Avaliação do autocuidado como indicador para supervisão clínica em enfermagem / Self-care assessment as an indicator for clinical supervision in nursing

Avaliar as necessidades dos enfermeiros em supervisão clínica para avaliar o grau de dependênciano autocuidado e planear intervenções de enfermagem. Métodos: estudo analítico, recolhendo dados de umaamostra de 110 doentes. Resultados: evidenciaram-se diferenças na identificação dos graus de dependênciaentre registos e especialistas, bem como na seleção das intervenções para cada autocuidado e falhas ao níveldo preenchimento da avaliação inicial (não avaliação dos autocuidados/descuro na identificação dos graus dedependência). Conclusão: identificaram-se lacunas no processo de enfermagem; propuseram-se estratégiascomo sessões de supervisão clínica, formação, estudo de casos, protocolos e guias de orientação, a seremincluídas em um modelo de supervisão clínica em enfermagem...

Atendimentos de emergência por causas externas não intencionais envolvendo idosos de Florianópolis, SC: viva 2006-2007 / Emergency calls for external causes not intentional involving older ones from Florianópolis, SC: 2006-2007 viva

O presente estudo tem como objetivo descrever o perfil dos atendimentos de urgência e emergência por acidentes não intencionais em idosos da capital do estado de Santa Catarina. Participaram do estudo idosos acima de 60 anos que foram atendidos nos serviços de urgência e emergência do município de Florianópolis, SC, no período de 2006 (n= 40) e 2007 (n=17), por meio da análise dos dados secundários do Sistema de Vigilância de Violências e Acidentes (VIVA). Foram coletadas informações referentes ao sexo, à idade, à cor da pele, ao grau de escolaridade, à área de domicílio e aos eventos relacionados às injúrias. Em 2006, as causas externas não intencionais predominaram nas mulheres, em idosos de 60 a 69 anos, de cor de pele branca, com escolaridade de primeira a quarta série do ensino fundamental, residentes na área urbana e cujo meio de transporte mais utilizado foi SAMU/Resgate. Em 2007, as causas externas foram mais evidentes nos idosos de 60 a 69 anos, com ensino fundamental, de cor de pele branca, e domiciliados na área urbana. Utilizaram o veículo particular para chegar ao hospital. Em ambos os períodos, o tipo de ocorrência que prevaleceu foram quedas na residência. A natureza da lesão mais frequente foi a de fratura nos membros inferiores. A maioria dos idosos teve alta e encaminhamento ambulatorial, sem registro de óbito. Considera-se de suma importância o estabelecimento de iniciativas de prevenção voltados para idosos e que integrem as práticas de saúde coletiva e do cuidado individual de idosos.

The aim of this study was to describe the profile of urgent and emergency care and unintentional injuries involving seniors of the state capital of Santa Catarina. Study participants were aged 60 years old who were treated in emergency from Florianópolis, SC, from 2006 (n = 40) and 2007 (n = 17), through the analysis of secondary data collected from reporting Surveillance System for Violence and Accidents (VIVA). Information on gender, age, skin color, level of education and area of residence and from the events related to injury were collected. In 2006, unintentional external causes predominated in 60 -69-year-old women, white skin color, schooling from first to fourth grade elementary incomplete, teaching residents in the urban area and the means of transport most used was SAMU/Rescue. In 2007, external causes were more evident in 60-69-year-olds with primary school, white skin color, resedent in urban area. The private vehicle was the most used to go to the hospital. In both periods, the occurrence of which prevailed was falls in residence. The nature of the most frequent injury was fracture of the lower limbs. Most seniors were discharged and outpatient referral without death record. It is considered of paramount importance to establish prevention initiatives aimed at elderly and integrate the practices of individual and collective health care of the elderly.

Delayed hemodynamic monitoring with pulmonary artery catheter is a non-essential care in severe sepsis and septico shock

Objective: Prompt adequate antibiotic therapy, eradication of infection, fluids and vasoactive drugs are themain strategies for initial resuscitation of septic shock. Once initial resuscitative efforts are not effective,invasive hemodynamic monitoring (HM) with pulmonary artery catheter (PAC) has been frequently used toguide filling pressures and optimal doses of vasoactive agents. However, the evidence of benefit from PACuse in septic shock is still a matter of debate. We aimed to determine whether early compared to delayplacement of PAC could have influenced outcome.Methods: Retrospective analysis in a 24-bed general ICU tertiary care university hospital. From January 1999to December 2000, patients admitted with severe sepsis and septic shock and having a PAC inserted werestudied. Early invasive HM was defined whenever a PAC was placed in the first 48 hours, and delayedinvasive HM was placed more than 48 hours after the diagnosis of severe sepsis or septic shock. Organ failurewas defined as a SOFA score of > 3 points.Results. Among 104 patients submitted to invasive monitoring with PAC, 56 patients had sepsis. Fifty-twopatients with severe sepsis (5, 9.6 por cento) and septic shock (47, 90.4 por cento) were enrolled. Thirty-six patients (69 por cento) hadearly HM and 16 (21 por cento) delayed HM. Overall in-hospital mortality was 69 por cento. The groups had similar APACHEII score (18.6 ± 8.0, early HM; 18.5 ± 3.8, delayed HM), SOFA score (9.4 ± 3.2, early HM; 9.9 ± 4.4, delayed HM)and number of organs failure (1.6 ± 0.9, early HM; 1.8 ± 1.4, delayed HM) at the onset of severe sepsis/septicshock. The in-hospital mortality rate was significantly higher in delayed HM group (87.5 por cento) compared withearly HM (61.3 por cento) (RR: 0.70, CI 95 por cento 0.50-0.96, p < 0.05). Compared with delayed HM, early HM patientsreceived significantly higher amount of fluids (10.3 ± 3.6 L vs 6.8 ± 3.5 L, p = 0.002) within 48 hours from onsetof severe sepsis/septic shock.Conclusion. Delayed monitoring with PAC patients with severe sepsis/septic shock is associated with a veryhigh risk of death and might be considered a non-essential care.

The effects of aging on biceps brachii muscle fibers: a morphometrical study from biopsies and autopsies

OBJECTIVES: In order to study the morphology and size of muscle fibers, cross sections of biceps brachii samples from autopsies, up to 9 hours after death, and biopsies of 72 subjects were compared. The subjects aged 13 to 84 years in both sexes. METHODS: The samples obtained from autopsies (n=47) were from subjects with sudden death, or who died after acute disease without evidence of neuromuscular involvement. The biopsies (n=25) were from patients with symptoms suggestive of inflammatory or metabolic myopathy, not confirmed morphologically. The lesser diameter of muscle fibers was measured using the ATPase reaction. RESULTS: Morphological analysis showed that aging changes were present from the sixth decade in autopsies, and consisted of atrophy and/or type-grouping. The statistical models adjusted for females in both autopsies and biopsies were linear straight with no variation in fiber size with increasing age. The models adjusted for males in both groups were quadratic, indicating that age influenced the size of different type fibers. In males type 2 were larger than type 1 fibers, and than fibers in females. CONCLUSIONS: These values might be useful as controls, helping interpretation of changes in fiber size in samples obtained from biopsies and autopsies