Thesis (M.S.)--University of Michigan, 1985.

Thesis (M.S.)--University of Michigan, 1986.

Thesis (M.S.)--University of Michigan, 1986.

Thesis (M.S.)--University of Michigan, 1985.

Current status: Safe process treatment should be provided to every patient in every hospital. Nurses should work to avoid security violation, especially in the surgical field, associated with irreversible changes in the treatment process. Perfect mastery of these measures assures patient safety. Risk prevention, safety of the patient and the medical personnel require the involvement of all members of the multidisciplinary team (Pokojová, 2011; Škrla and Škrlová, 2003). Objective of the research: to map the attributes of postoperative care in the safe treatment of patients. To determine whether nurses master preventive measures in safe patient care and whether they ensure compliance with the principles of safe care in practice. Methods: the research analysis was chosen to be based on qualitative research method. Data acquisition was performed in semi-structured interview with nurses, supplemented with hidden observation. The participation in the interviews was voluntary and anonymous. Audio data was recorded from the interviews and transcribed verbatim. The observation aimed to determine whether nurses respect the principles of safe care for patients in the postoperative care. Research cohort: consisted of general nurses who worked at the surgical wards and recovery room. The research was conducted in one of the hospitals of South Bohemia. Twelve nurses were interviewed. The interview and hidden observation were focused on patient safety in the postoperative period. The interviews were performed at nurse day-time rooms of individual surgical wards, some of them outside the hospital. All nurses met the criterion to be a provider of nursing care for post-operative patients at surgical wards and recovery rooms. The interviews were finished when reaching the theoretical saturation, when the answers and hidden observation of the respondents started to repeat the already acquired data, i.e. after twelve interviews and observations. Results: The nurses working in surgical wards and recovery rooms are exposed to a considerable mental and physical strain. This profession is very demanding and requires not only theoretical knowledge, but also manual dexterity in practice. Nurses are involved in the care process in a considerable extent. Therefore, it is important that the care was good and safe. In the treatment process, the nurses sometimes do not comply with relevant standards and the requirements for safe treatment. It is essential to follow the identification bracelets to avoid patient mismatch, thus endangering patients' health. Some nurses checked the identification bracelets thoroughly, but there were also nurses who ignored these rules too much and gamble with the patients' health. Medication errors are the most common cause of patient injury. The risk of medication errors increases also due to improper storage of hazardous drugs. In our investigation, the medication was repeatedly stored at a different place (not returned back to the original area), poorly stored or left freely available to anyone. If the physician records are illegible, the nurses solve the issue rather by guessing or asking an assistance from colleagues in the department. This area also includes replacement of medication by nurses if the prescribed product is not available at the ward, without consulting a physician first. The negligence in the use of protective equipment during dressing changes is alarming. Possible transmission of nosocomial infections. Poor or little use of disinfectants. Conclusions: Treatment of patients in the early and late postoperative care is one of the high risk parts of the hospitalization of patients at healthcare facilities. In this period, patient monitoring and risk prevention are essential. It includes pain control, the care for surgical wounds, safe patient identification, prevention of adverse events in both medication administration and patient falls, the compliance with hand hygiene ...

