München, Techn. Univ., Diss., 2004.

München, Techn. Univ., Diss., 2004.

Universiẗat, Diss., 2003--Leipzig.

Thesis (M.A.)--Northern Kentucky University, 2006. / Made available through ProQuest. Publication number: AAT 1434310. ProQuest document ID: 1136092721. Includes bibliographical references (p. 41-43)

ABSTRACT Background: Pressure ulcer is caused by pressure on the same skin area for a certain period of time, which causes a reduced blood circulation in the affected area and causes the tissue to die. Pressure ulcer is a major strain on healthcare, society and a big suffering for the patient. It contributes with high costs, extended care and pain. Aim: The aim was to describe the relationship between postoperative care and the appearance of pressure ulcer. Method: A literature study with 10 quantitative studies was used. Results: The intensive care department has an influence on the onset of pressure ulcers, and most of the pressure ulcers occur postoperatively in patients. The operating time is of no significance, but prolonged surgery may be a risk factor for pressure ulcer postoperatively. The majority of patients developing pressure ulcers in the postoperative process have underlying diseases such as diabetes, heart failure and renal failure. Other risk factors are patients who are older, underweight and have low Bradenpoints. Preventive measures such as air-changing mattresses are of great importance to counteract the onset of pressure ulcers, as well as saving large sums of money. Conclusion: Pressure ulcers are a contributing factor to patients having extended periods of suffering, which at the same time contribute to major costs for society and hospitals. In the postoperative stage, patients are more vulnerable due to reduced mobility and underlying diseases. Preventive measures such as mattresses help reduce the appearance of pressure ulcers and save big sums of money in the end. / SAMMANFATTNING Bakgrund: Trycksår uppkommer av att det blir tryck på samma hudområde under en viss tid, vilket leder till att det blir en nedsatt blodcirkulation i det drabbade området och att vävnaden tillslut dör. Trycksår är en stor belastning för sjukvård, samhälle och skapar ett stort lidande för patienten. Tryckskador bidrar med stora kostnader, förlängda vårdtider, smärta samt ett lidande för patienten. Syfte: Syftet var att beskriva sambandet mellan den postoperativa vården och uppkomsten av trycksår.Metod: En litteraturstudie med 10 kvantitativa artiklar. Resultat: Intensivvårdsavdelningen har en påverkan på uppkomsten av trycksår, och större delen av trycksåren uppkommer postoperativt hos patienter som är inneliggande på intensiven. Operationstiden har ingen signifikant betydelse, men en förlängd operation kan vara en riskfaktor för att trycksår uppkommer postoperativt. Majoriteten av patienterna som utvecklar trycksår i det postoperativa förloppet har bakomliggande sjukdomar som diabetes, hjärtsvikt och njursvikt. Andra riskfaktorer är patienter som är äldre, underviktiga och har låga Bradenpoäng. Förebyggande åtgärder som luftväxlande madrass har en stor betydelse för att motverka uppkomsten av trycksår, samt sparar in stora summor pengar. Slutsats: Trycksår är en bidragande faktor till att patienter får förlängda vårdtider med mycket lidande som samtidigt bidrar med stora kostnader för samhälle och sjukhus. I det postoperativa skedet är patienter extra utsatta på grund av nedsatt rörlighet och bakomliggande sjukdomar. Förebyggande åtgärder som madrasser bidrar till minskad uppkomst av trycksår och sparar stora summor pengar i slutändan

Postoperativ halssmärta (POST) är en mycket vanlig komplikation hos patienter som genomgått generell anestesi med intubation.  POST anses av anestesipersonal vara en relativt lindrig komplikation. Patienter upplever det dock som ett stort problem och därför bör det undvikas. Syftet med denna litteraturstudie var att undersöka vad anestesisjuksköterskor kan göra för att förebygga POST som komplikation hos patienter som genomgått generell anestesi med intubation. Examensarbetet är en integrativ litteraturstudie som innefattar tolv globala studier. Litteraturstudiens resultat visar att det finns flera farmakologiska och icke farmakologiska metoder som kan förebygga POST. Lokal behandling med kortikosteroider och NSAID-preparat har förebyggande effekt på POST. Icke farmakologiska interventioner som konformad kuff, substanser som lakritslösning, magnesium och zink lindrar. Vissa studier finner att kortikosteroider och lidokain kan öka förekomsten av POST. I nuläget kan resultatet inte tillämpas av anestesisjuksköterskor då resultaten är tvetydiga och inte kan utföras utan ordination av anestesiolog. Vidare forskning inom området med inriktning på omvårdnad är av yttersta vikt.

