Técnica modificada Mölndal/Jubilee frente a tratamiento tradicional en heridas quirúrgicas tras cirugía menor en atención primaria / The modified Mölndal/Jubilee technique versus traditional treatment for minor surgical wounds in primary care

Objetivos: General: Comparar la técnica de cura en ambiente húmedo Mölndal/Jubilee modificada para las suturas en cirugía menor ambulatoria, en relación con la cura seca. Específicos: a) medir el tiempo de cicatrización en días entre la técnica Mölndal/Jubilee modificada y la cura seca; b) número de curas realizadas en cada técnica y tiempo en minutos invertido en cada técnica; c) valorar el dolor en cada técnica, y d) comparar las complicaciones aparecidas en cada técnica. Metodología: Ensayo de intervención longitudinal prospectivo multicéntrico y aleatorizado, con grupo control, para evaluar la eficacia de una metodología de cura aplicada tras cirugía menor en atención primaria. La muestra se compone de los pacientes cuyo procedimiento quirúrgico finaliza con sutura. Resultados: Los días hasta la retirada de la sutura invertidos en el grupo intervención fueron de media 9,2 días, con una desviación típica de 2,1, mientras que en el grupo control se emplearon 10,5 días, con una desviación de 2,3. El número de curas que se realizaron en el grupo intervención hasta la retirada de la sutura resultaron de 2 en 45 pacientes (46,9%), 45 pacientes 3 visitas (46,9%) y 6 (6,2%) 4 visitas. En el grupo control no hubo ningún paciente que necesitara menos de 3 visitas; con 3 visitas 18 pacientes (18,8%) del grupo, 4 visitas 41 (42,7%), 5 visitas 30 pacientes (31,2%) y con 7 visitas 7 pacientes (7,3%). El tiempo medio invertido en cada visita para el grupo intervención fue de 2,7 min con una desviación de 0,6 y para el grupo control de 3,1 min con desviación de 0,6. El dolor medio, escala visual analógica, en el grupo intervención se posicionó en 0,5, con desviación típica de 1,0, y de 2,1 para el grupo control con desviación de 1,2. Las complicaciones supusieron el 6,2% en el grupo intervención, 6 complicaciones, en el grupo control se apreciaron 27, el 28,1% (AU)

Objectives: General: Compare the healing technique in a wet environment (Mölndal/Jubilee modified by Grupo Heridas Axarquia) for surgical wounds in minor outpatient surgery, in relation to a dry healing. Specific:a) measure the healing time between the modified technique Mölndal/Jubilee and the dry healing; b) number of cures in each technique and the time spent in both techniques; c) assess the pain in each technique; and d)compare the complications that appear in each technique. Methodology:Multicenter, randomized, control-group, prospective longitudinal intervention trial to evaluate the efficacy of a cure methodology applied after minor surgery in primary care. The sample includes patients whose surgical procedure ends up with suture. Results: The days up to the removal of the inverted suture in the intervention group were on average 9.2 days with a standard deviation of 2.1, while in the control group 10.5 days were used with a deviation of 2.3. The number of cures that were performed in the intervention group until the suture was removed was 2 in 45 patients (46.9%), 3 visits in 45 patients (46.9%) and 4 visits (6.2%) in 6 patients. In the control group there were no patients who needed less than 3 visits; with 3 visits, 18 patients (18.8%) of the group, 4 visits, 41 patients (42.7%), 5 visits 30 patients (31.2%) and with 7 visits 7 patients (7.3%). The average time spent on each visit for the intervention group was 2.7 minutes with a deviation of 0.6 and for the control group 3.1 with a deviation of 0.6. Average pain, analog visual scale, in the intervention group was positioned at 0.5 with standard deviation of 1.0 and 2.1 for control with deviation of 1.2. Complications accounted for 6.2% in the intervention group, 6 complications, and in the control, 27 and 28.1% (AU)

