Made available in DSpace on 2014-12-17T15:38:41Z (GMT). No. of bitstreams: 1 RemersonRM.pdf: 448865 bytes, checksum: 14cbfed29d38210302974844ec6adb11 (MD5) Previous issue date: 2008-07-11 / Introduction: This work intents to characterize behavioral indicators of tack to the hemodialysis treatment in a sample of carrying patients of chronic kidney failure (CKF) in the great Natal/RN. The therapeutical adherence represents the agreement degree between the patient behavior and the health team lapsings. The CKF is the gradual and irreversible loss of the renal function, being the hemodialysis treatment an important alternative to assist or to substitute the kidneys. Method: The sample consisted in 80 chronic kidney patients in hemodialysis treatment in two located clinical centers in the region of the great Natal, RN. It was used as instruments (a) a protocol of clinical data collection, (b) the Millon Index of Personality Styles (MIPS) and (c) a script of halfstructuralized interview. Results: The results show a balance between the genders (51% of female and 48.8% of the male sex), average age and equal average time of dialysis respectively to the 43,4 years (?13,25 years) and 22,04 years (?4,24 years). The marital status of half of the sample is married, predominating basic education (43.6%) and a familiar income until a minimum wage (43.8%). It had been defined six physicianlaboratorial indicators to evaluate the therapeutical adherence, further the use of the evaluation of the health team and the patient themselves. Thus, there was an average adherence around 55.97% of the sample ?18.37%). However only between selfassessment of the patients about the adherence and the assessment made by blood pressure post-dialysis indicated a significant association (p=0,029, qui-square test). On the other hand, there was a significant association (p <0.05, chi-square test) among the criteria for treatment adherence and issues investigated in the interview - the perception on the quality of the health services provided to patients, the difficulties following the prescribed diet, the characterization of the days between dialysis sessions and the perception of patients about the dialysis sessions. It was also noted a significant association (p <0.05, Levene test) between adherence to therapy and scales that constitute the MIPS. The health team characterized the patients more adherent behavior as an attitude of acceptance of the treatment, looking actively for their implementation, for more information and knowledge, and establishing a positive communication with the team and with other patients. Similar results were confirmed by the MIPS evaluation. According to that assessment the more compliant patients adopt a more optimistic attitude, trying to act or adapt themselves to their environment, processing cognitively both concrete and objective information, such as more speculative and symbolic information. In addition they establish a gregarious, cooperative, submissive and flexibly pattern of interpersonal relationships to social demands. These characteristics managed to explain 55.7% of the adherence variation according the health team and 23.3% of the variation according the CaxP laboratory indicator. Conclusions: The MIPS shown to be able to identify the most and least adherent to therapy patients. The use of different adherence indicators is important for an evaluation covering the different facets of this process. The adhesion levels are observed within registered by the relevant literature. There is need for further studies with a larger sample to deepen the data findings in this work / Introdu??o: Este trabalho busca caracterizar indicadores comportamentais de ader?ncia ao tratamento hemodial?tico por meio do Invent?rio Millon de Estilos de Personalidade em uma amostra de pacientes portadores de insufici?ncia renal cr?nica (IRC) na grande Natal/RN. A ader?ncia terap?utica representa o grau de concord?ncia entre o comportamento do paciente e as prescri??es da equipe de sa?de. A IRC ? a perda progressiva e