Incidence of urinary retention and relations between patient's complaint, physical examination, and bladder ultrasound.

OBJECTIVE: To describe the frequency of urinary complaints, bladder globe, and need for bladder relief catheterization according to ultrasound; to investigate the relationship between the urinary volume estimated by ultrasound and the one drained in catheterization; and to describe the relationship of patient's complaints and detection of bladder globe with the diagnosis of urinary retention. METHOD: A cross-sectional study with clinical patients with suspected urinary retention in a tertiary hospital, conducted from February to September 2018. Urinary volume ≥500 mL in ultrasound was considered urinary retention. RESULTS: Two hundred and five evaluations were performed in 44 patients. Urinary retention was detected by ultrasound in 33.2% of the evaluations. There was a strong correlation between ultrasound and bladder catheterization. There was a higher frequency of identification of bladder globe in urinary volumes ≥300 mL. CONCLUSION: The incidence of urinary retention was higher when ultrasound was used for the diagnosis, when compared to patient's complaint and physical examination. Ultrasound showed to be accurate in establishing urinary volume.

Incidence of urinary retention and relations between patient's complaint, physical examination, and bladder ultrasound / Incidencia de la retención urinaria y relaciones entre queja del paciente, examen físico y ultrasonografía vesical / Incidência de retenção urinária e relações entre queixa do paciente, exame físico e ultrassonografia vesical

ABSTRACT Objective To describe the frequency of urinary complaints, bladder globe, and need for bladder relief catheterization according to ultrasound; to investigate the relationship between the urinary volume estimated by ultrasound and the one drained in catheterization; and to describe the relationship of patient's complaints and detection of bladder globe with the diagnosis of urinary retention. Method A cross-sectional study with clinical patients with suspected urinary retention in a tertiary hospital, conducted from February to September 2018. Urinary volume ≥500 mL in ultrasound was considered urinary retention. Results Two hundred and five evaluations were performed in 44 patients. Urinary retention was detected by ultrasound in 33.2% of the evaluations. There was a strong correlation between ultrasound and bladder catheterization. There was a higher frequency of identification of bladder globe in urinary volumes ≥300 mL. Conclusion The incidence of urinary retention was higher when ultrasound was used for the diagnosis, when compared to patient's complaint and physical examination. Ultrasound showed to be accurate in establishing urinary volume.

RESUMEN Objetivo Describir la frecuencia de las quejas urinarias, el globo vesical y la necesidad del cateterismo de la vejiga por ultrasonido; verificar la relación entre el volumen urinario estimado por ultrasonido y drenado en el cateterismo y describir la relación entre las quejas de los pacientes y la detección de globo vesical y el diagnóstico de retención urinaria. Método Estudio transversal con pacientes clínicos con sospecha de retención urinaria, realizado entre febrero y septiembre de 2018 en un hospital de nivel terciario. El volumen urinario ≥500 mL en el ultrasonido se consideró retención urinaria. Resultados Se realizaron 205 evaluaciones en 44 pacientes. La retención urinaria se detectó por ultrasonido en el 33,2% de las evaluaciones. Hubo una fuerte correlación entre el ultrasonido y el cateterismo vesical. Se registró una mayor frecuencia de identificación de globo vesical en volúmenes urinarios superiores a 300 mL. Conclusión La incidencia de la RU fue mayor cuando se empleó ultrasonografía para el diagnóstico, comparado con la queja del paciente y el examen físico. La ultrasonografía se mostró precisa en determinar el volumen urinario.

RESUMO Objetivos Descrever frequência de queixas urinárias, globo vesical e necessidade de cateterismo vesical de alívio a partir da realização da ultrassonografia; verificar relação entre volume urinário estimado pela ultrassonografia e drenado no cateterismo e descrever relação entre queixas dos pacientes e detecção de globo vesical com o diagnóstico de retenção urinária. Método Estudo transversal com pacientes clínicos com suspeita de retenção urinária, no período de fevereiro a setembro de 2018, em um hospital terciário. Volume urinário ≥500mL na ultrassonografia foi considerado retenção urinária. Resultados Realizaram-se 205 avaliações, em 44 pacientes. Detectou-se retenção urinária pela ultrassonografia em 33,2% das avaliações. Houve forte correlação entre ultrassonografia e cateterismo vesical. Verificou-se maior frequência de identificação de globo vesical em volumes urinários ≥300mL. Conclusão Incidência de retenção urinária foi maior quando a ultrassonografia foi empregada para o diagnóstico, quando comparado à queixa do paciente e exame físico. Ultrassonografia mostrou-se precisa em determinar volume urinário.

Concordância entre observadores e entre métodos no diagnóstico de retenção urinária / Agreement between observers and between methods in urinary retention diagnosis

