Nursing care in the transfusion of blood components to surgical patients in the perioperative period

Introduction: blood transfusion consists of the administration of blood components intravenously in clinical or surgical treatments. In the preoperative period, it is performed with the objective of improving tissue oxygenation, as well as promoting hemodynamic and hemostatic balance. Objective: to understand nursing care in the transfusion of blood components to surgical patients in the perioperative period. Method: this is a descriptive and exploratory study with a qualitative approach. Grounded Theory was used, with constant comparative analysis. A total of 18 nurses and 28 nursing technicians from a university hospital took part in the study. Data were collected between October 2019 and February 2020, through a sociodemographic questionnaire and semi-structured interviews. Results: the study resulted in the central category nursing care during transfusion, which gave rise to the categories: caring for before transfusion; caring for during transfusion; and caring for after transfusion, which were discussed according to the standardized nursing methodology. Conclusion: it was understood that nursing care is planned and implemented following an ordering of practices in a logical sequence due to the characteristics of the procedure in the perioperative period. Nurses demand indirect care; in contrast, nursing technicians engage in direct patient care.

Trajectory of the Victims of Overland Transport Accidents: From Prehospital to Hospital Care

Objective

The aim is to evaluate the trajectory of the victims of ground transportation accidents from the prehospital care to the hospital.

Methods

The sample consisted of 1,264 patients collected from the prehospital care, from June 2015 to June 2016. The trajectory was analyzed by the difference in the average time elapsed between the call and the hospital entrance. The Mann–Whitney and Kruskal–Wallis tests were used, adopting a significance level of 5% and 95% confidence.

Results

Patients had a mean age of 31.2 years, Glasgow Coma Scale of 14.8 points, and 24.8 days of hospitalization. It is characterized predominantly masculine, conductive of the vehicle, being the motorcycle prevalent; most of them wore a helmet/seat belt and no alcohol. The association between the average time of care and the characteristics related to the victim was significant: the use of the belt/helmet, alcoholism, and type of discharge and relative to the accident: area of occurrence, period of the week, shift of occurrence, type of prehospital care, and other party involved.

Conclusion

The characteristics related to ground transportation accident interfere in the time of prehospital care to the hospital, which can influence the prognosis.

Factors associated with current tobacco use among adolescents and young students

OBJECTIVES

To determine the prevalence of current tobacco use and its association with sociodemographic factors and risk behaviors among adolescents and young students, according to gender.

METHODS

The sample consisted of students from the state public school network aged between 12 and 24 years, who answered the Brazilian version of the Youth Risk Behavior Survey questionnaire. The data were analyzed in SPSS software (v. 20.0), using Poisson regression to evaluate the prevalence ratio (PR) of the independent variables in relation to the outcome. p<0.05 was established as the significance level.

RESULTS

The final analysis consisted of 1275 adolescents, of whom 716 (56.2%) were girls and 559 (43.8%) were boys. The prevalence of current tobacco use was 6.6% among girls and 9.7% among boys. In females, consuming alcohol in the last 30 days (3.91 [1.54-9.94]) and being 14 years old or younger (0.50 [0.26-0.96]) influenced current tobacco use. In the male gender, tobacco use in the last 30 days was influenced by current alcohol consumption (2.92 [1.21-7.08]) and involvement in physical fighting in the last 12 months (2.32 [1.32-4.09]).

CONCLUSION

Although the prevalence of current tobacco use was low in both genders, the assessed population still presents a risk, since male involvement in physical fighting and current consumption of alcohol in both genders increased the probability of this population becoming regular tobacco users.

Prevalência e fatores associados à ocorrência de lesão por pressão em pacientes internados em unidade de terapia intensiva