Submitted by BRUNO MENDES CARMONA null (bcarmona.carmona@gmail.com) on 2016-04-26T12:16:33Z No. of bitstreams: 1 Avaliação do Conteúdo Gástrico pela Ultrassonografia - versão após defesa.pdf: 2166029 bytes, checksum: 42b7f42731a983d695921971a79a7d22 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-04-29T14:59:20Z (GMT) No. of bitstreams: 1 carmona_bm_me_bot.pdf: 2166029 bytes, checksum: 42b7f42731a983d695921971a79a7d22 (MD5) / Made available in DSpace on 2016-04-29T14:59:20Z (GMT). No. of bitstreams: 1 carmona_bm_me_bot.pdf: 2166029 bytes, checksum: 42b7f42731a983d695921971a79a7d22 (MD5) Previous issue date: 2016-02-26 / Justificativas e objetivos: O jejum pré-operatório adequado é fundamental na prevenção da aspiração pulmonar do conteúdo gástrico. As diretrizes recomendam que este período de jejum seja de acordo com o tipo de alimento ou líquido ingerido. Esta pesquisa avaliou o volume do conteúdo gástrico e suas características físicas por meio da ultrassonografia após períodos de jejum pré-estabelecidos para alimentos sólidos e líquidos em voluntários sadios. Métodos: Realizamos um estudo prospectivo, crossover, com 17 voluntários, com estado físico ASA I ou II. Cada participante realizou jejum de 10 h. Em seguida, foi submetido a ultrassonografia do abdome de controle (momento C), ingestão do alimento sorteado (sólido ou líquido), ultrassonografia após 10 min (momento 0) e a cada hora (momentos 1 a 6) após a ingestão do alimento até 6 h ou até o momento que que o o estômago estivesse completamente vazio novamente. Resultados: No Momento C (controle) todos estavam com o estômago vazio. No momento zero os volumes de líquido e sólido foram semelhantes. Nos momentos subsequentes, o esvaziamento gástrico do líquido foi mais rápido que do sólido, havendo diferença estatística significativa nos momentos 1, 2 e 3 (p < 0,001). A partir do momento 4, apenas o alimento sólido foi detectado pela ultrassonografia. Conclusão: A ultrassonografia pode avaliar o conteúdo gástrico em tempo real, pode estimar o volume do conteúdo gástrico distinguir suas características de forma objetiva, sem a necessidade de colaboração ou obtenção de informações adicionais. O examinador deve seguir as recomendações quanto ao posicionamento do voluntário, à sonda utilizada e as medidas obtidas. / Justification and objectives: Proper pre-surgical fasting is fundamental to the prevention of pulmonary aspiration of gastric content. The guidelines recommend that such a period of fasting may fit the type of ingested food or liquid. This study has evaluated the volume of gastric content and its physical characteristics through ultrasound after pre-established periods of fasting to solid and liquid food in healthy volunteers. Methods: We conducted a prospective study, crossover, with 17 volunteers, with ASA I or II physical state. Each participant performed 10 hour fasting. After, they were submitted to a control abdominal ultrasound (moment C), sorted ingestion of food (solid or liquid), ultrasound after 10 minutes (moment 0) and hourly (times 1-6) after ingestion of up 6 h or until such time that the the stomach was completely empty again Results: At moment C (Control), all of them had empty stomachs. At moment Zero, the volumes of liquid and solid were similar. At the following moments, gastric emptying of liquid was faster than the solid one, with a significant statistics difference at moments 1, 2 and 3 (p<0.001). Up from moment 4, only the solid food was detectable by ultrasound. Conclusion: Ultrasound may evaluate gastric content in real time, estimate the volume of gastric content, and distinguish its characteristics in an objective way, without the need for collaboration or obtaining additional information. The examiner should follow the recommendations in the placement of the volunteer, the probe to used and the measurements.

Uma das manifestações mais comuns em sala de recuperação anestésica é a náusea, geralmente associada à anestesia. Além do aspecto subjetivo do desconforto, os pacientes que não apresentam melhora desse sintoma podem ter alta retardada, tanto da sala de recuperação anestésica quanto hospitalar. Como conseqüências, temos a demora do retorno às funções normais, a elevação dos custos hospitalares e um menor grau de satisfação do paciente. O objetivo do presente estudo foi realizar uma análise crítica das evidências disponíveis na literatura sobre os fatores relacionados e características definidoras do diagnóstico de enfermagem náusea, no período pós-operatório imediato, por meio de uma revisão integrativa. No desenvolvimento deste estudo, utilizaram-se como fonte de levantamento de dados quatro base de dados: Lilacs, Pubmed, Cinahl e Cochrane - Revisões Sistemáticas, e a amostra constituiu-se de 31 estudos. A análise das publicações selecionadas demonstrou que as náuseas e vômitos no período pós-operatório são considerados eventos relacionados e, na maioria das vezes, avaliados como um evento único. Os fatores relacionados identificados, de acordo com a freqüência de aparecimento e nível de evidência, foram: sexo feminino, não fumante, história prévia de náuseas e vômitos no pós-operatório, história de náusea associada ao movimento, idade, tipo de cirurgia, uso de opióides no trans e pós-operatório, uso de anestésicos voláteis e administração de óxido nitroso. Em relação às características definidoras evidenciamos nos estudos analisados: palidez, taquicardia, aumento na salivação, transpiração, sensação de calor e frio, rubor, consciência do impulso do vômito, tonturas, bradicardia, dilatação pupilar, variações na pressão arterial, respiração profunda, rápida e irregular. A importância de aperfeiçoar e legitimar os elementos que fazem parte da Taxonomia II da NANDA (2006) está em possibilitar aos profissionais enfermeiros que atuam em centro cirúrgico e recuperação pós-anestésica o planejamento da assistência de enfermagem ao paciente nos três períodos da experiência cirúrgica, visando à minimização das complicações no pósoperatório e promover uma reabilitação mais rápida e tranqüila. / Nausea is one of the most common adverse events in the pots-anesthesia recovery room. It is usually associated to anesthesia. Besides the subjective aspect it can be very distressing for patients. The patients who are suffering from nausea and do show any improvement at all may have a late discharge from both the post-anesthesia recovery room and the hospital. The delayed return to normal functions, the high hospital costs, and the lower degree of the patient\'s satisfaction are some of the consequences. The aim of the present study was to perform a critical analysis of the available evidences in the literature about the related factors and the defining characteristics of nursing diagnosis nausea over the immediate postoperative period by means of an integrative review. During the development of this study systematic reviews and four databases for data collection were used: Lilacs, Pubmed, Cinahl, and Cochrane. From the screened reports, 31 of those were potentially relevant for the purpose of this study. The analysis of the retrieved studies showed that vomiting and nausea in the postoperative period are considered to be closely related and most of the time no distinction can be made between nausea and vomiting. The identified factors related according to the rate of appearance and evidence level were the following: female gender, non-smoking, prior history of vomiting and nausea in the postoperative period, history of nausea associated to motion, age, type of surgery, opioid use in a trans- and a postoperative period, use of volatile anesthetics, and nitrous oxide administration. In relation to the defining characteristics we highlighted the following: pallor, tachycardia, an increased secretion of saliva (sialorrhea, salivation), and perspiration, sensation of cold and heat, blush, awareness of the vomiting impulse, dizziness, bradycardia, pupillary dilation, arterial blood pressure changes, deep, fast, and irregular breathing. The importance to improve and to validate the NANDA\'s Taxonomy II (2006) elements is to enable the registered nurses, who work at surgery centers and anesthesia recovery rooms, to plan the nursing care for the patient in the 3-period of surgical experience aiming at to minimizing the complications in the postoperative period and to stimulate a fast and an undisturbed rehabilitation.

