Melhoria do outcome da pessoa em situação crítica com lesão cerebral secundária: intervenção especializada de enfermagem / Improving the outcome of people in critical situations with secondary brain injury: specialized nursing intervention

A Lesão Cerebral Secundária é um processo fisiopatológico complexo, o qual desencadeia inúmeras respostas inflamatórias que conduzem à morte de neurónios, por vezes de forma irreversível. Este fenómeno pode surgir horas ou dias após uma lesão cerebral primária, independentemente da sua etiologia, e a equipa de enfermagem desempenha um papel preponderante na minimização do impacto causado por este processo. A intervenção de enfermagem deve ser pautada pela vigilância e deteção célere de focos de instabilidade, garantindo a segurança do utente, e direcionada no sentido da otimização da oxigenação e perfusão cerebral adequadas, através de intervenções interdependentes e, particularmente de intervenções autónomas, com o objetivo major de minimizar o impacto neurológico e melhorar o outcome final, numa perspetiva de melhoria contínua da qualidade dos cuidados prestados. Com o intuito de desenvolver competências no cuidado ao doente neurocrítico, de uma forma especializada, foi realizado um estágio em contexto de cuidados intensivos e serviço de urgência. A realização da revisão integrativa da literatura, acerca da influência do posicionamento corporal na gestão da pressão intracraniana e pressão de perfusão cerebral, enquanto intervenção autónoma de enfermagem, subsidiou a componente teórica e científica. Este relatório foi desenvolvido no âmbito do curso de Mestrado em Enfermagem na área de especialização da pessoa em situação crítica e pretende descrever, de forma crítica e reflexiva, o percurso formativo desenvolvido, perspetivando-se o olhar sobre este tema nas teorias de enfermagem Nursing as Caring e Technological Competency as Caring in Nursing.

The secondary brain injury is a complex physio-pathological process that triggers a range of inflammatory responses that lead to the death of neurons, sometimes, irreversibly. This phenomenon may surface hours, or even, days after the primary brain injury regardless of its aetiology, and the nursing team playing a critical role minimizing the impacts caused by this process. The nursing assistance should be steered towards both vigilance and quick detection of instability hot spots, ensuring, patient safety steered towards the optimization of proper brain oxygenation and perfusion, through independent interventions, and specifically autonomous interventions with the ulterior goal of minimizing the neurological impact while improving the outcome, all from the viewpoint of continual improvement of the provided care. With the purpose of further consolidating the skill set, an internship in intensive care and emergency service was also undertaken. The integrative literature review on the body positioning and its influence on the management of intracranial and perfusion pressures of the brain, as an autonomous procedure, subsidized the theoretical and scientific components. This report was written for the study plan of the Master of Nursing in Critical Care and aims to describe and discuss the learning path while rooting the topic in modern nursing theories Nursing as Caring and Technological Competency as Caring in Nursing.

Climate-Change Adaptation Framework for Multiple Urban Areas in Northern Portugal.

Climate change is increasingly exerting pressure with intensified impacts in the short-, medium-, and long-term. Cities are highly vulnerable to the impacts of climate change, and it is recognized that they play a significant role in the European Strategy on adaptation to climate change. This study intends to develop a climate adaptation framework to identify effective measures that will be evaluated using a multi-urban area located in the north of Portugal, as a case study. The climate adaptation framework was developed following the Urban Adaptation Support Tool (AST), adapted to the Portuguese reality. The Weather Research and Forecasting (WRF) model was used to provide future projections with a high level of spatial resolution over the study area, increasing the accuracy of the identification of future climatic vulnerabilities. The results show a tendency for an increase of extreme weather events associated with the increase of both temperature and annual accumulated precipitation variables. A set of both urban and rural measures to promote a sustainable development path to climate adaptability and increase cities resilience to climate change are presented and discussed.