Submitted by Erika Demachki (erikademachki@gmail.com) on 2017-01-12T16:02:46Z No. of bitstreams: 2 Dissertação - Nádia Ferreira Gonçalves - 2013.pdf: 1051840 bytes, checksum: 75498ee692a1a652339e16003a0de36c (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-16T10:42:43Z (GMT) No. of bitstreams: 2 Dissertação - Nádia Ferreira Gonçalves - 2013.pdf: 1051840 bytes, checksum: 75498ee692a1a652339e16003a0de36c (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-01-16T10:42:43Z (GMT). No. of bitstreams: 2 Dissertação - Nádia Ferreira Gonçalves - 2013.pdf: 1051840 bytes, checksum: 75498ee692a1a652339e16003a0de36c (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2013-10-21 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Compliance with preventive measures by health professionals is a large challenge, and it is believed that in the intensive care unit, especially those classified as neonatal and pediatric, contamination of goods, equipment, and environmental surfaces contribute significantly to the increased epidemiology of healthcare associated infections (HAIs). The objective of this study was to analyze the epidemiological and microbiological profiles of tools, equipment, and ambient surfaces contaminated with antimicrobial resistant Staphylococcus spp. in neonatal and pediatric intensive care units. It is a cross-sectional epidemiological study carried out from August 2011 to September 2012, in a neonatal and pediatric intensive care unit specializing in maternal and child health of the public health system in GoiâniaGoiás, Brazil. Samples were collected using sterile swabs moistened with saline solution 0.9%, which were subjected to microbiological processing consisting of isolation, identification and antimicrobial susceptibility testing. Analysis and interpretation of results followed. Of the 137 samples, 1 02 were identified as Staphylococcus spp. and, in six of the 12 incubators, different strains of these microorganisms were isolated, totaling 108 isolates. Among the isolates, only four were identified as Staphylococcus aureus, and the remaining 104 were coagulasenegative Staphylococcus. During the processing of isolates it was revealed that 74.5% of the tools, surfaces and equipment were infected by Staphylococcus spp., and of these, more than 80% were resistant to antimicrobials. In four, MLSB phenotype was detected. As for oxacillin-resistant isolates, 82.3 % had resistance confirmed by Etest®. Upon completion of the analysis, it became clear that the tools, surfaces and equipment used in pediatric neonatal intensive care units are reservoirs of bacteria. This immediately highlights an important contributor to the epidemiology of HAIs: compliance with procedure for the safety of infants and healthcare workers, since these findings signal gaps in the work process and therefore in the processing of these items. Therefore, it is believed that the perception of the professionals who work in health facilities (related to the risks of cross-contamination) is of unique value to understanding the need to adopt safe work practices. It is hoped, that contributing to the development of other studies, with the goal of identifying possible gaps, involving both the management of the service and standard operating procedures for the cleaning and disinfection of ambient surfaces, tools and equipment in compliance with guidelines. / A adesão às medias preventivas pelos profissionais de saúde é um amplo desafio e, acredita-se que na unidade de terapia intensiva, em especial nas de caráter neonatal e pediátrico, a contaminação de artigos, superfícies ambientais e equipamentos contribua expressivamente para o avanço da cadeia epidemiológica das Infecções Reacionadas à Assistência à Saúde (IrAS). Objetivou-se neste estudo analisar os aspectos epidemiológicos e microbiológicos de artigos, superfícies ambientais e equipamentos contaminados por Staphylococcus spp. resistentes aos antimicrobianos em unidades de terapia intensiva neonatal e pediátrica. Trata-se de um estudo epidemiológico tipo transversal desenvolvido de agosto de 2011 a setembro de 201 2, nas unidades de terapia intensiva neonatal e pediátrica de uma instituição especializada em saúde materna e infantil do Sistema Único de Saúde de Goiânia-Goiás, Brasil. Os dados foram obtidos por meio de swab, coletou-se amostras biológicas dos artigos, superfícies ambientais e equipamentos existentes nas unidades selecionadas para estudo. Realizou-se fricção bidirecional com swab estéril umedecido em solução salina a 0,9%; em seguida foi feito o processamento laboratorial dos espécimes, com isolamento, identificação e teste de suscetibilidade dos micro-organismos aos antimicrobianos; por fim, a análise e interpretação dos resultados. Das 1 37 amostras, em 1 02 foram identificados Staphylococcus spp. sendo que, em seis das 12 incubadoras foram isoladas diferentes cepas desses micro-organismos, totalizando 1 08 isolados. Dentre os isolados, apenas quatro foram identificados como Staphylococcus aureus, e os 104 restantes de Stafilococos coagulase negativo. Durante o processamento dos isolados, verificou-se que 74,5% dos artigos, superfícies e equipamentos se encontravam contaminados por Staphylococcus spp., destes mais de 80%, resistentes aos antimicrobianos testados. Mas em apenas quatro foi detectado o fenótipo resistente a macrolídeos, lincosamidas e estreptogramina B (MLSB). Quanto aos isolados resistentes à oxacilina, 82,3% tiveram a resistência confirmada pelo Epsilometer Test (Etest®). Ao concluir as análises, evidenciou-se que artigos, superfícies e equipamentos de unidades de terapia intensiva neonatal e pediátrica, são reservatórios de bactérias. Logo, representam importante papel na cadeia epidemiológica das IrAS, o que configura inconformidades com a segurança do recém nascido e do trabalhador, uma vez que, esses achados sinalizam falhas no processo de trabalho e consequentemente no processamento desses artefatos. Nessa direção, acreditase que a percepção dos profissionais que laboram em estabelecimentos de saúde relacionada aos riscos de contaminação cruzada é de singular valor para compreenderem a necessidade de adotarem atitudes seguras no ato laboral. Espera-se ainda, contribuir com o desenvolvimento de outros estudos, com o objetivo de compreender as possíveis falhas envolvendo o tanto a gestão do serviço, quanto aos processos de trabalho e de limpeza e desinfecção das superfícies ambientais, artigos e equipamentos em conformidade com as diretrizes.

