This article discusses the characteristics of dysphagic patients victims of a stroke. The objectives were to identify the profile of patients with dysphagic and measure its association with age, risk factors, episodes of stroke and consistency of food. As a methodology, we used the cross-sectional study sample of thirty patients. Results show that all 17 dysphagic patients were hypertensive and more than half also diabetic (58.82%). All of them had ischemic stroke. There was no association between dysphagic and age, neither with the frequency of stroke episodes. Patients with hypertension and diabetes had higher odd ratio for dysphagic referring to the swallowing of liquids. All of them were elderly with three risk factors (hypertension, diabetes and obesity) and with increased difficulty in swallowing liquids. As a conclusion, it was observed that the nurse needs to be trained to recognize dysphagia and its complications, such as pneumonia and malnutrition.
Trata-se de revisão descritiva dos fatores de risco para hipoglicemia em pacientes com infusão contínua de insulina na terapia intensiva. Buscaram-se publicações entre 2006 e 2012, em livros e artigos de bases indexadas em bibliotecas virtuais. Selecionadas oito publicações ordenadas em categorias que tratavam da hipoglicemia, terapia nutricional e protocolos glicêmicos associados à insulinoterapia venosa. Conclui-se que há fatores de risco comuns à equipe multiprofissional e o conhecimento desses fatores permitirá a segurança dos pacientes na utilização dessa terapêutica.
Lean practices and thinking have increased substantially in the last few years. Applications of lean practices to health care are found worldwide. Despite that, new contributions are required because the application of lean thinking to hospitals has a long way to go. Lean practices and thinking do not include, in the literature or practice programs, any references to triage systems in health care units. The common triage systems require physical presence, but there are alternative methods to avoid the need to move patients: these alternative triage systems, given their characteristics, may be included in the spectrum of lean practices. Currently, patients that are already known to suffer from cancer are encouraged to go to hospital (public or private, with an oncological focus) when facing side effects from chemotherapy or radiation treatments; they are then submitted to a triage system (present themselves to the hospital for examination). The authors of this paper propose the introduction of telephone or email triage for impaired patients as a valid substitute for moving them physically, thereby often avoiding several unnecessary moves. This approach has, in fact, characteristics similar to a lean practice in that it reduces costs and maintains, if done properly, the overall service offered. The proposed ‘remote’ triage emerged from the results of a large survey sent to patients and also as the outcome of a set of semistructured interviews conducted with hospital nurses. With the results they obtained, the authors felt comfortable proposing this approach both to public and private hospitals, because the study was conducted in the most important, largest, and best-known oncological unit in Spain. As a final result, the health care unit studied is now taking the first steps to implement a remote triage system by telephone, and has begun to reduce the previously necessary movement of impaired patients.
RESUMO: Pesquisa com o objetivo de identificar os fatores predisponentes para hipoglicemia nos pacientes críticos que receberam infusão contínua de insulina. Estudo documental, retrospectivo, se rastrearam 550 prontuários dos anos de 2012 e 2013 de pacientes do pós-operatório de cirurgia cardíaca, dos quais 168 receberam insulina intravenosa e 74 apresentaram hipoglicemia grave. Os resultados principais apontam que entre os pacientes que apresentaram hipoglicemia grave, a maioria era do sexo masculino (60,11%), idosos (md=61,78), com sobrepeso (26,75Kg/m2,), hipertensos (78,57%) e isquêmicos(52,38%). Os fatores predisponentes encontrados para hipoglicemia,com significado estatístico foram ser diabético(OR=3,6), ter insuficiência renal(OR=5,4), em uso de aminas vasoativas(OR=3,1). Conclui-se que uma medida de segurança, para pacientes com estes fatores, é a coleta de amostras de sangue venoso e o uso de hemogasometros para a aferição da medida glicêmica. Palavras-Chave: Insulina; glicemia; hipoglicemia; enfermagem. ABSTRACT: Documentary, retrospective cross research aiming at describing the predisposing factors studied in critically ill patients receiving continuous insulin infusion. Tracking was made of five hundred and fifty (550) medical records for the years 2012 and 2013 of post-operative cardiac surgery patients who received intravenous insulin. Main results show that nearly half of the patients had at least one record of hypoglycemia, the majority were male (60.11%), elderly (md = 61.78), overweight (26,75Kg / m2), hypertense (78.57%), and ischemic (52.38%). Predisposing factors for hypoglycemia, with statistical significance identified among patients were as follows: diabetes (OR = 3.6); renal failure (OR = 5.4); and use of vasoactive amines (OR = 3.1). Conclusions identified security actions for patients in those conditions such as venous blood collection as well as the use of blood meters to assess glycemic levels.
Este artigo trata da disfagia decorrente de acidente vascular cerebral (AVC). O objetivo foi identificar o perfil das publicações sobre disfagia em pacientes vítimas de AVC. Pesquisa de revisão integrativa que usou os mesmos descritores nas bases Medline, Lilacs e Scielo, selecionando 17 artigos entre 1998 e 2008. Os dados foram analisados a partir das categorias correspondentes aos enfoques das publicações encontradas. Os resultados mostram dezessete artigos agrupados em duas categorias a que abordou a incidência e características da disfagia(9) e a que discutiu as complicações da disfagia(8). As publicações da primeira categoria mostram incidência de disfagia entre 30% e 91% e indicam que tamanho e localização da lesão são determinantes na gravidade da disfagia. A segunda categoria apresenta a pneumonia e desnutrição como consequencias da disfagia. Conclui-se que o enfermeiro deve nortear os cuidados direcionados a limitar o efeito da disfagia pós AVC e suas complicações para o paciente.
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