ABSTRACT
Calcific tendinitis is a pathology characterized by the deposits of periarticular hydroxyapatite. Its pathophysiology is not completely known. It is clinically characterized by important inflammatory changes with incapacitating pain. It most commonly affects the shoulder joint and it rarely affects the hand and wrist. Given the unusual nature of this localization, we present the clinical case of a woman who developed calcific tendinitis of the third metacarpophalangeal muscle. We present the clinical evolution of the case, the treatments carried out, and a review of the literature related to this unusual localization of calcific tendinitis.
Subject(s)
Humans , Female , Adult , Tendon Injuries/therapy , Wrist Injuries/therapy , Calcinosis/complications , Tendinopathy/complications , Acute Pain/etiology , Calcinosis/diagnosis , Magnetic Resonance Imaging , Radiography , Tendinopathy/diagnosis , Acute Pain/diagnosisABSTRACT
ABSTRACT BACKGROUND: Using pain scales helps nurses in making early diagnoses and in assessing and managing pain symptoms and findings when developing a nursing care plan. OBJECTIVE: To determine the validity and reliability of the Turkish form of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS). DESIGN AND SETTING: Prospective study conducted in Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. METHODS: 145 newborns in the 26th to 42nd gestational weeks that were receiving treatment and care in the neonatal intensive care unit were included in this study. A total of 1740 pain assessments were made by two independent observers on these 145 newborns. The research data was collected using a newborn description form, NIAPAS and the Neonatal Infant Pain Scale (NIPS). RESULTS: The scope validity index of NIAPAS was found to be between 0.90 and 1.00 and its Cronbach's alpha coefficient was 0.914. Correlations between characteristics and total scores (r = 0.20-0.82) were found to be sufficiently high. In an assessment on concurrency validity, there was a strong positive relationship between NIAPAS and NIPS scores (r = 0.73-0.82; P < 0.000). From kappa analysis (0.73-0.99) and intraclass correlation (r = 0.75-0.96), it was determined that there was concordance between the observers. CONCLUSION: NIAPAS was found to be a valid and reliable scale for evaluating acute pain in newborns.
Subject(s)
Humans , Infant, Newborn , Infant , Acute Pain/diagnosis , Turkey , Pain Measurement , Prospective Studies , Reproducibility of ResultsABSTRACT
Abstract Background and objectives Patient self-rating based scales such as Numerical Rating Scale, Visual Analog Scale that is used for postoperative pain assessment may be problematic in geriatric or critically ill patients with communication problems. A method capable of the assessment of pain in objective manner has been searched for years. Analgesia nociception index, which is based on electrocardiographic data reflecting parasympathetic activity, has been proposed for this. In this study we aimed to investigate the effectiveness of analgesia nociception index as a tool for acute postoperative pain assessment. Our hypothesis was that analgesia nociception index may have good correlation with Numerical Rating Scale values. Methods A total of 120 patients of American Society of Anesthesiologists (ASA) physical status I and II undergoing any surgical procedure under halogenated-based anesthesia with fentanyl or remifentanil were enrolled for the study. At the 15th minute of arrival to the Postoperative Care Unit the patients' pain was rated on a 0-10 point Numerical Rating Scale. The patients' heart rate, blood pressure, and analgesia nociception index scores were simultaneously measured at that time. The correlation between analgesia nociception index, heart rate, blood pressure and Numerical Rating Scale was examined. Results The study was completed with 107 patients, of which 46 were males (43%). Mean (SD) analgesia nociception index values were significantly higher in patients with initial Numerical Rating Scale ≤3, compared with Numerical Rating Scale >3 (69.1 [13.4] vs. 58.1 [12.9] respectively, p < 0.001). A significant negative linear relationship (r 2 = -0.312, p = 0.001) was observed between analgesia nociception index and Numerical Rating Scale. Conclusion Analgesia nociception index measurements at postoperative period after volatile agent and opioid-based anesthesia correlate well with subjective Numerical Rating Scale scores.