<p>Cardiac arrest results in immediate interruption of blood flow. The primary goal of cardiopulmonary resuscitation (CPR) is to re-establish blood flow and hence oxygen delivery to the vital organs. This thesis describes different pharmacological interventions aimed at increasing cerebral blood flow during CPR and after restoration of spontaneous circulation (ROSC).</p><p>In a porcine model of cardiac arrest, continuous infusion of adrenaline generated higher cortical cerebral blood flow during CPR as compared to bolus administration of adrenaline. While bolus doses resulted in temporary peaks in cerebral blood flow, continuous infusion led to a sustained increase in this flow.</p><p>Administration of vasopressin resulted in higher cortical cerebral blood flow and a lower cerebral oxygen extraction ratio as compared to continuous infusion of adrenaline during CPR. In addition, vasopressin generated higher coronary perfusion pressure during CPR and increased the likelihood of achieving ROSC.</p><p>Parameters of coagulation and inflammation were measured after successful resuscitation from cardiac arrest. Immediately after ROSC, thrombin-antithrombin complex, a marker of thrombin generation, was elevated and eicosanoid levels were increased, indicating activation of coagulation and inflammation after ROSC. The thrombin generation was accompanied by a reduction in antithrombin. In addition, there was substantial haemoconcentration in the initial period after ROSC.</p><p>By administration of antithrombin during CPR, supraphysiological levels of antithrombin were achieved. However, antithrombin administration did not increase cerebral circulation or reduce reperfusion injury, as measured by cortical cerebral blood flow, cerebral oxygen extraction and levels of eicosanoids, after ROSC. </p><p>In a clinical study, the adrenaline dose interval was found to be longer than recommended in the majority of cases of cardiac arrest. Thus, the adherence to recommended guidelines regarding the adrenaline dose interval seems to be poor. </p>