Intervention beamin prevention of local surgical infection

Introduction: Surgical site infections are frequent complications that affect patients undergoing surgery. These are preventable infections that constitute a loss of reputation for healthcare systems worldwide, with consequences for the patient in terms of morbidity, mortality, excessive length of stay, and additional costs to the system and the community. They aggravate their functional disability, increase the emotional stress of patients and families, leading to decreased quality of life.Nurses, as members of the multidisciplinary team, play a crucial role as promoters of adherence to the best practices for prevention and control of surgical site infection called "intervention bundle". Objective: Evaluate the adhesion of nurses to the intervention bundle in the prevention of Surgical Site Injury. Methods: Descriptive, cross-sectional, quantitative study. Sample of convenience, made up to 54 nurses. The data collection instrument was the checklist of the DGS of 2015. Results: The results revealed low adhesion in the presurgical bath with 2% chlorhexidine. Regarding trichotomy, it was avoided in about 59% of the cases. In the maintenance of capillary glycemia and normothermia, these were not met by 33% of professionals. Regarding adherence to surgical antibiotic prophylaxis, it was obeyed by 63% of the professionals, respecting the ideal timing of administration, 120 minutes before surgery. Conclusion: The implementation of programs of continuing education, accountability and awareness of the management bodies for the implementation of a safety culture are substantial in the prevention of surgical site disruption

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Managing chronic, nonhealing wounds stalled in the inflammatory phase: a case series using a novel matrix therapy, CACIPLIQ20.

One of the biggest challenges faced by healthcare providers is the treatment of chronic, non-healing wounds. This paper reports for the first time in the UK the results of five case studies in which a novel regenerating matrix-based therapy, CACIPLIQ20, was used. CACIPLIQ20 is a heparan sulphate mimetic designed to replace the destroyed heparan sulphate in the extracellular matrix of wound cells. All five patients in this case series had chronic, non-healing ulcers that had not improved with conventional care. Treatment included two applications of CACIPLIQ20 per week, for a maximum of 12 weeks. Three of the five wounds healed completely, and the remaining two showed significant improvements in size and quality. The treatment was well tolerated by the patients and also led to a significant reduction in pain. Moreover, CACIPLIQ20 treatment was found to be highly cost-effective when compared to conventional care, with the potential to save healthcare systems significant resources. Further studies are needed to build a strong evidence base on the use of this product, but these preliminary findings are certainly promising.

Cuidados de la herida con fístula enterocutánea postoperatoria / No disponible

Las fístulas enterocutáneas son un problema mayor en la práctica quirúrgica. En general son secundarias a complicaciones postoperatorias. Hasta el 90% de los casos se desarrolla después de una cirugía. La morbilidad y la mortalidad continúan siendo muy elevadas a pesar de los avances en el manejo de esta patología. Las tres complicaciones principales de los pacientes con fístulas son desequilibrio hidroelectrolítico, desnutrición y sepsis, las cuales están en relación con la localización de la fístula, el gasto, las características bioquímicas y electrolíticas de la descarga y la condición patológica subyacente. El objetivo final en el manejo de los pacientes con fístulas es el cierre de la misma. En 1964, Chapman propuso un plan de tratamiento de los pacientes con base en cuatro prioridades. El propósito del tratamiento médico es el cierre espontáneo de la fístula o la preparación del paciente para cirugía. La instalación de un apoyo nutricional adecuado juega un papel esencial para el éxito del tratamiento. El control de la sepsis es una prioridad; la sepsis descontrolada debe ser atacada rápidamente ya que es la principal causa de muerte. El cierre espontáneo ha aumentado en los últimos años; sin embargo, es probable que todavía una gran parte de los pacientes necesite tratamiento quirúrgico, y éste debe ser realizado en el momento adecuado

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An observational study of temperature and thermal images of surgical wounds for detecting delayed wound healing within four days after surgery.

