A intervenção do enfermeiro especialista em enfermagem de reabilitação à criança com alteração da função respiratória no primeiro ano de vida / The intervention of a nurse specialist in rehabilitation nursing for children with respiratory function alterations in the first year of life

O primeiro ano de vida envolve uma transformação progressiva e célere de todos os sistemas corporais, particularmente, do sistema respiratório, predispondo o lactente a alterações da função respiratória e, consequentemente, ao desenvolvimento de doenças respiratórias agudas e crónicas, pelo que a sua prevenção e tratamento precoces são fundamentais. O presente relatório de estágio apresenta a descrição e reflexão sobre o percurso concretizado para adquirir as competências específicas e comuns do Enfermeiro Especialista em Enfermagem de Reabilitação e as competências preconizadas nos descritores de Dublin, para a obtenção do grau de Mestre. Tendo em conta que os cuidados de Enfermagem de Reabilitação integram a pessoa com necessidades especiais ao longo de todo o ciclo vital e que as intervenções autónomas do Enfermeiro Especialista em Enfermagem de Reabilitação na função respiratória carecem de investigação premente, pretendemos evidenciar o seu contributo no cuidado à criança com alteração da função respiratória, no primeiro ano de vida, sustentando-nos no Modelo de Sistemas de Betty Neuman. Compreendemos, através da pesquisa e ao longo deste percurso formativo, que no âmbito da prevenção primária, o Enfermeiro Especialista em Enfermagem de Reabilitação intervém na educação e capacitação da família para promover a saúde respiratória da criança e prevenir doenças respiratórias agudas. Através da reeducação funcional respiratória contribui para a prevenção secundária dos compromissos de ventilação e oxigenação da criança, prevenindo complicações. No que concerne à prevenção terciária, sustenta a reconstituição da estabilidade do sistema cliente, criança e família, colaborando na transição segura para a comunidade, mitigando o impacto das limitações e promovendo a continuidade dos cuidados.

The first year of life involves a gradual and rapid transformation of all body systems, particularly the respiratory one, predisposing the infant to respiratory function impairments and, consequently, to the development of acute and chronic respiratory diseases, which makes its prevention and early treatment essential. This internship report presents the description and reflection on the path taken to acquire the specific and common skills of the Specialist Nurse in Rehabilitation Nursing and the Dublin descriptors for the Master level. Taking into consideration that Rehabilitation Nursing care integrates the person with special needs throughout the life cycle and that the autonomous interventions of these Specialist Nurses in person's respiratory function require urgent research, we intend to highlight their contribution to the care of infants with respiratory function impairment, sustained on the Neuman Systems Model. We understood, through research and along this formative path, that, in the context of primary prevention, the Specialist Nurse in Rehabilitation Nursing intervenes in the anticipatory guidance of the family to promote infant's respiratory health and prevent acute respiratory diseases. Through functional respiratory re-education promotes secondary prevention of infant's ventilation and oxygenation impairments, preventing complications. Regarding tertiary prevention, supports the reconstitution of the child and family/client system stability, collaborating in the safe transition to the community, mitigating the impact of limitations and promoting the continuity of care.

Effectiveness Active Cycle of Breathing Technique (ACBT) with Pursed Lips Breathing Technique (PLBT) to tripod position in increase oxygen saturation in patients with COPD, West Sumatera

Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung disease characterized by obstruction or obstruction of airflow in a reversible or partial nonreversible airway. Dyspnea is a common symptom in COPD sufferers; this can cause problems with oxygen saturation, or the oxygen saturation value is below normal. Non-pharmacological actions given in the form of breathing exercises can be done by a nurse to help reduce shortness of breath in COPD patients. The exercise is given by adjusting the resting position that is comfortable and comfortable so that the extra breath muscles can work well. The position that can do the position of the tripod with Active Cycle of Breathing and Pursed lips are breathing so that shortness of breath is reduced and SaO2 can have increased so that more oxygen has obtained in Lung Hospital, West Sumatra. This research is quantitative research, with quasi-experimental research methods. They used two pre-test-posttest design groups. The sample in this study amounted to 30 people with quota sampling technique. In this study showed that there was a difference in the increase in oxygen saturation of COPD patients which was effective in the tripod position group with Active Cycle Breathing Technique (ACBT) with a p-value of 0.00 while in the tripod position group with the Active Respiratory and Lip Cycle there was a difference of p-value 0.023. It has concluded that the tripod position with ACT and PBLT could increase oxygen saturation and nasal breathlessness reduced, but the tripod position with ACT is more effective in COP patients because with chronic respiratory patients who are short of breath due to sputum buildup, then with ACT will clean the airway and the flow of the road effective breathing so that shortness of breath have reduced and oxygen saturation increases. Furthermore, it has recommended that in hospitals, especially nurses, in dealing with COPD patients in addition to the correct position of breathing exercises with ACT to help patients