<p>Evaluating respiratory mechanics during dynamic conditions without interrupting ongoing ventilation and flow, adds to the information obtained from the mechanics derived from static (= no flow) conditions, i.e., the flow signal has the potential to provide information on the properties of the respiratory system (including the tubing system). Hence monitoring the changes in the flow signal during ongoing mechanical ventilation would give information about the dynamic mechanics of the respiratory system. Any change in the mechanics of the respiratory system including the endotracheal tube (ETT) and the ventilatory circuit would affect the shape of the flow signal. </p><p>Knowledge of the airway pressure distal to the ETT at the carina level (= tracheal pressure) is required for calculating the extra resistive load exerted by the endotracheal tube in order to compensate for it. In a porcine model, the flow signal was used to non-invasively calculate tracheal pressure. There was good agreement between calculated and measured tracheal pressure with different modes of ventilation. However, calculation of tracheal pressure assumes that the inner diameter of the ETT is known, and this assumption is not met if the inner diameter is narrowed by secretions. Flow that passes a narrowed tube is decelerated and this is most pronounced with the high flow of early expiration, yielding a typical time constant over expiratory volume pattern that is easy to recognize during mechanical ventilation. This pattern reliably detected partial endotracheal obstruction during volume and pressure controlled mechanical ventilation. </p><p>A change in compliance of the respiratory system modifies the elastic recoil and this also affects the rate of the expiratory flow and the shape of its signal. In a porcine model, lung volume gains on the flow signal generated by the heartbeats (cardiogenic oscillations) provided information about the compliance of the respiratory system during ongoing mechanical ventilation</p><p>In conclusion analyzing the flow signal during ongoing ventilation can be a cheap, non-invasive and reliable tool to monitor the elastic and resistive properties of the respiratory system including the endotracheal tube.</p>

Cardiac arrest results in immediate interruption of blood flow. The primary goal of cardiopulmonary resuscitation (CPR) is to re-establish blood flow and hence oxygen delivery to the vital organs. This thesis describes different pharmacological interventions aimed at increasing cerebral blood flow during CPR and after restoration of spontaneous circulation (ROSC). In a porcine model of cardiac arrest, continuous infusion of adrenaline generated higher cortical cerebral blood flow during CPR as compared to bolus administration of adrenaline. While bolus doses resulted in temporary peaks in cerebral blood flow, continuous infusion led to a sustained increase in this flow. Administration of vasopressin resulted in higher cortical cerebral blood flow and a lower cerebral oxygen extraction ratio as compared to continuous infusion of adrenaline during CPR. In addition, vasopressin generated higher coronary perfusion pressure during CPR and increased the likelihood of achieving ROSC. Parameters of coagulation and inflammation were measured after successful resuscitation from cardiac arrest. Immediately after ROSC, thrombin-antithrombin complex, a marker of thrombin generation, was elevated and eicosanoid levels were increased, indicating activation of coagulation and inflammation after ROSC. The thrombin generation was accompanied by a reduction in antithrombin. In addition, there was substantial haemoconcentration in the initial period after ROSC. By administration of antithrombin during CPR, supraphysiological levels of antithrombin were achieved. However, antithrombin administration did not increase cerebral circulation or reduce reperfusion injury, as measured by cortical cerebral blood flow, cerebral oxygen extraction and levels of eicosanoids, after ROSC. In a clinical study, the adrenaline dose interval was found to be longer than recommended in the majority of cases of cardiac arrest. Thus, the adherence to recommended guidelines regarding the adrenaline dose interval seems to be poor.

Evaluating respiratory mechanics during dynamic conditions without interrupting ongoing ventilation and flow, adds to the information obtained from the mechanics derived from static (= no flow) conditions, i.e., the flow signal has the potential to provide information on the properties of the respiratory system (including the tubing system). Hence monitoring the changes in the flow signal during ongoing mechanical ventilation would give information about the dynamic mechanics of the respiratory system. Any change in the mechanics of the respiratory system including the endotracheal tube (ETT) and the ventilatory circuit would affect the shape of the flow signal. Knowledge of the airway pressure distal to the ETT at the carina level (= tracheal pressure) is required for calculating the extra resistive load exerted by the endotracheal tube in order to compensate for it. In a porcine model, the flow signal was used to non-invasively calculate tracheal pressure. There was good agreement between calculated and measured tracheal pressure with different modes of ventilation. However, calculation of tracheal pressure assumes that the inner diameter of the ETT is known, and this assumption is not met if the inner diameter is narrowed by secretions. Flow that passes a narrowed tube is decelerated and this is most pronounced with the high flow of early expiration, yielding a typical time constant over expiratory volume pattern that is easy to recognize during mechanical ventilation. This pattern reliably detected partial endotracheal obstruction during volume and pressure controlled mechanical ventilation. A change in compliance of the respiratory system modifies the elastic recoil and this also affects the rate of the expiratory flow and the shape of its signal. In a porcine model, lung volume gains on the flow signal generated by the heartbeats (cardiogenic oscillations) provided information about the compliance of the respiratory system during ongoing mechanical ventilation In conclusion analyzing the flow signal during ongoing ventilation can be a cheap, non-invasive and reliable tool to monitor the elastic and resistive properties of the respiratory system including the endotracheal tube.