AIM: To elucidate the infrared thermal patterns and temperature readings of the surfaces of surgical wounds for detecting delayed wound healing within four days after surgery. BACKGROUND: The nursing assessment of surgical wounds within the first four days after surgery is commonly based on visual and physical examination. Surgical wounds with delayed healing may be not detected if they do not exhibit signs such as redness or exudate within four days after surgery. DESIGN: This study was conducted using prospective observational design with reference to the STROBE Statement (see Supporting Information Appendix S1) to examine the temperatures of surgical wounds in their natural settings. METHODS: Based on convenience sampling, 60 participants admitted to the colorectal surgical ward for enterostoma closure from January-November 2013 were recruited. RESULTS: Although both infected and noninfected surgical wounds exhibited a significant increase in wound temperature from Days 1-4, the infected wounds revealed a statistically significantly lower temperature than the noninfected ones. Within the infrared thermal images, the infected wounds presented with partial warming of the skin surrounding and along the incision, suggesting that delayed healing could be identified. CONCLUSION: This study demonstrates that delayed wound healing can be detected within the first four days after surgery for early intervention of prevention and treatment before discharge. RELEVANCE TO CLINICAL PRACTICE: This paper provides evidence-based information for healthcare professionals in assessing surgical wounds for delayed healing within the first four days after surgery. The findings herein enable the early detection of delayed wound healing, based on which early intervention of prevention and treatment may be instituted for affected patients before their discharge.

Estudio antes-después sobre el uso de la técnica Mölndal / Before and after study about the use of mölndal technique versus tradicional wound care of surgical wound for elective colorrectal surger

La infección del sitio quirúrgico representa un problema persistente en la ci-rugía electiva o programada. Objetivo. Analizar la efectividad de la cura en ambiente húmedo respecto a la cura tradicional en la cirugía electiva. Material y Métodos. Estudio cuasi experimental antes-después. Se comparó la cura tradicional realizada durante el año 2013 frente a la cura mediante técnica Mölndal evaluada durante el año 2014. Se incluyeron pacientes sometidos a cirugía colorrectal programada. El estudio fue aprobado por el comité ético correspondiente al centro. Resultados. Se incluyó un total de 556 pacientes, de los cuales 256 lo fueron durante el año 2013 y 300 en el año 2014. La cirugía pertenece al grupo contaminada o limpia-contaminada. Se observó una reducción del 30 % en la infección del sitio quirúrgico mediante el uso de la técnica Mölndal comparada con la cura tradicional. Se obtuvo una reducción en los costes derivados de la estancia hospitalaria. Conclusión. El uso de la técnica Mölndal reduce la tasa de complicaciones de la herida quirúrgica y el tiempo de ingreso hospitalario en pacientes sometidos a cirugía colorrectal

Objectives. Surgical site infection represents a persistent problem in elective or scheduled surgery. Objective. To analyze the effectiveness of the cure in a humid environment with respect to the traditional cure in elective surgery. Material and Methods. Quasi-experimental study before and after. We compared the traditional cure carried out during 2013 versus the cure using the Mölndal technique evaluated during 2014. Patients undergoing scheduled colorectal surgery were included. The study was approved by ethics committee. Results. A total of 556 patients were included of which 256 were during the year 2013 and 300 in the year 2014. The patients had contaminated or clean-contaminated surgery. A reduction of 30 % in the infection of the surgical site was observed using the Mölndal technique compared with the traditional dressings. A reduction in the costs derived from the hospital stay was obtained. Conclusion. The use of the Mölndal Technique reduces the complication rate of the surgical wound and the time of hospital admission in patients undergoing colorectal surgery

Preventing surgical site infections: Facilitators and barriers to nurses' adherence to clinical practice guidelines-A qualitative study.

AIMS: To identify the facilitators of and barriers to nurses' adherence to evidence-based wound care clinical practice guidelines (CPGs) in preventing surgical site infections (SSIs) in an Australian tertiary hospital. BACKGROUND: Current research suggests that up to 50% of nurses are unaware of the evidence-based recommendations to prevent SSIs and that adherence to evidence-based CPGs is suboptimal. However, little is known regarding the facilitators and barriers to adherence to evidence-based CPGs. DESIGN: A qualitative study incorporating ethnographic data collection techniques. METHODS: Data collection included semi-structured individual interviews and focus groups (N = 20), and examination of existing hospital policy and procedure documents. Thematic analysis using inductive and deductive approaches was conducted. This manuscript adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines. FINDINGS: Data analysis revealed four themes: adhering to aseptic technique, knowledge and information seeking, documenting wound care and educating and involving patients in wound care. Facilitators and barriers within each theme were identified. Facilitators included participants' active information-seeking behaviour, a clear understanding of the importance of aseptic technique, and patient participation in wound care. Barriers included participants' knowledge and skills deficits regarding application of aseptic technique principles in practice, the availability of the hospital's wound care procedure document, suboptimal wound care documentation and the timing of patient education. CONCLUSIONS: There is a need to develop interventions to improve nurses' adherence to recommended CPGs including following aseptic technique principles, hand hygiene, documentation and patient education. Hospital procedure documents that outline wound care need to reflect current recommended CPGs. RELEVANCE TO CLINICAL PRACTICE: Adhering to evidence-based CPGs has been found to be effective in reducing and preventing SSIs. Our study provides an in-depth understanding of the barriers and facilitators to nurses' adherence to recommended CPGs. The findings may inform future practice improvements in wound care.

