Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

In this study, examinations of 6 patiens of the ICU of the University Hospital in Hradec Kralove were included. The aim of this study was to describe case reports of individual patients and to look for statistically significant correlations between nutritional support, oxidation of nutrients and other parameteres. Anthropometric measuring and indirect calorimetry were used for the examination of patients. The case reports show the individuality that occurs in patients. Spearman's correlation analysis was used to evaluate measured data. Statistically significant correlations were proven, among them relations between enterally given nutrition and the creation/loss of muscle tissue (carbohydrates: P = 0,000189, lipids: P = 0,001284, proteins: P = 0,000255), between carbohydrate oxidation, resp. protein oxidation and the number of hours spent on ventilation (carbohydrates: P = 0,041278, proteins: P = 0,02185), between respiratory quotients and the duration of the trauma (respiratory quotient: P = 0,014695, nonprotein respiratory quotient: P = 0,027904), between carbohydrate oxidation related to ideal body weight and lipid intake (P = 0,014085) and between protein oxidation and carbohydrate intake (P = 0,012703). Key words: polytrauma, indirect calorimetry, nutritional support, malnutrition

Orientador: Maria Isabel Pedreira de Freitas Ceribelli / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-05T09:31:35Z (GMT). No. of bitstreams: 1 Santos_DeolindaMarcalVieirados_M.pdf: 1137442 bytes, checksum: f494b25a2200a3b5a65c13fabbce5bd8 (MD5) Previous issue date: 2005 / Resumo: A desnutrição é um problema que atinge uma em cada três pessoas no mundo. No âmbito hospitalar, é causa de aumento de tempo de internação, custos e maiores chances de complicações. A especialização é uma modalidade que pode otimizar a qualidade do cuidado prestado ao paciente. Em 2005, existem no Brasil 105.841 profissionais registrados no Conselho Federal de Enfermagem. Deste contingente, 400 participam ativamente ou já participaram, em algum momento, como membros da Sociedade Brasileira de Nutrição Parenteral e Enteral (SBNPE), porém 47 enfermeiros são Especialistas pela SBNPE, o que corresponde a 0,04%. Este trabalho teve como finalidade apresentar a legislação vigente em Terapia Nutricional (TN), identificar os enfermeiros especialistas em TN pela SBNPE, no Brasil, sua atuação e conhecimento em relação à legislação vigente, identificar fatores que os levaram à busca pela especialização em TN, verificar se e como atuam. Trata-se de estudo descritivo. A população estudada compreendeu 57,4% dos enfermeiros Especialistas pela SBNPE. O instrumento foi um questionário enviado aos Especialistas por correio ou por e-mail, após contato direto. Dentre os resultados observou-se que: os fatores motivadores para a busca do título por 40,7% foi o aperfeiçoamento em TN e a titulação ; a SBNPE foi citada por 77,8% da amostra como agente facilitador de intercâmbio com outros profissionais de saúde envolvidos com a TN. Apesar de todos serem especialistas em TN, 63,0% relataram ser especialistas em outras áreas do conhecimento como Enfermagem do Trabalho (18,5%) e Enfermagem em Unidade de Terapia Intensiva (14,8%) dentre outras. A capacitação do grupo estudado demonstrou 37,1% portadores do título de Mestre, 18,5% com título de Doutorado e 7,4% com título de Pós Doutorado, sendo que apenas 11,1% optaram pela capacitação stricto sensu na área de TN. Embora 18,5% tenha relatado ter cargo relacionado à TN, observou-se que 59,3% dos profissionais entrevistados atuam direta e indiretamente com a TN, através da participação em comissão de TN (59,3%), da atuação em unidades de internação com pacientes sob TN (55,6%) ou desenvolvendo pesquisas na área de TN (74,0%). Foi observado que esses profissionais tem conhecimento da legislação vigente em 74,1% e utilizam estas informações na prática para 88,9% dos entrevistados. Embora os resultados obtidos nesta amostra signifiquem apenas um perfil do enfermeiro especialista em TN, observa-se uma diminuição da opção de escolha para aprimoramento profissional na área de TN ao longo dos anos e pequena quantidade de profissionais nesta especialidade, sendo que no Brasil, há densa e específica legislação para os enfermeiros neste campo de atuação / Abstract: Malnutrition is a problem that affects one in three people in the world, and in hospital environment, it is the cause of longer periods of staying, costs and more complications chances. The specialization is a kind of work that must be favourable to the optimisation of the patient care quality through the knowledge. This research had as objective to present the effective legislation on Nutritional Therapy in the year of 2004,. identify the specialists on Nutritional Therapy by the Sociedade Brasileira de Nutrição Parenteral e Enteral, identify the action and knowledge of this group related to the actual legislation; identify factors that led them to the specialization on nutrition support, verify if they act and how they do it. This is a exploratory and prospective research. There are 47 specialist nurses in Brazil by SBNPE, which percentage corresponds to 0,04% of the total number of 105.841 COFEN registered professionals. From this population, it was obtained a return of 57,4%. From this percentage, 40.7% pointed out the searching for improvement and professional title as the main factors that took them to the specialization. 77.8% of nurses have pointed out SBNPE as an interchanging facilitator agent among other health professionals involved in Nutritional Therapy (NT). Although all of them are specialists on Nutritional Therapy, 63,0% related be specialists on other knowledge areas as Work nursing (18,5%) or Therapy intensive nursing(14,8%) The capacitating of the studied group demonstrated 37,1% as masters, 18,5% with doctor title and 7,4% with post doctor title, but only 11,1 optioned to had stricto sensu capacitating on Nutritional Though 18,5% reported to work in NT, when they were asked about direct and indirect action with NT, 59.3% of these professionals confirmed they had worked in NT. 55.6% work in units with patients under NT; 74.0% develop research in this area. It was observed that this professionals has knowledge about actual legislation from 74,1% of specialist nurses, and 88,9% use low information¿s on their practice. Although this is a small sample, signifying just a draft of the specialist nurse who is acting on NT, it is observed a diminution degree on the option choices to develop professional issue in NT all long the years and a small number of professionals on this specialization, and in Brazil there are dense and specific legislation to nurses in this actuation area / Mestrado / Enfermagem e Trabalho / Mestre em Enfermagem