Thesis (M.N.)--Memorial University of Newfoundland, 1999. / Typescript. Bibliography: p. 113-123.

Thesis (M.N.)--Memorial University of Newfoundland, School of Nursing, 2002. / Typescript. Bibliography: leaves 216-228.

Bakgrund: Intensivvårdspatienter lider ofta av dålig sömnkvalitet och sömnen är karaktäriserad av korta sömnperioder på natten och ökad sömn på dagen. En sammanhängande nattsömn är livsviktig för en gynnsam återhämtning hos den kritiskt sjuka patienten. Intensivvårdspatienter rankar sömnbrist som en av de vanligaste orsakerna till stress och oro under vårdtiden. Därför är det som intensivvårdssjuksköterska angeläget att ta reda på vilka olika faktorer som inverkar negativt på patienters sömn. Syfte: Syftet med studien är att belysa faktorer som kan störa sömnen hos den vuxne intensivvårdspatienten. Metod: En integrativ litteraturstudie. Resultat: Ljuden från alarm och personalens röster utmärkte sig som mest sömnstörande på intensivvårdsavdelningen. Kontroller av vitalparametrar och blodprovstagning var de omvårdnadsåtgärder som nämndes som mest sömnstörande. Stress, ångest och smärta var andra vanligt förekommande sömnstörande faktorer. Resultatet presenteras med två teman som i sin tur är indelade i fem kategorier. Slutsats: Intensivvårdsmiljön är en högteknologisk miljö där de sömnstörande faktorerna är multifaktoriella. Det finns ett behov av en ökad kunskap hos intensivvårdssjuksköterskan kring sömnens betydelse för intensivvårdspatienten och vidare forskning behövs inom området som rör intensivvårdssjuksköterskans kunskap och attityder till intensivvårdspatienters sömn. / Background: Intensive care patients often suffer from interrupted sleep and disturbed daily rhythm. Intensive care patients often have poor sleep quality and the sleep is characterized by short sleep periods at night and increased sleep during the day. A coherent night's sleep is vital for the critically ill patient, for a favorable recovery. Intensive care patients rank sleep disorder as one of the most common causes of stress and worry during time in hospital. Therefore, as an intensive care nurse, it is important to find out different factors that affect patients sleep. Purpose: The purpose of the study is to highlight factors that may interfere with the sleep of the adult intensive care patient. Method: An integrative literature study. Result: The sounds of alarm and staffs’ voices were characterized as most sleep disturbing in the intensive care unit. Verification of vital parameters and blood sampling were those nursing actions referred to as most sleep disturbing. Stress, anxiety and pain were other common sleep disturbing factors. The result is presented with two themes which in turn are divided into five categories. Conclusion: The intensive care environment is a high-tech environment where the sleep disturbing factors are multifactorial. There is a need for increased knowledge of the intensive care nurse regarding the importance of sleep for the intensive care patient, and further research is needed in the field of the intensive care nurse knowledge and attitudes towards the intensive care patient's sleep.

Critically ill patients experience overwhelming communication problems; caused by intubation and cognitive, sensory or language deficits that distance the patients from communicating their needs and wants from nurses and loved ones. The purpose of this study was to explore communication patterns and strategies with the aim of implementing intervention strategies for nurse/patient communication in the intensive care units. The American Association of Critical Care Nurses’ Synergy Model for Patient Care was used to guide the study. A mixed method approach using quasi-experimental design combining quantitative and qualitative data collections and analysis was used. Concurrent data collection for quantitative and qualitative data was used. Auditing of patient’s files, protocols, family counselling conference and in-service books and a survey for nurses was used for quantitative data. Qualitative data collection was through interviewing nurses and nurse managers. Lack of documentation and use of other communication strategies were the key findings of the study. In accordance with the model used for the study clinical judgment and moral distress were found to be common among nurses. Lack of collaboration between nurses and other health care workers was also attributed to poor communication with mechanically ventilated patients. Conclusions derived from the study are that nurses need to be supported through informal and formal training on documentation and use of communication methods available / Health Studies / D. Litt. et Phil. (Health Studies)