Evaluation of Surgical Wound Healing in Orthopedic Patients with Impaired Tissue Integrity According to Nursing Outcomes Classification.

PURPOSE: To assess the surgical wound (SW) healing in orthopedic patients with Impaired tissue integrity according to the Nursing Outcomes Classification (NOC). METHODS: A prospective longitudinal study performed with 24 patients. Data collection was performed through an instrument containing the NOC indicators. FINDINGS: The indicators skin approximation, drainage, surrounding skin erythema, periwound edema, increased skin temperature, and foul wound odor presented a statistically significant increase when compared the means between the first and the last day of evaluation. CONCLUSION: The NOC indicators allowed to monitor the SW healing indicating an improvement. IMPLICATIONS FOR NURSING PRACTICE: The NOC can favor an earlier identification of the degree of commitment for each patient and enables implementation of care to achieve target outcomes.

Scoping Review of Clinical Outcomes Related to Advanced Training in Wound Care.

INTRODUCTION: There are different levels of wound education which exist amongst healthcare providers treating wounds. It is unknown if advanced wound training can lead to improved clinical outcomes. PURPOSE: To review and summarize existing literature focused on the impact of different healthcare professionals with advanced wound care training and the associated effect of clinical outcomes. MATERIALS AND METHODS: The methods used to conduct this scoping review are based on the methodological framework developed by Arksey and O'Malley. An electronic search was performed by independent reviewers using Scopus, CINAHL, PubMed, Google, and EWMA. Consensus decision-making amongst the reviewers resulted in relevant final articles being selected for review. RESULTS: In the literature, there is no universally accepted definition for advanced training in wound care. Seven of the eight selected articles focused on nurses with a specialization in wound healing and their impact on wound healing outcomes. The five main themes identified were wound improvement, cost savings, influence on other nurses, wound recurrence rate, and advanced education. CONCLUSION: A minimum level of advanced training or education would be beneficial to ensure consistency in the provision of advanced wound care by professionals practicing wound care.

Assessing knowledge of wound care among cardiothoracic nurses.

AIMS: to explore cardiothoracic nurses' knowledge and self-reported competence of wound care following cardiac surgery and to ascertain if there were any differences in knowledge between nurses working in public and private hospitals. BACKGROUND: cardiothoracic nurses are the main providers of wound care for patients post cardiac surgery, however, there is a lack of research about their knowledge of wound care. DESIGN: a descriptive, quantitative design was used in the form of a cross-sectional, self-reported questionnaire. METHOD: the questionnaire was developed to ascertain nurses' knowledge of cardiac wound management. Census sampling was used and the questionnaire was distributed to 503 nurses in 6 hospitals in the Republic of Ireland. Total knowledge scores were calculated and data analysed using descriptive and inferential statistics. RESULTS: the response rate was 31.2% (n=158). The main knowledge deficits identified were wound healing, the signs and symptoms of surgical site infection and cardiac-specific wound care. Some nurses reported using inappropriate products for cleansing wounds and variable time for initial postoperative dressing removal. CONCLUSION: the combination of low total knowledge scores and requests for further training and education suggest the need for ongoing wound care education. Audit of the use of wound cleansing products, support bras and wound assessment charts is recommended.

Nursing wound care practices in Haiti: facilitators and barriers to quality care.

