Nursing outcomes for patients with multiple traumas and impaired physical mobility: An integrative review

PURPOSE

This research identifies nursing outcomes for patients with multiple traumas who present changes in physical mobility.

METHODS

This was a thorough literature review, following Whittemore and Knafl's method and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses´ guidelines (2005) and adopting the Oxford Center for Evidence-Based Classification Medicine-Levels of Evidence (2011). The literature search included databases from Virtual Health Library, Cochrane Library, Excerpta Medica Database, Medical Literature Analysis and Retrieval System Online, PubMed, SciVerse Scopus, The Cumulative Index to Nursing and Allied Health Literature, and Web of Science. It was conducted between October and December 2019 and updated in April 2022.

FINDINGS

Upon our first analysis of the 254 articles that could correlate to the present study, we concluded that 15 of them are of foremost relevance. The nursing outcomes found are correlated with skin care, position in hospital bed, pressure injury prevention, self-care assistance to bath, intimate, and oral hygiene, pain control, circulatory precaution, and impaired physical mobility assistance. All of these outcomes are directly or indirectly involved with the consequences of mobility impairment.

CONCLUSIONS

The main nursing outcomes of our research identified for patients with multiple traumas were related to mobility, the consequences of immobility, self-care, and skin maintenance. In conclusion, this review highlights the importance of measuring outcomes related to the provision of nursing care.

IMPLICATIONS FOR NURSING PRACTICE

The nursing outcomes classification provides results that can be used across the continuum of care to assess the patient's status after nursing interventions. It also allows for improved care for multiple trauma patients who have altered mobility, identifying the real needs of these patients.

Accuracy of delirium risk factors in adult intensive care unit patients

OBJECTIVE

To assess the accuracy measurements for predisposing and precipitating Risk Factors for delirium in an adult Intensive Care Unit.

METHOD

Cohort, prospective study with patients over 18 who had been hospitalized for over 24 hours and were able to communicate. The patients were assessed once a day until the onset of delirium or permanence in the Intensive Care Unit. Instruments were employed to track delirium, characterize the sample, and identify the risk factors. Descriptive statistics was employed for sample characterization and accuracy tests for risk factors.

RESULTS

The included patients amounted to 102, 31 of which presented delirium. The predisposing predictive risk factors were hypoalbuminemia, American Society of Anesthesiology over three, severity, altered tissue perfusion, dehydration, and being a male, whereas precipitating predictive factors were physical restraint, infection, pharmacological agent, polypharmacy, anemia, altered renal function, dehydration, invasive devices, altered tissue perfusion and altered quality and quantity of sleep.

CONCLUSION

An accurate identification of predisposing and precipitating risk factors may contribute to planning preventive measures against delirium.

Classification tree for the inference of the nursing diagnosis Fluid Volume Excess (00026)

OBJECTIVE

To generate a Classification Tree for the correct inference of the Nursing Diagnosis Fluid Volume Excess (00026) in chronic renal patients on hemodialysis.

METHOD

Methodological, cross-sectional study with patients undergoing renal treatment. The data were collected through interviews and physical evaluation, using an instrument with socio-demographic variables, related factors, associated conditions and defining characteristics of the studied diagnosis. The classification trees were generated by the Chi-Square Automation Interaction Detection method, which was based on the Chi-square test.

RESULTS

A total of 127 patients participated, of which 79.5% (101) presented the diagnosis studied. The trees included the elements "Excessive sodium intake" and "Input exceeds output", which were significant for the occurrence of the event, as the probability of occurrence of the diagnosis in the presence of these was 0.87 and 0.94, respectively. The prediction accuracy of the trees was 63% and 74%, respectively.

CONCLUSION

The construction of the trees allowed to quantify the probability of the occurrence of Fluid Volume Excess (00026) in the studied population and the elements "Excessive sodium intake" and "Input exceeds output" were considered predictors of this diagnosis in the sample.

