Caracterização clínica dos pacientes sob ventilação mecânica internados em unidade de terapia intensiva / Características clínicas de los pacientes hospitalizados en menos de ventilación mecánica unidad de cuidados intensivos / Clinical characterization of patients under mechanical ventilation in an intensive therapy unit

Objetivo: descrever as características clínicas de pacientes sob ventilação mecânica internados em Unidade de Terapia Intensiva (UTI). Métodos: Estudo transversal e quantitativo, com amostra de 90 pacientes internados em um hospital referência em atendimento de doenças cardiopulmonares, situado na cidade de Fortaleza/Ceará. Coleta de dados realizada em outubro de 2016 através de um instrumento estruturado. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Instituição sob o protocolo CAAE53956816.2.0000.5052. Resultados: Observou-se que 56,7% eram do sexo feminino, na faixa etária de 50 a 59 anos (59%). Os principais motivos de internação foram as doenças cardiovasculares (53,3%); 88,9% utilizaram antibioticoterapia; 34,4% apresentaram pneumonia associada à ventilação mecânica; 80% utilizaram drogas vasoativas e apenas 25,6% realizaram traqueostomia após a internação 36,7%. Conclusão: O paciente crítico possui peculiaridades que exige do enfermeiro um planejamento das ações de cuidados que vise à redução de possíveis complicações graves e letais.

Objetivo: describir las características clínicas de pacientes sometidos a ventilación mecánica en unidad de cuidados intensivos (UCI). Métodos: Estudio transversal y cuantitativa, con 90 pacientes ingresados en un hospital de atención enfermedades cardiopulmonares, situado en la ciudad de Fortaleza/Ceará. Recopilación de datos realizada en octubre de 2016 a través de un instrumento estructurado. El estudio fue aprobado por el Comité de ética de investigación de la institución bajo el protocolo CAAE-53956816.2.0000.5052. Resultados: Se observó que el 56,7% eran mujeres entre las edades de 50 a 59 años (59%). Las principales razones de hospitalización fueron las enfermedades cardiovasculares (53.3%), 88.9% utiliza antibióticos; 34,4% presentadas ventilador había asociado neumonía; 80% usada drogas y sólo 25.6% traqueotomía realizada vasoactivos después de hospitalización 36,7%. Conclusión: El paciente crítico tiene particularidades que requiere que la enfermera una planificación de la atención dirigida a la reducción de posibles complicaciones graves y letales.

Objective: lo describe the clinical characteristics of patients under mechanical ventilation admitted to the Intensive Care Unit (ICU). Methods: A cross - sectional and quantitative study with a sample of 90 patients admitted to a referral hospital for cardiopulmonary diseases, located in the city of Fortaleza / Ceará. Data collection conducted in October 2016 through a structured instrument. The study was approved by the Institutional Research Ethics Committee under protocol CAAE-53956816.2.0000.5052. Results: It was observed that 56.7% were female, in the age group of 50 to 59 years (59%). The main reasons for hospitalization were cardiovascular diseases (53.3%); 88.9% used antibiotic therapy; 34.4% presented pneumonia associated with mechanical ventilation; 80% used vasoactive drugs and only 25.6% performed tracheostomy after hospitalization 36.7%. Conclusion: The critical patient has peculiarities that require the nurse to plan care actions aimed at reducing possible serious and lethal complications.

Associação entre polifarmácia e adesão ao tratamento farmacológico em pacientes com diabetes / Association between polypharmacy and the adherence to pharmacological treatment in patients with diabetes

Objetivo: avaliar a ocorrência da polifarmácia e sua associação com a adesão ao tratatamento farmacológico em pacientes com diabetes mellitus tipo 2. Métodos: estudo transversal realizado com 235 portadores de diabetes mellitus tipo 2 por meio de entrevista sobre os dados sociodemográficos e clínicos, a terapêutica medicamentosa prescrita e a adesão ao tratamento. Para análise dos dados foram utilizados os testes t de Student e quiquadrado, com nível de significância p<0,05. Resultados: a polifarmácia foi evidenciada em 88,4% dos casos com predomínio da moderada. Foram utilizados, em média, 7,5 comprimidos por pessoa dentre os 19 tipos de fármacos prescritos. A adesão à terapêutica prescrita foi relatada por 88,2% dos pacientes avaliados e não houve associação com a polifarmácia (p=0,266). Conclusão: foi verificado que a polifarmácia é uma condição de elevada prevalência e não está associada a pior adesão à terapêutica. (AU)