AIM: To describe the facilitators and barriers for nurses to perform quality wound care in three surgical wards of a hospital in Port-au-Prince, Haiti. BACKGROUND: Up to a quarter of patients in low- and middle-income countries may acquire at least one infection while hospitalized. There is a paucity of research investigating nursing wound care practices in low- and middle-income countries regarding the prevention of hospital-acquired infections. METHODS: The design was qualitative descriptive. We observed nursing staff on the general surgery, orthopaedics and maternity units while they performed routine dressing changes (n = 15). We interviewed nursing (n = 13) and medical residents (n = 3) and inquired about their perceptions of facilitators and barriers for nurses to perform quality wound care. FINDINGS: A number of wound care practices appeared well integrated including using gloves to remove dressings, applying sterile dressings, properly disposing of soiled materials, inspecting wounds for signs of infection and employing comfort and privacy measures. Areas that may need improvement included aseptic technique, hand hygiene, pain assessments, patient education and documentation. We identified four themes related to barriers and facilitators to perform quality wound care: (i) materials and resources; (ii) nurse-to-patient ratios, workload and support; (iii) roles and responsibilities of nurses; and (iv) knowledge and training of nurses. CONCLUSION: Nursing wound care practices may be optimized by improving nurses' professional status and working conditions. IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY: Greater financial investment in health care and (continuing) education, self-regulation and development of the nursing role, including more autonomy, are needed to elevate the professional status of nurses in Haiti. Institutional policies should promote best practices, clarify nursing roles and responsibilities and foster interdisciplinary collaboration in patient care.

Cuidados de enfermería en un paciente intervenido de neovejiga ileal ortotópica tipo Hautmann. Caso clínico / No disponible

Entre las derivaciones urinarias en pacientes sometidos a una cistectomía radical por cáncer vesical infiltrante, la neovejiga ileal ortotópica, tipo Hautmann, es una excelente alternativa. Como objetivos nos planteamos: 1) exponer los cuidados de enfermería en pacientes intervenidos de cistectomía radical por cáncer vesical infiltrante a los que se les ha construido una neovejiga ileal tipo Hautmann, y 2) señalar el importante papel que juega enfermería, tanto hospitalaria como de atención primaria, en este tipo de intervención quirúrgica. Se expone un caso clínico de un paciente diagnosticado de cáncer urotelial papilar de alto grado con infiltración perineural al que se le ha construido una neovejiga. Se muestra el procedimiento seguido en el servicio, así como los protocolos empleados y actuaciones de enfermería. Como complicación presentó un íleo paralítico. La bibliografía especializada señala que el íleo paralítico es una de las complicaciones inmediatas que se da con más frecuencia en la cistectomía radical por cáncer vesical infiltrante, junto con la fístula urinaria, retención urinaria por mucus y urosepsis. Estudios de seguimientos de casos de neovejiga ileal tipo Hautmann muestran buenos resultados funcionales, una baja tasa de complicaciones, tanto inmediatas como tardías, y, sobre todo, una buena calidad de vida de estos pacientes

Orthopic ileal neobladder, type Hautmann, is currently the preferred method for urinary derivation in patients undergoing radical cystectomy for muscle-infiltrating bladder cancer. We set goals such as: 1) to supply useful information to patients with neobladder, specifically Hautmann neobladder about patients who underwent radical cystectomy due to infiltrating bladder cancer. 2) to highlight the important role that nursing staff plays by promoting quality in nursing care in this type of surgical intervention. It is described the case of a patient diagnosed with high-grade papillary urothelial carcinoma with evidence of perineural invasion. This patient underwent a radical cystectomy with neobladder reconstruction. The patient presented paralytic ileus. Paralytic ileus is a severe complication resulting from a variety of disorders, which is most commonly associated with radical cystectomy due to infiltrating bladder cancer. Other complications are urinary fistula, urinary retention due to mucus and urosepsis. Surveys aimed at monitoring the Hautmann neobladder show good functional outcomes, a low rate of complications of both immediate and late responses, and therefore, the quality of life for these patients was good

Self-care and postoperative dressing management.