Made available in DSpace on 2014-06-11T19:28:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-05Bitstream added on 2014-06-13T19:57:33Z : No. of bitstreams: 1 razera_apr_me_botfm.pdf: 848184 bytes, checksum: 13d0d4a85353b2bc99b09cde1bd57242 (MD5) / Secretaria de Saúde do Estado de São Paulo / Este estudo teve como objetivo conhecer as orientações pós-operatórias fornecidas pela equipe de enfermagem a pacientes e/ou familiares de uma instituição privada e apreender a percepção destes indivíduos acerca das orientações recebidas. Foi um estudo transversal, com abordagem qualitativa, que utilizou o referencial teórico da Comunicação Interpessoal e o referencial metodológico da Análise de Conteúdo. Foram entrevistados 16 pacientes submetidos a procedimentos cirúrgicos eletivos, de urgência e/ou emergência que permaneceram, no mínimo, 3 dias internados. Os resultados evidenciaram que a equipe de enfermagem se preocupa com as técnicas instrumentais da profissão em si desconsiderando o indivíduo de forma holística, ou seja, além das necessidades físicas, as emocionais e espirituais. Também foi possível perceber que, quando o profissional enfermeiro permanece afastado do paciente e/ou não presta informações adequadas gera sentimentos de ansiedade, medo, insegurança e sensação de falta de cuidado. Por outro lado, quando a equipe de enfermagem se fez presente com cuidado e informações coerentes, os clientes relataram a sensação de ser bem cuidado. As conclusões deste estudo nos permitem considerar que a competência em comunicação é uma condição para o exercício da Enfermagem com qualidade e cidadania, que a capacitação em comunicação prepara a equipe de enfermagem para serem os profissionais exigidos pelos clientes do sistema de saúde e, finalmente, que a comunicação é um alicerce importante para que a relação de cuidado se estabeleça de forma efetiva e eficaz, proporcionando a compreensão do cliente em sua complexidade, com resultados qualitativos de atenção, dignidade e respeito ao ser cuidado. / This study aims to identify the guidelines provided by the nursing team of a private institution to patients and family as well as learn with their perception of the aid received. It consists of a cross-sectional study with qualitative approach based on a theoretical reference of Interpersonal Communication and methodological reference of Content Analysis. 16 patients underwent elective surgical procedures of emergency and remained in the hospital for at least 3 days. Results showed that the nursing team is concerned about the instrumental techniques of the job disregarding the patient as a holistic individual, that is, besides their physical, emotional and spiritual needs. When the nurses stayed away from patients and did not provide appropriate guidelines which caused anxiety, fear and feeling of neglect. On the other hand, when nurses were present providing coherent care and assistance, patients reported to feel well cared. This study concluded that communicative competence is an essential condition for nurses to offer qualified assistance. Good communicative skills enable the nursing team to be the professionals required by the patients of the health system and are fundamental to provide effective care, resulting in the patients’ comprehension that are assisted with attention, dignity and respect.