Introdução: A Unidade de Terapia Intensiva é o ambiente mais susceptível ao desenvolvimento de lesão por pressão devido ao estado crítico dos pacientes, representando campo importante para compreensão dos fatores desencadeantes deste evento a fim de preveni-lo. Objetivo: Avaliar a prevalência e os fatores associados ao surgimento de lesão por pressão em pacientes internados em uma unidade de terapia intensiva. Material e métodos: Estudo quantitativo, analítico e documental. Para a análise dos dados foi realizada estatística descritiva e inferencial. Os fatores associados foram analisados por meio da regressão logística binária. Adotou-se significância de 5% e confiança de 95%. Resultados: A amostra totalizou 566 prontuários de pacientes, sendo prevalente o sexo masculino, entre 20 e 39 anos de idade. Foi prevalente a ausência de lesão por pressão na admissão, como também o não desenvolvimento durante o internamento, embora a maioria dos pacientes apresentasse risco moderado para o desenvolvimento de lesão por pressão pela escala de Braden. Houve prevalência de 22,3% no surgimento de lesão por pressão, mesmo na existência do protocolo preventivo no setor. Os fatores associados ao surgimento de lesão por pressão foram a urgência/sala vermelha como setor de procedência (p=0,032) e o tempo de internamento igual ou superior a dez dias (p=0,029). Conclusão: Os resultados deste estudo evidenciaram prevalência relevante visto que a ocorrência de lesões por pressão é considerada um evento adverso relacionado ao internamento e a assistência prestada ao paciente crítico.

Risky sexual behaviors and their association with overweight and obesity among adolescent students: a cross-sectional study

Objective

To determine the prevalence of risky sexual behavior and its association with overweight and obesity among adolescent students.

Methods

This is a cross-sectional study, conducted in public schools with adolescents aged 12 to 17 years. We used the questionnaire Youth Risk Behavior Survey. The body mass index percentiles were calculated by means of table from the Center for Control and Prevention of Diseases. Possible associations were assessed using the χ² test and binary logistic regression model. The odds ratio and 95%CI were calculated.

Results

We evaluated 1,169 students, and 33.9% reported having had sexual intercourse. Of those, 33% did not use a condom during their last intercourse, and 32.7% had had four or more sexual partners thus far. Regarding nutritional status, 15.3% were overweight or obese. In relation to the non-use of condoms, we observed only an association with the number of lifetime sexual partners (OR: 0.50; 95%CI: 0.28-0.88). The number of lifetime sexual partners was associated with males (OR: 9.17; 95%CI: 4.16-20.22), sexual debut age at 13 years or less (OR: 2.51; 95%CI: 1.23-5.13) and drinking alcohol or using drugs before the last intercourse (OR: 6.16; 95%CI: 2.14-17.73).

Conclusion

Risky sexual behavior rates were high and no association was found between risky sexual behaviors and overweight and obesity.

Congenital malformations in neonates: analysis of morbidity and associated factors

Objective: To evaluate the neonatal morbidity due to congenital malformations in the city of Petrolina-PE, from 2008 to 2013. Methods: A descriptive study with data from the Information System on Live Births (Sinasc). The analyzes were carried out through frequency distribution and measures of central tendency and dispersion. The associations were tested by the Pearson and Kruskal Wallis chi-square tests. Significance was set at 5% and 95% confidence. Results: 436 cases of congenital malformations were recorded in the study period, with 2011 being the highest occurrence year. The mothers of the newborns were young (25.2 years old), single, upper level of education and household. In general multiparous, with single gestation, vaginal delivery and performed up to six prenatal visits. The newborns were males, at 39 weeks or more of gestation and with normal weight (> = 2500g). The malformations of the musculoskeletal system were the most frequent followed by the genitourinary system. Congenital malformations were especially associated with neonatal characteristics such as gender and weight. In all causes the mean weight was greater than 2500g (p <0.05). The causes of malformation of greater occurrence in both sexes were osteomuscular (p <0.05). The aspects of the mother did not present significant differences in the present study (p> 0.05). Conclusion: The present study evidenced relevant aspects in the occurrence of morbidities due to congenital malformations, directing to a greater attention the occurrence of these diseases especially in relation to the newborn.

Factors associated with mortality in a neonatal intensive care unit

Aims: To describe the factors associated with mortality of newborns hospitalized in a Neonatal Intensive Care Unit in the period from 2012 to 2015. Methods: This was a descriptive, quantitative study of secondary data, correlated with the causes of death and hospitalization according to classification by ICD-10.  The categorical variables were presented in absolute and relative frequencies, with measurements of central tendency and dispersion. Evaluation of the factors associated with neonatal death was made by the logit model of analysis with correction of robust errors by the statistical program Stata 12.0, considering values of p<0.05 and interval of confidence of 95%.  Results: Of the 563 newborns, 58.6% were of the male sex; 89.0% were early newborns, 73.0% were premature. 181 newborns died (32.3%). The main causes of hospitalization were: difficulties during birth, conditions of birth and immaturity (45.0%), pathologies associated with the respiratory system (21.1%), congenital malformations (9.7%). The main causes of death were: septicemia of the NB (40.4%), respiratory discomfort of the NB (22.4%). The significant associations for mortality were the use of ventilatory supports: Mechanical Ventilation (p=0.001), Hallo (p=0.000), CPAP (p=0.000), VNI (p=0.005). Conclusions: The major risk factors for neonatal mortality were associated with septicemia and use of mechanical ventilation.

