No abstract
Introdução: As lesões cutâneas constituem um sério problema de saúde pública, acometendo pessoas independente de sexo, faixa etária ou etnia, sendo responsável pelo aumento de morbidade e mortalidade por prejudicar a integridade tissular, causando impactos em pacientes provocando sofrimento físico e emocional e o afastamento de suas atividades diárias, além de trazer altos custos para as instituições hospitalares. Objetivos: Relatar a importância do Setor de Estomaterapia (SET) do Hospital de Referência de Porto Nacional (HRPN), no tratamento de lesões cutâneas. Material e Métodos: Trata-se de um relato de experiência de dois acadêmicos de enfermagem, durante estágio curricular no HRPN. O SET estende-se pela clínica médica, clinica cirúrgica, geriatria e pronto socorro. Foi utilizado como técnica de coletas de dados, a observação estruturada e participação na execução de curativos. Resultados: O estágio curricular ocorreu durante o turno matutino, neste turno os curativos são realizados após o banho de cada paciente de forma periódica, contribuindo para a cicatrização completa das lesões. No transcorrer do estágio foi observado a predominância de lesão por pressão estagio I, II,III e inclassificável, feridas neuropáticas, queimaduras de 2° e 3° grau, erisipela, e outras lesões que eram atendidas em menor quantidade. Na manutenção do processo de cicatrização são utilizadas coberturas disponibilizadas pelo HRPN, sendo elas, Ácidos Graxos Essenciais (AGE), creme de barreira, hidrogel, hidrocoloide, carvão ativado, carvão ativado com prata, papaína, solução com Polihexametileno Biguanida (PHMB), alginato de cálcio, Petrollatum, pó de proteção de estomias, sulfadiazina de prata, entre outras. Destaca-se a importância do SET tanto para o HRPN, quanto para equipe de saúde e aos pacientes internados. Conclusão: É de fundamental importância o SET no HRPN, pois o mesmo contribui positivamente no tratamento de pacientes portadores de lesões cutâneas, alcançando resultados positivos diminuído os riscos de infecções cruzadas por ter uma equipe especifica e qualificada no tratamento de lesões, contribui também para a redução da sobrecarga na equipe do serviço de saúde, proporcionando aos pacientes um atendimento resolutivo e de qualidade.
Diabetes mellitus is a metabolic disorder that leads to a deficiency in insulin secretion, its action or both. Poor glycemic control can lead to a number of complications, including diabetic foot, which is responsible for most nontraumatic lower limb amputations and generates a very high cost for wound healing and amputation healing. The technology has provided the creation of new treatment methods, such as drug-bearing hydrogel membranes. Our aim is to test the efficiency of papain hydrogel in the treatment of diabetic foot ulcers. The study was carried out in the municipality of Porto Nacional (TO) with all patients with diabetic foot who entered the HRPPN from October 1, 2014 to October 31, 2015, who fit within the inclusion criteria of the work and signed The TCLE. For the socioeconomic analysis a questionnaire with direct questions was applied. For the application of the membrane the wounds were washed with 0.9% saline and the dressings were performed according to the hospital protocol and changed every 24 hours. A diagnostic worksheet was used to perform the daily follow-up of the wounds. Eighteen patients participated in the study, and 16 of them were hospitalized due to diabetic foot and decompensated DM. 50% of the patients were female and 50% were male, all aged between 29 years and 80 years. 22% use oral hypoglycemic and insulin and the other 78% only use oral hypoglycemic. 82% have a partner or are married and most of them have no income or receive up to a minimum wage (61%). As for schooling, 28% are illiterate and 34% did not finish high school. 50% of the patients are from Porto Nacional and 11% from other states. As for the patients' knowledge of the complications caused by DM, the diabetic foot was the only one mentioned by all, the other complications were unknown by many; only one patient is aware of all the complications. From 18 patients, 7 could be treated with the papain hydrogel membrane, but as there was no significant improvement, the membrane had to be replaced by the conventional dressing. The membrane did not adhere to healthy skin or even to the wound, since it presented rigidity, a fact that may have delayed the healing process since the dressing did not involve the wound completely. The membrane also had a low absorption rate of the exudate, causing the wounds to become macerated. The cysteine, a compound present in the membrane, caused it to release a strong odor that caused disgust in patients and their families, a fact that discouraged the patient from wanting to perform the treatment. Given these results, it was inferred that the use of the papain hydrogel did not improve the wounds of the diabetic foot, there was a slight debridement in some wounds, but without healing.
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