Thesis (M. Sc.)--University of Canterbury, 2009. / Typescript (photocopy). Includes bibliographical references (leaves 49-57).

Diss. (sammanfattning) Göteborg : Univ. , 2010.

No description available.

O objetivo deste estudo é avaliar a eficácia de duas técnicas de acupuntura no controle da náusea e vômito em pacientes portadoras de Carcinoma Invasivo de mama, submetidas à quimioterapia anti-neoplásica. Foram incluídas no estudo 64 pacientes no período de março de 2003 a fevereiro de 2007, do Hospital A.C. Camargo com diagnóstico anatomopatológico de carcinoma invasivo da mama, candidatas à quimioterapia adjuvante com esquemas que incluem doxorrubicina e ciclofosfamida. O estudo foi realizado no primeiro ciclo de quimioterapia. As pacientes foram randomizados em 3 grupos: As pacientes do grupo A, receberam tratamento antiemético convencional com medicamentos. As pacientes do grupo B, receberam o tratamento antiemético convencional e aplicação de acupuntura clássica. As pacientes do grupo C, receberam tratamento convencional e aplicação de acupuntura auricular. As pacientes foram submetidas à auto-avaliação nos primeiros 21 dias após o início da quimioterapia, e conforme os critérios da Common toxicity criteria of the National Cancer Institute (NCI CTC), preencheram a ficha de coleta de dados em relação à náusea e vômito neste período. Quanto à náusea do primeiro ao sétimo dia, encontramos pelo teste de Kruskal-Wallis diferença significativa (p=0.040), sugerindo que a acupuntura diminui a intensidade de náusea deste período, e quanto à duração de dias de pior intensidade também foi significativo (p=0,037) ou seja a acupuntura diminui os dias de pior intensidade.Quando utilizamos o teste de Mann-Whitney encontramos diferença significativa da intensidade de náusea somente entre os grupos A e B (p=0,013), significando que a acupuntura clássica diminui a intensidade de náusea em relação ao grupo controle. Em relação aos dias de pior intensidade de náusea encontramos diferença entre os grupos A e B (p=0,043) e entre grupos B e C (p=0,010) ou seja, a acupuntura clássica diminui os dias de pior intensidade de náusea em relação aos grupos controle e acupuntura auricular. Quanto à gravidade do vômito, do primeiro ao sétimo dia, encontramos pelo teste de Kruskal-Wallis diferença significativa (p=0,036) entre os grupos, sugerindo que a acupuntura diminui a gravidade de vômitos. Pelo teste de Mann-Whitney entre os grupos A e B encontrou-se diferença significativa (p=0,017), ou seja, a acupuntura clássica diminui a gravidade de vômitos comparado ao grupo controle. Quanto ao número de dias de vômito de pior grau entre o primeiro e o sétimo dia encontramos ao aplicar o teste ANOVA diferença significativa entre os grupos (p=0,029), sendo que a acupuntura diminui o número de dias com vômito. O teste t aplicado para os grupos em pares revelou entre grupos A e B (p=0,035), portanto, a acupuntura clássica diminui o número de dias de vômito comparado ao grupo controle. Ao estudarmos a intensidade de náusea entre oitavo e vigésimo primeiro dia encontramos pelo teste de Kruskal-Wallis entre os grupos diferença significativa (p=0,022), sendo que a acupuntura diminui a náusea entre oitavo e vigésimo primeiro dia. Pelo teste de Mann-Whitney entre grupos aos pares encontrou-se diferença significativa entre os grupos A e B (p=0,016), houve diferença entre grupos A e C (p=0,049). Portanto, há diferença significativa entre grupos B e C em relação ao grupo A, ou seja, a acupuntura clássica e auricular diminuem a náusea entre oitavo e vigésimo primeiro dias em relação ao grupo controle. Conclusão: A acupuntura clássica diminui a intensidade e duração de náusea e vômito do primeiro ao sétimo dia pós-quimioterapia. A acupuntura clássica e auricular diminuem a intensidade de náusea do oitavo ao vigésimo primeiro dia pós-quimioterapia. / The purpose of this study is to evaluate