Submitted by Natalia Patrizi Maximino (natalia.maximino@hotmail.com) on 2018-04-20T13:51:08Z No. of bitstreams: 1 Dissertação Natalia Maximino .pdf: 3583367 bytes, checksum: af81291ae78c8dea7ca6eda126a62c87 (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-04-20T14:37:58Z (GMT) No. of bitstreams: 1 maximino_np_me_bot.pdf: 3583367 bytes, checksum: af81291ae78c8dea7ca6eda126a62c87 (MD5) / Made available in DSpace on 2018-04-20T14:37:58Z (GMT). No. of bitstreams: 1 maximino_np_me_bot.pdf: 3583367 bytes, checksum: af81291ae78c8dea7ca6eda126a62c87 (MD5) Previous issue date: 2018-02-26 / Introdução: O traumatismo cranioencefálico constitui um dos principais problemas de saúde pública e está entre as principais causas de morte, incapacidade ou invalidez. As suas características variam de acordo com a população envolvida, sendo de expressiva importância o conhecimento das características das internações de modo a elaborar diretrizes básicas para programas de prevenção e também intervenções específicas na área assistencial. Objetivos: Caracterizar o perfil epidemiológico do traumatismo cranioencefálico (TCE) na Unidade de Terapia Intensiva do Hospital de Base de Bauru e elaborar um Guia de orientações pós-alta hospitalar para o cuidador. Métodos: Estudo quantitativo, retrospectivo e de natureza documental, baseado na análise de prontuários eletrônicos de pacientes vítimas de traumatismo cranioencefálico internados no período de janeiro a julho de 2016. Resultados: Foram admitidos 156 pacientes (29,65%) com traumatismo cranioencefálico; 139 prontuários atendiam os critérios de inclusão e foram analisados. Houve predomínio de idosos e adultos (idade 41 anos ou mais), representando 58,28% da amostra; prevalência do sexo masculino (82%) e traumatismos causados por quedas (39,57%), seguidos de espancamentos (15,11%) e acidentes motociclísticos (14,39%). Desses pacientes, 24 evoluíram a óbito; 19 pacientes receberam alta com algum déficit (neurológico, motor ou visual) e com 27 dispositivos invasivos. Conclusão: Apesar das altas taxas de prevalência de traumatismo cranioencefálico no Brasil e do seu significativo impacto econômico e social, o número de estudos com dados epidemiológicos consistentes permanece escasso. Este estudo pode contribuir para direcionar ações de saúde e políticas públicas na região de Bauru em relação ao cuidado com as vítimas de TCE, assim como do agente causador. Pode também ajudar na efetivação do processo de cuidar da população vulnerável e investir em programas de prevenção, reduzindo sequelas e minimizando os custos ao Sistema Único de Saúde. Produto da dissertação: O Guia “Orientações pós-alta hospitalar para o cuidador de pacientes acamados” foi elaborado para orientar os cuidadores e apoiar as principais ações no domicílio, proporcionando assistência de qualidade. / Cranioencephalic trauma is a major public health problem and is among the main causes of death, incapacity or disability. Its characteristics vary according to the population involved, and the knowledge of the characteristics of hospitalizations is of significant importance in order to elaborate basic guidelines for prevention programs and also specific interventions in the care area. Objectives: To characterize the epidemiological profile of Traumatic Brain Injury (TBI) in the Intensive Care Unit of Bauru Base Hospital and to prepare a post-discharge guidebook with orientations to caregivers. Methods: Quantitative, retrospective and documental study based on the analysis of the electronic records of patients with traumatic brain injury hospitalized from January to July, 2016. Results: A total of 156 patients (29.65%) were admitted with traumatic brain injury; 139 medical records met the inclusion criteria and were analyzed. There was a predominance of elderly and adults (age 41 years or older), representing 58.28% of the sample; male prevalence (82%) and injuries caused by falls (39.57%), followed by beatings (15.11%) and motorcycle accidents (14.39%). Of these patients, 24 evolved to death; 19 patients were discharged with some neurological, motor or visual deficit, and another 27 with invasive devices. Conclusion: Despite the high rates of prevalence of cranioencephalic trauma in Brazil, and its significant economic and social impact, the number of studies with consistent epidemiological data remains scarce. This study may contribute to orientate health actions and public policies in the region of Bauru related to the care for the victims of TBI, as well as those regarding the causative agent. It can also help with the effectiveness of the process of caring among segments of the population considerd vulnerable, as well as in investiments in prevention programs, reducing sequelae and minimizing costs to the Unified Health System. Outcome of the dissertation: The guidebook Post-discharge guidelines for the caregiver of bedridden patients was developed to guide caregivers and support main actions at home, helping to provide quality care.