Nursing Care of Individuals in Domestic Violence Situations

Objective: This study aimed to analyze the nursing care of individuals in situations of domestic violence, assisted in the hospital emergency room. Methods: This qualitative survey was conducted in May, 2015, with fifteen nurses from hospital emergencies in Juazeiro/Bahia and Petrolina/Pernambuco. Data was collected through semi-structured interviews and analyzed by content analysis. Results: Nurses do not see domestic violence in all its aspects, but understand the bureaucracy of services. Conclusion: Physical structure; lack of protocols, and the little knowledge acquired during graduation, which are limiting factors when faced with the measures required in cases of violence.

Condom use and alcohol consumption in adolescents and youth

OBJECTIVE

To determine the association between not using the male condom and alcohol consumption in adolescents and schoolchildren.

METHODS

An epidemiological study, with a cross-sectional, descriptive, and correlation design carried out from March to July 2014. The sample consisted of students in public primary and secondary education, aged between 12 and 24 years. The social and demographic survey and the Youth Risk Behavior Survey questionnaire were used.

RESULTS

The study included 1,275 students, of these; 37.0% reported having had sexual relations. The prevalent age of sexual initiation was 14-16 years 55.7% and 65.6% used condom in the last sexual intercourse. Regarding the lack of condom use at the last intercourse, girls showed an association with drunkenness in the previous 30 days (2.19; 95%CI: 1.06-4.54).

CONCLUSION

In females, the non-use of condoms was associated with drunkenness in the previous 30 days.

OBJETIVO

Identificar os fatores associados ao não uso de preservativo masculino e ao consumo de bebida alcoólica em adolescentes e jovens escolares.

MÉTODOS

Estudo epidemiológico, com delineamento transversal, descritivo e correlacional, desenvolvido de março a julho de 2014. A amostra foi composta por estudantes dos Ensinos Fundamental e Médio da rede pública estadual, com idades entre 12 e 24 anos. Empregaram-se o inquérito sociodemográfico e o questionário Youth Risk Behavior Survey.

RESULTADOS

Foram incluídos 1.275 estudantes; 37,0% deles relataram terem tido relação sexual. A idade prevalente de iniciação sexual foi de 14 a 16 anos, com 55,7%; 65,6% usaram preservativo na última relação. Com relação ao não uso de preservativo na última relação, as meninas apresentaram associação com bebedeira nos últimos 30 dias (2,19; IC95%: 1,06-4,54).

CONCLUSÃO

O não uso de preservativos esteve associado com bebedeira nos últimos 30 dias nas meninas.

Correlation between semen parameters of electroejaculates and achieving pregnancy by intrauterine insemination

OBJECTIVE

To investigate whether any parameter in the routine semen analysis of electroejaculates is correlated with success in achieving pregnancy by IUI.

DESIGN

Retrospective observational study.

SETTING

An Assisted Reproductive Program at a tertiary care university center.

PATIENT(S)

Twenty-seven anejaculatory men with spinal cord injury (n = 24) or history of retroperitoneal lymph node dissection (n = 3), thirteen of whom attempted conception with their wives.

INTERVENTION(S)

Anejaculatory men underwent rectal probe electroejaculation and electroejaculates were used for IUI.

MAIN OUTCOME MEASURE(S)

Statistical correlation of semen parameters between electroejaculates that resulted in pregnancy and those that did not.

RESULT(S)

Seven pregnancies resulted from 56 IUIs using electroejaculates (pregnancy rate = 12.5% per IUI). The total motile sperm count and percentage of normal morphology were significantly higher in the specimens that resulted in pregnancies than those that did not. However, there was no statistically significant difference observed in pH, sperm concentration, or percentage of motility between the two groups. Swim-up techniques used to process electroejaculates significantly improved the motility of the specimens. No pregnancy occurred beyond the fifth IUI attempt. Repeated electroejaculation and duration of spinal cord injury had no effect on the quality of the ejaculates.

