CAMILA TAKAO LOPES
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- Nursing diagnoses and interventions for a child after cardiac surgery in an intensive care unit(2015) CAVALCANTE, Agueda Maria Ruiz Zimmer; BRUNORI, Evelise Helena Fadini Reis; LOPES, Camila Takáo; SILVA, Andréa Braz Vendramini; HERDMAN, T. HeatherObjetivo: descrever o julgamento clínico de enfermagem para identificar diagnósticos NANDA e desenvolver um plano de tratamento NIC para uma criança em pós-operatório de cirurgia cardíaca em terapia intensiva. Método: estudo de caso com coleta de dados retrospectiva no prontuário. Resultados: três enfermeiras identificaram diagnósticos NANDA e intervenções NIC. Criança de 6 meses, submetida a cirurgia cardíaca, necessitou oxigenação extracorpórea por membrana no pós-operatório. Foram identificados quatro principais diagnósticos, aos quais foram direcionadas dez intervenções. A proposta de intervenções para responder às necessidades humanas prioritárias da criança foi otimizada pelo uso das terminologias padronizadas. Todos os diagnósticos foram sustentados por indicadores diagnósticos; todas as intervenções foram cientificamente sustentadas. Conclusão: espera-se que os enfermeiros abordem não somente as respostas fisiológicas, mas também aquelas dos domínios psicossociais.
- Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study(2015) LOPES, Camila Takao; BRUNORI, Evelise Helena Fadini Reis; CAVALCANTE, Agueda Maria Ruiz Zimmer; MOORHEAD, Sue Ann; LOPES, Juliana de Lima; BARROS, Alba Lucia Bottura Leite deObjective: To identify predictors of red blood cell transfusion (RBCT) after cardiac surgery. Method: A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. Results: The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count < 150x10(3)/mm(3), lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. Conclusion: Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.
- Excessive bleeding predictors after cardiac surgery in adults: integrative review(2015) LOPES, Camila Takao; SANTOS, Talita Raquel dos; BRUNORI, Evelise Helena Fadini Reis; MOORHEAD, Sue A.; LOPES, Juliana de Lima; BARROS, Alba Lucia Bottura Leite deAims and objectivesTo integrate literature data on the predictors of excessive bleeding after cardiac surgery in adults. BackgroundPerioperative nursing care requires awareness of the risk factors for excessive bleeding after cardiac surgery to assure vigilance prioritising and early correction of those that are modifiable. DesignIntegrative literature review. MethodsArticles were searched in seven databases. Seventeen studies investigating predictive factors for excessive bleeding after open-heart surgery from 2004-2014 were included. ResultsPredictors of excessive bleeding after cardiac surgery were: Patient-related: male gender, higher preoperative haemoglobin levels, lower body mass index, diabetes mellitus, impaired left ventricular function, lower amount of prebypass thrombin generation, lower preoperative platelet counts, decreased preoperative platelet aggregation, preoperative platelet inhibition level >20%, preoperative thrombocytopenia and lower preoperative fibrinogen concentration. Procedure-related: the operating surgeon, coronary artery bypass surgery with three or more bypasses, use of the internal mammary artery, duration of surgery, increased cross-clamp time, increased cardiopulmonary bypass time, lower intraoperative core body temperature and bypass-induced haemostatic disorders. Postoperative: fibrinogen levels and metabolic acidosis. ConclusionsPatient-related, procedure-related and postoperative predictors of excessive bleeding after cardiac surgery were identified. Relevance to clinical practiceThe predictors summarised in this review can be used for risk stratification of excessive bleeding after cardiac surgery. Assessment, documentation and case reporting can be guided by awareness of these factors, so that postoperative vigilance can be prioritised. Timely identification and correction of the modifiable factors can be facilitated.
- Clinical usefulness of the definitions for defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output in decompensated heart failure: a descriptive exploratory study(2015) SOUZA, Vanessa de; ZEITOUN, Sandra Salloum; LOPES, Camila Takao; OLIVEIRA, Ana Paula Dias de; LOPES, Juliana de Lima; BARROS, Alba Lucia Bottura Leite deAims and objectivesTo assess the clinical usefulness of the operational definitions for the defining characteristics of the NANDA International nursing diagnoses, activity intolerance, decreased cardiac output and excess fluid volume, and the concomitant presence of those diagnoses in patients with decompensated heart failure. BackgroundContent validity of the operational definitions for the defining characteristics of activity intolerance, excess fluid volume and decreased cardiac output have been previously validated by experts. Their clinical usefulness requires clinical validation. DesignThis was a descriptive exploratory study. MethodsTwo expert nurses independently assessed 25 patients with decompensated heart failure for the presence or absence of 29 defining characteristics. Interrater reliability was analysed using the Kappa coefficient as a measure of clinical usefulness. The Fisher's exact test was used to test the association of the defining characteristics of activity intolerance and excess fluid volume in the presence of decreased cardiac output, and the correlation between the three diagnoses. ResultsAssessments regarding the presence of all defining characteristics reached 100% agreement, except with anxiety. Five defining characteristics of excess fluid volume were significantly associated with the presence of decreased cardiac output. Concomitant presence of the three diagnoses occurred in 80% of the patients. However, there was no significant correlation between the three diagnoses. ConclusionsThe operational definitions for the diagnoses had strong interrater reliability, therefore they were considered clinically useful. Only five defining characteristics were representative of the association between excess fluid volume and decreased cardiac output. Therefore, excess fluid volume is related to decreased cardiac output, although these diagnoses are not necessarily associated with activity intolerance. Relevance to clinical practiceThe operational definitions may favour early recognition of the sequence of responses to decompensation, guiding the choice of common interventions to improve or resolve excess fluid volume and decreased cardiac output.