocionais, espirituais e sociais, demanda do Enfermeiro Intensivista constante atualização teórica e metodológica para fundamentar uma prática baseada em Diagnósticos e Prescrições das Intervenções de Enfermagem capazes de suprir as demandas do paciente. Conclusão: a estruturação do cuidado no qual a Sistematização da Assistência de Enfermagem alicerça metodologicamente a aplicação dos conhecimentos como viabilizadores do Processo de Enfermagem permite a realização de um cuidado intensivo diferenciado ao Paciente em Pós-operatório cardíaco

Objective: to know the current state of the art regarding the Systematization of Nursing Care in the intensive care to the patient in Post-operative Cardiac. Methods: integrative review of indexed data as of 2012 in accordance with the Protocol Reporting of Qualitative Research Studies. Results: eligible 08 articles from 40 pre-selected with denser evidence capable of responding to the objective in research. Discussion: to perceive the surgical patient in the scope of their physical, emotional, spiritual and social needs, the Intensive Nurse's demand constant theoretical and methodological update to base a practice based on Diagnoses and Prescriptions of Nursing Interventions able to meet the demands of the patient. Conclusion: the structure of care in which the Nursing Assistance Systematization methodologically supports the application of knowledge as an enabler of the Nursing Process allows the performance of an intensive care differentiated to the Patient in the Cardiac Post-operative

Objetivo: Conocer el estado del arte actual respecto a la Sistematización de la Asistencia de Enfermería en los cuidados intensivos al paciente en Post-operatorio Cardiaco. Métodos: Revisión integrativa de datos indexados a partir de 2012 de conformidad con el Protocolo de informes de expertos en investigación. Resultados: Elegibles 08 artículos de 40 preseleccionados con adensamiento de evidencias capaces de responder al objetivo de investigación. Discusión: Percibir al paciente quirúrgico en el alcance de sus necesidades físicas, emocionales, espirituales y sociales, demanda del Enfermero Intensivista constante actualización teórica y metodológica para fundamentar una práctica basada en Diagnósticos y Prescripciones de las Intervenciones de Enfermería capaces de suplir las demandas del paciente. Conclusión: La estructuración del cuidado en el que la Sistematización de la Asistencia de Enfermería fundamenta metodológicamente la aplicación de los conocimientos como viabilizadores del Proceso de Enfermería permite la realización de un cuidado intensivo diferenciado al Paciente en Postoperatorio cardíaco

Orientações de alta hospitalar para o desempenho do autocuidado após a cirurgia cardíaca: revisão integrativa / Orientaciones de alta hospitalaria para el rendimiento del autocuidado después de la cirugía cardíaca: revisión integrativa / Hospital discharge guidelines for self-care performance after cardiac surgery: integrative review

Objetivo: identificar as orientações de saúde necessárias, para que o paciente em pós-operatório de cirurgia cardíaca possa desempenhar comportamentos de autocuidado após a alta hospitalar. Método: revisão integrativa, seguindo as etapas propostas por Whittemore, limitada aos idiomas português, inglês e espanhol, e publicação entre 2007 e 2018. Utilizaram-se as bases de dados disponíveis nas bibliotecas virtuais PubMed e Biblioteca Virtual em Saúde e o instrumento de Ursi para extração dos dados. Classificaram-se os artigos conforme o nível de evidência. Resultados: foram incluídos seis artigos. Os achados possibilitaram a criação de nove categorias que agrupam as orientações de saúde para o desempenho do autocuidado após alta hospitalar decorrente de cirurgia cardíaca. Conclusão: atividades de vida diária, alimentação, atividade e exercício físico, sintomas psicológicos, controle de fatores de risco, complicações, terapia medicamentosa, manejo dos sintomas e pele foram orientações de saúde identificadas para o desempenho do autocuidado após alta hospitalar de pacientes submetidos a cirurgia cardíaca.

