This dissertation deals with the issue of continuous elimination methods in intensive care, and of subsequently creating teaching materials for incoming nurses. The goal was to create teaching materials for incoming nurses. These teaching materials should help incoming nurses work with a device intended for continuous elimination methods. The dissertation is divided into a theoretical and practical part. The empirical part was implemented in the form of a qualitative research, using semi-structured interviews with respondents at the Accident and Emergency Ward of Nemocnice České Budějovice a.s. at the RES 2 station. The first stage of research was implemented by conducting interviews with the respondents. These interviews were recorded in the form of detailed notes which were later transcribed in order to prevent losses of data and inaccuracies. Subsequently, categories were established and, proceeding from these categories, schemes created using the ATLAS programme. The second stage consisted of creating an instruction video and teaching materials for incoming nurses. As a part of the third stage of research, the created video and teaching materials were presented at the Accident and Emergency Ward for evaluation. Then, interviews with the original respondents were re-conducted. During these interviews, the respondents were tasked with evaluating whether the teaching materials fulfil their needs and whether they will be usable in practice. The learned information was then arranged in corresponding schemes. Two goals were set with regards to the practical part. The first goal was to determine which form of teaching materials is suitable for incoming nurses. The second goal was to establish the benefits and usability of the created materials in practice. Based on the goals, two research questions were formulated. The first research question was: Is the form of the teaching materials suitable for incoming nurses? The second research question was: What is the benefit of the created materials in practice? Based on the research, it was discovered that most of the respondents would welcome teaching materials in the form of printed leaflets; however, opinions on the option of creating a video were also heard. Therefore, an instruction video, suitably complementing the printed leaflet, was created. The third part of research implied that most of the eight interviewed respondents were satisfied with the teaching materials. Three respondents suggested supplementing the printed leaflet with additional images. All eight respondents agreed that in their opinion, the provided teaching materials would make it easier for incoming nurses to familiarize themselves with the issues discussed. The head nurse at the Accident and Emergency Ward views the created teaching materials as beneficial. She intends to continue using these materials at her ward.

Made available in DSpace on 2016-01-26T12:51:13Z (GMT). No. of bitstreams: 1 pires_tese.pdf: 363791 bytes, checksum: af03ea5388a25575042d8de8b77224dd (MD5) Previous issue date: 2003-02-23 / Acute Renal Failure can be defined as an abrupt and sustained reduction in the glomerular filtration rate with a consequent retention of nitrogenous waste products. Despite the development in treatment, mortality remains high, varying beetween 50 and 70%. In hospitalised patients the incidence is about 5% but in respect to intensive care units it varies from 10 to 30%. In the last three decades, the characteristics of patients who suffer from acute renal failure changed dramatically. Before the advent of dialytic treatment, the main causes of mortality were uraemia, hyperkalaemia and the cardiac complications arising from volume overload. Nowadays, the causes are sepsis, cardiopulmonary failure, nephrotoxic drugs, and post renal transplantation complications. Multiple organ dysfunction, disseminated intravascular coagulation and diabetes mellitus are morbid conditions that can aggravate the prognosis of acute renal failure in intensive care units. Due to the high prevalence of diabetes mellitus in the population, this study intends to evaluate its influence in the morbidity and mortality of patients suffering from acute renal failure in the intensive care unit of Hospital de Base of São José do Rio Preto, Brazil was made in the period from January 1997 to December 2000. A total of 255 (25%) of the patients were diabetic and 765 (75%) were not. Demographic data, the presence of underlying diseases, aetiology, types, the clinical features and complications of acute renal failure were evaluated. Besides these, the presence of multiple organ failure syndrome was observed. In the study population 64% were male, 46% were more than 60 years old and 85% had one or more concomitant diseases. The ischaemic aetiology predominated in 53% of cases and a clinical cause was the