ABSTRACT
O presente relatório tem como objetivo explanar o meu percurso de aprendizagem, apresentando a análise crítica da aquisição e desenvolvimento das competências comuns e especializadas de enfermeiro especialista, no âmbito da Unidade Curricular Estágio com Relatório, inserida no 11º Curso de Mestrado em Enfermagem de Saúde Materna e Obstetrícia, bem como descrever a investigação realizada acerca da utilização dos esforços expulsivos expiratórios (EEE) durante o parto, estabelecendo a necessidade de reflexão relativamente à inclusão desta temática na prática de cuidados do enfermeiro obstetra. As opções metodológicas tiveram por base a prática baseada na evidência e, assentaram numa Scoping Review de acordo com as orientações do Joanna Briggs Institute (2020), onde se pretendeu mapear a evidência científica relevante sobre a temática. A questão de pesquisa foi: "Quais os resultados dos esforços expulsivos expiratórios durante o parto." Os resultados obtidos suportaram o estudo descritivo e transversal desenvolvido no contexto de Bloco de Partos com uma amostra de 21 parturientes, cujos objetivos foram: Descrever a importância do conhecimento e treino durante a gravidez dos EEE para potenciar os contributos desta técnica no período expulsivo; analisar a relação entre a utilização dos EEE, a duração do período expulsivo, a gestão da dor no período expulsivo, a posição adotada, a integridade do períneo após o parto, a satisfação com a experiência de parto e os outcomes neonatais (adaptação do RN à vida extrauterina/Índice de Apgar). Os resultados evidenciaram que ao promover a utilização dos EEE, o enfermeiro obstetra promove o bem-estar, a diminuição da fadiga e a vivência positiva do parto, o que contribui para elevados índices de satisfação com a experiência de parto. As parturientes referiram como fatores relevantes para o sucesso dos EEE a intervenção de apoio e orientação do enfermeiro obstetra e o conhecimento prévio da técnica. Os EEE respeitam o processo fisiológico do parto contribuindo para um parto normal e para uma experiência de parto mais positiva.
The main purpose of this report is to explain my learning path and present the critical analysis of the development of common and specialized skills of specialist nurse, within the Report Curricular Unit, included in the 11th Master Course in Maternal and Obstetrics Nursing, as well to describe the scientific evidence about the use of expulsive exhalation efforts (EEE's) during childbirth, imposing the need for reflection on the inclusion of this theme in the practice of obstetric nurses. The methodological options of this report were founded on evidence-based practice in accordance with the Scoping Review within the guidelines of the Joanna Briggs Institute (2020), where the intention was to map the relevant scientific evidence on the subject. The research question was: "What are the results of expiratory expulsive efforts during childbirth." The results obtained supported the descriptive and cross-sectional study developed in the Labour Ward with a sample of 21 pregnant women in labour, whose aims were: To describe the importance of knowledge and training EEE's during pregnancy to enhance the contributions of this technique in the expulsive period; to analyze the relationship between the use of EEE's and the duration of the expulsive period, pain management in the expulsive period, the position adopted, the integrity of the perineum after delivery, childbirth experience satisfaction and neonatal outcomes (newborn's adaptation to extrauterine life/Apgar score). The results showed that by promoting the use of EEE's, the obstetric nurse promotes well-being, decreased fatigue and the positive childbirth experience, which contributes to high levels of satisfaction with the childbirth experience. The parturient women mentioned that obstetric nurse support and guidance as well as previous knowledge of the technique, were determinant for the EEE's success. The EEE's respect the physiological process of childbirth contributing to a normal childbirth and a more positive childbirth experience.
Subject(s)
Parturition , Obstetric Nursing , RespirationABSTRACT
A Endodontia busca o constante aprimoramento de técnicas e sistemas de instrumentação que otimizem a limpeza e modelagem dos canais. Nos últimos anos, foram lançados no mercado os sistemas com o princípio de instrumentação com lima única, Reciproc e Wave One, que devido à cinemática e características morfológicas dos instrumentos, representam um novo conceito de preparo do canal. O presente trabalho de revisão buscou justificar o uso clínico desses sistemas, concluindo que, como em qualquer nova técnica, devem ser consideradas as vantagens e desvantagens dos instrumentos, além de ser necessário treinamento como forma de atingir melhor resultado no tratamento...
Endodontic science is constantly seeking to improve techniques and instrumentation systems for root canal cleaning and shaping. In this context, Reciproc and WaveOne, are two systems based on single file instrumentation technique principle. Due to the kinematics and morphological characteristics, these instruments represent a new concept of root canal preparation. The present review sought to justify these systems on clinical usage. Thus it can be concluded that such as any new technique, advantages and disadvantages should be considered and in addition proper training is required in order to achieve better treatment outcomes...
Subject(s)
Dental Instruments , Endodontics , Root Canal PreparationABSTRACT
Qualitative and quantitative approaches were tested to assess zebrafish liver effects after sub-acute exposures of certain pharmaceuticals. Carbamazepine, fenofibric acid, propranolol, sulfamethoxazole and trimethoprim were tested individually and in mixtures, including low environmental levels. Overall, data showed sex specific reactions in liver, with the major alterations being observed in males. Males treated with propranolol, fenofibric acid and with mixtures, showed an increase of vitellogenin immunostaining, compared with the control. Males also evidenced a tendency for an increased hepatic mass, after individual and mixture exposures. The volume-weighted nuclear volume of hepatocytes was high in males after exposures to either mixture, which together with the greater cytoplasmic eosinophilia and changes in cytochrome P450 1A immunoreactivity, point to an increase in metabolic/detoxification activity. These investigations revealed distinct impacts depending on the exposure type, and strengthened the importance of studying non-steroidal compounds in mixtures, including environmental levels and both sexes.
Subject(s)
Liver/drug effects , Water Pollutants, Chemical/toxicity , Animals , Carbamazepine/toxicity , Cytochrome P-450 CYP1A1/metabolism , Female , Fenofibrate/analogs & derivatives , Fenofibrate/toxicity , Fish Proteins/metabolism , Liver/metabolism , Liver/pathology , Male , Portugal , Propranolol/toxicity , Rivers , Sulfamethoxazole/toxicity , Trimethoprim/toxicity , Vitellogenins/metabolism , ZebrafishABSTRACT
Most patients on chronic oral anticoagulant therapy are monitored through anticoagulation clinics, or rather by assistant physicians. Our aim was to compare warfarin anticoagulated patients who were treated with usual medical care (assistant physician) with those treated routinely at an anticoagulation clinic for anticoagulation control. The later was assessed by comparing in both groups of patients the proportion of INRs within the therapeutic range, above 5.0 and below 1.5. The group treated at an anticoagulation clinic achieved better anticoagulation control (both among the patients receiving lower-range anticoagulation therapy and in the patients requiring higher-range anticoagulation therapy) than the group treated with usual medical care.