Resumo Justificativa e objetivo As escalas baseadas na autoavaliação de pacientes, como a Escala Visual Numérica e a Escala Visual Analógica, que são usadas para avaliar a dor pós-operatória podem ser problemáticas em pacientes geriátricos ou em estado crítico com problemas de comunicação. Portanto, um método capaz de avaliar a dor de maneira objetiva vem sendo pesquisado há anos. O índice de analgesia/nocicepção, baseado em dados eletrocardiográficos que refletem a atividade parassimpática, tem sido proposto para tal avaliação. Neste estudo, objetivamos investigar a eficácia do índice de analgesia/nocicepção como uma ferramenta para a avaliação da dor pós-operatória aguda. Nossa hipótese foi que o índice de analgesia/nocicepção pode ter boa correlação com os valores da Escala de Classificação Numérica. Métodos Um total de 120 pacientes com estado físico ASA I e II, submetidos a qualquer procedimento cirúrgico com o uso de anestésicos halogenados associados a fentanil ou remifentanil, foi incluído no estudo. No 15º minuto após a chegada à sala de recuperação pós-anestesia, a dor dos pacientes foi avaliada em uma escala numérica de 0-10 pontos. Os escores de frequência cardíaca, pressão arterial e o índice de analgesia/nocicepção dos pacientes foram medidos simultaneamente naquele momento. A correlação entre o índice de analgesia/nocicepção, frequência cardíaca, pressão arterial e a Escala Visual Numérica foi avaliada. Resultados O estudo foi concluído com 107 pacientes, dos quais 46 eram do sexo masculino (43%). Os valores da média (DP) do índice de analgesia/nocicepção foram significativamente maiores nos pacientes com valor inicial na Escala Visual Numérica ≤ 3, em comparação com valor na mesma escala > 3 (69,1 [13,4] vs. 58,1 [12,9], respectivamente, p < 0,001). Uma relação linear negativa significativa (r2 = -0,312, p = 0,001) foi observada entre o índice de analgesia/nocicepção e a Escala Visual Numérica. Conclusão As mensurações do índice de analgesia/nocicepção no pós-operatório após anestesia com agentes halogenados e opioides mostraram boa correlação com os escores subjetivos da Escala Visual Numérica.
Subject(s)
Humans , Male , Female , Adult , Young Adult , Pain Measurement/methods , Acute Pain/diagnosis , Nociception/drug effects , Analgesia/methods , Pain, Postoperative/diagnosis , Pain, Postoperative/prevention & control , Fentanyl/administration & dosage , Prospective Studies , Acute Pain/prevention & control , Remifentanil/administration & dosage , Analgesics, Opioid/administration & dosage , Middle AgedABSTRACT
INTRODUCCIÓN: el dolor postoperatorio es un importante problema de salud pública, con una elevada incidencia según publicaciones internacionales. el dolor crónico postoperatorio (DCPO) se desarrolla posterior a una cirugía y persiste por más de dos meses, excluyendo otras causas y problemas preexistentes. se han descrito factores de riesgo demográficos, psicosociales y médicos para el desarrollo de dolor crónico postoperatorio (DCPO), siendo el más importante el dolor postoperatorio agudo elevado. actualmente, en Chile se carece de datos locales sobre dolor postoperatorio agudo y crónico. OBJETIVO: evaluar la intensidad del dolor agudo en pacientes post-operados y las medidas analgésicas utilizadas, esto en el contexto de la identificación de los factores de riesgo para el desarrollo de DCPO en pacientes hospitalizados en el servicio de cirugía de un hospital de alta complejidad. MATERRIALES Y MÉTODOS: se realizó un estudio observacional descriptivo de corte transversal retrospectivo. La muestra incluyó a 100 pacientes post-operados seleccionados en forma aleatoria del área de cirugía del Hospital del Salvador entre los meses de septiembre y octubre de 2017. Se realizó una revisión de protocolos operatorios, evoluciones e indicaciones médicas y se registraron edad, sexo, dolor postoperatorio según la escala numérica del dolor (EN) y factores de riesgo de DCPO (cirugía con riesgo de daño nervioso, revisional, abierta, malla, complicaciones postoperatorias, dolor postoperatorio sobre 5, según EN), además del tiempo operatorio. Se realizó un registro electrónico en planilla de excel (Microsoft® Excel® 2011) pre-codificada y diseñada para este fin, resguardando la identidad de los participantes. Los datos obtenidos se expresaron como promedios (con desviación estándar) y medianas. RESULTADOS: se encontró una incidencia de 44% de dolor postoperatorio, con intensidad promedio de 4,4 ± 1,64 puntos entre los pacientes que presentaron dolor en algún