irrevers?vel da fun??o renal, sendo o tratamento hemodial?tico uma importante alternativa para auxiliar ou substituir os rins. M?todo: A amostra consistiu de 80 pacientes renais cr?nicos em tratamento hemodial?tico em dois centros cl?nicos localizados na regi?o da grande Natal, RN. Utilizaram-se como instrumentos (a) um protocolo de coleta de dados cl?nicos, (b) o invent?rio Millon de estilos de personalidade (MIPS) e (c) um roteiro de entrevista semi-estruturada. Resultados: Os resultados mostram que houve equil?brio entre os sexos (51% do sexo feminino e 48,8% do sexo masculino), idade m?dia e tempo m?dio de di?lise respectivamente iguais ? 43,4 anos (?13,25 anos) e 22,04 anos (?4,24 anos). O estado civil de metade da amostra ? casado, predominando o ensino fundamental (43,6%) e uma renda familiar at? um sal?rio m?nimo (43,8%). Definiram-se seis indicadores cl?nico-laboratoriais para avaliar a ader?ncia terap?utica, mais o uso da avalia??o da equipe de sa?de e do pr?prio paciente. Desse modo, observou-se uma ader?ncia m?dia em torno de 55,97% da amostra (?18,37%). Contudo apenas entre a auto-avalia??o do paciente acerca da ader?ncia e a avalia??o feita atrav?s da press?o arterial p?s-di?lise indicou-se uma associa??o significativa (p=0,029, teste qui-quadrado). Por outro lado, houve uma associa??o significativa (p<0,05, teste qui-quadrado) entre os crit?rios de ader?ncia ao tratamento e aspectos investigados na entrevista a percep??o da qualidade dos servi?os de sa?de prestados aos pacientes, as dificuldades no seguimento da dieta prescrita, a caracteriza??o dos dias entre as sess?es de di?lise e a percep??o dos pacientes acerca das sess?es de di?lise. Tamb?m se observou uma associa??o significativa (p<0,05, teste de Levene) entre a ader?ncia terap?utica e as escalas que constituem o MIPS. A equipe de sa?de caracterizou o comportamento do paciente mais aderente como uma postura de aceita??o do tratamento, buscando ativamente pela sua realiza??o, por informa??es e mais conhecimento, al?m de estabelecer uma comunica??o positiva com a equipe e com os demais pacientes. Resultados semelhantes foram confirmados pela avalia??o do MIPS. Segundo essa avalia??o os pacientes mais aderentes adotam uma atitude mais otimista, buscando agir ou adaptar-se ao seu meio, processando cognitivamente tanto informa??es concretas e objetivas, como informa??es mais especulativas e simb?licas. Al?m de estabelecer um padr?o de relacionamento interpessoal greg?rio, cooperativo, submisso e flex?vel ?s demandas sociais. Estas caracter?sticas conseguiram explicar 55,7% da varia??o da ader?ncia definida segundo a equipe de sa?de e 23,3% da varia??o da ader?ncia segundo o indicador laboratorial CaxP. Conclus?es: O MIPS demonstrou ser capaz de identificar os pacientes mais e menos aderentes. O uso de diferentes indicadores de ader?ncia ? importante para uma avalia??o que abarque as diferentes facetas desse processo. Os n?veis de ader?ncia observados est?o dentro do registrado pela literatura pertinente. H? a necessidade de outros estudos com uma amostra maior para aprofundar os dados achados nesse trabalho

Made available in DSpace on 2014-12-17T14:46:50Z (GMT). No. of bitstreams: 1 SueniaSMX_DISSERT.pdf: 1506804 bytes, checksum: e19da1d457fc43b9cffcb6bedf264524 (MD5) Previous issue date: 2011-12-09 / Reconstruct, from listening, the life histories of a chronic renal patient, submitted to hemodialysis, is the objective of this investigation. How methodological procedure,we worked with oral history of life, ,according Meihy, within a qualitative approach. For this, we had the approval of the Ethics Committee in Research of Hospital Universit?rio Onofre Lopes (HUOL), under protocol no 591/2011. As instrument to approach the patient, we did interviews with open questions, conducted in the patient's house. There were five meetings, in which we hear his story, experiences and ways of coping during their course of illness and treatment. The analysis was based on the collaborator's narratives, anchored in studies dealing with oral history, of