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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

MÃtodo de avaliaÃÃo visual aplicado ao recÃm - nascido / Evaluation method of the newbornsâ vision

Ingrid Martins Leite LÃcio 20 August 2004 (has links)
CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Estudo exploratÃrio com abordagem quantitativa, realizado em uma maternidade pÃblica de Fortaleza-CE, que objetivou descrever um mÃtodo de avaliaÃÃo visual aplicado ao recÃm-nascido. Para tanto, utilizou-se um formulÃrio composto por trÃs partes - 1) histÃria materna e neonatal 2) exame ocular e 3) condutas de enfermagem - o qual foi aplicado ao recÃm-nascido cuja idade gestacional ao nascimento era inferior a 37 semanas (RNPT) com o consentimento pÃs-esclarecido da mÃe no perÃodo de marÃo a maio de 2004. Os dados foram processados com o auxÃlio do software SPSS versÃo 11.0 e apresentados em forma de tabelas. Para anÃlise das tabelas 2x2 foram utilizados os testes de Fisher e para as tabelas rxc os testes de Fisher-Freeman-Halton, adotando-se o nÃvel de significÃncia de 5%. O mÃtodo foi aplicado a 114 recÃm-nascidos prematuros. Dentre os fatores da histÃria materna destacaram-se as mÃdias das idades, 23 anos e de consultas de prÃ-natal igual a 3,8. SobressaÃram-se na histÃria familiar/oftalmolÃgica casos de erros de refraÃÃo (17%) seguidos por casos de diabetes (14%). Em menor freqÃÃncia, catarata (4%) e glaucoma (1%). Na histÃria pessoal sobressaiu-se a hipertensÃo arterial (12%), seguida por distÃrbios visuais (8%). Em relaÃÃo à histÃria neonatal, verificou-se que 71% dos RNPT nasceram por cesariana, 52% eram do sexo feminino e 68% apresentaram apgar inferior a sete no primeiro minuto. Quanto à classificaÃÃo da prematuridade 78% eram RNPT moderados. Constatou-se que 112 RNPT utilizaram oxigenoterapia, 71% destes de 1 a 10 dias e 68 RNPT fototerapia, 53% destes de 1 a 5 dias. A profilaxia contra a oftalmia neonatal foi realizada em 27% dos RNPT. Referindo-se ao exame ocular externo, 27% dos RNPT apresentaram alteraÃÃo na pÃlpebra, 16% na conjuntiva, 14% na esclera, 9% no ducto lacrimal, 6% na cÃrnea e 5% na pupila. Nenhum RNPT apresentou alteraÃÃo nas estruturas da sobrancelha e Ãris. Houve associaÃÃo significativa entre alteraÃÃo de esclera e uso de soluÃÃo e/ou medicamento via ocular (p= 0,055). Treze RNPT (11%) apresentaram alteraÃÃo de movimentos extra-oculares (estrabismo fisiolÃgico) e treze (11%) o reflexo vermelho alterado. Houve associaÃÃo estatisticamente significativa entre reflexo vermelho e apgar no primeiro minuto de vida (p= 0,041) e o tempo de oxigenoterapia (p= 0,028). As condutas de enfermagem, a partir dos achados da avaliaÃÃo visual, foram dirigidas ao prontuÃrio, à equipe de enfermagem, aos cuidados com a visÃo do recÃm-nascido ao utilizar terapÃuticas especÃficas, aos seus pais e a outros profissionais (encaminhamento). Os resultados indicaram que o mÃtodo utilizado foi eficiente pelo fato de ressaltar e identificar fatores que podem colaborar para alteraÃÃes visuais precoces, assim como os possÃveis achados do exame ocular do recÃm-nascido. TambÃm almejou como tecnologia contribuir para o âsaberâ e o âcomo fazerâ do enfermeiro no cuidado dirigido à saÃde ocular do recÃm-nascido. A operacionalizaÃÃo do mÃtodo de avaliaÃÃo visual mostrou-se viÃvel e necessÃria no perÃodo de internaÃÃo neonatal, como um dos cuidados do enfermeiro visando a contribuir para a minimizaÃÃo ou mesmo diminuiÃÃo dos agravos à saÃde ocular da crianÃa. / This is a quantitative study, which took place in a public maternity of Fortaleza - CE during the months of March and May of 2004. The aim was to describe the implementation of a visual evaluation during the intern of 114 premature newborns (PN) whose gestation age until birth was under 37 weeks. The babiesâ mothers gave their permission to be subject of the study. The evaluation questionnaire consisted of three categories: 1) maternal and newborn history, 2) ocular exam and 3) nursing care. The data was analysed with the help of SPSS software 11.0 version and presented through table charts. To analyse the 2x2 tables it was used Fisherâs tests and for the rxc tables, Fisher-Freeman-Haltonâs tests, adopting a significance level of 5%. Under the category maternal history, the data showed that the ageâs ratio of the mothers was 23 and 3.8 was the average number of pre - natal consultation. Under family history/ophthalmologic, it stood out deflection errors (17%) followed by diabetes (14%) and in a lower frequency, cataract (4%) and glaucoma (1%). Under personal history it stood out high blood pressure (12%) followed by visual disorder (8%). Under newborn history it was found that 71% of PN were born thought caesarean section, also 52% are female and 68% had an apgar lower than seven during the first minute of their lives. 78% were average PN according to the premature classification. It was found that 112 PN used oxigenotherapy in which 71% of them were between the ages of 1 and 10 days. Also 68 PN were under phototherapy in which 53% were between 1 and 5 days old. The prophylaxis against newborn ophthalmologic disease was done in 27% of the premature newborns. As for the external ocular exam, 27% of those babies showed alteration in the eyelid, 16% in the conjunctiva, 14% in the sclera, 9% in the lachrymal duct, 6% in the cornea and 5% in the pupil (opening of the iris). None of the premature newborns showed any alterations on the eyebrow or iris. There was a meaning variation between the sclera and the ophthalmologic medication used (p=0,055). Thirteen premature newborns (11%) showed variation of the extra-ocular movements (physiologic strabismus) and thirteen (11%) had their red reflex altered. It was found a relevant relation among the red reflex, the apgar in the first minute of the newbornsâ lives (p=0,041) and the time of oxigenotherapy treatment (p=0,028). The nursing care, based on visual assessment, was noted on the register book, informed to the nursing team, conducted as an specific treatment for the newbornsâ vision, transmitted to their parents and other professionals (if one was to be needed). The results showed that the method used was efficient because it emphasizes and identifies factors that may help cooperate treatments against premature visual disorders. Indeed a technology resource contributes to the knowledge and nursing practice for the newbornsâ visual health. The evaluation process came to be useful and necessary during a newborn intern period as one of the nursing treatments to reduce childrenâs ocular disorders.

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