As the increasing burden on healthcare costs continues to rise, posing clinical and financial challenges for all healthcare providers attempting to provide optimal, evidence-based wound care, the situation appears to be reaching the tipping point with regard to reduced resources, increasing patient groups with complex wounds and financial restraints. It is clearly time for action and new ways of working that include empowering patients and carers to take appropriate ownership within their personal wound-care journey. This observational evaluation explores 10 community-based patients presenting with postoperative acute surgical wounds; it examines and evaluates the patients' experience with regard to self-care satisfaction, Leukomed Control product satisfaction and actual traditional/personal costs incurred up to a 4-week period. The evaluation highlights not only an overall positive improvement within patient satisfaction and experience, alongside optimised wound progression and related cost savings, but also offers a valuable insight into the promotion and success of patients taking ownership of their wound-care journey.

Surgical wound dehiscence in an Australian community nursing service: time and cost to healing.

OBJECTIVE: Surgical wound dehiscence (SWD) increases the length of hospital stay and impacts on patient wellbeing and health-care costs. Globally, the health-care costs associated with SWD are poorly reported and those reported are frequently associated with surgical site infection (SSI), rather than dehiscence of non-microbial cause. This retrospective study describes and reports on the costs and time to healing associated with a number of surgical patients who were referred to a community nursing service for treatment of an SWD following discharge from a metropolitan hospital, in Perth, Western Australia. METHOD: Descriptive statistical analysis was carried out to describe the patient, wound and treatment characteristics. A costing analysis was conducted to investigate the cost of healing these wounds. RESULTS: Among the 70 patients referred with a SWD, 55% were treated for an infected wound dehiscence which was a significant factor (p=0.001). Overall, the cost of treating the 70 patients with a SWD in a community nursing service was in excess of $56,000 Australian dollars (AUD) (£28,705) and did not include organisational overheads or travel costs for nurse visits. The management of infection contributed to 67% of the overall cost. CONCLUSION: SWD remains an unquantified aspect of wound care from a prevalence and fiscal point of view. Further work needs to be done in the identification of SWD and which patients may be 'at risk'. DECLARATION OF INTEREST: The authors declare they have no competing interests.

A Cross-sectional, Descriptive, Quality Improvement Project to Assess Undergraduate Nursing Students' Clinical Exposure to Patients With Wounds in an Introductory Nursing Course.

Because nurses frequently participate in decisions related to wound care, learning about wounds and their care during undergraduate education is critical. A cross-sectional, descriptive, quality improvement project was conducted in an introductory baccalaureate nursing course to identify: 1) the types of patients with wounds assigned to beginning students, 2) patient wound care procedures and dressings, and 3) student level of participation in wound care. Data were collected from the weekly notes recorded about students' (N = 49) patient care experiences in 3 acute care hospitals for 9 clinical days during 1 semester. Data were recorded on a paper-and-pencil form by instructors at the end of the clinical day and included type of wound, wound irrigation, dressing, technique of care, and student's participation. Descriptive statistics were used to examine the frequency and distribution of the wound characteristics and care assessed. Of the 284 patients assigned to students, 75 (26.4%) had a wound. The most common wound was a surgical incision (49, 65%) and was closed (36, 73.5%). Twenty-six (26) patients had a pressure ulcer, most commonly Stage II. The most common dressing was dry gauze (29). Damp gauze was used on 18 wounds. Wound irrigation was recorded for 24 wound protocols and performed with a bulb syringe or by pouring the solution from a container. Generally, nonsterile wound care was performed. Twenty-five (25) students performed wound care with the instructor, 16 watched the care performed by another clinician, and 10 participated with another nurse in the wound care. For 22 patients, the wound care was neither observed nor performed because either it was not time for the dressing to be changed or it was only to be changed by a medical team. From these data, it was concluded beginning nursing students had some, but limited, clinical experience with patients with wounds. Students' wound care experiences need further examination, especially across multiple educational courses.

Clinical profile, nursing diagnoses and nursing care for postoperative bariatric surgery patients. / Perfil clínico, diagnósticos e cuidados de enfermagem para pacientes em pós-operatório de cirurgia bariátrica.