human subjectivity, highlighting the resilience, as indicated Cyrulnik. Her story leads us to conclude that despite the adversities of life and suffering, there is in humans, the strength to navigate the streams and be happy. This is the lesson that leaves us the collaborator this study. / Reconstruir, a partir da escuta, a trajet?ria de vida de uma paciente renal cr?nica, submetida ao tratamento hemodial?tico, constitui o objetivo desta investiga??o. Como procedimento metodol?gico, trabalhamos com a hist?ria oral de vida, conforme Meihy, dentro de uma abordagem qualitativa. Para isto, tivemos a aprova??o do Comit? de ?tica em Pesquisa, do Hospital Universit?rio Onofre Lopes (HUOL), sob protocolo de n?. 591/2011. Como instrumento de abordagem da paciente, fizemos entrevistas com quest?es abertas, realizadas na casa da paciente. Foram cinco encontros, nos quais escutamos sua hist?ria, experi?ncias e formas de enfrentamento, durante sua trajet?ria de adoecimento e tratamento. A an?lise foi pautada nas narrativas da colaboradora, ancorada em estudos que tratam da hist?ria oral, da subjetividade humana, com destaque para a resili?ncia, conforme assinala Cyrulnik. Sua hist?ria nos leva a concluir que, apesar das adversidades da vida e do sofrimento, existe, no ser humano, a for?a de navegar nas torrentes e conseguir ser feliz. Essa ? a li??o que nos lega a colaboradora deste estudo.

Made available in DSpace on 2014-12-17T14:47:04Z (GMT). No. of bitstreams: 1 MariaICDF_DISSERT.pdf: 1911495 bytes, checksum: b33fd53ec7c7e2b2d0bd96f5e0ea12e9 (MD5) Previous issue date: 2014-01-27 / Trasnversal study, with the objective of evaluating the accuracy of clinical indicators of nursing diagnosis excessive fluid volume in patients undergoing hemodialysis. The study occurred in two stages, the first consisted of the evaluation of the diagnostic indicators in study; and the second, the diagnostic inference conducted by nurse diagnosticians. The first stage occurred from december 2012 to april 2013, in a University Hospital and a Hemodialysis Clinic in Northeastern of Brazil, with a sample of 100 chronic renal failure patients on hemodialysis. The data were selected through an interview form and a physical examination, organized into spreadsheets and analyzed as to the presence or absence of the indicators of diagnosis excessive fluid volume. In the second step, the spreadsheets were sent to three nurses diagnosticians, who judged the presence or absence of diagnosis in the clientele searched. This step was conducted from july to september 2013. For analysis of the data, we used descriptive and inferential statistics. In the descriptive analysis, we used measures of central tendency and dispersion. In inferential analysis, we used the tests Chi- square, Fisher and prevalence ratios. The accuracy of the clinical indicators pertaining to the diagnosis were measured as to the specificity, sensitivity, predictive values, likelihood ratios and Diagnostic Odds Ratio. Also developed a logistic regression. The results were organized in tables and discussed with literature. This study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte, with Presentation Certificate for Ethics Appreciation n? 08696212.7.0000.5537. The results revealed that the diagnosis studied was present in 82% of patients. The characteristics with prevalence above 50 % that stood out were: azotemia, decreased hematocrit, electrolyte imbalance, intake exceeds output, anxiety, edema, decreased hemoglobin, oliguria and blood pressure changes. Eight defining characteristics were presented statistically significant association with the nursing diagnosis investigated: pulmonary congestion, intake exceeds output, electrolytes imbalance, jugular vein distension, edema, weight gain over short period of time, agitation and adventitious breath sounds. Among these, the 10 characteristics which showed higher prevalence ratios were: edema and weight gain over short period of time. The features with the highest sensitivity were edema, electrolytes imbalance and intake