Objetivo: identificar las orientaciones de salud necesarias, para que el paciente en el período postoperatorio de la cirugía cardíaca pueda realizar comportamientos de cuidado personal después del alta hospitalaria. Método: revisión integradora, siguiendo los pasos propuestos por Whittemore, limitada a los idiomas portugués, inglés y español, y publicación entre 2007 y 2018. Fueron utilizadas las bases de datos disponibles en las bibliotecas virtuales PubMed y Biblioteca Virtual en Salud y el instrumento Ursi para la extracción de datos. Los artículos fueron clasificados de acuerdo con el nivel de evidencia. Resultados: se incluyeron seis artículos. Los hallazgos permitieron la creación de nueve categorías que agrupan las orientaciones de salud para el desempeño del autocuidado después del alta hospitalaria debido a la cirugía cardíaca. Conclusión: las actividades de la vida diaria, la dieta, la actividad y el ejercicio físico, los síntomas psicológicos, el control de los factores de riesgo, las complicaciones, la terapia farmacológica, el manejo de los síntomas y la piel fueron orientaciones de salud identificadas para el desempeño del autocuidado después del alta hospitalaria de los pacientes sometidos a cirugía cardíaca.

Objective: to identify the necessary health guidelines, so that the patient in the postoperative period of cardiac surgery can perform self-care behaviors after hospital discharge. Method: integrative review, following the steps proposed by Whittemore, limited to the Portuguese, English and Spanish languages, and publication between 2007 and 2018. The databases used were available on the virtual libraries PubMed and Virtual Health Library and the Ursi instrument for data extraction. The articles were classified according to the level of evidence. Results: six articles were included. The findings allowed creating nine categories that group the health guidelines for self-care performance after hospital discharge from cardiac surgery. Conclusion: activities of daily living, diet, physical activity and exercise, psychological symptoms, control of risk factors, complications, drug therapy, management of symptoms and skin were health guidelines identified for the performance of self-care after hospital discharge of patients undergoing cardiac surgery.

Nursing outcome "airway permeability" in postoperative patients / Resultado de enfermería "permeabilidad de las vías aéreas" en pacientes en el posoperatorio / Resultado de enfermagem "permeabilidade das vias aéreas" em pacientes no pós-operatório

ABSTRACT Objectives: to evaluate the evolution of clinical indicators that characterize airway permeability in patients in the postoperative period of thoracoabdominal surgeries and to analyze their relationship with the occurrence of the diagnosis "ineffective airway clearance". Methods: descriptive, quantitative, longitudinal research with 60 patients who were followed for five consecutive days. Eleven indicators of the nursing outcome "respiratory status: airway permeability" were used. Results: on the first day of evaluation, the most compromised indicators were: respiratory rate, cough, depth of breath and use of accessory muscles. During follow-up, most of the indicators presented a slight deviation from normal variation and, in the last evaluation, there was a predominance of indicators with some degree of impairment. Conclusions: with the aid of the Nursing Outcomes Classification, it was observed that patients submitted to thoracoabdominal surgeries may present compromised airway permeability even days after surgery.

RESUMEN Objetivos: valorar la evolución de los indicadores clínicos que caracterizan la permeabilidad de las vías aéreas en pacientes en el posoperatorio de cirugías toracoabdominales y evaluar su relación con la ocurrencia del diagnóstico "desobstrucción ineficaz de las vías aéreas". Métodos: investigación descriptiva, cuantitativa, longitudinal en la cual participaron 60 pacientes que recibieron seguimiento por cinco días. Se utilizaron 11 indicadores del resultado de enfermería "estado respiratorio: permeabilidad de las vías aéreas". Resultados: en el primer día de evaluación, los indicadores más comprometidos fueron: frecuencia respiratoria, tos, profundidad de la respiración y utilización de músculos accesorios. Durante el seguimiento, se verificó que la mayor parte de los indicadores presentó una leve desviación de la variación normal y, en la última evaluación, hubo un predominio de indicadores con algún grado de comprometimiento. Conclusiones: con la ayuda de la Clasificación de los resultados de enfermería, se observó que los pacientes sometidos a cirugías toracoabdominales pueden presentar comprometimiento de la permeabilidad de las vías aéreas incluso después de algunos días de realizar el procedimiento quirúrgico.

