ABSTRACT
Precocious admission to specifically "dedicated" wards proved to improve reduction of mortality and degree of residual disability in patients with stroke, even if their inhomogeneous distribution gets most patients admitted to wards of Internal Medicine. We purposed to evaluate the importance of this problem, to check adhesion to the national guidelines and to show the main problems in management of patients with stroke in the Operative Unit of Internal Medicine, Vascular and Metabolic Diseases of the IRCCS S. Matteo Hospital of Pavia. 143 patients with stroke were admitted in 2001, 126 were ischemic, 17 hemorragic; the mean age was of 73. The most frequent risk factors were hypertension, diabetes, smoke and atrial fibrillation. 59% of patients were admitted within 6 hours from onset of symptoms. Within the ischemic subtypes, 17.5% were atherotrombothic, 16.7% cardioembolic, 23.8% lacunar and 42% with undetermined etiology. Lacunar syndromes were the most part. 80% of patients underwent computed tomography, 50% underwent epiaortic Doppler sonography, 38% echocardiography. 61% of ischemic subtypes underwent acute antiplatelet treatment. Complications were prevalent in oldest patients. Mortality of inpatients was 17%, influenced by age, hypertension, severe sensorial compromission at admission, cardioembolism and complications. This study proved leak of adhesion to national guidelines which brought to inadequate accuracy in diagnosis and difficulty in making correct and coherent therapeutic choices. At least in great hospitals, "dedicated" areas in wards of Internal Medicine with selected, trained and motivated staff should be desirable.
Subject(s)
Guideline Adherence , Stroke/therapy , Age Factors , Aged , Aged, 80 and over , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Aspirin/administration & dosage , Aspirin/therapeutic use , Atrial Fibrillation/complications , Brain Ischemia/diagnosis , Cerebral Hemorrhage/diagnosis , Diabetes Complications , Echocardiography , Female , Fibrinolytic Agents/administration & dosage , Fibrinolytic Agents/therapeutic use , Heparin, Low-Molecular-Weight/administration & dosage , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Hypertension/complications , Male , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/therapeutic use , Practice Guidelines as Topic , Risk Factors , Severity of Illness Index , Sex Factors , Smoking/adverse effects , Stroke/diagnosis , Stroke/diagnostic imaging , Stroke/etiology , Stroke/mortality , Tomography, X-Ray Computed , Ultrasonography, DopplerABSTRACT
Trata-se de um estudo cujo marco teórico é a Modiifcabilidade cognitivo ou o da inteligência como dinâmicos, sujeitos à modificabilidade, através de uma ação deliberaa de mediadores colocando a disposição da pessoa aprendiz novos significados e sentidos culturais. Sendo enfermeira e compromissada com o cuidado humano, refleti sobre a lacuna existente entre o fazer cotidiano do enfermeiro e sua consciência sobre esse fazer, no que se refere às funções cognitivas envolvidas no ato mental. Com formação teórica, didática e prática ministrada pelo Centro de Desenvolvimento Cognitivo do Paraná interferi nesta lacuna ao aplicar quatro instrumentos do Programa de Enriquecimento instrumental (ferramenta analítico-didática) a um grupo composto por sete enferneiros, em duas sessões semanais, durante trinta e seis horas, tendo por objetivo geral a instrumentalização do enfermeiro promovendo um pensar mais crítico e reflexivo sobre o porcesso de cuidar e a prática de Enfermagem e sua postura frente a estas, mediante a observação e organização de suas ações e o estabelecimento de prioridades. A abordagem metodológica foi de natureza qualitativa, tendo sido utilziada a técnica de observação participante para a coleta de dados e, no decorrer da análise dos resultados, a abordagem histórico-cultural de Vygotsky, pela apropriação do conhecimento por meio de um sistema coletivo que compreende relações entre o indivíduo e o mundo, indiretas, mediadas pela cultura. Foram demarcados quatro indicadores: transcendência, metacognição, aplicabilidade e o uso de mediação na perspectiva do outro que detalharam os aspectos da modificabilidade ocorrida no grupo, este agora mais competente e perceptivo.
Subject(s)
Cultural Characteristics , Cognition , Nursing Process/ethics , Professional Practice , Nursing TheoryABSTRACT
This is a thought-provoking study approaching inclusive nursing care rendered to individuals suffering from Down's syndrome in light of some assumptions made in Paterson and Zderad's theory. Its aim is to uncover Paterson and Zderad's humanistic theory, by emphasizing some of its assumptions as applied to individuals suffering from Down's syndrome, and by outlining the participation of nurses in inclusive care of such cases, through a conscious practice related to the humanistic theory. By providing individuals suffering from Down's syndrome with health care based on the humanistic theory referential, it is possible to reckon each human being as a unique existent being, therefore understanding his/her meaning.
Subject(s)
Down Syndrome/nursing , Nursing Theory , Humanism , HumansABSTRACT
Trata-se de um estudo teórico-reflexivo que contempla a visão determinista de Laplace de previsibilidade e controle, contrapondo-se à possibilidade da modificação das funções cognitivas de um ser humano pela Teoria da Mobilidade Cognitiva Estrutural de Reuven Feuerstein.