the efficacy of two acupuncture techniques in the control of the nausea and vomiting in patients diagnosed of Invasive Breast Carcinoma submitted to chemotherapy. Sixty four patients with pathological diagnosis of Invasive Breast Carcinoma were included in the study during the period of March 2003 to February 2007 at Hospital A.C. Camargo. The patients received adjuvant chemotherapy including doxorubicin and ciclophosphamide. The study was developed during the first chemotherapy cycle. The patients were randomized in 3 groups: Patients of the group A received conventional antiemetic treatment with drug administration. Patients of the group B received conventional antiemetic treatment with drug administration and application of classic acupuncture. Patients of the group C received conventional antiemetic treatment with drug administration and application of auricular acupuncture. During the first 21 days, the patients performed self-reports after receiving the chemotherapy shot, according to the Common toxicity criteria of the National Cancer Institute (NCI CTC). They filled out the data collection instrument related to the nausea and vomiting in this period. As for the nausea from the first to the seventh day, we found statistical significancy (p=0.040) using the Kruskal - Wallis test, suggesting that acupuncture reduces the intensity of nausea in this period. Regarding length of days having worse intensity of nausea in this period, results were statistically significant by ANOVA test (p=0.037) with acupuncture decreasing the number of days of worse intensity. Through the Mann Whitney test, we also found significant difference regarding the intensity of nausea among the groups A and B (p=0.013), showing that classic acupuncture reduces the intensity of nausea when compared to the control group. In relation to the days of worse intensity of nausea we found difference among the groups A and B (p=0.043) and among groups B and C (p=0.010) meaning that classic acupuncture decreases the days of worse intensity of nausea when compared to control group and auricular acupuncture group. As for the severity of the vomit, from the first to the seventh day, we found through Kruskal - Wallis test a significant difference (p=0.036) among the groups, suggesting that acupuncture reduces the severity of the vomits. Using the Mann - Whitney test among the groups A and B a significant difference was found (p=0.017) meaning that classic acupuncture reduces the severity of vomits compared to the control group. As for the number of days of vomit in worse degree between the first and the seventh day, we used the ANOVA test and found significant difference among the groups (p=0.029) with acupuncture reducing the number of days with vomit. The t test applied for the groups in pairs revealed statistical significance among groups A and B (p=0.035) and therefore, classic acupuncture reduces the number of days of vomit compared to the control group. We have analysed the intensity of nausea between eighth and twentieth first day. Through the Kruskal - Wallis test, we found significant difference among the groups (p=0.022) showing that acupuncture also reduces the nausea between eighth and twentieth first day. Analyzing the groups in pairs with the Mann - Whitney test, we found significant difference among the groups A and B (p=0.016) and among groups A and C (p=0.049). Therefore, there is significant difference among groups B and C in relation to the group A. Classic acupuncture and auricular acupuncture reduce the nausea between eighth and twentieth first days when compared to control group. Conclusion: Classic acupuncture reduces the intensity and duration of nausea and vomit from the first to the seventh day after chemotherapy. Classic acupuncture and auricular acupuncture reduce the intensity of nausea from the eighth to the twentieth first day after chemotherapy.