RESUMO Objetivos: avaliar a evolução dos indicadores clínicos que caracterizam a permeabilidade das vias aéreas em pacientes no pós-operatório de cirurgias toracoabdominais e analisar sua relação com a ocorrência do diagnóstico "desobstrução ineficaz das vias aéreas". Métodos: pesquisa descritiva, quantitativa, longitudinal realizada com 60 pacientes que foram acompanhados por cinco dias consecutivos. Foram utilizados 11 indicadores do resultado de enfermagem "estado respiratório: permeabilidade das vias aéreas". Resultados: no primeiro dia de avaliação os indicadores mais comprometidos foram: frequência respiratória, tosse, profundidade da respiração e uso de músculos acessórios. Durante o acompanhamento, verificou-se que a maior parte dos indicadores apresentou desvio leve da variação normal e, na última avaliação, houve predomínio de indicadores com algum grau de comprometimento. Conclusões: com auxílio da Classificação dos resultados de enfermagem, observou-se que pacientes submetidos a cirurgias toracoabdominais podem apresentar comprometimento da permeabilidade das vias aéreas mesmo após dias da realização do procedimento cirúrgico.

O Processo de transição da pessoa idosa sujeita a cirurgia ortopédica: Intervenção do enfermeiro de reabilitação / The transition process for elderly people undergoing orthopedic surgery: rehabilitation nurse intervention

O confronto com a necessidade de cirurgia ortopédica constitui um momento de transição que pode colocar o idoso numa situação de vulnerabilidade. Cabe ao Enfermeiro Especialista em Enfermagem de Reabilitação intervir e, através das suas competências específicas, facilitar esta transição. Tendo por base um projeto de formação, suportado pela teoria da transição de Meleis, defini como objetivo desenvolver competências de Enfermeiro Especialista em Enfermagem de Reabilitação na intervenção junto do idoso a vivenciar um processo de transição decorrente do tratamento cirúrgico de uma patologia ortopédica. A experiência de ensino clínico num serviço de internamento de ortopedia e numa Unidade de Cuidados na Comunidade permitiu-me compreender que a cirurgia ortopédica para além de gerar um processo de transição saúde-doença pode ser geradora de outros tipos de transição, como é o caso da transição situacional, onde se destacam como pontos críticos essencialmente o confronto com o internamento, o momento antes da alta hospitalar e o regresso ao domicílio. Ao longo do processo de transição, o Enfermeiro Especialista em Enfermagem de Reabilitação pode implementar múltiplas intervenções, intervenções baseadas numa avaliação que contemple as condições da transição e a identificação dos intervenientes neste processo, de forma a identificar as necessidades e os recursos do idoso e sua família. Como conclusão verifica-se que uma intervenção organizada e articulada do Enfermeiro Especialista em Enfermagem de Reabilitação pode ser fundamental para facilitar este processo de transição, residindo na intervenção preventiva o principal desafio na melhoria dos cuidados.