CONCLUSION(S)

The total motile sperm count and the percentage normal morphology of electroejaculates correlate with success in achieving pregnancy by IUI. Because repeated electroejaculation does not improve quality of ejaculate, the initial semen analysis of electroejaculates is not only useful in counseling couples undergoing such treatment program but should be planned for use as an inseminate.

Inhibition of H+ secretion in the turtle bladder by colchicine and vinblastine

In order to investigate a possible role of the microtubules in urinary acidification we measured H+ secretion by the turtle bladder in vitro before and after addition of either colchicine or vinblastine to the serosal phase. Both colchicine and vinblastine inhibited H+ secretion in a dose-dependent fashion; in the control hemibladders H+ secretion remained unchanged. The half-maximal inhibition of H+ secretion occurred at 5.2 x 10(-5) M for colchicine and 7.2 x 10(-6)M for vinblastine. The inhibitory effect of colchicine and vinblastine on H+ secretion was maximal at 10(-4)M and 5 x 10(-4)M, respectively. At these concentrations these compounds failed to alter SCC and resistance. The inhibition of H+ secretion by colchicine or vinblastine increased with time of exposure to the drugs. The effect of colchicine or vinblastine on H+ secretion was not reversible with removal of the drug or with addition of 5% CO2 in the serosal phase. Lumicolchicine, an isomer of colchicine devoid of capacity to interact with microtubules, failed to alter the rate of H+ secretion, suggesting that the observed effect of colchicine on H+ secretion was the result of disruption of microtubule function and not the consequence of nonspecific effect of the drug. These data provide evidence for a role of microtubules in urinary acidification by the turtle bladder in vitro, but an effect of these drugs on membrane-bound tubulin cannot be excluded.

On the mechanism of lithium-induced renal tubular acidosis: studies in the turtle bladder

The mechanism whereby lithium impairs urinary acidification was investigated in vitro with the bladder of the fresh water turtle. The effect of lithium was compared to that of choline or cesium. In the presence of 1% carbon dioxide, lithium (40 mM in the mucosa) failed to alter hydrogen ion secretion. Lithium also caused a significant decrease in sodium transport and in potential difference. Lithium failed to increase the passive loss of hydrogen ions from the mucosal solution, indicating that it does not affect the permeability of the mucosa to hydrogen ions. Bicarbonate secretion also was unchanged in lithium-treated hemibladders. Under open-circuit conditions, lithium caused a significant decrease in potential difference and, hence, caused a significant decrease in hydrogen ion secretion. Restoration of the potential difference, in the presence of lithium, to control levels caused a return of hydrogen ion secretion to the original value. These data demonstrate that in the turtle baldder lithium inhibits hydrogen ion secretion solely by reducing the potential difference and suggest that in vivo lithium causes an acidification defect not by directly inhibiting the hydrogen ion pump or causing a hydrogen ion backleak but by inhibiting sodium transport, thereby decreasing the favorable electric gradient for hydrogen ion secretion.

Effect of calcium and magnesium on transport processes by the turtle bladder

The role of the changes in intracellular concentration of Ca and Mg in Na and H+ transport by the turtle bladder in vitro was studied with the use of the ionophore A23187. This ionophore increases the permeability of living and artificial membranes to divalent cations. In the presence of a minimal concentration of Ca (0.2 mM), which is necessary for the membranes to remain stable, the ionophore failed to alter the rate of Na transport or H+ secretion in the presence of 2.5 mM Mg. These data demonstrate that changes in intracellular Mg do not play an important role in Na or H+ transport by the turtle bladder. In the presence of 1.8 mM Ca the ionophore caused a significant decrease in Na transport as compared to control hemibladders treated with dimethylsulfoxide, the vehicle used to dissolve the ionophore. In the presence of a minimal concentration of Ca (0.2 mM) the ionophore failed to alter the rate of Na transport. These observations demonstrate that the decrease in Na transport in the presence of Ca was the result of changes in intracellular Ca concentration rather than a non-specific effect of the ionophore. The data further demonostrate that calcium plays an important role in Na transport by the turtle bladder but that Mg does not seem to be important in the regulation of Na or H+ transport by this membrane.