grado. el 93% de los pacientes con dolor presentó dolor moderado a severo. en el 98% del total de pacientes se indicó terapia analgésica; de éstos, el 47,95% solo tuvo indicación de antiinflamatorios no esteroidales (AINEs), 39,79% AINEs y paracetamol, 7,14% solo paracetamol y 5,10% otras combinaciones. el 95% de los pacientes presentó uno o más factores de riesgo para DCPO, y el 11%, cuatro o más. DISCUSIÓN: el conocimiento de la incidencia e intensidad local de dolor postoperatorio es un primer paso para optimizar su manejo. la identificación de la población en riesgo de desarrollar DCPO podría permitir implementar a futuro medidas preventivas, que mejoren la calidad de vida de los pacientes postoperados
INTRODUCTION: postoperative pain is an important public health issue, with a high incidence reported in international literature. chronic postoperative pain (CPOP) is developed posterior to a surgical intervention and persists over two months, excluding other causes and preexisting problems. several risk factors for CPOP have been mentioned, including demographic, psicosocial and medical ones; the most relevant being high acute postoperative pain. nowadays, Chile lacks local data of acute and chronic postoperative pain. OBJECTIVES: assess the intensity of acute postoperative pain and the analgesia used, in the context of the identification of risk factors for CPOP in a surgery department of a high complexity hospital. MATERIALS AND METHODS: an observational descriptive tranversal restrospective study was used. the sample was constituted by 100 postsurgical patients selected randomly from the surgical department of the Hospital del Salvador between september and october 2017. a revision of surgical protocols and medical charts was made; age, sex, postsurgical pain according to numeric pain scale (NPS) and risk factors for CPOP (surgery with risk of nervous damage, second look, open, use of mesh, postsurgical complications, postsurgical pain above 5 according to NPS) were registered, besides surgical time. the record was made on an precoded excel sheet (Microsoft® Excel® 2011), designed for this purpose. the identity of the patients was kept anonymous. the data obtained was expressed as mean (with standard deviation) and median. RESULTS: an incidence of 44% of postsurgical pain was found, with mean intensity of 4.4 ± 1.64points between patients that presented any degree of pain.93% from the patients with pain presented moderate to severe pain. 98% from the total of patients had analgesia, from them 47.95% only had non-steroidal antiinflamatory drugs (NSAIDs), 39.79% NSAIDs and acetaminophen, 7.14% only acetaminophen and 5.10% other combinations. 95% of patients had one or more risk factors for CPOP, and 11% four or more of them. DISCUSSION: the knowledge of the incidence and intensity of postsurgical pain is the first step in order to optimize its manage. the identification of the population at risk to develop CPOP could allow the implementation of preventive measures that may improve the quality of life of postsurgical patients.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pain, Postoperative/drug therapy , Pain, Postoperative/epidemiology , Analgesia/methods , Pain Measurement , Chile , Epidemiology, Descriptive , Incidence , Risk Factors , Acute Pain/diagnosis , Acute Pain/drug therapy , Chronic Pain/epidemiology , Hospitalization , Analgesics/therapeutic useABSTRACT
ABSTRACT Objective: to develop the operational and conceptual definitions of the defining characteristics and related factors of the nursing diagnosis Acute Pain (00132) for nonverbal critically ill patients. Method: integrative literature review in the databases/libraries: Medical Literature Analysis and Retrieval System Online (MEDLINE via Pubmed), Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Latin American & Caribbean Health Sciences Literature (LILACS). Results: 799 results were found in the literature, of which 80 studies were selected for full text reading and 16 were used in the elaboration of definitions for the 17 defining characteristics and three related factors of the nursing diagnosis. The gray literature, ie, thesis, dissertations, books, guidelines and dictionary was also explored to ensure the robustness needed to clarify the topics not covered by the studies. Conclusion: the definitions aim to facilitate the identification of the nursing diagnosis for nonverbal critically ill patients and to support future teaching and research on the nursing diagnosis of Acute Pain (00132).