Micellar effects and analytical applications of nitro substitution in 4-Nitro-N-alkyl-1,8-naphthalimide by cysteine derivatives

The aromatic nucleophilic substitution reactions of the nitro group of 4-Nitro-N-alkyl-1,8-naphthalimides by thiolate anions produce fluorescent derivatives and their rates are strongly accelerated by micelles of hexadecyltrimethylammonium chloride even at low pH. Acceleration factors of this reactions can reach million-fold. As the products are oxidant-insensible, this reaction allows the determination of SH- containing compounds such as cysteine, glutathione or proteins even in oxidative conditions. Limits of detection are as low as 5 × 10⁻⁷ M, ten times lower than the limit for the classic 5,5′-dithiobis-(2-nitrobenzoic) acid method. Moreover, this reaction can be developed at pHs between 6.5 and 7.5 thereby diminishing the rate of spontaneous oxidation of the thiols. In addition, we demonstrated that 4-Nitro-N-alkyl-1,8-naphthalimides can be used to evidence SH groups in peptides, proteins and living cells.

DISTURBED SLEEP PATTERN (000198): CONTENT ANALYSIS IN PATIENTS WITH ACUTE CORONARY SYNDROME

ABSTRACT Objective: to analyze the content of the defining characteristics of the Disturbed Sleep Pattern Nursing Diagnosis (00198) in patients with Acute Coronary Syndrome. Method: content analysis performed by specialists who achieved a score equal to or greater than five, according to established criteria: clinical experience, teaching and/or research; participation in research groups; doctorate degree; master's degree; specialization and/or residency in cardiology and/or sleep and/or nursing classifications. Eight defining characteristics were evaluated for their relationship to population, relevance, clarity and accuracy. Descriptive statistics were performed to characterize the sample, binomial statistical test to establish if there is agreement between the experts and chi-square and Fisher's exact to establish associations between the evaluated items and the experts' variables. Results: 54 experts participated in the study. The defining characteristics validated by the experts were the following: dissatisfaction with sleep, feeling unrested, sleep deprivation, alteration in sleep pattern, unintentional awakening, difficulty initiating sleep and daytime sleepiness. There was a statistically significant association between evaluated items and the variables time of training, time of operation and punctuation. Conclusion: seven of the eight defining characteristics were considered valid after the application of binomial test. This study will contribute to the refinement of the Disturbed Sleep Pattern Nursing Diagnosis (000198) and may enable the improvement of the quality of care of patients hospitalized with Acute Coronary Syndrome regarding changes in sleep pattern. The content analysis stage will support the next stage of the validation process of the present diagnosis, the clinical validation.

Hb40-61a: Novel analogues help expanding the knowledge on chemistry, properties and candidacidal action of this bovine α-hemoglobin-derived peptide

This study expands the knowledge on chemical synthesis and properties of Hb40-61a as well as provides results of the first steps given towards knowing how it kills Candida cells. For the first time, this peptide, its all-D analogue (D-Hb40-61a) and its fluorescently labeled analogue (FAM-Hb40-61a) were successfully assembled on resin at 60°C using conventional heating in all steps. Purified and characterized, these peptides exhibited very low toxicity on human erythrocytes. Hb40-61a and D-Hb40-61a were equally active against Candida strains, ruling out sterically specific interactions on their working mechanism. Cell permeabilization assays confirmed progressive damage of the yeast plasma membrane with increasing concentrations of Hb40-61a. While experiment using the fluorescent probe DiBAC4(5) revealed that this synthetic hemocidin alters the yeast plasma membrane potential, test employing DPH indicated that Hb40-61a might affect its dynamics. Exposure of the yeast cells to FAM-Hb40-61a showed that the peptide accumulates in the cell membrane at the ½ MIC, but stains about 97% of the cells at the MIC. Such effect is salt-dependent and partially energy-dependent. These new findings indicate that the central target of Hb40-61a in Candida cells is the plasma membrane and that this synthetic hemocidin should be considered as a potential candidacidal for topic uses.