Cuidados de enfermagem na prevenção da pneumonia associada à ventilação mecânica / Nursing care in preventing pneumonia associated with mechanical ventilationt / Atención de enfermería en la prevención de la neumonía associada a la ventilación mecânica

Introdução:A ventilação mecânica invasiva é um recurso terapêutico artificial, que possui a finalidade de equilíbrio da ventilação e/ou oxigenação de pacientes com insuficiência respiratória, entre as complicações desta intervenção, destaca-se a pneumonia. Nesse âmbito, o enfermeiro tem um papel primordial na criação de programas de prevenção das infecções, sobretudo na precaução da pneumonia associada à ventilação mecânica nas unidades de terapia intensiva. Objetivo:Descrever as ações de enfermagem para prevenção da pneumonia associada à ventilação mecânica invasiva na Unidade de Terapia Intensiva. Metodologia:Trata-se de um estudo do tipo revisão integrativa da literatura, para qual, definiu-se como ambiente de pesquisa as bases de dados BDENF, LILACS e MEDLINE. Elencou-se artigos publicados nos idiomas português, inglês e espanhol no período entre 2015 a 2019. Explorou-se os artigos a partir dos parâmetros estabelecidos pelo guia PRISMA, verificação dos títulos, resumos e texto completo, considerando os estudos que estivessem de acordo com o objetivo proposto, sendo selecionados 7 artigos para compor esta revisão. Resultados:Observou-se nos artigos analisadosa importância da adesão de ferramentas de ações no processo de cuidado, como os protocolos e bundles (um conjunto de medidas e intervenções) de prevenção da pneumonia associada à ventilação mecânica, para quais compreendem práticas como a verificação da pressão do cuff, elevação da cabeceira, aspiração de secreção, higiene oral, validade dos artigos médicos, lavagens das mãos e a interrupção da infusão de sedativos. Conclusões:Preconiza-se a adesão de medidas preventivas da pneumonia associada à ventilação mecânica nas unidades de terapia intensiva, as quais precisam ser praticadas rigorosamente pelos profissionais de enfermagem, por serem representantes do cuidado. Ressalta-se a necessidade de atualizações e construções de protocolos com medidas que possam prevenir as infecções de trato respiratório oriundas do uso da ventilação mecânica invasiva (AU).

Introduction:Invasive mechanical ventilation is an artificial therapeutic resource, which aims to balance ventilation and / or oxygenation of patients with respiratory failure, among the complications of this intervention, pneumonia stands out. In this context, the nurse has a primary role in creating infection prevention programs, especially in the prevention of pneumonia associated with mechanical ventilation in intensive care units. Objective:To describe nursing actions to prevent pneumonia associated with invasivemechanical ventilation in the Intensive Care Unit.Methodology:This is a bibliographic study, of the type integrative literature review, for which the databases BDENF, LILACS and MEDLINE were defined as a research environment. Articles published in Portuguese, English and Spanish from 2015 to 2019 were listed. Articles were explored using the parameters established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guide, verification of titles, abstracts and full text, considering studies that were in accordance with the proposed objective, with 7 articles selected to compose this review. Results: It was observed in the analyzed articles the importance of adhering to action tools in the care process, such as protocols and bundles (a set of measures and interventions) for preventing pneumonia associated with mechanical ventilation, for which they comprise practices such as checking the cuff pressure, elevating the headboard, secretion aspiration , oral hygiene, validity of medical articles, hand washing and stopping the infusion of sedatives. Conclusions:Adherence to preventive measures for pneumonia associated with mechanical ventilation in intensive care units is recommended, which must be strictly practiced by nursing professionals, as they are representatives of care. The need to update and build protocols with measures that can prevent respiratory tract infections arising from the use of invasive mechanical ventilation is emphasized (AU).