Orientador: Norma Sueli Pinheiro Módolo / Resumo: Justificativas e objetivos: O jejum pré-operatório adequado é fundamental na prevenção da aspiração pulmonar do conteúdo gástrico. As diretrizes recomendam que este período de jejum seja de acordo com o tipo de alimento ou líquido ingerido. Esta pesquisa avaliou o volume do conteúdo gástrico e suas características físicas por meio da ultrassonografia após períodos de jejum pré-estabelecidos para alimentos sólidos e líquidos em voluntários sadios. Métodos: Realizamos um estudo prospectivo, crossover, com 17 voluntários, com estado físico ASA I ou II. Cada participante realizou jejum de 10 h. Em seguida, foi submetido a ultrassonografia do abdome de controle (momento C), ingestão do alimento sorteado (sólido ou líquido), ultrassonografia após 10 min (momento 0) e a cada hora (momentos 1 a 6) após a ingestão do alimento até 6 h ou até o momento que que o o estômago estivesse completamente vazio novamente. Resultados: No Momento C (controle) todos estavam com o estômago vazio. No momento zero os volumes de líquido e sólido foram semelhantes. Nos momentos subsequentes, o esvaziamento gástrico do líquido foi mais rápido que do sólido, havendo diferença estatística significativa nos momentos 1, 2 e 3 (p < 0,001). A partir do momento 4, apenas o alimento sólido foi detectado pela ultrassonografia. Conclusão: A ultrassonografia pode avaliar o conteúdo gástrico em tempo real, pode estimar o volume do conteúdo gástrico distinguir suas características de forma objetiva, sem a necessid... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Justification and objectives: Proper pre-surgical fasting is fundamental to the prevention of pulmonary aspiration of gastric content. The guidelines recommend that such a period of fasting may fit the type of ingested food or liquid. This study has evaluated the volume of gastric content and its physical characteristics through ultrasound after pre-established periods of fasting to solid and liquid food in healthy volunteers. Methods: We conducted a prospective study, crossover, with 17 volunteers, with ASA I or II physical state. Each participant performed 10 hour fasting. After, they were submitted to a control abdominal ultrasound (moment C), sorted ingestion of food (solid or liquid), ultrasound after 10 minutes (moment 0) and hourly (times 1-6) after ingestion of up 6 h or until such time that the the stomach was completely empty again Results: At moment C (Control), all of them had empty stomachs. At moment Zero, the volumes of liquid and solid were similar. At the following moments, gastric emptying of liquid was faster than the solid one, with a significant statistics difference at moments 1, 2 and 3 (p<0.001). Up from moment 4, only the solid food was detectable by ultrasound. Conclusion: Ultrasound may evaluate gastric content in real time, estimate the volume of gastric content, and distinguish its characteristics in an objective way, without the need for collaboration or obtaining additional information. The examiner should follow the recommendations in the pl... (Complete abstract click electronic access below) / Mestre

