Evolução de úlceras vasculares e o contexto do atendimento na rede municipal em uma cidade do interior do Brasil
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2014-07-10
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Universidade Federal de Goiás
Resumo
Analyze the conditions of care to people with vascular ulcers and the
evolution of venous ulcers and associated factors among users of the public
healthcare system in an interior city. The research integrated a cross-
sectional design with a cohort study, developed from July 2011 to October
2013, in an interior Brazilian Midwest city. It involved people with vascular
ulcers, the wound dressing units where this population was cared for and
nursing professionals who worked there. Data were collected using
interviews, clinical examinations, the Pressure Ulcer Scale Healing (PUSH),
planigraphy, photographic records of the lesions, samples collected from the
lesions for microbiological analysis, and a script for observation of the units.
The greatest ulcer was elected as the main lesion. Criteria were established
to detect ulcers considered to be infected and to classify the risk for cross-
contamination in the units. A questionnaire was used to approach the nursing
professionals. Associations were analyzed using a marginal homogeneity
test, McNemar and the chi-square test, with p<0.05. The research proposal
was approved by the Research Ethics Committee of the Federal University of
Goiás (protocol 026/2011). Initially,31 people with vascular ulcers undergoing
treatment at the 13 wound dressing units of the studied city were included. All
units presented conditions classified as highly susceptible to cross-
contamination. Of the 31 assessed ulcers, 29 (93.5%) presented evidence of
infection. Samples could be collected from 25 lesions, and a positive result in
culture was found for 23 (92.0%), with presence of one to three
microorganisms. Seven (20.0%) occurrences were found for oxacillin-
resistant staphylococcus, four (11.4%) forampicillin-resistant enterococci, and
two (5.7%) for beta-lactam-resistant pseudomonasaeruginosa. Of the 26
participants with venous ulcers, 22 were included in the cohort and presented
a mean age of 57.9 years, ulcers of median duration of 24 months
(SD±32.8), covering an area up to 12 cm 2 (63.5%). An 18.2% healing rate
was found in the follow-up from 6 to 15 months, with improvement in the
condition of the ulcers, as evidenced by decreased total scores in the PUSH
(p=0.041). Aggravation in healing conditions was associated with clinical
signs of infection in the lesions (p=0.019). Regarding self-care, there was a
prevalence of reports of care with feeding and rest, which did not agree with
the recommendations in literature, and the use of medications to control
systemic diseases. Among the 53 nursing professionals who worked in the
units, nursing technicians (56.6%) prevailed. Of the 411 activities referred in
the care of people with vascular ulcers, 392 were mapped in theNursing
Intervention Classification, with 53.3% corresponding to the “wound/skin
control” class, demonstrating that care is focused on the topical treatment of
the lesion. In a context of limitations in the care of users, the evolution of the
healing of ulcers in follow-up was found favorable, however, the healing rate
was significantly low. This context points to the need to reorganize public
policies for the care of people with vascular ulcers, as well as the model of
management of care to this population.
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MALAQUIAS, Suelen Gomes. Evolução de úlceras vasculares e o contexto do atendimento na rede municipal em uma cidade do interior do Brasil. 2014. 277 f. Tese (Doutorado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2014.