"Diagnósticos de enfermagem em vítimas de trauma no atendimento avançado pré-hospitalar móvel"

Abstract

The aim of this study was to identify the nursing diagnoses of adult trauma victims in the pre-hospital attendance. The research methodology used was a descriptive, qualitative, case study strategy. It was based on Horta's Conceptual Model and the ATLS (Advanced Trauma Life Support) theoretical framework. The researcher collected data in the SAMU-192 pre-hospital intensive care ambulance, from the Advanced Vital Support Unit, in Ribeirão Preto (SP), Brazil during the period of January to June 2004, using a previously validated instrument for data collection. The sampling was made up of 23 adult trauma victims, of 18 years or older. After data collection the nursing diagnostics were identified through a rational thought process and forming of diagnostic categories based on the NANDA (North American Nursing Diagnosis) taxonomy II. Both the collected data and nursing diagnoses elaborated by the researcher were analyzed by five other nurses with experience in trauma care and specific Knowledge of nursing diagnosis and afterwards, the suggestions made were reviewed and accepted. During the advanced mobile prehospital assistance 24 nursing diagnoses were identified, 15 of which were actual problems and 9 were at risk of occurring.Of the latter, the factors with a 50% or higher at risk status were infection, trauma, acute pain and tissue integrity damage. The other diagnoses that were established included: ineffective airway clearance (17%), ineffective breathing pattern(30%), risk for aspiration (22%), risk for altered breath pattern (13%), fluid volume deficit (43%), risk for fluid volume deficit (43%), altered peripheral tissue perfusion (13%),. altered cerebral tissue perfusion (30%), altered gastrointestinal tissue perfusion (8%), risk for peripheral neurovascular dysfunction (39%), visual sensory/perceptual alterations (4%), tactile and kinesthetic sensory/perceptual alterations (22%), acute confusion (17%),risk for altered corporal temperature (34%), damaged skin integrity (22%), impaired physical mobility (22%),risk for falling, anxiety (43%), fear (4%) and risk for self directed violence (4%). We verify that the group of disgnostic represents the gravity of the victim for identifying alterations in vital organic systems.

Diagnósticos de enfermagem em vítimas de trauma nas primeiras seis horas após o evento

“…This finding, in line with another Brazilian study (12) , appoints the need for safety measures in invasive interventions at the emergency sector and in pre-hospital care, considering the large number of invasive procedures victims need and, at the same time, their increased environmental exposure to pathogens in care delivery to trauma cases. The need for rapid procedures does not make it less important to respect the technical premises of asepsis and antisepsis in their accomplishment, as ignoring them negatively affects the patient's evolution, mainly when considering the fragility of victims' vital condition.…”

“…Nursing protocols should be developed and applied to practice the most common invasive procedures, and their outcomes should be disseminated and refined to improve the actions, which are sometimes done mechanically and hardly effective (13) . Impaired skin integrity and impaired tissue integrity are closely related with the most frequent injuries in trauma victims: external surface and limb injuries (12) . Reaffirming this relation, these diagnoses show physical immobilization, impaired sensations, altered circulation and impaired physical mobility as the most frequent related factors, besides disruption of skin surface, destruction of skin layer, injured tissue and destroyed tissue, as defining characteristics.…”

Intervenções de enfermagem para situações de volume de líquidos deficientes: aplicabilidade da NIC no atendimento avançado pré-hospitalar móvel

“…É fato que assistir uma vítima em risco de vida não nos exime da obrigação de prestar cuidados individualizados, direcionados não somente aos problemas físicos, mas também aos originados de suas emoções e segurança. Esta pessoa diante de uma situação de ameaça de perda da vida sofre a perda da independência, de valores, de crenças dentre outras características pessoais (SHAPIRO, 2000;CYRILLO, 2005).…”

“…No âmbito do Atendimento Pré-hospitalar (APH) Avançado Móvel, quando o enfermeiro se propõe a instrumentalizar seu raciocínio para o cuidado a ser prestado, à luz de um referencial teórico, é identificado um comportamento relevante nesta conduta, pois é a crença, o conhecimento ténico-científico, os valores éticos e os referenciais humanitários que conduzirão as ações do enfermeiro. A autonomia de suas ações nessa prática está fundamentada em sua capacidade de realizar a avaliação clínica, conduzir e organizar seu trabalho visando ao restabelecimento e à manutenção da vida (CYRILLO, 2005). (COREN, 1999).…”

“…Este estudo baseou-se nos resultados da pesquisa de Cyrillo (2005), no qual foram caracterizados os diagnósticos de enfermagem da North American Nursing Diagnosis Association -NANDA em vítimas de trauma no APH Avançado Móvel, como parte do processo de enfermagem para essa fase da assistência.…”