RESUMO Objetivo: construir as definições operacionais e conceituais das características definidoras e fatores relacionados do diagnóstico de Enfermagem Dor Aguda (00132) para pacientes criticamente enfermos não comunicativos. Método: revisão integrativa da literatura nas bases de dados/bibliotecas: Medical Literature Analysis and Retrieval System Online (MEDLINE via Pubmed), Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) e na Literatura Latino-Americana em Ciências da Saúde (LILACS). Resultados: 799 ocorrências na literatura, das quais 80 artigos foram selecionados para leitura na íntegra e 16 deles foram utilizados na construção das definições para as 17 características definidoras e os três fatores relacionados do diagnóstico em estudo. A literatura cinzenta, qual seja, tese, dissertações, livros, diretriz e dicionário também foi explorada para garantir a robustez necessária à elucidação dos tópicos não abarcados pelos artigos. Conclusão: as definições visam facilitar a identificação do diagnóstico de enfermagem na prática clínica de pacientes criticamente enfermos não comunicativos, auxiliando o ensino e pesquisas futuras com o diagnóstico Dor Aguda (00132).
RESUMEN Objetivo: construir las definiciones operacionales y conceptuales de las características definidoras y de los factores relacionados con el diagnóstico de Enfermería Dolor Agudo (00132) en pacientes críticamente enfermos no comunicativos. Método: revisión integradora de literatura en las bases de datos/bibliotecas: Medical Literature Analysis and Retrieval System Online (MEDLINE vía Pubmed), Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) y en la Literatura Latinoamericana de Ciencias de la Salud (LILACS). Resultados: se estudiaron 799 casos en la literatura, de los cuales se seleccionaron 80 artículos para lectura completa y 16 de ellos se utilizaron en la construcción de las 17 características definidoras y de los tres factores relacionados al diagnóstico en estudio. Se exploró, también, la literatura gris, ya sea, tesis, disertaciones, libros, directivas y diccionarios para garantizar la elucidación necesaria de los tópicos no abarcados por los artículos. Conclusión: las definiciones pretenden facilitar la identificación del diagnóstico de enfermería en la práctica clínica de pacientes críticamente enfermos no comunicativos, auxiliando a la enseñanza y a investigaciones futuras con el diagnóstico Dolor Agudo (00132).
Subject(s)
Humans , Nursing Diagnosis , Acute Pain/diagnosis , Critical IllnessABSTRACT
Summary Low back pain is in one of the most common reasons for seeking medical care in emergency care units, and also the second most common cause of work absenteeism. The recognition of red flags for serious diseases such as tumors and fractures, through proper history-taking and clinical examination, is essential for proper treatment and to rule out differential diagnoses. In the absence of suspected severe underlying disease, subsidiary radiological examinations are unnecessary. Analgesic and anti-inflammatory drugs are the treatment of choice and can be cautiously associated with muscle relaxants and opioids in more severe cases. Most patients will have complete improvement of symptoms after a few months, but a minority can develop chronic low back pain or present with recurrent episodes. The proper understanding of all of the above can optimize results and avoid diagnostic and therapeutic errors.
Resumo A dor lombar é uma das causas mais comuns de procura à assistência médica em unidades de pronto atendimento. É ainda a segunda causa de afastamento laboral. O reconhecimento de sinais de alerta de doenças graves, como tumores e fraturas, por meio de anamnese e adequado exame clínico, é fundamental para o adequado tratamento e a exclusão de diagnósticos diferenciais. Na ausência de suspeita de doença grave subjacente, exames radiológicos subsidiários são desnecessários. O uso de analgésicos e anti-inflamatórios é o tratamento de primeira escolha, podendo estar associado a relaxantes musculares e opioides, com cautela em casos mais graves. A maior parte dos pacientes apresentará melhora total dos sintomas após alguns meses; porém, uma minoria irá desenvolver lombalgia crônica ou quadros recorrentes. O adequado entendimento de todos esses pontos permite otimizar resultados e evitar erros diagnósticos e terapêuticos.