Critical illness is typically associated with a catabolic stress state in which patients commonly demonstrate a systemic inflammatory response that brings about changes in their body systems. Changes in the body systems make the critically ill dependent on mechanical ventilation and inotropic support for longer periods in order to survive. However, this inflammatory response can be attenuated by the timely introduction of nutritional support to provide energy and nutrients to diminish catabolism and promote anabolism. The result could be a decrease in the morbidity and mortality rates, as well as the financial burden on the patients, institutions and the state. Since registered nurses initiate and utilise feeding protocols to achieve target goals, there is a strong need for nurse-initiated feeding protocols. These protocols should be coupled with a comprehensive nurse-directed nutritional educational intervention that will focus on their safe and effective implementation. This focus on nursing nutrition education represents a major shift away from traditional education which has focused on dietitians and physicians. Evidence suggests that incorporating guideline recommendations into nurse-initiated protocols for starting and advancing enteral feedings is an effective strategy to improve the delivery of nutritional support. The study was aimed at exploring the provision of nutritional support to critically ill hospitalised patients by registered nurses to identify and describe possible gaps in the practice, through determining the potential relationship between the provision of nutritional support and characteristics of its providers. A quantitative, descriptive correlational study was undertaken. Seventy registered nurses working in neonatal/paediatric and adult critical care units in two public and three private hospitals in East London in the Eastern Cape participated in the study. The sample also included public critical care students. The results showed that registered nurses in private hospitals have more knowledge about the importance of nutritional support than their public hospital counterparts and students. The mean score was on the question was 80.3% with the highest score of 91% which was for the private hospital nurses, followed by 77.2% for public and 71.4% for students. Again, the mean score for knowledge on timing of initiating nutritional support was 48%, the highest score being 69.4% for students followed by private hospital nurses with 49.6%. Close to 63% (n = 44) of these nurses were either unsure about the availability of nutritional protocols or clearly attested to their non-availability. This is seen as an issue of concern because a protocol is meant to be a standard document with which all members of the ICU should be familiar. It is meant to guide and facilitate the manner of working in the unit. While facilitation of maintenance of nutritional support to patients is the responsibility of registered nurses, according to Regulation 2598(1984) section 45 (1) (q) of the South African Nursing Council, 68% (n = 48) of the respondents felt that this was in the practising scope of doctors and dietitians. The study concluded that the nurses are knowledgeable about the importance of nutritional support but knowledge gaps have been identified as far as the timing of initiating nutritional support is concerned. Some attested to unavailability of standard guidelines that are tailored into protocols guiding the provision of nutritional support by registered nurses in the critical care units. Nutrition should be prioritised as an important therapy for improving the outcomes of critically ill patients. Nurses need to analyse its provision, identify barriers to nutritional strategies and engage in nutritional education to empower themselves regarding the practice. Most importantly, there is a need for nurse-initiated nutritional protocols that are tailored from the broad nutritional guidelines and aligned with the local context and ways of practising. Nutritional support should be included as a key component of the curriculum in academic programmes that specialise in critical care nursing.