most common type seen at 57%. The means and standard deviations of the Apache II score and creatinine levels (mg/dL) were 20.5 + 6.7 and 3.7 + 2.0 respectively. The prevalence of disseminated intravascular coagulation, shock, liver failure and respiratory failure were 32%, 69%, 15% and 79% respectively. Among the observed complications hyperkalaemia was seen in 35%, acidosis in 70%, sepsis in 61%, systemic arterial hypertension in 14%, bleeding in 22%, central nervous system disfunction in 44% and mortality in 71% of the cases. The demographic data, clinical features, morbidity and mortality due to acute renal failure of diabetic and non-diabetic individuals were compared. The hyperkalaemia, acidosis, respiratory failure, shock, central nervous system dysfunction, hypervolaemia and the bleeding were similar in both groups. A logistic regression analysis did not demonstrate a significant association between diabetes mellitus and mortality. An ischaemic aetiology, the failure of three or more organs, hyponatraemia and acidosis exhibited significant association between mortality and acute renal failure. In conclusion, the diabetic patients were older involving fewer men, with less oliguria, disseminated intravascular coagulation, hyponatraemia and liver failure than the non-diabetic individuals. Diabetes mellitus had no influence on the mortality due to acute renal failure in the intensive care unit. / A insuficiência renal aguda pode ser definida como uma redução abrupta e sustentada da taxa de filtração glomerular com conseqüente retenção de produtos nitrogenados. Apesar da evolução terapêutica, a sua mortalidade ainda continua elevada, variando entre 50 e 70%. Em pacientes hospitalizados, a sua incidência está próxima de 5% e, especificamente, em unidades de terapia intensiva, varia entre 10 e 30%. Nas últimas três décadas, as características dos pacientes acometidos de insuficiência renal aguda alteraram-se profundamente. Antes do advento do tratamento dialítico, as principais causas de mortalidade eram a uremia, a hipercalemia e as complicações cardiológicas decorrentes da sobrecarga de volume. Atualmente, são a sepse, a insuficiência cardiopulmonar, drogas nefrotóxicas e complicações pós-transplante renal. Quanto ao prognóstico de insuficiência renal aguda em unidades de terapia intensiva, a disfunção de múltiplos órgãos, a coagulação intravascular disseminada e o diabete melito são condições mórbidas que podem piorar a sua evolução. Devido à alta prevalência de diabete melito na população, o presente trabalho propôs-se avaliar a sua influência na morbidade e mortalidade da insuficiência renal aguda em unidade de terapia intensiva. Para tal, foram estudados, retrospectivamente, 1020 pacientes com insuficiência renal aguda internados na unidade de terapia intensiva do Hospital de Base de São José do Rio Preto, Brasil, no período de janeiro de 1997 a dezembro de 2000, dos quais, 255 (25%) eram diabéticos e 765 (75%) não diabéticos. Foram avaliados dados demográficos, presença de doenças de base, etiologia, tipos, quadro clínico e complicações de insuficiência renal aguda e ainda a presença de síndrome de disfunção de múltiplos órgãos. Entre a população estudada, 64% eram do sexo masculino, 46% tinham mais de 60 anos de idade, e 85% tinham uma ou mais doenças concomitantes. Nota de Resumo A etiologia isquêmica predominou com 53%, e a causa clínica foi o tipo mais freqüente com 57%. As médias e os desvios padrão de apache II e creatinina (mg/dL) foram 20,56,7 e 3,7+2 O respectivamente. A prevalência de coagulação intravascular disseminada, de choque, de insuficiência hepática e respiratória foi 32%, 69%, 15% e 79%, respectivamente. Entre as complicações, observamos a hiperpotassemia em 35%, a acidose em 70%, a sepse em 61%, a hipertensão arterial sistêmica em 14%, os sangramentos em 22%, a disfunção do sistema nervoso central em 44% e a mortalidade em 71%. Foram comparados, entre os diabéticos e os não diabéticos, os dados demográficos, quadro clínico, morbidade e mortalidade de insuficiência renal aguda. A hipercalemia, a acidose, a insuficiência respiratória, a sepse, o choque, a disfunção do sistema nervoso central, a hipervolemia e os sangramentos foram similares em ambos os grupos. A análise de regressão logística não mostrou associação significante entre diabete melito e a mortalidade. A etiologia isquêmica, a presença de três ou mais insuficiências de órgãos, a hiponatremia e a acidose foram de forma significante associadas com a mortalidade de insuficiência renal aguda. Em conclusão, os diabéticos foram mais idosos, menor prevalência de masculinos, menos oligúria, coagulação intravascular disseminada, hiponatremia e falência hepática do que os não diabéticos. O diabete melito não teve influência na mortalidade da insuficiência renal aguda em unidade de terapia intensiva.