Facing the need for orthopedic surgery is a moment of transition that can put the elderly in a vulnerability situation. It is up to the Specialist in Rehabilitation Nursing to intervene and facilitate this transition through its specific abilitys. Based on a training project, supported by Meleis' transition theory, the objective defined was to develop the skills of Specialist Rehabilitation Nursing in the intervention with the elderly experiencing a transition process as result from the surgical treatment of an orthopedic pathology. The experience of clinical teaching in an inpatient orthopedic service and in a Community Care Unit has allowed me to understand that orthopedic surgery, besides generating a health-disease transition process, can generate other types of transition, as is the case of the situational transition, where the critical points are essentially the confrontation with the hospitalization, the moment before the hospital discharge and the return to the home. Throughout the transition the Specialist Rehabilitation Nurse can implement multiple interventions, based on an evaluation that contemplates the transition conditions and the identification of the participants in this process, in order to identify the needs and resources of the elderly and their family. In conclusion, an organized and articulated intervention of the Nursing Specialist in Rehabilitation Nursing may be fundamental to facilitate this transition process, with preventive intervention as the main challenge in improving care.

Eficácia de um protocolo de assistência fisioterapêutica no pós-operatório de cirurgia abdominal eletiva / Efficacy of a protocol of physical therapy assistance in the postoperative period of elective abdominal surgery

Introdução: A realização de cirurgias abdominais possuem riscos de complicações pulmonares no período pós-operatório. A atuação fisioterapêutica no ambiente hospitalar vem se destacando na melhoria das funções pulmonares e na otimização da capacidade funcional. O presente estudo teve como objetivo analisar a eficácia de um protocolo fisioterapêutico em pacientes no pós-operatório de cirurgias abdominais eletivas. Métodos: Trata-se de um estudo intervencionista de abordagem quantitativa, tipo ensaio clínico randomizado. O grupo intervenção após solicitação da prescrição médica foi submetido a um protocolo de assistência fisioterapêutica, e o grupo controle, por não ter sido prescrito pelo médico assistente, realizou a avaliação e recebeu orientações quanto à necessidade da deambulação e da importância da inspiração profunda. As análises foram realizadas através software Statistical Package for Social Sciences, sendo adotado nível de significância valor de p menor que 0,05. Resultados: A amostra foi composta por 93 pacientes divididos em dois grupos homogêneos. As principais causas de internamento foram cirurgias cesarianas e histerectomias. A média de atendimentos de fisioterapia realizada no grupo intervenção foi 6,3 ± 3,7 sessões. Em relação às variáveis respiratórias o GI mostrou-se estatisticamente superior, com exceção no grau de dispneia e na característica da tosse. A capacidade aeróbica no momento da alta hospitalar foi superior no grupo intervenção. O tempo de internamento e os custos hospitalares foram inferiores no grupo submetido ao protocolo. Conclusão: Conclui-se que a realização de um programa de fisioterapia no pós-operatório se faz uma estratégia segura, melhora significativamente as funções respiratórias e reduz o tempo de internamento hospitalar. (AU)

Introduction: The performance of abdominal surgeries presents risks of pulmonary complications in the postoperative period. Physical therapy in the hospital environment has been emphasized in the improvement of pulmonary functions and optimization of functional capacity. The present study aimed to analyze the efficacy of a physiotherapeutic protocol in patients in the postoperative period of elective abdominal surgeries. Methods: This is an interventional study with a quantitative approach, like a randomized clinical trial. The intervention group after requesting the medical prescription was submitted to a physiotherapeutic assistance protocol, and the control group, because it was not prescribed by the attending physician, carried out the evaluation and received guidance on the need for ambulation and the importance of deep inspiration. The analyzes were carried out through software Statistical Package for Social Sciences, being adopted level of significance value of p less than 0.05. Results: The sample consisted of 93 patients divided into two homogeneous groups. The main causes of hospitalization were cesarean surgeries and hysterectomies. The average number of physical therapy visits performed in the intervention group was 6.3 ± 3.7 sessions. Regarding the respiratory variables, GI was statistically superior, except for the degree of dyspnea and the characteristic of cough. The aerobic capacity at the moment of hospital discharge was higher in the intervention group. The hospitalization time and hospital costs were lower in the group submitted to the protocol. Conclusion: It is concluded that the implementation of a physiotherapy program in the postoperative period is a safe strategy, significantly improves respiratory functions and reduces hospitalization time. (AU)