Introdução: A retenção urinária (RU) é definida pelo esvaziamento incompleto da bexiga e seu diagnóstico costuma ser embasado na queixa do paciente e na avaliação clínica do enfermeiro. Apesar da ultrassonografia (US) da bexiga vir sendo empregada por enfermeiro em algumas salas de recuperação anestésica, a sondagem vesical (SV) é o "padrão-ouro" para sua confirmação. A falta de consenso sobre o volume urinário que defina RU e o emprego de diferentes métodos de diagnósticos contribuem para a variabilidade na incidência. A literatura carece de estudos que comparem os métodos de avaliação de RU, especialmente em pacientes clínicos e no cenário brasileiro. Objetivo: Avaliar a concordância entre observadores e entre métodos no diagnóstico de RU. Método: Estudo transversal, de enfoque diagnóstico, realizado de fevereiro a setembro de 2018, em uma unidade de internação clínica. A coleta de todos os dados foi realizada por enfermeiros experientes. Os pacientes foram avaliados diante da suspeita de RU a partir da sua queixa. Seguiu-se a avaliação clínica do enfermeiro, da realização de US da bexiga e da SV. Foram realizadas avaliações independentes e em duplicata para avaliar a concordância entre os observadores. A drenagem de > 500mL de urina na SV foi considerada como RU. A concordância entre observadores e entre métodos foi testada por meio do coeficiente de Kappa. A relação entre o volume urinário estimado na US e o obtido na SV foi avaliada por meio de Correlação de Spearman. Também, foi produzido gráfico de Bland-Altman para avaliar esta relação. O estudo foi aprovado quanto aos seus aspectos éticos e metodológicos (CAE: 73406017.4.0000.5327). Resultados: Foram realizadas 208 avaliações em 50 pacientes. As avaliações em duplicata (n = 40) mostraram excelente concordância entre os enfermeiros em determinar RU de acordo com a queixa do paciente (k = 1,0; IC95%: 0,853 ­ 1,146), moderada concordância entre os enfermeiros em determinar RU quando embasam seu diagnóstico na impressão clínica (k = 0,551; IC95%: 0,591 ­ 0,883). Por outro lado, a concordância foi substancial (k = 0,783; IC95%: 0,703 ­ 0,996) quando se embasaram na US. Houve mínimas diferenças (<50mL) entre enfermeiros ao estimarem o volume de urina utilizando a US. No total de avaliações, a taxa de incidência de RU variou de acordo com o método de avaliação. De acordo com a queixa do paciente foi 21,2%, mediante a impressão clínica dos enfermeiros foi 22,1% e com a realização da US foi 34,1%. Nem sempre houve coincidência entre os métodos. Houve concordância plena somente entre a avaliação pela US e a realização de sondagem vesical (k = 1,0; IC95%: 0,935 ­ 1,064). A concordância para a decisão de realizar SV foi menor entre a impressão do paciente (k = 0,41; IC95%: 0,351 ­ 0,479) e a impressão clínica do enfermeiro (k = 0,67; IC95%: 0,611 ­ 0,739). Conclusão: Enfermeiros discordam ao emitir parecer sobre a presença de RU. A queixa do paciente e a impressão do enfermeiro são insuficientes para determinar o quadro de RU de modo seguro. Enfermeiros embasam sua decisão de realizar sondagem vesical nas estimativas geradas na US.

Introduction: Urinary retention (UR) is defined by the incomplete emptying of the bladder and your diagnosis is usually based on the complaint of the patient and the clinical evaluation of the nurse. Despite the bladder Ultrasound (US) come being employed by nurses in some anesthetic recovery rooms, vesical catheterization (VC) is the "gold standard" for your confirmation. The lack of consensus on the urinary volume that define UR and the use of different diagnostic methods contribute to the variability in incidence. Literature lacks studies that compare the methods of assessment of RU, especially in clinical patients and in the Brazilian scenario. Objective: to evaluate the correlation between observers and between methods in the diagnosis of UR. Method: transversal study, diagnostic approach, held from February to September 2018, in an inpatient clinic unit. All data collection was performed by experienced nurses. Patients were evaluated on suspicion of UR from your complaint. Followed the clinical evaluation of the nurse, the bladder US by the nurse and VC. Independent evaluations were carried out in duplicate to assess the correlation between observers. Drainage of > 500 ml of urine in VC was regarded as UR. The agreement between observers and between methods was tested through the Kappa coefficient. The relationship between urinary volume estimated in US and the VC was evaluated by Spearman's Correlation. Also, was produced Bland- Altman chart to evaluate this relationship. The study was approved as to their ethical and methodological aspects (CAE: 73406017.4.0000.5327). Results: 208 evaluations were conducted in 50 patients. Duplicate assessments (n = 40) showed excellent agreement among nurses in determining UR according to the patient's complaint (k = 1.0; 95% CI: 0.853-1.146), moderate agreement among nurses in determining UR when their diagnosis was supported by the clinical impression (k = 0.551; 95% CI: 0.591-0.883). On the other hand, the correlation was substantial (k = 0.783; 95% CI: 0.703-0.996) when supported by the US. There were minimal differences (< 50 ml) between nurses to estimate the volume of urine using US. Total evaluations, the incidence rate of UR varied according to the method of evaluation. According to the complaint of the patient was 21.2%, by clinical impression of the nurses was 22.1% and with the US was 34.1%. Not always there was overlap between the methods. There was full agreement between the evaluation by the US and VC (k = 1.0; 95% CI: 0.935-1.064). The agreement for the decision to make VC was lower between the impression of the patient (k = 0.41; 95% CI: 0.351-0.479) and the nurse's clinical impression (k = 0.67; 95% CI: 0.611-0.739). Conclusion: Nurses disagree to issue opinions on the presence of UR. The complaint of the patient and the nurse's impression are insufficient to determine the framework of UR. Nurses base your decision to perform VC on the estimates generated by the US.

[Education, care and management technologies: a reflection based on nursing teachers' conception]. / Tecnologias educacionais, assistenciais e gerenciais: uma reflexão a partir da concepção dos docentes de enfermagem.

This study involved the teachers of sixteen Nursing Courses at Higher Education Institutions in the State of Rio Grande do Sul and aimed to identify the care, education and management technologies that are used and/or produced in their professional praxis in professionalizing subjects. This text presents a research extract and focuses on the conceptions about the different types of technologies the teachers approached. Data were collected through a questionnaire with closed and open questions and later analyzed according to the methodological framework of content analysis. The study revealed that most teachers presented a restricted concept of the theme, manifesting difficulties for technology use and production and suggesting ways of support to overcome these difficulties, with a view to improving professional praxis.