nÃo hà / Na complexidade do tratamento da obesidade, inclui-se a cirurgia bariÃtrica. EntÃo, conhecer os fatores relacionados e caracterÃsticas definidoras dos diagnÃsticos da classe cardiopulmonar associados no perÃodo pÃs-operatÃrio imediato de cirurgia bariÃtrica torna-se essencial para o desenvolvimento da assistÃncia de enfermagem, jà que, a partir dos diagnÃsticos de enfermagem mais prevalentes, intervenÃÃes serÃo instituÃdas. Assim, o estudo teve por objetivo avaliar o perfil de diagnÃstico de enfermagem da classe respostas cardiovasculares/pulmonares de acordo com a taxonomia II da NANDA dos pacientes no pÃs-operatÃrio de cirurgia bariÃtrica. Um estudo transversal foi desenvolvido com 59 pacientes internados em um hospital de referÃncia de cirurgia bariÃtrica no MunicÃpio de Fortaleza/CE, cuja coleta de dados ocorreu no perÃodo de junho de 2010 a junho de 2011. As informaÃÃes foram coletadas por meio de entrevista e exame fÃsico; posteriormente trÃs juÃzes realizaram a inferÃncia dos diagnÃsticos de enfermagem na classe respostas cardiovasculares/pulmonares segundo a Taxonomia da NANDA versÃo 2009-2011. Os dados foram compilados em planilha Excel e a anÃlise estatÃstica realizou-se no STATA versÃo 8.0. O nÃvel de significÃncia adotado no estudo foi 5%. Observou-se o predomÃnio do sexo feminino, com mÃdia de idade 35,3 anos. A maior parte dos pacientes apresentou diagnÃstico de obesidade mÃrbida com IMC > 40 Kg/m2. Os diagnÃsticos reais de maior concordÃncia entre os juÃzes foram PerfusÃo Tissular PerifÃrica Ineficaz (78%), DÃbito CardÃaco DiminuÃdo (76,3%), IntolerÃncia à Atividade e PadrÃo RespiratÃrio Ineficaz (47,5%). Pulsos perifÃricos diminuÃdos, edema, fadiga pÃs-carga alterada e prÃ-carga alterada foram proporcionalmente associados ao diagnÃstico DÃbito CardÃaco DiminuÃdo. AlteraÃÃes na profundidade respiratÃria, dispneia, ortopneia, uso da musculatura acessÃria para respirar, ansiedade, dor, fadiga, fadiga da musculatura respiratÃria foram proporcionalmente associados a PadrÃo RespiratÃrio Ineficaz. Desconforto aos esforÃos, relato verbal de fadiga, relato verbal de fraqueza, resposta anormal da pressÃo sanguÃnea à atividade, estilo de vida sedentÃrio, imobilidade e repouso no leito foram proporcionalmente associados a IntolerÃncia à Atividade. Edema, parestesia, pulsos diminuÃdos, hipertensÃo e tabagismo foram proporcionalmente associados à PerfusÃo Tissular PerifÃrica Ineficaz. Este estudo contribuirà para a construÃÃo da SistematizaÃÃo da AssistÃncia de Enfermagem frente aos diagnÃsticos de enfermagem da classe respostas cardiovasculares/pulmonares, como descrito nos resultados apresentados, e na fundamentaÃÃo cientÃfica para cada diagnÃstico. AlÃm da importante contribuiÃÃo para identificar as reais necessidades e facilitar a utilizaÃÃo de intervenÃÃes adequadas nessa populaÃÃo, està a capacidade de o profissional usufruir dessas informaÃÃes, vista a escassez de pesquisas realizadas com diagnÃsticos de enfermagem em pacientes submetidos à cirurgia bariÃtrica. / The bariatric surgery is included in the complexity of the treatment of obesity. Then, knowing the related factors and defining characteristics of cardiopulmonary diagnostic associated with the immediate postoperative period of bariatric surgery becomes essential for the development of nursing care, since, from the most prevalent nursing diagnoses, interventions will be instituted. Thus, the study aimed to evaluate the profile of nursing diagnosis of the class cardiovascular/pulmonary answers according to NANDA Taxonomy II of the patients after bariatric surgery. A cross-sectional study was conducted with 59 patients hospitalized in a referral hospital for bariatric surgery in the city of Fortaleza, state of CearÃ, which data collection occurred from June 2010 to June 2011. Information was collected through interviews and physical examinations; then three judges made the inference of nursing diagnoses in the class cardiovascular/pulmonary answers according to the NANDA-I Taxonomy 2009-2011. The data were compiled in an Excel spreadsheet and the statistical analysis was carried out in the STATA version 8.0. The significance level in this study was 5%. There was a predominance of females, mean age of 35.3 years. Most patients had a diagnosis of morbid obesity with BMI>40kg/m2. The actual diagnoses of greater agreement among the judges were Ineffective Peripheral Tissue Perfusion (78%), Decreased Cardiac Output (76.3%), and Activity Intolerance and Ineffective Breathing Pattern (47.5%). Decreased peripheral pulses, edema, altered preload and afterload fatigue were proportionally associated with the diagnosis Decreased Cardiac Output. Changes in respiratory depth, dyspnoea, orthopnoea, use of accessory muscles for breathing, anxiety, pain, fatigue, respiratory muscle fatigue were proportionally associated with Ineffective Breathing Patterns. Discomfort in efforts, verbal report of fatigue, verbal report of weakness, abnormal blood pressure response to activity, sedentary lifestyle, immobility and bed rest were proportionally associated with Activity Intolerance. Edema, paresthesia, decreased pulses, hypertension and smoking were proportionally associated with Ineffective Peripheral Tissue Perfusion. This study will contribute to the construction of the Systematization of Nursing Care regarding nursing diagnoses of the class cardiovascular/pulmonary answers, as described in the results presented, and in the scientific basis for each diagnosis. Besides the important contribution to identifying the real needs and facilitating the use of appropriate interventions in this population, it is the ability of the professionals in taking advantage of this information, in view of the scarcity of researches related to nursing diagnoses in patients undergoing bariatric surgery.

