Qualitative real-time analysis by nurses of sublingual microcirculation in intensive care unit: the MICRONURSE study.

INTRODUCTION: We aimed to determine i) the feasibility of nurses taking bedside measurements of microcirculatory parameters in real time in intensive care patients; and ii) whether such measurements would be comparable to those obtained by the classical delayed semi quantitative analysis made by a physician. METHODS: This prospective observational study was conducted in a university hospital and was approved by our local Institutional Review Board (IRB 00006477). After ICU admission and study inclusion, a set of measurements of macrocirculatory and microcirculatory parameters was taken by the nurse in charge of the patient every 4 h within the first 12 h after admission and before and after every hemodynamic therapeutic intervention. Seventy-four sublingual microvascular measurements were performed with incident dark field illumination (IDF) microscopy in 20 mechanically ventilated patients hospitalized in the ICU. RESULTS: There were no significant differences between the microvascular flow index (MFI) taken in real time by the nurses and the delayed evaluation by the physician. In fact, the nurses' real-time measurement of MFI demonstrated good agreement with the physician's delayed measurement. The mean difference between the two MFIs was -0.15, SD = 0.28. The nurses' real-time MFI assessment showed 97 % sensitivity (95 % CI: 84-99 %) and 95 % specificity (95 % CI: 84-99 %) at detecting a MFI <2.5 obtained by a physician upon delayed semiquantitative measurement. Concerning the density, 81 % of the paramedical qualitative density measurements corresponded with the automatized total vessel density (TVD) measurements. The nurses' real-time TVD assessment showed 77 % sensitivity (95 % CI: 46-95 %) and 100 % specificity (95 % CI: 89-100 %) at detecting a TVD <8 mm/mm(2). CONCLUSION: A real-time qualitative bedside evaluation of MFI by nurses showed good agreement with the conventional delayed analysis by physicians. The bedside evaluations of MFI and TVD were highly sensitive and specific for detecting impaired microvascular flow and low capillary density. These results suggest that this real-time technique could become part of ICU nurse routine surveillance and be implemented in algorithms for hemodynamic resuscitation in future clinical trials and regular practice. These results are an essential step to demonstrate whether these real-time measurements have a clinical impact in the management of ICU patients.

Evaluación de la ansiedad en pacientes ante pruebas diagnósticas de patología cardiovascular / Assessment of anxiesty in patient with cardiovascular disease diagnostic test

Se realizó un estudio para indagar el nivel de ansiedad que presentan los pacientes ante pruebas diagnosticas cardiovasculares durante el año 2011. El trabajo fue de tipo descriptivo, transversal. La muestra fue de 161 pacientes que asistieron a un servicio de medicina nuclear. Se utilizó la esacala de ansiedad Estado Rasgo A/E STAI (inventario de ansiedad estado y rasgo) Entre los resultados se destaca el nivel de A/E medio en el 45,34% de los pacientes, y A/R en el 50,31%. Niveles altos de ansiedad en el 22,36%. Las mujeres presentaron mayores porcentajes que los varones de A/E con 24,46% de nivel medio y 14,91% de nivel alto. Se puede concluir que los niveles de ansiedad media fueron los de mayor frecuencia, mientras que las mujeres mostraron mayores porcentajes en los niveles de ansiedad que los varones.

Intervenciones de enfermería en la toma de electrocardiograma, círculo torácico y medrano / Nursing interventions in making electrocardiogram, thoracic circle and Medrano", "_i": "

Aun después del advenimiento de métodos innovadores de mapeo electrocardiográfico tridimensional, el electrocardiograma conserva su significado central en el diagnóstico cardiológico y continúa vigente para orientar el tratamiento de los pacientes cardiópatas. El electrocardiograma ya sea de 12 derivaciones, círculo torácico o Medrano, refleja la actividad eléctrica del corazón y por lo tanto brinda información acerca de la función cardiaca, se imprime sobre un papel cuadriculado de modo que se obtiene un registro continuado de la actividad cardiaca. En la práctica diaria, el profesional de enfermería representa una parte fundamental en la detección oportuna de enfermedades o complicaciones de las mismas, por lo tanto la correcta toma del electrocardiograma es indispensable para obtener un registro de calidad que contribuya con el tratamiento de un paciente y por ende con el mejoramiento de su salud.

Even after the advent of innovative methods for mapping three-dimensional, electrocardiogram its central significance in the cardiological diagnosis and remains in force to guide the treatment of cardiac patients. The electrocardiogram either 12 leads, chest circle or Medrano, reflects the electrical activity of the heart and therefore provides information on cardiac function, is printed on graph paper so that a continuous recording of cardiac activity is obtained. In daily practice, the nurse is a fundamental part in the early detection of diseases or complications thereof therefore correct decision electrocardiogram is essential to obtain a record of quality that contribute to the treatment of a patient and thus to improving your health.

Safety of mobilizing hospitalized adults: review of the literature.

This article examines literature that provides evidence about the safety of mobilizing hospitalized adults. A search of electronic databases and hand searches yielded 24 studies that were included in the review. Evidence of mobilization safety was found in 4 clinical settings (medical, surgical, cardiac procedure, and intensive care), and the findings from these studies suggest that early mobilization of hospitalized adults is safe.