exceeds output and the standing out with greater specificity were: anasarca, weight gain over short period of time, change in respiratory pattern, adventitious breath sounds, pulmonary congestion, agitation and jugular vein distension. The indicators jugular vein distension, electrolytes imbalance, intake exceeds output, increased central venous pressure and edema, together, were identified in the logistic regression model as the most significant predictors. It is concluded that the identification of accurate clinical indicators allow a good prediction of the nursing diagnosis of excessive fluid volume in patients undergoing hemodialysis in order to assist the nurse in the inference process, which will contribute to the success of patient care. In addition, nurses will consider for diagnostic inference not only his clinical experience, but also scientific evidence of the occurrence of excessive fluid volume, contributing to the control of volemia in these patients / Estudo transversal, com o objetivo de avaliar a acur?cia dos indicadores cl?nicos do diagn?stico de enfermagem Volume de l?quidos excessivo em pacientes submetidos ? hemodi?lise. Ocorreu em duas etapas, a primeira composta pela avalia??o dos indicadores do diagn?stico em estudo; e a segunda, pela infer?ncia diagn?stica realizada por enfermeiros diagnosticadores. A primeira etapa aconteceu nos meses de dezembro de 2012 a abril de 2013, em um Hospital Universit?rio e em uma Cl?nica de Hemodi?lise do Nordeste do Brasil, com uma amostra de 100 pacientes renais cr?nicos submetidos ? hemodi?lise. Os dados foram obtidos mediante formul?rio de entrevista e exame f?sico, organizados em planilhas eletr?nicas e analisados quanto ? presen?a ou aus?ncia dos indicadores do diagn?stico Volume de l?quidos excessivo. Na segunda etapa, as planilhas foram encaminhadas a tr?s diagnosticadores, que julgaram a presen?a ou aus?ncia do diagn?stico na clientela pesquisada. Essa etapa desenvolveu-se nos meses de julho a setembro de 2013. Para a an?lise dos dados, utilizou-se a estat?stica descritiva e inferencial. Na an?lise descritiva, utilizaram-se medidas de tend?ncia central e de dispers?o. Na inferencial, utilizaram-se os testes de Qui-quadrado, Fisher e as raz?es de preval?ncia. Mensurou-se a acur?cia dos indicadores cl?nicos do diagn?stico estudado por meio da especificidade, da sensibilidade, dos valores preditivos, das raz?es de verossimilhan?a e da Odds Ratio Diagn?stica. Desenvolveu-se tamb?m uma regress?o log?stica. Os resultados foram organizados em tabelas e discutidos com literatura pertinente. O estudo foi aprovado pelo Comit? de ?tica da Universidade Federal do Rio Grande do Norte, com Certificado de Apresenta??o para Aprecia??o ?tica n? 08696212.7.0000.5537. Os resultados revelaram que o diagn?stico de enfermagem estudado esteve presente em 82% dos pacientes. Dentre as caracter?sticas com preval?ncia acima de 50% destacaram-se: azotemia, hemat?crito diminu?do, eletr?litos alterados, ingest?o maior que o d?bito, ansiedade, edema, hemoglobina diminu?da, olig?ria e mudan?a na press?o arterial. 8 Apresentaram associa??o estatisticamente significativa com o diagn?stico de enfermagem investigado oito caracter?sticas definidoras: congest?o pulmonar, ingesta maior que o d?bito, eletr?litos alterados, distens?o da jugular, edema, ganho de peso em um curto per?odo de tempo, agita??o e ru?dos advent?cios. Dentre estas, as que apresentaram maiores raz?es de preval?ncia foram edema e ganho de peso em um curto per?odo de tempo. A caracter?stica com maior sensibilidade foi o edema e sobressa?ram-se com maior especificidade ru?dos advent?cios, congest?o pulmonar e agita??o. Os indicadores distens?o da jugular, eletr?litos alterados, ingesta maior que o d?bito, press?o venosa central aumentada e edema, em conjunto, foram identificados no modelo da regress?o como as caracter?sticas preditoras mais significantes. Conclui-se que a identifica??o de indicadores cl?nicos acurados permite uma boa predi??o do diagn?stico de enfermagem Volume de l?quidos excessivo em pacientes submetidos ? hemodi?lise, de modo a auxiliar no processo de infer?ncia do enfermeiro, o que contribuir? no sucesso do cuidado prestado ao paciente. Al?m disso, os enfermeiros considerar?o para a infer?ncia diagn?stica n?o apenas sua experi?ncia cl?nica, mas tamb?m evid?ncias cient?ficas da ocorr?ncia do Volume de l?quidos excessivo, contribuindo para o controle da volemia nesses pacientes