Background: Postoperative delirium (POD) is a common neurocognitive disorder in patients undergoing surgical procedures. Delirium is a disorder that is poorly understood, frequently unrecognized and associated with numerous adverse outcomes including longer hospital stays, significantly higher costs and increased morbidity and mortality. While there has been a great deal of research on proposed etiologies, risk factors and outcomes of delirium, few studies have explored the patient’s subjective experience of the phenomenon. Purpose: The purpose of this qualitative descriptive research was to investigate the patient experience of postoperative delirium and measure the distress associated with the experience. The Delirium Symptoms Experience Model (DSEM) provided the theoretical framework in which to understand the postoperative delirium experience. The three specific aims used to guide the investigation were: 1) Identify patient age, gender, race, type and length of surgery, past medical and surgical history, length of admission, delirium subtype (if known), and medications (including anesthetic agents) used in the perioperative period to better characterize the sample and provide context for the qualitative findings; 2) Describe the postoperative patients’ experience of being and feeling delirious; and, 3) Measure the distress associated with the recall of delirium using the Delirium Experience Questionnaire (DEQ) Methods: Ten participants ranging in age from 33-75 years (mean = 66.2 years of age) who experienced postoperative delirium were interviewed. Patients were screened for persistent delirium or cognitive impairment as assessed with the Confusion Assessment Method and the Mini-Cog™ Instruments. Results: Three organizing themes emerged from the content analysis: 1) Altered Perceptions of Reality; 2) Stuck in the Confusion; and, 3) Seeking Reality. The analysis of the quantitative measures and descriptive data demonstrated a high rate of psychological distress associated with delirium recall with 80% participants reporting it caused severe to very severe distress. The anesthetic drug propofol was the common medication prescribed in the perioperative period and given to all ten participants. Conclusion: Understanding this phenomenon from the patients’ perspective may provide a better understanding of the delirium experience and aid in the development of interventions and treatments to improve care and reduce suffering.

This project set out to derive a prediction rule based on preoperative clinical variables to identify patients with high risk of developing atrial fibrillation following cardiac surgery. Methods: Prospectively collected data from a perioperative database was corroborated with chart review to identify eligible patients who had non-emergent surgery in 2010. Details on 28 preoperative variables were collected and significant predictors (p<0.2) were inserted into multivariable logistic regression and recursive partitioning. Results: 305 (30.5%) of 999 patients developed new onset postoperative atrial fibrillation. Eleven variables were significantly associated with atrial fibrillation, however, both final models included only three: left atrial dilatation, mitral valve disease and age. Bootstrapping with 5000 samples confirmed that both final models provide consistent predictions. Coefficients from the logistic regression model were converted into a simple seven point predictive score. Conclusions: This simple risk score can identify patients at higher risk of developing atrial fibrillation after cardiac surgery.