Subject(s)
Humans , Low Back Pain/diagnosis , Low Back Pain/therapy , Acute Pain/diagnosis , Acute Pain/therapy , Recurrence , Anti-Inflammatory Agents, Non-Steroidal , Diagnosis, Differential , Analgesics/therapeutic useABSTRACT
Abstract Objective: to describe acute and chronic pain from the perspective of the life cycle. Methods: participants: 861 people in pain. The Multidimensional Pain Evaluation Scale (MPES) was used. Results: in the category estimation method the highest descriptors of chronic pain for children/ adolescents were "Annoying" and for adults "Uncomfortable". The highest descriptors of acute pain for children/adolescents was "Complicated"; and for adults was "Unbearable". In magnitude estimation method, the highest descriptors of chronic pain was "Desperate" and for descriptors of acute pain was "Terrible". Conclusions: the MPES is a reliable scale it can be applied during different stages of development.
Resumo Objetivo: descrever a dor aguda e a crônica na perspectiva do ciclo vital. Métodos: participaram 861 pessoas com dor. Foi utilizada a Escala Multidimensional de Avaliação da Dor (EMADOR). Resultados: no método da estimação de categoria o descritor da dor crônica de maior atribuição para crianças e adolescentes foi "Chata" e para adultos foi "Desconfortável". Os descritores de maior atribuição para dor aguda em crianças e adolescentes foram "Complicada" e em adultos "Insuportável". No método de estimação de magnitude, o descritor de maior atribuição na dor crônica foi "Atormentadora" e na dor aguda foi "Terrível". Conclusões: a EMADOR é uma escala confiável e pode ser utilizada nas diferentes etapas do desenvolvimento humano.
Resumen Objetivo: la descripción del dolor agudo y crónico desde las perspectiva del ciclo de vida. Métodos: participaron 861 personas con dolor. Se utilizó la Escala Multidimensional de Evaluación del Dolor (EMEDOR). Resultados: en el método de estimación de categoría el descriptor de dolor crónico más alto para niños y adolescentes fue de Molesto y para adultos fue Incómodo. Los descriptores mayores de dolor agudo para niños y adolescentes fueron Complejo y para adultos Insoportable. En el método de estimación de magnitud, el mayor descriptor de dolor crónico fueron Atormentador y el mayor de dolor agudo fue Terrible. Conclusiones: la EMEDOR es una escala confiable y puede ser utilizada en diferentes etapas de desarrollo.
Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pain Measurement/methods , Acute Pain/diagnosis , Chronic Pain/diagnosis , Psychophysics , Pain Measurement/psychology , Cross-Sectional Studies , Age Factors , Acute Pain/psychology , Chronic Pain/psychologyABSTRACT
OBJECTIVE: To evaluate the increased value of using coronal reformation of a transverse computed tomography (CT) scan for detecting adnexal torsion. MATERIALS AND METHODS: This study included 106 woman suspected of having adnexal torsion who underwent CT with coronal reformations and subsequent surgical exploration. Two readers independently recorded the CT findings, such as the thickening of a fallopian tube, twisting of the adnexal pedicle, eccentric smooth wall thickening of the torsed adnexal mass, eccentric septal thickening of the torsed adnexal mass, eccentric poor enhancement of the torsed adnexal mass, uterine deviation to the twisted side, ascites or infiltration of pelvic fat, and the overall impression of adnexal torsion with a transverse scan alone or combined with coronal reformation and a transverse scan. The areas under the receiver operating characteristic curves (AUCs), sensitivity, specificity, and positive predictive value were used to compare diagnostic performance. RESULTS: Fifty-two patients were confirmed to have adnexal torsion. The addition of coronal reformations to the transverse scan improved AUCs for readers 1 and 2 from 0.74 and 0.75 to 0.92 and 0.87, respectively, for detecting adnexal torsion (p < 0.001 and p = 0.004, respectively). Sensitivity of CT for detecting twisting of the adnexal pedicle increased significantly for readers 1 and 2 from 0.27 and 0.29 with a transverse scan alone to 0.79 and 0.77 with a combined coronal reformation and a transverse scan, respectively (p < 0.001 and p < 0.001, respectively). CONCLUSION: Use of a coronal reformation with transverse CT images improves detection of adnexal torsion.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Middle Aged , Young Adult , Acute Pain/diagnosis , Adnexa Uteri/pathology , Adnexal Diseases/diagnostic imaging , Area Under Curve , Pelvis/diagnostic imaging , ROC Curve , Retrospective Studies , Tomography, X-Ray Computed/methods , Torsion Abnormality/diagnosisABSTRACT