La resonancia magnética y el profesional de enfermería / Magnetic resonance imaging and the nursing professional", "_i": "

Actualmente en México existe escasa información acerca de las actividades que realiza el profesional de enfermería en el Servicio de Resonancia Magnética, el cual es considerado un método diagnóstico inocuo y seguro para los pacientes. Por lo anterior, en este artículo se da a conocer de manera general en qué consiste dicho estudio de gabinete y se resalta la participación e importancia de los cuidados que se proporcionan a las personas antes, durante y después del procedimiento.

Currently in Mexico, there is little information about the activities of the nursing professionals in the service of Magnetic Resonance, which is considered a safe and secure method to diagnose patients at earlier in this article is disclosed so what is the general desk study and highlights the importance of participation and care provided to people before, during and after the procedure.

Diagnósticos de enfermería más frecuentes por necesidad en la persona con afección cardiovascular / The most frequent nursing diagnoses by necessity in the person with cardiovascular disease", "_i": "

Introducción: Los diagnósticos de enfermería describen problemas de salud reales, potenciales o de bienestar, son un juicio clínico de la persona, familia o comunidad que se obtiene tras la valoración. Objetivo: Identificar los diagnósticos de enfermería más frecuentes por necesidad en la persona con afección cardiovascular. Material y métodos: Estudio descriptivo, transversal y prospectivo de octubre del 2007 a diciembre del 2008. Muestra por conveniencia de n = 667 valoraciones exhaustivas de enfermería cardiovascular con el enfoque de Virginia Henderson; incluyó valoraciones realizadas a las personas de todas las edades y hospitalizadas en el Instituto Nacional de Cardiología Ignacio Chávez y se eliminaron aquéllas donde no se registró el diagnóstico de enfermería o éste era ilegible. Análisis de datos en Excel 2003 con frecuencias y porcentajes. Resultados: Del total de valoraciones; 54% corresponden al sexo masculino. Necesidad alterada de mayor frecuencia: oxigenación con 68%. Se obtuvieron un total de 113 etiquetas diagnósticas, 81% pertenecen a la taxonomía Nursing Diagnosis: Definitions & Classification (NANDA) y 19% redactadas en formato: Problema, Etiología, Signos y Síntomas (PESS). De manera general, el insomnio, el riesgo de caída y el deterioro de la movilidad física son las etiquetas más frecuentes en el paciente cardiópata. Para la necesidad de oxigenación, las etiquetas más frecuentes son: patrón respiratorio ineficaz (35.7%) y deterioro del intercambio gaseoso (31.8%). Conclusión: Las etiquetas diagnósticas se encuentran directamente relacionadas con las manifestaciones clínicas cardiovasculares y son aplicables para el desarrollo de los planes de cuidado de enfermería. También existe una correspondencia directa de la entidad clínica cardiovascular con el deterioro de la necesidad de oxigenación y seguridad.

Introduction: Nursing diagnoses described problems of health, real, potential or welfare; a clinical trial of the person, family or community, which is obtained after the assessment they are. Objective: Identify the most frequent nursing diagnoses by necessity in the person with cardiovascular condition. Material and methods: descriptive, transversal and prospective study from October 2007 to December 2008. Sample for convenience of n = 667 comprehensive assessments of cardiovascular nursing Virginia Henderson approach; It included all assessment to people of all ages and hospitalized at the National Institute of Cardiology Ignacio Chavez and eliminated those where there was the nursing diagnosis or this was the unreadable. Data analysis in Excel 2003 with frequencies and percentages. Results: Of the total of valuations; 54% are male. Altered more often need: oxygenation with 68%. Were a total of 113 diagnostic labels, 81% belong to the taxonomy Nursing Diagnosis: Definitions & Classification (NANDA) and 19% in format: problem, etiology, signs and symptoms. In general, the insomnia, the risk of falling and the deterioration of physical mobility are more common in the patient with cardiovascular alteration labels. For the need of oxygen, most frequent labels are: ineffective breathing pattern (35.7%) and impairment of gas exchange (31.8%). Conclusion: The diagnostic labels are directly related to cardiovascular clinical manifestations and are applicable for the development of nursing care plans. There is also a direct correspondence of cardiovascular clinical entity with the deterioration of the oxygenation and security need.

Cardiovascular aspects of septic shock: pathophysiology, monitoring, and treatment.

The care of patients with septic shock is exceedingly complex. New therapies and monitoring technologies are being rapidly developed. To create an effective plan of care that integrates these new therapies and technologies, critical care nurses must understand the underlying pathophysiology of septic shock, techniques to accurately monitor patients' status, and the rationale for care.

Nursing assessment of circulatory function.

Assessment of circulatory function demands of the nurse skilled observation integrated with knowledge and understanding. Appreciation of normal physiology allows the nurse to make sound evaluations and judgments. Because of her increased understanding, the nurse brings security to the patient, family, and physician, as well as herself, by her ability to anticipate and often prevent catastrbphic circulatory events, and thus actively contributes to the survival of patients.