Introducción:La ventilación mecánica invasiva es un recurso terapéutico artificial, con la finalidad de equilibrar la ventilación y / u oxigenación enpacientes con insuficiencia respiratoria, entre las complicaciones de esta intervención se destaca la neumonía. En este contexto, la enfermera es fundamental en la creación de programas de prevención de infecciones, especialmente en neumonía asociada a ventilador en unidades de cuidados intensivos. Objetivo:Describir las acciones de enfermería para prevenir la neumonía asociada a la ventilación mecánica invasiva en la Unidad de Cuidados Intensivos. Metodología:Se trata de una revisión integradora de la literatura, realizada a través de las bases de datos BDENF, LILACS y MEDLINE. Se enumeraron los artículos publicados en portugués, inglés y español en el período comprendido entre 2015 y 2019. Los artículos fueron explorados en base a los parámetros establecidos por la guía Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA), verificación de títulos, resúmenes y texto completo.,considerando los estudios que estaban de acuerdo con el objetivo propuesto, seleccionándose 7 artículos. Resultados:Se observó la importancia de la adherencia a herramientas de acción en el proceso de atención, como protocolos y paquetes (conjunto de medidas e intervenciones) para la prevención de la neumonía asociada al ventilador, que incluyen prácticas comoel control de la presión del paciente. manguito, elevación de la cabeza, aspiración de secreciones, higiene bucal, vigencia de artículos médicos, lavado de manos e interrupción de la infusión de sedantes. Conclusiones:Se recomienda la adherencia a las medidas preventivas, las cuales deben ser practicadas con rigor por los profesionales de enfermería, por ser representantes del cuidado. Se destaca la necesidad de actualización y construcción de protocolos con medidas que puedan prevenir las infecciones deltracto respiratorio derivadas del uso de ventilación mecánica invasiva (AU).

Pré-natal masculino: desafios na prática de enfermagem na atenção básica à saúde / Male prenatal care: challenges in nursing practice in primary health care

Objetivo: descrever os desafios existentes na prática de Enfermagem quanto à implementação do pré-natal masculino. Método: Estudo descritivo, qualitativo, realizado com dez enfermeiras que atuam na Atenção Básica à Saúde, em Unidades de Saúde da Família, no município de Feira de Santana, Bahia, Brasil. Realizou-se entrevista individual, semiestruturada, analisadas pelo método do Discurso do Sujeito Coletivo. Resultados: Há desafios relacionados com as dimensões da formação acadêmica e profissional, tal como da captação e adesão masculina e no fazer técnico, atitudinal e assistencial direcionado à saúde de homens, e consequentemente a inserção masculina no pré-natal, que se encontra direcionada ao atendimento da lógica da produção das demandas, e focalizada na perspectiva cisheteronormativa. Conclusão: A presença dos desafios na implementação do pré-natal masculino, implica na ausência da produção do cuidado de Enfermagem direcionado a este contexto, com relação direta às construções de gênero, tal qual da organização do processo de formação acadêmica e da organização das práticas em saúde no sistema.

Objective: To describe the challenges in nursing practice regarding the implementation of male prenatal care. Method: Descriptive, qualitative study, conducted with ten nurses who work in Primary Health Care, in Family Health Units, in the municipality of Feira de Santana, Bahia, Brazil. An individual semi-structured interview was conducted, analyzed by the Collective Subject Discourse method. Results: There are challenges related to the dimensions of academic and vocational training, such as male uptake and adherence and technical, attitudinal and care delivery directed to men's health, and consequently male insertion in prenatal care, which is directed to meeting the logic of the production of demands, and focused on the cisheteronormative perspective. Conclusion: The presence of challenges in the implementation of male prenatal care implies the absence of nursing care production directed to this context, with direct relation to gender constructions, such as the organization of the academic formation process and the organization of practices. in health in the system.

Left ventricular noncompaction in a patient with fabry disease: overdiagnosis, morphological manifestation of fabry disease or two unrelated rare conditions in the same patient?

We report a clinical case of a young female with Fabry disease but without left ventricular hypertrophy, which fulfills the diagnostic criteria of left ventricular noncompaction (LVNC). To our knowledge, this is the first report of LVNC in a patient with Fabry disease. The possibility of an overdiagnosis of LVNC is discussed based on the limitations of the current diagnostic criteria. This case was further investigated by genetic analysis, which came to demonstrate the limited usefulness of genetic testing in the diagnosis of LVNC. Assuming a true trabecular pattern of LVNC, the hypothesis that the same patient has two unrelated and rare conditions, although possible, is unlikely. The genetic and clinical heterogeneity of LVNC is discussed and supports, along with this clinical case, the hypothesis that LVNC is a morphological expression of different diseases rather than a distinct cardiomyopathy. Accordingly, LVNC could be a rare cardiac manifestation of Fabry disease.

Massive right atrial myxoma presenting as syncope and exertional dyspnea: case report.

Primary heart neoplasms are rare occurring with an estimated incidence of 0.0017-0.19%. Myxoma is the most prevalent primary heart tumor. The right atrium is an unusual localization, occurring only in 15-20% of myxoma cases. We report a rare case of a massive right atrial myxoma causing tricuspid valve obstruction and presenting as syncope and exertional dyspnea. This case illustrates the influence of myxoma's size, position and mobility as well as patient's body posture and respiration to the development of signs and symptoms. Three-dimensional echocardiography proved useful in surgery planning, allowing a better definition of the tumor outline and attachment.