<p><strong>Background:</strong> Insufficient nutritional support is associated with prolonged hospitalisation, impaired wound healing and impaired survival for patients in intensive care. In severe sepsis and septic chock, calculation of nutritional need is complicated since the metabolism is affected by decease. <strong>Aim:</strong> The aim of the study was to investigate nutritional support and to examine the quality of nursing documentation of nutritional status and nutritional support in patient records in severe sepsis and septic chock.  <strong>Method:</strong> The study was conducted as a retrospective investigation where 64 patient records were studied. The quality of documentation was examined in 10 patient records using an examinational model.</p><p><strong>Findings:</strong> Calculation of average nutritional support showed insufficient supply particularly in the two first days of intensive care. During the next five days nutritional supply was higher but individual variation was seen, why a clear picture of nutritional support is hard to detect. Examining the quality of nursing documentation revealed that most records contained nutritional status and treatment, while anamnesis, nutritional goals and nutritional diagnoses were rare. <strong>Conclusion:</strong> The study is of limited significance, but could be used to map out the present regimen of nutritional support. Future nursing research could include the caloric need and the amount of enteral support patients in severe sepsis and septic shock tolerates.</p>

Background: Insufficient nutritional support is associated with prolonged hospitalisation, impaired wound healing and impaired survival for patients in intensive care. In severe sepsis and septic chock, calculation of nutritional need is complicated since the metabolism is affected by decease. Aim: The aim of the study was to investigate nutritional support and to examine the quality of nursing documentation of nutritional status and nutritional support in patient records in severe sepsis and septic chock.  Method: The study was conducted as a retrospective investigation where 64 patient records were studied. The quality of documentation was examined in 10 patient records using an examinational model. Findings: Calculation of average nutritional support showed insufficient supply particularly in the two first days of intensive care. During the next five days nutritional supply was higher but individual variation was seen, why a clear picture of nutritional support is hard to detect. Examining the quality of nursing documentation revealed that most records contained nutritional status and treatment, while anamnesis, nutritional goals and nutritional diagnoses were rare. Conclusion: The study is of limited significance, but could be used to map out the present regimen of nutritional support. Future nursing research could include the caloric need and the amount of enteral support patients in severe sepsis and septic shock tolerates.

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (p. 125-137).

This Master's Thesis "The Role of a Nurse in the Care of a Patient's Nutrition" is written in a purely theoretical plane, deals with the basic pillar of the existence of the human organism the correct and sufficient nutrition of a human, and studies the extent of an involvement of the general nurse in satisfying biological, psychological aspects of patient's nutrition in the nursing process. The topic of nutrition plays an important part of the complete spectrum of each medical expertise. The satisfaction of patient's need for nutrition in all of the stages of his life is a part of a nurse's job in a nursing process not only in Intensive Care Units, Resuscitation Care Units and Standard Care Departments, but even in Geriatric Units and Social Care Institutes. The thesis is methodically divided into separate parts, each logically following its preceding one. In the Introduction we define malnutrition as a global medicinal and social problem, introduce principles and theoretical starting points of an organisation of an optimal nutrition care and introduce international activities, which contribute to creating guidelines using the Evidence Based Practice method, and implementation of effective methods in providing complex care of a patient's nutrition in medical facilities and institutes of social care. We follow with the summarisation of basic nutrients, emphasising their importance for the right function of a human body, and negative effects of their insufficiency in the food intake. The thesis presents an algorithm of an evaluation of a patient's nutrition state in a nursing process, comparing available screening standardised questionnaires, which are usable in detecting sings of a malnutrition. We present the possibilities of food fortification, specify targets of nutritional support in medical facilities, focusing on indications, benefits, risks and paths of application of enteral and parenteral nutrition, and provide complete summary of nutritional interventions in the context of nursing care, which is oriented on ensuring the food intake. In the Conclusion, we identify those aspects of the patient's nutrition care, which are hard to fulfil and realise, and those psychological and social-cultural aspects, which the nurse can in the nursing process satisfy only when using holistic and empathetic approach. The altruistic, but controversial and ethical-philosophical topic represents not initiating or ending the interventions of nutritional support, where this decision respects principles of beneficence and non-maleficence of The Hippocratic Oath, the quality of a patient's life and human dignity.