Made available in DSpace on 2014-12-17T15:32:30Z (GMT). No. of bitstreams: 1 AdrianaGA_TESE.pdf: 950866 bytes, checksum: c8ffb7409c37936ff546c9f7cffeb2d8 (MD5) Previous issue date: 2012-02-29 / The present study evaluated the influence of non-surgical periodontal treatment on the levels of C- reactive protein (hsCRP) in patients with chronic renal failure (CRF) in pretransplant. We conducted a controlled and randomized trial to evaluate the periodontal condition and plasma concentrations of hsCRP, albumin and transferrin in 56 dialysis patients divided into two groups: experimental and control. The study was conducted at the dental clinic of Family and Community Health s Unit (USFC), located in Onofre Lopes University Hospital (HUOL), Federal University of Rio Grande do Norte (UFRN), from December 2010 to November 2011. Severe periodontitis was the type of periodontal disease more common, affecting 78.6% of patients. Periodontal conditions, evaluated through the means of probing depth, clinical attachment level, bleeding index and plaque index, proved to be uniform for both groups at the initial examination. There were no differences in levels of inflammatory markers between the two groups. The analysis of the concentrations of hsCRP allowed classifying study participants as at high risk of developing cardiovascular disease. After completion of periodontal treatment in the experimental group, there was a statistically significant reduction of the mean of all periodontal parameters assessed; however this improvement of periodontal health was not accompanied by changes in the levels of hsCRP, albumin and transferrin in the evaluation time. Given this, the periodontal treatment did not promote the reduction of systemic inflammatory burden and risk of cardiovascular complications in patients with CRF / O presente estudo se prop?s a avaliar a influ?ncia do tratamento periodontal n?o cir?rgico sobre os n?veis da prote?na C reativa (PCR-US) em indiv?duos com Insufici?ncia Renal Cr?nica (IRC) em fase de pr?-transplante. Realizou-se um ensaio cl?nico, controlado e randomizado para avaliar as condi??es periodontais e as concentra??es plasm?ticas de PCRUS, albumina e transferrina em 56 pacientes dial?ticos com doen?a periodontal divididos em dois grupos: Experimental e Controle. O estudo foi realizado no ambulat?rio odontol?gico da Unidade de Sa?de Familiar e Comunit?ria (USFC), localizada no Hospital Universit?rio Onofre Lopes (HUOL), Universidade Federal do Rio Grande do Norte (UFRN), no per?odo de dezembro de 2010 a novembro de 2011. A periodontite severa foi o tipo de doen?a periodontal mais frequente, acometendo 78,6% dos pacientes. As condi??es periodontais, avaliadas atrav?s das m?dias da profundidade de sondagem, n?vel de inser??o cl?nica, ?ndice de sangramento e ?ndice de biofilme se mostraram uniformes para os dois grupos no exame inicial. Tamb?m n?o foram encontradas diferen?as nos n?veis dos marcadores inflamat?rios entre os grupos. A an?lise inicial das concentra??es da PCR-US permitiu classificar os participantes do estudo como de alto risco para o desenvolvimento de doen?as cardiovasculares. Ap?s a realiza??o do tratamento periodontal no grupo Experimental, houve redu??o estatisticamente significante das m?dias de todos os par?metros periodontais avaliados, entretanto esta melhora das condi??es de sa?de periodontal n?o foi acompanhada pela altera??o dos n?veis da PCR-US, albumina e transferrina no tempo de avalia??o da pesquisa. Diante disto, o tratamento periodontal n?o promoveu a redu??o da carga inflamat?ria sist?mica e o risco de desenvolvimento de complica??es cardiovasculares nos indiv?duos com IRC