Objective To analyze the clinical profile, nursing diagnoses, and nursing care established for postoperative bariatric surgery patients. Method Cross-sectional study carried out in a hospital in southern Brazil with a sample of 143 patients. Data were collected retrospectively from electronic medical records between 2011 and 2012 and analyzed statistically. Results We found a predominance of adult female patients (84%) with class III obesity (59.4%) and hypertension (72%). Thirty-five nursing diagnoses were reported, among which the most frequent were: Acute Pain (99.3%), Risk for perioperative positioning injury (98.6%), and Impaired tissue integrity (93%). The most frequently prescribed nursing care were: to use protection mechanisms in the surgical patient positioning, to record pain as 5th vital sign, and to take vital signs. There was an association between age and comorbidities. Conclusion The nursing diagnoses supported the nursing care prescription, which enables the qualification of nursing assistance.

Perfil clínico, diagnósticos e cuidados de enfermagem para pacientes em pós-operatório de cirurgia bariátrica / Perfil clínico, diagnósticos y cuidados de enfermería para pacientes en el post-operatorio de la cirugía bariátrica / Clinical profile, nursing diagnoses and nursing care for postoperative bariatric surgery patients

RESUMO Objetivo Analisar o perfil clínico, os diagnósticos e os cuidados de enfermagem estabelecidos para pacientes em pós-operatório de cirurgia bariátrica. Método Estudo transversal realizado em um hospital do Sul do Brasil, com amostra de 143 pacientes. Os dados foram coletados retrospectivamente entre 2011-2012 no prontuário eletrônico dos pacientes, os quais foram analisados estatisticamente. Resultados Identificaram-se pacientes femininas adultas (84%) com obesidade grau III (59,4%) e hipertensas (72%), com 35 diagnósticos de enfermagem, sendo os mais frequentes: Dor aguda (99,3%), Risco de lesão pelo posicionamento perioperatório (98,6%) e Integridade tissular prejudicada (93%). Dentre os cuidados de enfermagem prescritos, os mais utilizados foram: usar mecanismos de proteção no posicionamento cirúrgico do paciente, registrar a dor como 5° sinal vital e verificar sinais vitais. Foi observada associação entre a idade e as comorbidades. Conclusão Os diagnósticos de enfermagem subsidiaram a prescrição de cuidados, possibilitando qualificar a assistência de enfermagem.

RESUMEN Objetivo Analizar el perfil clínico, diagnósticos de enfermería y cuidados de enfermería establecidos para los pacientes en postoperatorio de cirugía bariátrica. Método Estudio transversal con la muestra de 143 pacientes. El estudio se realizó entre 2011-2012, en un hospital en el sur de Brasil. Los datos fueron recolectados retrospectivamente de los registros médicos electrónicos y analizados estadísticamente. Resultados Se identificaron pacientes femeninas adultas (84%), con obesidad clase III (59,4%), hipertensión (72%) y con 35 diagnósticos de enfermería, siendo los más frecuentes: el Dolor agudo (99,3%), Riesgo de lesión perioperatoria de posicionamiento (98,6%) y la Integridad del tejido deteriorado (93%). Entre los cuidados de enfermería prescritos los más utilizados fueron: utilizar los mecanismos de protección en el posicionamiento quirúrgico del paciente, registrar el dolor como quinto signo vital y verificar los signos vitales. Se observó una asociación entre la edad y las comorbilidades. Conclusión Los diagnósticos de enfermería apoyaron la prescripción de los cuidados de enfermería, lo que permite calificar la asistencia de enfermería.

ABSTRACT Objective To analyze the clinical profile, nursing diagnoses, and nursing care established for postoperative bariatric surgery patients. Method Cross-sectional study carried out in a hospital in southern Brazil with a sample of 143 patients. Data were collected retrospectively from electronic medical records between 2011 and 2012 and analyzed statistically. Results We found a predominance of adult female patients (84%) with class III obesity (59.4%) and hypertension (72%). Thirty-five nursing diagnoses were reported, among which the most frequent were: Acute Pain (99.3%), Risk for perioperative positioning injury (98.6%), and Impaired tissue integrity (93%). The most frequently prescribed nursing care were: to use protection mechanisms in the surgical patient positioning, to record pain as 5th vital sign, and to take vital signs. There was an association between age and comorbidities. Conclusion The nursing diagnoses supported the nursing care prescription, which enables the qualification of nursing assistance.