Cardiomyopathy and kidney disease in a patient with maternally inherited diabetes and deafness caused by the 3243A>G mutation of mitochondrial DNA.

Cardiomyopathy is a manifestation of mitochondrial cytopathies, but rarely constitutes the dominant feature, especially in adults. We report the case of a 59-year-old male with a personal and maternal history of diabetes and deafness, who presented with cardiomyopathy and kidney disease. We diagnosed the patient as having a mitochondrial cytopathy resulting from the 3243A>G mutation on the tRNA(Leu(UUR)) gene in the mitochondrial DNA. The family history, broad spectrum of clinical manifestations and fluctuant clinical course provided clues to the diagnosis. We discuss the possible mechanisms underlying the phenotypic variability and fluctuant clinical course of mitochondrial disorders and the potential usefulness of coenzyme Q10 and L-carnitine in 3243A>G mutation patients.

Influência das condições de corte no preparo de lojas receptoras de implantes dentais / Influence of the cutting conditions in the preparation of sites bone for dental implants

O objetivo deste trabalho é apresentar a influência das condições de corte na furação de tíbia bovina, através do monitoramento da temperatura próxima à parede da loja receptora de implante e da força de avanço sobre a ferramenta. Foi utilizado um kit de brocas odontológicas sem revestimento, de aço inoxidável martensítico AISI 440C; uma mistura a 20% de fluido de arrefecimento automotivo e água como fluido refrigerante (irrigação), a uma vazão de 160 ml/min; três termopares do tipo T (cobre-constantam) e uma unidade de aquisição de dados Agilent para a medição de temperatura e, finalmente, um dinamômetro rotativo Kistler, para a medição de força de avanço. Concluiu-se que, do modo como os testes foram realizados, a broca mais exigida foi a helicoidal de 2 mm de diâmetro. Para ela foram obtidos os menores valores de temperatura e um estado de conformidade aos padrões clínicos para os valores de força de avanço, quando se usinou com os maiores parâmetros de corte (45 mm/min e 2500 rpm). Observou-se também, que a velocidade de avanço alta influencia, principalmente, a queda da temperatura, enquanto a rotação elevada à diminuição da força de avanço.

The goal of this work is to investigate the influence of the cutting conditions in bovine tibia drilling through the measure of temperature next to dental site wall and of the thrust force over the tool. It was used dentistry drills made of uncoated martensitic stainless steel AISI 440C. A mixture of 20% radiator fluid and water was used as coolant (irrigation) with a flow of 160 ml/min. Three T type thermocouples (copper-constantam) and an Agilent data acquisition unit were used for temperature measurement. And, a rotating Kistler dynamometer was used for thrust force measurement. The results showed that the twist drill with 2 mm diameter was the most stressed. This tool obtained the lowest values of temperature and a conformity state with clinic standard for the trust force values, when machined with the highest cutting parameters (45 mm/min and 2500 rpm). Also was observed that the higher feed speed has a main influence on the temperature drop, while higher rotation decreases the thrust force.

Use of an implantable loop recorder: initial experience.

OBJECTIVE: Retrospective analysis of the initial experience at our department with an implantable loop recorder (ILR) for the evaluation of patients with recurrent syncope, palpitations or dizziness. METHODS: We studied ten patients aged 31-65 (52.3) years referred to our center after an inconclusive evaluation that included ECG, Holter monitoring, events recorder, stress test, echocardiogram and electrophysiological study. Seven patients had structural heart disease. We used a Reveal Plus (Medtronic, USA) ILR, which allows up to 41 minutes of electrocardiographic recording, over a period of 24 months, patient or device activated, according to the programmed parameters. Follow-up was scheduled every three months or after every event activated by the patient. Symptoms and recorded events were analyzed. RESULTS: Eight patients activated events, out of a total of 45 episodes, and five patients reported two or more symptoms. Dizziness was reported by five patients (24 episodes), palpitations by three (seven episodes), syncope by three (seven episodes) and nonspecific symptoms by five patients (seven episodes). The first symptom occurred between the twelfth day and the sixth month after implantation. Four episodes (three syncope and one dizziness) occurred with significant AV conduction disturbance (complete or high grade AV block) and in 41 episodes no rhythm or AV disturbance was recorded. Thirty events were automatically activated. There were no device-related complications. None of the patients died during follow-up.