Objetivou-se com esta pesquisa identificar o diagnóstico de enfermagem (DE) dor aguda em pacientes no pós-operatório(PO) de cirurgia cardíaca. Trata-se de um estudo quantitativo-descritivo, realizado em uma Unidade de Terapia Intensivaem um hospital geral de referência do interior do Estado de Goiás, para tratamento cirúrgico de cardiopatias. A dor foiavaliada nas situações: tosse, inspiração profunda, vômito e repouso. A amostra foi composta por 37 pacientes que seencontravam no 3º PO de cirurgia cardíaca. A coleta de dados foi realizada entre outubro de 2009 e abril de 2010. Arevascularização do miocárdio foi a cirurgia mais frequente (62,1%). Quanto à intensidade, a dor foi classificada comomoderada na dor geral e tosse, leve respectivamente a inspiração profunda, vômito e repouso. O local de dor maisrelatado foi a região esternal e o principal analgésico utilizado foi a dipirona. O fator relacionado do DE dor agudafoi agentes lesivos (100%) e as principais características definidoras com associações significativas (p=<0,05) foramcomportamento de proteção, expressão facial e gestos protetores. Este estudo permitiu caracterizar a dor aguda dopaciente em pós-operatório por meio do DE junto com instrumento unidimensional (Escala Numérica-EN), que contribuipara a caracterização do DE dor aguda. A utilização de instrumento de mensuração de dor unidimensional podecontribuir para o julgamento clínico do enfermeiro diante das dificuldades do pós-operatório de cirurgia cardíaca.
The objective of this study was to identify nursing diagnosis for acute pain in patients'postoperative cardiac surgery. It is a quantitative descriptive study conducted in an Intensive Care Unit of a Referral Hospital in the state of Goiás. Pain was assessed when coughing, deep breathing, vomiting, and resting. The sample comprised 37 patients on a third postoperative cardiac surgery. Data was collected between October 2009 and April 2010. Myocardial revascularization was the most frequent surgery (62.1%). Pain intensity was classified as mild in general pain and with coughing; moderate on taking a deep breath, vomiting, and resting. Pain was located mostly in the sternal region and the analgesic usually prescribed was dipyrone. Nursing diagnosis for acute pain was associated with harmful agents (100%) and the main defining characteristics with significant associations (p = <0.05) were guarded behaviour, facial expressions, and protective gestures. The present study characterized acute pain in post-operative patients by means of nursing diagnosis and numeric rating scale to typify acute pain. The use of a one-dimensional instrument to measure pain may contribute to the nurses' clinical judgement in the face of cardiac surgery postoperative difficulties
El objetivo de este estudio fue identificar diagnósticos de enfermería (DE) de dolor agudo postoperatorio (PO) en pacientes de cirugía cardiaca. Se trata de un estudio descriptivo cuantitativo realizado en la unidad de cuidados intensivos de un hospital general de referencia del estado de Goiás para tratamiento quirúrgico de cardiopatías. El dolor fue evaluado en las siguientes situaciones: tos, inspiración profunda, vómito y reposo. La muestra estuvo compuesta por 37 pacientes en el tercer PO de cirugía cardíaca. La recogida de datos se realizó entre octubre 2009 y abril 2010. La revascularización miocárdica fue la cirugía más frecuente 62,1%. En cuanto a su intensidad, el dolor fue clasificado como moderado en el dolor general y tos, ligero respectivamente en inspiración profunda, vómito y reposo. El sitio más dolorido fue la región esternal y el analgésico más empleado la dipirona. El factor relacionado de DE dolor agudo fue agente lesivo (100%) y las principales características que definen el dolor a una asociación significativa (p = <0,05) fueron comportamientos de protección, expresiones faciales y gestos de protección. Este estudio permitió caracterizar el dolor agudo del paciente después de la cirugía por medio de DE e instrumentos unidimensionales (escala numérica - EN). El uso del instrumento de medición unidimensional del dolor puede contribuir al diagnóstico de enfermería ante las dificultades del postoperatorio de cirugía cardíaca.