Made available in DSpace on 2016-01-26T12:51:24Z (GMT). No. of bitstreams: 1 fernandonestor_tese.pdf: 1042593 bytes, checksum: af0a555c2adb2f553fd7214a6ca2774b (MD5) Previous issue date: 2006-03-14 / The aim of the present study was to investigate the effects of the use of the anti-inflammatory protein annexin 1 (Anx-A1), which is found in most cells. It is characterized by its ability in binding to calcium and phospholipids, conferring protection against the initial effects of ischemia-reperfusion injury. Right nephrectomy was performed on 48 adult males Wistar rat, with sizes ranging between 250-300 g, maintained on a diet normosodic , normoprotein and with water ad libitum. The animals was divided into 3 groups: Annexin-1/Ischemia (Anx-A1-I/R) (n=16), vehicle (PBS40)-Ischemia (Vehicle-I/R) (n=16) and Sham Group (n=16). The endovenous administration of Anx-A1 was made 30 minutes before ischemia of the left renal artery. The animals of each group were divided and studied at 2 and 7 days post-reperfusion, in respect to the glomerular, tubular and renal structure functions. The results showed that there was a reduction in the glomerular filtration rate (GFR) in the Vehicle-I/R Groups at 2 and 7 days post-reperfusion (0.42 ± 0.02 mL/min-100g and 0.48 ± 0.05 mL/min-100g, respectively). There was a significantly greater filtration rate in the Anx-A1-I/R Groups compared to the Vehicle-I/R Groups (0.86 ± 0.05 mL/min-100g and 0.73 ± 0.04 mL/min-100g, respectively). A significant difference between the Anx-A1-I/R and Sham Groups (p-value < 0.01) was also observed (7days). The fractional sodium excretion (FeNa) was significantly higher in the Vehicle-I/R Groups when compared to the Anx-A1-I/R and Sham Groups on the 2nd and 7th post-perfusion days. On the 2nd day of the study, the fractional sodium excretion was 0.17 ± 0.01% for the Anx-A1-I/R, 0.42 ± 0.03% for the Vehicle-I/R and 0.21 ± 0.01% for the Sham groups (p-value < 0.001). On the 7th day, the values were 0.27 ± 0.03%, 0.52 ± 0.03% and 0.29 ± 0.01%, respectively (p-value < 0.001). The potassium excretion fraction (FeK) on the 2nd and 7th post-perfusion days did not differentiate between the Anx-A1-I/R and Sham Groups, but it was significantly higher in the Vehicle-I/R Groups. The urinary-plasmatic osmolality ratio (U/Posm) showed a significant reduction in the Vehicle-I/R Groups after 2 and 7 days when compared with the Anx-A1-I/R and Sham Groups. A histopathologic evaluation of renal cortex samples, taken on the 2nd and 7th post-perfusion days, revealed a significant increase in the intravascular and transmigrated neutrophils in ischemic areas of the Vehicle-I/R Groups. Additionally, high rates of transmigrated neutrophils were identified in the ischemia-reperfusion areas of samples of renal medulla from the Vehicle-I/R Group taken on the 2nd and 7th days. There was a significant reduction of the neutrophil transmigration in samples of renal medulla on the 2nd and 7th post-perfusion days in the Anx-A1-I/R Groups, as well as a lower intravascular neutrophil rate. On the 2nd and 7th post-perfusion days, the Sham Group presented with structures of distal and proximal convoluted tubules and well-preserved brush-border structures in the renal cortex and medulla samples as seen by light microscopy. Similar results were evidenced in the Anx-A1-I/R Groups with preserved structures in the tubules, basal membrane and glomeruli. In the Vehicle-IR Groups, numerous monocytes, cellular debris inside proximal convoluted tubules, dilated capillaries and alterations in the basal membrane structure were seen. These results suggest that the administration of annexin-1 thirty minutes before renal ischemia in rat , prevents the transmigration