The current study investigated the relationship between principles of social learning theory and binge eating episodes in 31 normal weight bulimic women. Participants were asked to monitor the following: (1) levels of self-efficacy related to resisting the urge to binge and/or purge as well as levels of self-efficacy related to handling stressful events, (2) mood states, (3) enjoyment of daily activities, (4) number of stressful events, and (5) number of binging and purging episodes. Participants were asked to monitor these events four times a day for seven days. Measures of locus of control and enjoyment ratings of binging and purging were also gathered prior to monitoring. Results indicated that components of social learning theory predict number of binging and purging episodes. The best predictors were a combination frequency of binging, lowered levels of self-efficacy to resist the urge to binge, and having a general tendency to not feel in control of one's response-outcomes. However, heterogeneity within the group was apparent in that the predictive models failed to significantly predict binging and purging for all participants. It was also the case that there were differences in predictors of binging and purging on an individual level of analysis. For all individuals, self-efficacy to resist the urge to binge/purge was the only consistent predictor of these episodes. For four individuals, frequency of prior binging was an important predictor. Post-hoc analyses suggest that for the group as a whole self-efficacy expectancies affect current behavior more than current behavior affects future expectancies. Even here, variability exists at the individual level of analysis. For four participants, behaviors were more strongly related to subsequent expectancies than expectancies were related to subsequent behaviors. These findings increase our understanding of the role of social learning theory in predicting episodes of binge eating and purging, often thought to be a cycle of maladaptive, negatively reinforced behaviors. The results also have important implications for assessment and treatment of bulimia using a cognitive/behavioral model. The presence of individual differences in the applicability of the predictive models and the relationships between expectancies and behaviors over the course of several time periods suggests that a treatment approach emphasizing the relationship between expectancies and behaviors may have more or less meaning for different individuals. Future research should replicate, cross-validate and expand these findings in order to clarify these issues. / Ph. D.

Lau Hoi Yan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 134-157). / Abstracts in English and Chinese. / PUBLICATIONS BASED ON WORK IN THIS THESIS --- p.I / ABSTRACT --- p.II / ACKNOWLEDGEMENTS --- p.VI / TABLE OF CONTENTS --- p.VIII / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter 1.1 --- General Introduction --- p.1 / Chapter 1.2 --- Emesis --- p.3 / Chapter 1.2.1 --- Introduction --- p.3 / Chapter 1.2.2 --- Retching & Vomiting --- p.3 / Chapter 1.2.3 --- Nausea --- p.4 / Chapter 1.2.4 --- Motor Components of Emetic Reflex --- p.5 / Chapter 1.2.4.1 --- Pre-ejection Phase --- p.5 / Chapter 1.2.4.2 --- Ejection Phase --- p.5 / Chapter 1.2.4.3 --- Post-ejection Phase --- p.6 / Chapter 1.2.5 --- Components of Emetic Reflex --- p.6 / Chapter 1.2.5.1 --- Area Postrema (AP) --- p.6 / Chapter 1.2.5.2 --- Nucleus Tractus Solitarius (NTS) --- p.7 / Chapter 1.2.5.3 --- Vomiting Centre --- p.8 / Chapter 1.2.5.4 --- Vestibular System --- p.10 / Chapter 1.2.5.5 --- Abdominal Visceral Afferents --- p.10 / Chapter 1.2.5.6 --- Forebrain --- p.11 / Chapter 1.2.6 --- Neurotransmitters & Receptors --- p.12 / Chapter 1.2.7 --- Anti-emetics --- p.13 / Chapter 1.3 --- Models of Nausea --- p.16 / Chapter 1.3.1 --- Introduction --- p.16 / Chapter 1.3.2 --- Conditioned Taste Aversion --- p.18 / Chapter 1.3.3 --- Pica Behaviour --- p.20 / Chapter 1.3.4 --- Studies of the Involvement of Vasopressin --- p.21 / Chapter 1.3.5 --- Tachygastria --- p.24 / Chapter 1.3.6 --- Locomotor Activity --- p.26 / Chapter 1.4 --- Markers of Neuronal Activity --- p.27 / Chapter 1.4.1 --- General Comments --- p.27 / Chapter 1.4.2 --- c-fos Expression as a Marker of Neuronal Activity --- p.28 / Chapter 1.4.2.1 --- What is c-fos? --- p.28 / Chapter 1.4.2.2 --- Regulation of c-fos Expression --- p.30 / Chapter 1.4.2.2.1 --- Calcium Response Element --- p.31 / Chapter 1.4.2.2.2 --- Serum Response Element --- p.32 / Chapter 1.4.2.3 --- Types of Receptors Involved in c-fos Expression --- p.32 / Chapter 1.4.2.4 --- Feasibility of Using c-fos Expression as Marker of Cellular Activity --- p.36 / Chapter 1.4.2.5 --- Identification of Emetic Pathway by c-fos Immunohistochemistry --- p.36 / Chapter 1.5 --- Aims & Objectives --- p.37 / Chapter CHAPTER 2 --- METHODS --- p.42 / Chapter 2.1 --- Animals --- p.42 / Chapter 2.1.1 --- Ferrets --- p.42 / Chapter 2.1.2 --- Suncus murinus --- p.42 / Chapter 2.2 --- Measurement of Animal Behaviour --- p.43 / Chapter 2.2.1 --- Experiment Design --- p.43 / Chapter 2.2.2 --- Recording of Animal Behaviour --- p.43 / Chapter 2.2.3 --- Calibration of Equipment Used to Record Spontaneous Locomotor Activity --- p.44 / Chapter 2.2.4 --- Behaviour Recorded by the Observer --- p.45 / Chapter 2.3 --- Administration of Drugs --- p.46 / Chapter 2.3.1 --- Ferrets --- p.46 / Chapter 2.3.1.1 --- General Comments --- p.46 / Chapter 2.3.1.2 --- Drug Antagonism Studies --- p.47 / Chapter 2.3.2 --- Suncus murinus --- p.47 / Chapter 2.3.2.1 --- General Comments --- p.47 / Chapter 2.3.2.2 --- Dose-Response Studies --- p.48 / Chapter 2.3.2.3 --- Drug Antagonism Studies --- p.48 / Chapter 2.4 --- c-fos Expression Studies in Ferret Brainstems --- p.50 / Chapter 2.4.1 --- Animals and Anaesthesia --- p.50 / Chapter 2.4.2 --- Perfusion and fixation --- p.50 / Chapter 2.4.3 --- Dehydration of brains --- p.51 / Chapter 2.4.4 --- Embedding of tissue --- p.52 / Chapter 2.4.5 --- Sectioning --- p.52 / Chapter 2.4.6 --- Staining --- p.52 / Chapter 2.4.7 --- Antibodies used --- p.55 / Chapter 2.4.8 --- Positive Control Slides --- p.55 / Chapter 2.5 --- Experimental Design and Statistics --- p.56 / Chapter 2.5.1 --- Randomization of Treatments --- p.56 / Chapter 2.5.2 --- Statistics --- p.57 / Chapter 2.5.2.1 --- Ferrets --- p.57 / Chapter 2.5.2.2 --- Suncus murinus --- p.59 / Chapter 2.6 --- Drugs and Chemicals Used --- p.60 / Chapter 2.6.1 --- Drugs Used --- p.60 / Chapter 2.6.2 --- Chemicals Used --- p.62 / Chapter CHAPTER 3 --- RESULTS --- p.63 / Chapter 3.1 --- Ferret --- p.63 / Chapter 3.1.1 --- "The Effect of Ondansetron and CP-99,994 on Emesis and Locomotor Activity Changes Induced by Cisplatin in the Ferret" --- p.63 / Chapter 3.1.2 --- The Effect of Domperidone on Emesis and Locomotor Activity Changes Induced by Apomorphine in the Ferret --- p.69 / Chapter 3.1.3 --- "The Effect of CP-99,994 on Emesis and Locomotor Activity Changes Induced by Apomorphine in the Ferret" --- p.74 / Chapter 3.1.4 --- c-fos Expression Studies in Ferret Brainstems --- p.79 / Chapter 3.1.4.1 --- Cisplatin-treated Ferrets --- p.79 / Chapter 3.1.4.2 --- Positive Control Slides --- p.84 / Chapter 3.2 --- Suncus murinus --- p.88 / Chapter 3.2.1 --- The Emetic Potential of Nicotine and its Effects on the Spontaneous Locomotor Activity of Suncus murinus --- p.88 / Chapter 3.2.2 --- "The Effect of CP-99,994 on Emesis and Locomotor Activity Changes Induced by Nicotine in Suncus murinus" --- p.92 / Chapter 3.2.3 --- The Emetic Potential of Copper Sulphate and its Effects on the Spontaneous Locomotor Activity of Suncus murinus --- p.95 / Chapter 3.2.4 --- "The Effect of CP-99,994 on Emesis and Locomotor Activity Changes Induced by Copper Sulphate in Suncus murinus" --- p.98 / Chapter 3.2.5 --- The Emetic Potential of Cisplatin and its Effects on the Spontaneous Locomotor Activity of Suncus murinus --- p.101 / Chapter 3.2.6 --- The Effect of Ondansetron on Emesis and Locomotor Activity Changes Induced by Cisplatin in Suncus murinus --- p.104 / Chapter 3.2.7 --- "The Effect of CP-99,994 on Emesis and Locomotor Activity Changes Induced by Cisplatin in Suncus murinus" --- p.107 / Chapter 3.2.8 --- "The Effects of Ondansetron and CP-99,994 on Locomotor Activity in Suncus murinus" --- p.110 / Chapter CHAPTER 4 --- DISCUSSION --- p.113 / Chapter CHAPTER 5 --- GENERAL SUMMARY --- p.130 / REFERENCES --- p.134