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Respuesta a «Comentario sobre: Fisioterapia respiratoria en la unidad de cuidados intensivos: revisión bibliográfica» / Response to «Comment on: Respiratory physiotherapy in intensive care unit: Bibliographic review»

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Feasibility of a respiratory nurse specialist-led sleep disorder service in a district general hospital.

Aim The burden of referrals to investigate sleep disorders has escalated considerably. In order to address this, the feasibility of a nurse-led sleep disorder clinic was investigated. Methods Sleep referrals were stratified on the basis of information contained within the primary care referral, and appropriate home-based sleep studies arranged if obstructive sleep apnoea was considered the most likely working diagnosis. Selected patients were started on continuous positive airway pressure treatment if deemed appropriate. Education was almost exclusively provided by specialist nursing staff or by means of validated information by the British Lung Foundation. Results Eighty patients were included in the respiratory nurse-led sleep service. Feedback from the patient questionnaire was positive and 59 patients were managed without requirement to attend consultant-led outpatient services. Non-sleep breathing disorders as the reason for daytime somnolence, and patients requiring referral to tertiary services, were identified. Conclusion Developing a respiratory nurse-led sleep service is adequate to identify non-sleep breathing disorders, is fit for purpose, functions broadly in accordance with American Sleep Society guidelines, and is well received by patients.

A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD.

PURPOSE: With the limited reach of pulmonary rehabilitation (PR) and low levels of daily physical activity in chronic obstructive pulmonary disease (COPD), a need exists to increase daily exercise. This study evaluated telephone health-mentoring targeting home-based walking (tele-rehab) compared to usual waiting time (usual care) followed by group PR. PATIENTS AND METHODS: People with COPD were randomized to tele-rehab (intervention) or usual care (controls). Tele-rehab delivered by trained nurse health-mentors supported participants' home-based walking over 8-12 weeks. PR, delivered to both groups simultaneously, included 8 weeks of once-weekly education and self-management skills, with separate supervised exercise. Data were collected at three time-points: baseline (TP1), before (TP2), and after (TP3) PR. The primary outcome was change in physical capacity measured by 6-minute walk distance (6MWD) with two tests performed at each time-point. Secondary outcomes included changes in self-reported home-based walking, health-related quality of life, and health behaviors. RESULTS: Of 65 recruits, 25 withdrew before completing PR. Forty attended a median of 6 (4) education sessions. Seventeen attended supervised exercise (5±2 sessions). Between TP1 and TP2, there was a statistically significant increase in the median 6MWD of 12 (39.1) m in controls, but no change in the tele-rehab group. There were no significant changes in 6MWD between other time-points or groups, or significant change in any secondary outcomes. Participants attending supervised exercise showed a nonsignificant improvement in 6MWD, 12.3 (71) m, while others showed no change, 0 (33) m. The mean 6MWD was significantly greater, but not clinically meaningful, for the second test compared to the first at all time-points. CONCLUSION: Telephone-mentoring for home-based walking demonstrated no benefit to exercise capacity. Two 6-minute walking tests at each time-point may not be necessary. Supervised exercise seems essential in PR. The challenge of incorporating exercise into daily life in COPD is substantial.