Riscos psicossociais relacionados ao trabalho: percepção dos profissionais de enfermagem / Psychosocial risks related to work: perception of nursing professionals / Los riesgos psicosociales relacionados con el trabajo: percepción de los profesionales de enfermería

Objetivo: analisar as percepções dos trabalhadores da enfermagem, de equipes de saúde da família, sobre a presença de possíveis riscos psicossociais no desempenho de suas atividades laborais. Método: estudo exploratório, de abordagem qualitativa, realizado nas unidades de saúde da família do Ceará/CE. A pesquisa foi constituída por enfermeiros e técnicos de enfermagem, no total de 10 profissionais. A coleta de dados constituiu-se de uma entrevista semiestruturada, e as falas das participantes foram transcritas na íntegra sendo, posteriormente, submetidas à análise de conteúdo. Resultados: o estudo revelou riscos psicossociais relacionados ao trabalho das equipes de saúde da família, como: falta de preparo e capacitação; sobrecarga de papéis; longas horas de trabalho e recursos materiais insuficientes. Conclusão: destaca-se que os riscos psicossociais no ambiente de trabalho são potencialmente comprometedores do bem-estar do trabalhador, trazendo consequências para o serviço e para a comunidade assistida.(AU)

Objective: to analyze the perceptions of nursing workers, family health teams, about the presence of possible psychosocial risks in the performance of their work activities. Method: an exploratory study of qualitative approach, carried out in health facilities of Ceará/CE family. The research consisted of nurses and nursing technicians, totaling 10 professionals. Data collection consisted of a semi-structured interview, the testimonies of the participants were transcribed in full, after being subjected to content analysis. Results: the study showed psychosocial risks related to the work of family health teams, such as: lack of preparation and training; overload of roles; long working hours and insufficient material resources. Conclusion: it is emphasized that psychosocial risks in the workplace are potentially compromising worker welfare, with consequences for service and the assisted community.(AU)

Objetivo: analizar las percepciones de los trabajadores de enfermería, equipos de salud de la familia, la presencia de posibles riesgos psicosociales en el desempeño de sus actividades. Método: estudio exploratorio de enfoque cualitativo, llevado a cabo en unidades de salud de la familia de Ceará/CE. La encuesta estaba compuesta por enfermeras y técnicos de enfermería, para un total de 10 profesionales. La recolección de datos consistió en una entrevista semiestructurada, las palabras de los participantes fueron transcritas en su totalidad, siendo posteriormente sometido a análisis de contenido. Resultados: el estudio mostró los riesgos psicosociales relacionados con el trabajo de los equipos de salud familiar, tales como: falta de preparación y entrenamiento, sobrecarga, largas horas de trabajo y recursos materiales suficientes. Conclusión: se destaca que los riesgos psicosociales en el trabajo son potencialmente comprometer del bienestar del trabajador, trayendo consecuencias para el servicio y la comunidad asistida.(AU)

Proposal of an Integrated Health Care Network System for Patients with Congenital Heart Defects.

The perspective of the integrated health system has a network of care with multiple integration dimensions among subsystems as nuclear representation, relating the clinical aspects and governance to the representations and collective values. The normative integration aims to ensure coherence between the system of representations and values of society simultaneously with the interfaces of clinical and functional integration. It builds a bridge with governance, which allows, through their skills, management of all system components, encouraging cooperation, communication and information, in order to ensure the population under their responsibility to access excellence services, exceeding their expectations. The integration of care consists of a durable coordination of clinical practices for those who suffer from health problems in order to ensure continuity and full range of the required professional services and organizations, coordinated in time and space, in accordance with the available knowledge. It is possible to establish the type of health equipment for each level of care for patients with congenital heart diseases. This strategy intends to offer timely care in appropriate moments and places, efficiently, operating cooperatively an interdependently, with ongoing exchange of its resources. Thus, situational integration establishes the system connection with the assessment environment that proposes to carry out value judgment, guided by an objective worldview, about an intervention or any of its components, in order to objectify the decision making.

Syndecan-1 improves severe acute kidney injury prediction after pediatric cardiac surgery.