Este estudo teve como objetivos analisar o conceito náusea em pacientes no período pósoperatório imediato; avaliar a validade de conteúdo e clínica do diagnóstico de enfermagem Náusea no período pós-operatório imediato, considerando-se o modelo de Fehring; identificar a incidência do referido diagnóstico em pacientes no período pós-operatório imediato; verificar possíveis associações entre os antecedentes de náusea obtidos na análise de conceito e os identificados nos pacientes com náusea no pós-operatório imediato e verificar a frequência de ocorrência das características definidoras principais e secundárias do diagnóstico Náusea. A pesquisa foi desenvolvida em três etapas: análise de conceito, validação de conteúdo e validação clínica. A análise de conceito seguiu as oito fases propostas por Walker a Avant: selecionar o conceito, definir o objetivo da análise, identificar a utilização do conceito, definir atributos definidores, desenvolver casos-modelos, desenvolver outros casos, identificar antecedentes e consequentes e verificar as referências empíricas. Essa etapa foi fundamental para a realização das etapas posteriores (validação de conteúdo e validação clínica), permitindo a construção de definições operacionais e a elaboração de instrumentos de coleta de dados mais direcionados ao cenário do paciente com náusea no período pós-operatório. Participaram da validação de conteúdo 52 expertos que responderam a um instrumento que continha dados de identificação profissional e de validação do diagnóstico de enfermagem Náusea (enunciado, definição, posição que ocupa na estrutura taxonômica e características definidoras, descritas em uma escala tipo Likert). A maioria dos expertos considerou o domínio 12 (Conforto), a classe 1 (conforto físico) e o enunciado (náusea) adequados ao diagnóstico. Foram sugeridas modificações na definição atual do referido diagnóstico de enfermagem. Quatro características definidoras foram consideradas principais (relato de náusea, salivação aumentada, aversão à comida e sensação de vômito) e oito foram denominadas secundárias (deglutição aumentada, gosto amargo na boca, palidez, taquicardia, diaforese, sensação de calor e frio, alterações da pressão arterial e dilatação pupilar). Na etapa de validação clínica, 106 pacientes foram incluídos na amostra. Para a coleta de dados, foram utilizados o questionário de avaliação pré, intra e pósoperatória e a Escala Hospitalar de Ansiedade e Depressão. A náusea foi avaliada em duas etapas: 1) análise das manifestações objetivas (dois enfermeiros simultaneamente) e 2) subjetivas (um enfermeiro). A incidência de náusea foi de 21,70% e, na maioria das vezes, de moderada intensidade. Os antecedentes associados à presença de náuseas no pós-operatório foram: sexo, idade, tipo de anestesia, presença de dor, movimentação e alimentação pósoperatória e odores nocivos. Na etapa 1, a característica definidora denominada principal foi relato de náusea, e as manifestações secundárias foram sensação de vômito, palidez e deglutição aumentada. O índice de concordância variou de 86,95% a 100,00%. Na etapa 2, as características consideradas principais foram relato de náusea e sensação de vômito, e as características definidoras secundárias identificadas foram salivação aumentada e sensação de calor e frio. Os escores totais do diagnóstico de enfermagem Náusea foram de 0,79 e 0,73 para as validações de conteúdo e clínica