Situación actual de la oxigenoterapia portátil en la Comunidad de Madrid / No disponible

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Evaluación de la eficacia en la limpieza de la vía aérea entre dos métodos de toma de aerosolterapia en pacientes con enfermedad pulmonar obstructiva crónica / Evaluation of the efficiency of cleaning the air between two methods of making in patients with aerosol chronic obstructive pulmonary disease

Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) es un trastorno que requiere la administración de medicación broncodilatadora y antiinflamatoria, entre otras, como uno de los cuidados de la enfermedad. Ayudan a mantener la limpieza de la vía aérea y a evitar recaídas por el acúmulo de secreciones. La vía inhalatoria, por su acción local y rápida, es la más usada para la aplicación de estos fármacos, que habitualmente se realiza en forma de aerosolterapia. El objetivo de este estudio es evaluar la eficacia en la limpieza de la vía aérea entre dos métodos de administración de aerosolterapia en pacientes con EPOC ingresados por una exacerbación de su enfermedad. También se pretende evaluar su efecto sobre los días de estancia, saturación de oxígeno, grado de disnea, autonomía y complicaciones. Método. Ensayo clínico aleatorizado. Se compararon dos formas de administrar aerosolterapia: método tradicional (grupo control) y dispositivo vibratorio con espiración positiva (grupo intervención). Se consideraron las siguientes variables resultado: días de estancia, días con fiebre, saturación de oxígeno, necesidad de VMNI o VM, las actividades básicas de la vida diaria, grado de autonomía (Barthel), grado de disnea (Escala de Borg) y pico flujo. Resultados. Se incluyeron 39 pacientes. En cuanto a los días de ingreso, los pacientes del grupo intervención presentaban de media un día menos de ingreso. También en este grupo hubo menos reingresos. No se encontraron diferencias estadísticamente significativas en el resto de las variables. Conclusiones. El tratamiento inhalatorio con un dispositivo vibratorio con espiración positiva parece reducir los días de estancia y prevenir los reingresos. Es importante seguir investigando sobre intervenciones no farmacológicas que consigan prevenir sus recaídas (AU)

Introduction. Chronic Obstructive Pulmonary Disease (COPD) is a condition which requires, among others, the administration of bronchodilators and anti-inflammatory drugs to control the disease. They help to keep the airways clear and prevent the buildup of fluid and mucus. Inhalation is the most widely used form of administrating the medication because of its local and rapid action which normally is done by aerosol therapy. The objective of this study is to evaluate the effectiveness of two aerosol methods in clearing the airways of COPD patients, admitted with an exacerbation due to their disease. It also aims to evaluate its effects on the length of stay, oxygen saturation, dyspnea, autonomy and complications. Methods. Randomized clinical trial. Traditional method (control group) and positive expiratory vibrating device (intervention group): two ways to deliver aerosol were compared. The following outcome variables were considered: length of stay, days of fever, oxygen saturation, need for NIV or VM, the basic activities of daily living index autonomy (Barthel), dyspnea (Borg scale) and peak-flow. Results. 39 patients were included. Regarding hospital stay, patients in the intervention group spend an average of one day less in hospital. Also in this group there were fewer readmissions. No statistically significant differences were found in the remaining variables. Conclusions. The inhalation treatment with a vibrating device with positive exhalation, appears to reduce the length of stay and prevent readmissions. It is important to continue research on non-pharmacological interventions as to achieve the prevention of relapses (AU)

The role of the nurse in pulmonary rehabilitation.

Pulmonary rehabilitation can help patients with chronic obstructive pulmonary disease improve their exercise tolerance and quality of life. Care packages can be devised and managed by respiratory nurses.

Change to a standardized airway clearance protocol for children with bronchiolitis leads to improved care.

Nurses at a pediatric hospital identified the liberal utilization of deep nasopharyngeal (NP) suction as the primary airway clearance modality in young children with bronchiolitis. This invasive practice lacked supporting evidence and a standardized approach. Nurses created an interdisciplinary team to develop a less invasive airway clearance protocol. Data from 2years, both pre and post protocol implementation, were analyzed. An 11% decrease in deep NP suctioning resulted in improved or unchanged balancing measures and perceptions of quality of care.

[Nursing practice of care to patients undergoing elective surgery in the immediate preoperative period]. / Prática do enfermeiro no cuidado ao paciente no pré-operatório imediato de cirurgia eletiva.