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2015-04-10T14:19:28Z No. of bitstreams: 2 Tese - Giovanni Gasperini - 2013.pdf: 607333 bytes, checksum: 8ba4489f6f3aa5e6fbd84e257811f196 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-04-10T14:48:18Z (GMT) No. of bitstreams: 2 Tese - Giovanni Gasperini - 2013.pdf: 607333 bytes, checksum: 8ba4489f6f3aa5e6fbd84e257811f196 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-04-10T14:48:18Z (GMT). No. of bitstreams: 2 Tese - Giovanni Gasperini - 2013.pdf: 607333 bytes, checksum: 8ba4489f6f3aa5e6fbd84e257811f196 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-06-21 / This study aimed to verify the effectiveness of using a low-level laser therapy protocol to reduce swelling, pain and neurosensory disturbance after orthognathic surgeries. Ten patients who underwent bilateral sagittal split (BSSO) with Le Fort I osteotomy and had low-level laser therapy on one side of the jaw were evaluated over a period of 60 days. The protocol used was intra oral application after surgery (λ = 660 nm (Red), ED = 5J/cm2, t = 10 s / point, P = 20 mW, E = 1.2 J per point). And extra oral application (λ = 789 nm infra-red), DE = 30J/cm2, t = 20 s / point, P = 60 mW, E = 1.2 J per point). After the fourth day, ten intraoral and extraoral applications were performed (λ = 780nm (infrared), DE = 70J/cm2, P = 70 mW, t = 40s / point, E = 2.8 J, per point). Irradiated and non-irradiated side data were compared post-operatively. In all assessments except the immediate post operative assessment, swelling and pain decreased. There is recovery of sensitivity on both sides, but on the irradiated side, recovery is faster and almost normal at the last evaluation. The data for the irradiated and non-irradiated sides were compared post-operatively. Fifteen, 30 and 60 days after surgery, sensitivity was recovered on both sides, but on the irradiated side, recovery was faster and was almost complete at the time of the last evaluation. Irradiated and non-irradiated sides were compared regarding swelling coefficient and Visual Analogue Scale for pain assessment. There were no significant differences between irradiated and non-irradiated sides regarding swelling and pain in the immediate postoperative assessment. Swelling significantly decreased in the irradiated side in the following post-operative assessments, from 2.15 to 0.21 (non irradiated side: 2.72 to 1.29). Self-reported pain was less intense in the irradiated side in the 24-hr (1.20 vs 3.4) and 3-day (0.60 vs 2.10) assessments, but after 7 days of surgery either side did not show any pain. This lower-level laser therapy protocol can improve tissue response and reduce pain and swelling resulting from orthognathic surgeries and accelerate the recovery of neurosensory disorders resulting from BSSO. / Este estudo teve como objetivo verificar a eficácia do uso de um protocolo de terapia laser de baixa intensidade para redução do edema, dor e disturbios neurossensoriais após cirurgias ortognáticas. Dez pacientes foram submetidos a osteotomia sagital bilateral com osteotomia Le Fort I recebendo aplicação da terapia laser de baixa intensidade em um dos lados e foram avaliados num periodo de 60 dias. O protocolo utilizado foi aplicação intra oral (λ = 660 nm (vermelho), ED = 5J/cm2, t = 10 s / ponto, P = 20 mW, E = 1,2 J por ponto) e extra oral (λ = 789 nm de infravermelho), DE = 30J/cm2, t = 20 s / ponto, P = 60 mW, E = 1,2 J por ponto) nos três primeiros dias pós operatorios . Depois do quarto dia, dez aplicações intra-orais e extra-orais foram realizadas (λ = 780nm (IR), DE = 70J/cm2, P = 70 mW, t = 40 / ponto, E = J 2,8, por ponto). Os dados pós operatorios entre os lados irradiados e não irradiados foram comparados e submetidos ao teste estatístico de Wilcoxon. Houve a recuperação da sensibilidade do labio inferior nos dois lados, mas no lado irradiado, essa recuperação foi mais rápida. O edema foi avaliado através do coeficiente de edema e a dor através de uma escala analogical visual. Não houve diferença estatisticamente significante entre o edema e a dor na avaliação imediatamente após a cirurgia entre os dois lados. O edema foi significantemente menor no lado irradiado nas outras avaliações pós operatórias (2.15 para 0.21) e lado não irradiado (2.72 para 1.29). A percepção de dor foi menos intensa do lado irradiado em 24 horas (1.20 vs 3.4) e 3 dias (0.60 vs 2.10), mas a partir do sétimo dia não observou-se dor em nenhum dos lados. O protocolo de terapia laser de baixa intensidade aqui descrito melhora a resposta dos tecidos e reduzir a dor e inchaço resultante de cirurgias ortognáticas e acelerar a recuperação de distúrbios neurossensoriais resultantes da osteotomia sagital bilateral do ramo