respectivamente, considerado válido para a Taxonomia da North American Nursing Diagnosis Association - International (NANDA-I). Concluiu-se que o relato de náusea, sensação de vômito, palidez, salivação aumentada, deglutição aumentada e sensação de calor e frio são fortes indicativos do diagnóstico de enfermagem Náusea. / The aims of this study were to analyze the nausea concept in patients during the immediate postoperative period; to assess the content and clinical validity of the nursing diagnosis nausea in the immediate postoperative period, considering Fehring\'s model; to identify the incidence of this diagnosis in patients during the immediate postoperative period; to check for possible associations between the nausea antecedents obtained in the concept analysis and those identified in patients with immediate postoperative nausea and to verify the frequency of the primary and secondary defining characteristics of the Nausea diagnosis. The research was developed in three phases: concept analysis, content validation and clinical validation. The concept analysis followed the eight phases proposed by Walker and Avant: select the concept, define the aim of the analysis, identify the use of the concept, define defining attributes, develop model cases, develop other cases, identify antecedents and consequences and check empirical references. This phase was fundamental to accomplish further phases (content validation and clinical validation), permitting the construction of operational definitions and the elaboration of data collection instruments that were better directed at the context of postoperative nausea patients. Fifty-two specialists participated in the content validation, who answered an instrument with professional identification data and the validation of the nursing diagnosis nausea (wording, definition, position in taxonomic structure and defining characteristics, described on a Likert scale). Most experts considered domain 12 (Comfort), class 1 (physical comfort) and the wording (nausea) adequate for the diagnosis. Modifications were suggested in the current definition of the referred nursing diagnosis. Four defining characteristics were considered primary (reported nausea, increased salivation, aversion toward food and gagging sensation), while eight were called secondary (increased swallowing, sour taste in the mouth, pallor, tachycardia, excessive sweating, feeling hot and cold, blood pressure alterations and pupil dilation). In the clinical validation phase, 106 patients were included in the sample. For data collection the pre, intra and post-operative assessment questionnaire and the Hospital Anxiety and Depression Scale were used. Nausea was assessed in two phases: 1) analysis of objective manifestations (two nurses simultaneously) and 2) subjective (one nurse). The incidence level of nausea corresponded to 21.70%, in most cases of moderate intensity. The following antecedents were associated with the presence of nausea and vomiting: gender, age, anesthesia type, presence of pain, postoperative movements and meals and harmful smells. In phase 1, the defining characteristic that was considered primary was reported nausea and the secondary manifestations were gagging sensation, pallor and increased swallowing. Agreement levels ranged between 86.95% and 100.00%. In phase 2, reported nausea and gagging sensation were considered primary characteristics, while increased salivation and feeling hot and cold were identified as secondary defining characteristics. The total scores of the nursing diagnosis Nausea corresponded to 0.79 and 0.73 for the content and clinical validations, respectively, which are considered valid for the Taxonomy of the North American Nursing Diagnosis Association - International (NANDA-I). In conclusion, reported nausea, gagging sensation, pallor, increased salivation, increased swallowing and feeling hot and cold are strong signs of the nursing diagnosis Nausea.