Made available in DSpace on 2014-06-11T19:23:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-03-03Bitstream added on 2014-06-13T20:11:38Z : No. of bitstreams: 1 brunetto_ma_me_jabo.pdf: 958952 bytes, checksum: 6724d0e6a3da1050f16ae04e406f6428 (MD5) / Funep / O objetivo deste trabalho foi investigar o efeito do suporte nutricional assistido sobre a taxa de alta de cães e gatos hospitalizados. Foram incluidos no estudo um grupo de 947 animais hospitalizados no período de março de 1998 a dezembro de 2000 que não receberam assistência nutricional (G1) e 522 animais, hospitalizados no período de março de 2003 a dezembro de 2005 que foram manejados nutricionalmente (G2). Para a comparação de G1 versus G2 empregou-se o teste t. Em G2 empregou-se o Qui-quadrado e a Correlação de Spearman para avaliar as associações entre ingestão calórica e alta, escore de condição corporal e alta, escore de condição corporal e ingestão calórica. Os pacientes de G2 apresentaram 83,16% de alta hospitalar e tempo médio de intemação de 9,42 dias, valores significantemente maiores (p<0.001) que os de G1, de 67,1% e 6,6 dias. Em G2, 63% dos animais apresentaram consumo voluntário com ou sem persuasão (92,93% de alta), 18,90% receberam terapia nutricional enteral (71,82% de alta), 6,19% alimentação forçada (75,0% de alta), 7,0% terapia nutricional parenteral (61,90 de alta) e 4,47% dos animais ficaram em jejum (38,46% de alta), demonstrando associação entre o tipo de suporte nutricional e alta hospitalar (p<O.01). Dentre os animais que receberam de 0% a 33% da necessidade energética de manutenção (NEM), 62,73% tiveram alta, dos que receberam entre 34% e 66% da NEM, 87,78% tiveram alta e para os que receberam mais de 67% da NEM, 93,28% tiveram alta, demonstrando menor mortalidade nas faixas de maior balanço calórico (p<0.001). Nas faixas de maior balanço calórico os animais permaneceram mais tempo internados (p<0.001). O escore de condição corporal não teve associação (p>0.05) com o consumo de calorias, porém apresentou dependência com as taxas de alta e óbito (p<0.01). / The objective of the present study was to investigate the effect of an assisted nutritional support on the outcome in dogs and cats.The study involved a group of 947 animals hospitalized in the Veterinary Hospital of FCAV - Unesp, before the Clinical Nutrition Service was implemented and therefore did not receive assisted nutritional support (G1), which was compared to a group of 522 animals that were nutritionally managed (G2). The statistical analysis of the results included the t test (G1 vs. G2) and Chi-Square and Spearman's correlation to evaluate G2 (CI and outcome, body condition score and outcome, body condition score e CI).The outcome in G2 was 83.16% and TH 9.42 days, values higher than G1 with 63% and 6.6 days (p<0.001). In G2, 63% showed voluntary feed consumption (92.93% outcome), 18.90% received enteral support (71.82% outcome), 6.19% were forced fed (75.0% outcome), 7.0% received parenteral support (61.90% outcome) and 4.47% did not eat (38.46% outcome), demonstrating an association between the type of nutritional support and outcome (p<0.01). In G2, animals that received 0% to 33% of their MER had 62.7% outcome and those receiving more than 67% of their MER had 93.28% outcome, showing a lower mortality in the higher CI range (p<0.001). TH was higher in the ranges with higher CI (p<0.001). The body condition score (BCS) was not associated with the calories consumption (p>O.05), but showed dependence on outcome (p<0.01), the discharged percentages were 73.0% for animals with low BCS, 86.32% for with ideal SCS, and 83.18% for overweight animals.