of neutrophils and confers protection against the initial effects of ischemia-reperfusion injury, as well as providing protection to the glomerular, tubular and renal structure functions. / O presente estudo objetivou investigar os efeitos do uso da anexina 1 (Anx-A1), considerada proteína antiinflamatória e que está presente na maioria das células. Caracteriza-se pela sua habilidade em ligar-se ao cálcio e fosfolipídeos, conferindo proteção contra os efeitos iniciais da lesão por isquemia e reperfusão. Realizou-se nefrectomia à direita em 48 ratos (Wistar-adultos-machos), pesando entre 250-300 gramas, mantidos com dieta normosódica , normoprotéica e água ad libitum. Os animais foram divididos em 3 grupos: Anexina 1-Isquemia (Anx-A1-I/R) (n=16), Veículo(PBS-40)-Isquemia (Veic-I/R) (n=16) e grupo Sham (n=16). A administração de anexina1 endovenosa foi realizada 30 minutos antes do clampeamento da artéria renal esquerda. Após reperfusão, os animais de cada grupo foram divididos e estudados com 2 e 7 dias, quanto às funções glomerulares , tubulares e à estrutura renal. Os resultados mostraram que houve redução da taxa de filtração glomerular (RFG) nos grupos veículo-I/R com 2 e 7 dias de experimento (0,42 ± 0,02 ml-min-100g e 0,48 ± 0,05 ml-min-100g, respectivamente) e verificamos aumento significativo da taxa de filtração glomerular nos grupos Anx-A1-I/R comparados aos grupos veículo-I/R (0,86 ± 0,05ml-min-100g e 0,73 ± 0,04ml-min-100g, respectivamente). Observou-se diferença significativa entre os grupos Anx-A1-I/R e Sham com 7 dias (p<0,01). A excreção fracional de sódio (FeNa) apresentou-se significantemente aumentada nos grupos veículo-I/R, comparada aos grupos Anx-A1-I/R e Sham nos 2º e 7º dias de experimento; apresentando assim no 2º dia de estudo,Anx-A1-I/R (0,17 ± 0,01%), Veic-I/R (0,42 ± 0,03%) e Sham (0,21 ± 0,01%) (p<0,001); e no 7º dia, Anx-A1-I/R (0,27 ± 0,03%), Veic-I/R (0,52 ± 0,03%) e Sham (0,29 ± 0,01%) (p<0,001). A fração de excreção de potássio (FeK) com 2 e 7 dias de experimento não diferiram entre os grupos Anx-A1-I/R e Sham, mas a FeK aumentou significativamente nos grupos Veic-IR. A razão das osmolalidades urinário-plasmáticas (U/Posm) mostraram uma redução importante nos grupos Veic-I/R em experimentos com 2 e 7 dias, comparados aos grupos Anx-A1-I/R e Sham. A avaliação histopatológica revelou aumento significativo de neutrófilos intravasculares e transmigrados, em áreas isquêmicas dos grupos Veic-I/R, de amostras avaliadas da porção do córtex renal com 2 e 7 dias. Verificaram-se altas taxas de transmigração de neutrófilos nas áreas de isquemia-reperfusão nos grupos Veic-I/R com 2 e 7 dias, em amostras avaliadas de medula renal. Houve significativa redução do extravasamento de neutrófilos em análise quantitativa, nas amostras de medula renal com 2 e 7 dias de estudo, nos grupos anexina 1-I/R, bem como menor taxa de neutrófilos no espaço intravascular. À microscopia de luz, verificou-se que, em amostras de córtex e medula renal, com 2 e 7 dias, o grupo Sham apresentou estruturas dos túbulos contorcidos proximais, distais e borda em escova bem preservados. Notou-se resultados semelhantes nos grupos de anexina1-I/R, com estruturas preservadas nos túbulos, membrana basal e glomérulos. Nos grupos Veic-I/R, verificou-se a presença de debris celulares no interior de túbulos contorcidos proximais, capilares dilatados e alterações na estrutura da membrana basal. Estes resultados sugerem que a administração da anexina1, trinta minutos antes da isquemia renal em ratos, previne a transmigração de neutrófilos e confere proteção contra os efeitos iniciais da lesão por isquemia e reperfusão, bem como proteção das funções glomerulares, tubulares e da estrutura renal.