Este estudo teve como objetivos analisar o conceito náusea em pacientes no período pósoperatório imediato; avaliar a validade de conteúdo e clínica do diagnóstico de enfermagem Náusea no período pós-operatório imediato, considerando-se o modelo de Fehring; identificar a incidência do referido diagnóstico em pacientes no período pós-operatório imediato; verificar possíveis associações entre os antecedentes de náusea obtidos na análise de conceito e os identificados nos pacientes com náusea no pós-operatório imediato e verificar a frequência de ocorrência das características definidoras principais e secundárias do diagnóstico Náusea. A pesquisa foi desenvolvida em três etapas: análise de conceito, validação de conteúdo e validação clínica. A análise de conceito seguiu as oito fases propostas por Walker a Avant: selecionar o conceito, definir o objetivo da análise, identificar a utilização do conceito, definir atributos definidores, desenvolver casos-modelos, desenvolver outros casos, identificar antecedentes e consequentes e verificar as referências empíricas. Essa etapa foi fundamental para a realização das etapas posteriores (validação de conteúdo e validação clínica), permitindo a construção de definições operacionais e a elaboração de instrumentos de coleta de dados mais direcionados ao cenário do paciente com náusea no período pós-operatório. Participaram da validação de conteúdo 52 expertos que responderam a um instrumento que continha dados de identificação profissional e de validação do diagnóstico de enfermagem Náusea (enunciado, definição, posição que ocupa na estrutura taxonômica e características definidoras, descritas em uma escala tipo Likert). A maioria dos expertos considerou o domínio 12 (Conforto), a classe 1 (conforto físico) e o enunciado (náusea) adequados ao diagnóstico. Foram sugeridas modificações na definição atual do referido diagnóstico de enfermagem. Quatro características definidoras foram consideradas principais (relato de náusea, salivação aumentada, aversão à comida e sensação de vômito) e oito foram denominadas secundárias (deglutição aumentada, gosto amargo na boca, palidez, taquicardia, diaforese, sensação de calor e frio, alterações da pressão arterial e dilatação pupilar). Na etapa de validação clínica, 106 pacientes foram incluídos na amostra. Para a coleta de dados, foram utilizados o questionário de avaliação pré, intra e pósoperatória e a Escala Hospitalar de Ansiedade e Depressão. A náusea foi avaliada em duas etapas: 1) análise das manifestações objetivas (dois enfermeiros simultaneamente) e 2) subjetivas (um enfermeiro). A incidência de náusea foi de 21,70% e, na maioria das vezes, de moderada intensidade. Os antecedentes associados à presença de náuseas no pós-operatório foram: sexo, idade, tipo de anestesia, presença de dor, movimentação e alimentação pósoperatória e odores nocivos. Na etapa 1, a característica definidora denominada principal foi relato de náusea, e as manifestações secundárias foram sensação de vômito, palidez e deglutição aumentada. O índice de concordância variou de 86,95% a 100,00%. Na etapa 2, as características consideradas principais foram relato de náusea e sensação de vômito, e as características definidoras secundárias identificadas foram salivação aumentada e sensação de calor e frio. Os escores totais do diagnóstico de enfermagem Náusea foram de 0,79 e 0,73 para as validações de conteúdo e clínica respectivamente, considerado válido para a Taxonomia da North American Nursing Diagnosis Association - International (NANDA-I). Concluiu-se que o relato de náusea, sensação de vômito, palidez, salivação aumentada, deglutição aumentada e sensação de calor e frio são fortes indicativos do diagnóstico de enfermagem Náusea. / The aims of this study were to analyze the nausea concept in patients during the immediate postoperative period; to assess the content and clinical validity of the nursing diagnosis nausea in the immediate postoperative period, considering Fehring\'s model; to identify the incidence of this diagnosis in patients during the immediate postoperative period; to check for possible associations between the nausea antecedents obtained in the concept analysis and those identified in patients with immediate postoperative nausea and to verify the frequency of the primary and secondary defining characteristics of the Nausea diagnosis. The research was developed in three phases: concept analysis, content validation and clinical validation. The