OBJECTIVE: Acute kidney injury is a common occurrence after pediatric cardiac surgery and is associated with adverse patient outcomes. Syndecan-1 is a biomarker of endothelial glycocalyx damage, and its early increment after surgery can be associated with acute kidney injury. METHODS: We performed a prospective cohort study with 289 patients aged less than 18 years who underwent cardiac surgery at 1 reference institution. Postoperative plasma syndecan-1 was collected within the first 2 hours after cardiac surgery. Severe acute kidney injury, defined according to Kidney Disease: Improving Global Outcomes stage 2 or 3, doubling of serum creatinine from the preoperative value, or need for dialysis during hospitalization, was the main outcome. Analyses were adjusted for clinical variables and "renal angina index" components (early decrease in estimated creatinine clearance from baseline and increase in percent of intensive care unit fluid overload on the first postoperative day). RESULTS: Plasma syndecan-1 levels measured early in the postoperative period were independently associated with severe acute kidney injury. The accuracy of postoperative syndecan-1 for the diagnosis of severe acute kidney injury was moderate (area under the curve receiver operating characteristic, 0.77; 95% confidence interval, 0.68-0.85). The addition of syndecan-1 improved the discrimination capacity of a clinical model from 0.80 to 0.86 (P = .004) and improved risk prediction, as measured by net reclassification improvement and integrated discrimination improvement. Postoperative sundecan-1 levels also were independently associated with longer length of intensive care unit and hospital stay. CONCLUSIONS: Postoperative plasma syndecan-1 is associated with subsequent severe acute kidney injury and poor outcomes among children undergoing cardiac surgery. It may be useful to identify patients who are at increased risk for acute kidney injury after cardiac surgery.

Proposal of an integrated health care network system for patients with congenital heart defects

ABSTRACT The perspective of the integrated health system has a network of care with multiple integration dimensions among subsystems as nuclear representation, relating the clinical aspects and governance to the representations and collective values. The normative integration aims to ensure coherence between the system of representations and values of society simultaneously with the interfaces of clinical and functional integration. It builds a bridge with governance, which allows, through their skills, management of all system components, encouraging cooperation, communication and information, in order to ensure the population under their responsibility to access excellence services, exceeding their expectations. The integration of care consists of a durable coordination of clinical practices for those who suffer from health problems in order to ensure continuity and full range of the required professional services and organizations, coordinated in time and space, in accordance with the available knowledge. It is possible to establish the type of health equipment for each level of care for patients with congenital heart diseases. This strategy intends to offer timely care in appropriate moments and places, efficiently, operating cooperatively an interdependently, with ongoing exchange of its resources. Thus, situational integration establishes the system connection with the assessment environment that proposes to carry out value judgment, guided by an objective worldview, about an intervention or any of its components, in order to objectify the decision making.

O enfermeiro na vivência do transplante cardíaco infantil: dialogando com as mães / The nurse's experience in the infant heart transplantation: a dialogue with mothers

A pesquisa objetiva conhecer a opinião das mães frente a vivência do enfermeiro no transplante cardíaco infantil. Estudo descritivo com abordagem qualitativa, desenvolvido no Hospital do Coração de Messejana, em Fortaleza-Ce - Brasil, no período de agosto a novembro de 2007. Os sujeitos foram sete mães de crianças transplantadas. A técnica de coleta foi a entrevista semiestruturada. Da análise das falas emergiram as unidades temáticas: atuação/profissional: enfermeiro na vidas das mães sobre o translante: mudanças decorrentes no pós-transplante. A doação é um momento de felicidade vivenciada por todas as mães, pois se trata da solução para vida de seus filhos, e a presença autêntica do enfermeiro nesta ocasião, torna-se ainda mais essencial, pois humanizar faz parte do cuidar da enfermagem Au.

This research aims to know the mothers opinion on the nurse's experience in the infant heart transplantation. This is a descriptive study with qualitative approach, carried out at the Messejana Heart Hospital, in Fortaleza-Ce-Brasil, from August to November 2007. The subjects were seven mothers of transplanted children. The collection technique wasthe semi-structures interview. From the speeches analysis we identified the thematic units: profissional practice; nurse's experience in transplantation: mother's perception; mother's unfamiliarity with the transplant; changes in post-transplant. Donating is a moment of happiness lived by all mothers, because it is a solution for their childre's life, and the authentic nurse presence on this situation becomes even more essential, because humanizing is part of the nursing care Au.