Research that aimed to analyze the care of nurses to patients, in the daily professional practice, provided in the preoperative period for patients undergoing elective surgery. It is a descriptive research with a qualitative approach that involved 15 nurses from Surgical Units and two nurses from the Surgical Centre of a hospital in the southern region of Brazil. Data was collected in semi-structured interviews conducted from April to July 2011. Data was analyzed using the Collective Subject Discourse (CSD) technique. The information obtained generated three CDS focused on the following ideas: administrative care, instruction in the preoperative period and surgical care in the immediate preoperative period. The results showed that caring consists mostly of giving instructions to the patient in the preoperative period. It is concluded that the care was directed to the physical aspects to the detriment of the psychological, in disagreement with the assistance methodology adopted in the hospital, supported by the Theory of Basic Human Needs.

Prática do enfermeiro no cuidado ao paciente no pré-operatório imediato de cirurgia eletiva / Práctica del enfermero en el cuidado al paciente en el preoperatorio inmediato de cirugía electiva / Nursing practice of care to patients undergoing elective surgery in the immediate preoperative period

A pesquisa objetivou analisar os cuidados dos enfermeiros com os pacientes, no cotidiano da prática profissional, no período pré-operatório imediato de cirurgia eletiva. Trata-se de uma pesquisa descritiva com abordagem qualitativa, em que participaram 15 enfermeiros das unidades cirúrgicas e dois do centro cirúrgico de um hospital da Região Sul do Brasil. Os dados foram coletados no período de abril a julho de 2011, por meio de entrevista semiestruturada. Para análise dos dados, utilizou-se o Discurso do Sujeito Coletivo (DSC). As informações deram origem a três DSCs com as ideias centrais: cuidados administrativos, orientação no pré-operatório e cuidados cirúrgicos no pré-operatório imediato. Os resultados mostram que grande parte dos cuidados se refere à orientação do paciente no pré-operatório. Conclui-se que os cuidados foram direcionados aos aspectos físicos em detrimento do psicológico, em discordância com a metodologia assistencial adotada no hospital, sustentada pela Teoria das Necessidades Humanas Básicas.

Investigación que examinó los cuidados de enfermeros a pacientes, en la práctica profesional cotidiana, en período preoperatorio inmediato de cirugía electiva. Se trata de una investigación descriptiva cualitativa, con la participación de 15 enfermeros de Unidades Quirúrgicas y dos del Centro Quirúrgico de un hospital de la región sur de Brasil. La recolección de datos ocurrió desde abril a julio de 2011 por medio de entrevista semiestructurada. Para el análisis de estos se utilizó el Discurso del Sujeto Colectivo (DSC). Las informaciones originaron tres DSC con las ideas centrales: cuidados administrativos, orientación preoperatoria y cuidados quirúrgicos en el preinmediato. Los resultados retratan que gran parte de los cuidados se refiere a la orientación del paciente en el preoperatorio. Se concluye que la atención se ha dirigido a los aspectos físicos en detrimento del psicológico, en desacuerdo con la metodología de la asistencia aprobada en el hospital, apoyada por la Teoría de las Necesidades Humanas Básicas.

Research that aimed to analyze the care of nurses to patients, in the daily professional practice, provided in the preoperative period for patients undergoing elective surgery. It is a descriptive research with a qualitative approach that involved 15 nurses from Surgical Units and two nurses from the Surgical Centre of a hospital in the southern region of Brazil. Data was collected in semi-structured interviews conducted from April to July 2011. Data was analyzed using the Collective Subject Discourse (CSD) technique. The information obtained generated three CDS focused on the following ideas: administrative care, instruction in the preoperative period and surgical care in the immediate preoperative period. The results showed that caring consists mostly of giving instructions to the patient in the preoperative period. It is concluded that the care was directed to the physical aspects to the detriment of the psychological, in disagreement with the assistance methodology adopted in the hospital, supported by the Theory of Basic Human Needs.