O presente estudo teve como objetivo identificar as evidências científicas relacionadas à retenção urinária (RU) do paciente no pós-operatório imediato. O estudo foi realizado através de Scoping Review, segundo preceitos do Instituto Joanna Briggs (JBI). A busca dos estudos foi realizada por meio da questão norteadora: quais as evidências científicas produzidas sobre o paciente em RU no pós-operatório imediato? Para a construção da pergunta de pesquisa, foi utilizada a estratégia PICO (Paciente, Intervenção, Comparação e Outcomes). Para a busca dos estudos, foram utilizadas as seguintes bases de dados: PubMed National Center for Biotechnology Information National Institutes of health; Web of Science (WOS); Centro Latino-Americano e do Caribe de Informações em Ciências (Lilacs); Base de dados de Enfermagem (BDENF); Cumulative Index to Nursing and Allied Health Literature (Cinahl); Sci Verse Scopus (Scopus); Cochrane Collaboration (Cochrane). Entre os 398 artigos encontrados, após leitura exaustiva dos títulos e resumos, 48 foram lidos na íntegra. Entre os 48 artigos analisados, oito foram incluídos nesta pesquisa. A maior parte dos artigos estudados foi escrita na língua inglesa e publicada em periódicos médicos; apenas um tratou-se de publicação na área de enfermagem, embora todos estivessem relacionados a diferentes modalidades cirúrgicas (vascular, abdominal, torácica, colorretal, ortopédica e cirurgias eletivas não determinadas). Nos estudos, foram encontradas evidências científicas relacionadas a fatores de risco para RU no pós-operatório, prevalência e incidência de RU no pós-operatório, taxas de cateterismos urinários desnecessários no pós- operatório, a possibilidade de intervenção do processo de micção do pré-operatório no pós-operatório e, ainda, a relação da RU com o uso de alguns anestésicos. Para o diagnóstico da RU no pós-operatório, o método de escolha utilizado foi o uso do ultrassom portátil de bexiga urinária e, para a resolução do problema, foi utilizado o cateterismo urinário. Conclui-se que existem evidências que relacionam a RU ao período pós-operatório imediato. Ao aplicar esse conhecimento na prática clínica, o enfermeiro pode individualizar a assistência de enfermagem a esse paciente. Todavia, são escassas as publicações da enfermagem sobre o assunto. Nesse sentido, faz-se necessário, por parte dos enfermeiros, investir nesse tema para qualificar e assegurar a assistência prestada / This study aimed to identify the scientific evidence related to urinary retention (UR) of the patient in the immediate postoperative. Study held through Scoping Review, according to Joanna Briggs Institute (JBI). The search of the studies was performed using the guiding question: What are scientific evidence produced about the patient in the UR in the immediate postoperative period? For the construction of the research question was used the PICO strategy (Patient, Intervention, Comparison and Outcomes). For the quest of the studies were used the following database: PubMed National Center for Biotechnology Information National Institutes of health; Web of Science (WOS); Latin American and Caribbean Center on Health Sciences Information (Lilacs); Base de dados de Enfermagem (BDENF); Cumulative Index to Nursing and Allied Health Literature (Cinahl); SciVerse Scopus (Scopus); Cochrane Collaboration (Cochrane). Among the 398 articles found, after exhaustive reading the titles and abstracts, 48 were read in full. Among the 48 analyzed, eight articles were included in this study. The majority of articles studied was written in English and published in medical journals and just one was treated for publication in the nursing field. These articles were related to different surgical procedures (vascular, abdominal, thoracic, colorectal, orthopedic and elective surgeries). In the selected studies, findings were related to risk factors for UR after surgery, prevalence and incidence of UR postoperative, unnecessary urinary catheterizations, rates after surgery, if the urination process preoperatively intervenes after surgery and still UR ratio using certain anesthetic. The method of choice was the portable ultrasound bladder for diagnosis of urinary retention in the immediate postoperative period. Regarding the resolution of the problem was used urinary catheterization. There are evidences relating to urinary retention in the immediate postoperative period. This knowledge in clinical practice enables nurse to apply individualized, quality and secure assistance. However are scarce nursing publications on this theme. In this sense, it is necessary by nurses will invest in this theme to qualify and ensure the assistance