concept analysis followed the eight phases proposed by Walker and Avant: select the concept, define the aim of the analysis, identify the use of the concept, define defining attributes, develop model cases, develop other cases, identify antecedents and consequences and check empirical references. This phase was fundamental to accomplish further phases (content validation and clinical validation), permitting the construction of operational definitions and the elaboration of data collection instruments that were better directed at the context of postoperative nausea patients. Fifty-two specialists participated in the content validation, who answered an instrument with professional identification data and the validation of the nursing diagnosis nausea (wording, definition, position in taxonomic structure and defining characteristics, described on a Likert scale). Most experts considered domain 12 (Comfort), class 1 (physical comfort) and the wording (nausea) adequate for the diagnosis. Modifications were suggested in the current definition of the referred nursing diagnosis. Four defining characteristics were considered primary (reported nausea, increased salivation, aversion toward food and gagging sensation), while eight were called secondary (increased swallowing, sour taste in the mouth, pallor, tachycardia, excessive sweating, feeling hot and cold, blood pressure alterations and pupil dilation). In the clinical validation phase, 106 patients were included in the sample. For data collection the pre, intra and post-operative assessment questionnaire and the Hospital Anxiety and Depression Scale were used. Nausea was assessed in two phases: 1) analysis of objective manifestations (two nurses simultaneously) and 2) subjective (one nurse). The incidence level of nausea corresponded to 21.70%, in most cases of moderate intensity. The following antecedents were associated with the presence of nausea and vomiting: gender, age, anesthesia type, presence of pain, postoperative movements and meals and harmful smells. In phase 1, the defining characteristic that was considered primary was reported nausea and the secondary manifestations were gagging sensation, pallor and increased swallowing. Agreement levels ranged between 86.95% and 100.00%. In phase 2, reported nausea and gagging sensation were considered primary characteristics, while increased salivation and feeling hot and cold were identified as secondary defining characteristics. The total scores of the nursing diagnosis Nausea corresponded to 0.79 and 0.73 for the content and clinical validations, respectively, which are considered valid for the Taxonomy of the North American Nursing Diagnosis Association - International (NANDA-I). In conclusion, reported nausea, gagging sensation, pallor, increased salivation, increased swallowing and feeling hot and cold are strong signs of the nursing diagnosis Nausea.

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.

Illamående och kräkningar hos kvinnor som behandlas med cytostatika mot bröstcancer är ettomfattande problem inom den onkologiska omvårdnaden. Många kvinnor upplever, trots välutvecklade läkemedel för att motverka cytostatika utlöst illamående och kräkningar denna, förmånga fruktade biverkan. Syftet med litteraturöversikten var att finna förebyggande ochlindrande icke farmakologiska metoder som kan hjälpa till att minska det cytostatika utlöstaillamåendet och kräkningarna som kan uppstå hos kvinnor med bröstcancer i samband medcytostatikabehandlingen och effekten av dessa metoder. Som teoretiskt stöd användes Orem´s egenvårdsteori och för att identifiera metoderna gjordesen litteraturöversikt med kvantitativa originalartiklar ur vetenskapliga tidskrifter. De ickefarmakologiska metoderna som studerades var akupressur, elektroakupunktur, yoga,fysiskträning, massage och utbildning.Användandet av dessa icke farmakologiska metoder visade på en minskning av cytostatikautlöst illamående och kräkningar, antingen som placeboeffekt eller som faktisk effekt. Sombifynd diskuteras ångest och stress effekt på illamående och kräkningar, eftersom metodernavisat sig kunna inverka och förbättra kvinnornas sinnesstämning genom suggestion.De studerade icke farmakologiska metoderna är förhållandevis lätta att tillämpa och är inte såtidskrävande. Även om metoderna visat en minskning av illamående och kräkningar utlösta av cytostatika, är kunskapsbasen med avseende på effekten inte fullständig och detbehövs mer forskning.