Conocimientos y prácticas del profesional de enfermería sobre las técnicas de fisioterapia respiratoria post operatoria en la prevención de complicaciones respiratorias en la UCI - Clínica Ricardo Palma 2013 / Knowledge and practice of professional nursing on the techniques of postoperative respiratory physiotherapy in the prevention of respiratory complications in the ICU-Clinic Ricardo Palma 2013

El objetivo fue determinar los conocimientos y prácticas del profesional de Enfermería sobre las técnicas de fisioterapia respiratoria post operatoria en la prevención de complicaciones .respiratorias en la UCI-Clínica Ricardo Palma 2013. Material y Método: El estudio fue de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal. La población estuvo conformada por 35 enfermeras. Las técnicas fueron la encuesta y la observación, los instrumentos un cuestionario y una lista de chequeo, que se aplicaron previo consentimiento informado. Resultados: Del 100 por ciento (35), 63 por ciento (22) desconoce y 37 por ciento (13) conoce, 57 por ciento (20) tienen practicas inadecuadas y 43 por ciento (15) practicas adecuadas. Conclusiones: El mayor porcentaje de las enfermeras desconoce que el drenaje postural es la técnica que se usa con mayor frecuencia, las diferentes técnicas de fisioterapia respiratoria y las técnicas respiratorias para prevenir las complicaciones post operatorias, mientras un porcentaje significativo conocen la importancia de la capacitación del personal de enfermería en las técnicas de fisioterapia respiratoria y que las complicaciones respiratorias en el post operatorio pueden ser prevenibles. Por otro lado la mayoría tiene practicas inadecuadas, referidos a que la enfermera no realiza la revisión de HC, tipo de cirugía y antecedentes, no realiza el drenaje postural a los pacientes por 15' con vibraciones torácicas en la fase inhalatoria, ni efectiviza la toma de rayos x de control, ni registra el procedimiento en las anotaciones de enfermería seguido de un porcentaje significativo tienen practicas adecuadas ya que la enfermeras aspira secreciones si el paciente está en ventilación o por oro faringe, registra las características de las secreciones, monitoriza signos vitales, facilita al paciente un espirómetro y demuestra los ejercicios espiratorios.

The objective was to determine the knowledge and practice of nursing professionals on chest physiotherapy techniques in preventing postoperative respiratory complications in the ICU-Ricardo Palma Clinic 2013. Material and Method: The study was level application, quantitative, cross-sectional descriptive method. The population consisted of 35 nurses. The techniques were the survey and observation, the instrument a questionnaire and a checklist, which applied prior informed consent. Results: 100 per cent (35), 63 per cent (22) and 37 per cent unknown (13) unknown, 57 per cent (20) have inadequate practices and 43 per cent (15) appropriate practices. Conclusions: The highest percentage of nurses known that postural drainage is the technique used most often, the different techniques of chest physiotherapy and breathing techniques to prevent postoperative complications, while a significant percentage know the importance of staff training nursing respiratory physiotherapy techniques and respiratory complications in the postoperative may be preventable. On the other hand most have inadequate practices, referred to the nurse for reviewing HC, type of surgery and history, do not perform postural drainage in patients for 15’ with thoracic vibration inhaler phase nor effective by making x-ray control, or record the proceedings in the nursing notes followed by a significant percentage have adequate practice nurses since aspires secretions if the patient is ventilated or oropharynx, records secretions characteristics, vital signs monitors, provides the patient with a spirometer and demonstrates the exercises expiratory.

Management of COPD patients in the intensive care unit.

Chronic obstructive pulmonary disease (COPD) is characterized by expiratory airflow limitation that is not fully reversible. Acute exacerbations in patients with moderate to severe COPD can cause severe hypoxia and persistent or severe respiratory acidosis, resulting in respiratory failure and the need for ventilator support. Acute respiratory failure, altered mental status, and hemodynamic instability associated with acute exacerbations of COPD are commonly encountered and require careful management in the intensive care unit (ICU). Noninvasive and invasive ventilator support in conjunction with pharmacotherapy can be lifesaving, although mortality remains high. It is important also to consider pulmonary rehabilitation and palliative care.

Patients with rib fractures: use of incentive spirometry volumes to guide care.

Rib fractures pose significant risk to trauma patients. Effective pain control and the ability to take deep breaths are crucial for optimal recovery, and these are key elements in current clinical guidelines. These guidelines use incentive spirometry volumes along with other assessment values to guide patient care. However, despite current guidelines, nurses do not routinely document inspired respiratory volumes. This article provides trauma nurses with the rationale for documenting and tracking incentive spirometry volumes to improve outcomes for patients with rib fractures. This promotes early detection of respiratory decline and early interventions to improve pain control and pulmonary function.