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A vigilância da pessoa em situação crítica sob entubação endotraqueal :
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Abstract(s)
A pessoa em situação crítica é aquela que se encontra sob um estado patológico agudo, que não detém a capacidade de autonomamente manter o seu equilíbrio fisiológico, aumentando o risco de rapidamente desenvolver instabilidade do mesmo. O cuidado individualizado à pessoa, bem como o seu estado crítico, definem e orientam a intervenção do enfermeiro, exigindo deste o desenvolvimento de um vasto leque de competências e conhecimentos que permitam a vigilância contínua da pessoa, bem como, a resposta célere suportada pela evidência científica, com o intuito de manter as funções vitais e prevenir possíveis complicações e incapacidades.
A manutenção de uma via aérea patente e permeável constitui o primeiro passo na abordagem à pessoa em situação crítica, sendo o tubo endotraqueal o dispositivo mais seguro para a sua conservação. Contudo, a existência do cuff na extremidade distal desta via aérea definitiva, aumenta a probabilidade de complicações associadas relacionadas com a pressão do mesmo e com a incorreta monitorização pelos enfermeiros, onde a sua intervenção é autónoma. Torna-se assim imperativo a implementação da vigilância de enfermagem promotora da segurança dos cuidados, através da prevenção e rápido reconhecimento de alterações na pessoa cuidada, assim como, o desenvolvimento de protocolos específicos que norteiem a monitorização da pressão do cuff.
O desenvolvimento deste documento, no âmbito do Curso de Mestrado em Enfermagem na Área de Especialização de Pessoa em Situação Crítica, tem como objetivo refletir o culminar de um percurso de desenvolvimento e aquisição de competências de enfermeiro mestre e especialista no cuidado à pessoa em situação crítica, em específico à pessoa sob intubação endotraqueal. O caminho percorrido teve como sustentação as sessões de orientação tutorial, a elaboração de uma revisão integrativa da literatura, a realização de estágios em dois contextos clínicos direcionados para o cuidado à pessoa em situação crítica e o investimento no estudo e reflexão individuais para suportar as necessidades de aprendizagem. Todas estas etapas foram norteadas pela Teoria da Vigilância de Meyer e Lavin (2005).
A person in critical situation is one who is in an acute pathological state, who does not have the ability to autonomously maintain their physiological balance, increasing the risk of quickly developing instability. Patient’s individualized care, as well as their critical condition, define and guide the nurse's intervention, requiring them to develop a wide range of skills and knowledge that enable continuous vigilance of the patient, as well as a rapid response supported by scientific evidence, in order to maintain vital functions and prevent possible complications and disabilities. Maintaining a patent and permeable airway is the first step while approaching a person in critical condition, and the endotracheal tube is the safest device for its preservation. However, the existence of the cuff at the distal end of this definitive airway, increases the probability of associated complications related to its pressure and incorrect monitoring by nurses, where their intervention is autonomous. It is therefore imperative to implement nursing vigilance that promotes safe care, through prevention and rapid recognition of changes in the patient being cared for, as well as the development of specific protocols to guide the monitoring of cuff pressure. The development of this document, within the scope of the Master's Degree in Nursing in the Specialization Area of Person in Critical Situation, aims to reflect the culmination of a journey of development and acquisition of master’s and specialist nurse skills in the care of persons in critical situations, specifically patients under endotracheal intubation. The path taken was supported by tutorial guidance sessions, the elaboration of an integrative literature review, internships in two clinical contexts specialized at taking care of patients in critical condition and investment in individual study and reflection to support learning needs. All these stages were guided by Meyer and Lavin's (2005) vigilance theory.
A person in critical situation is one who is in an acute pathological state, who does not have the ability to autonomously maintain their physiological balance, increasing the risk of quickly developing instability. Patient’s individualized care, as well as their critical condition, define and guide the nurse's intervention, requiring them to develop a wide range of skills and knowledge that enable continuous vigilance of the patient, as well as a rapid response supported by scientific evidence, in order to maintain vital functions and prevent possible complications and disabilities. Maintaining a patent and permeable airway is the first step while approaching a person in critical condition, and the endotracheal tube is the safest device for its preservation. However, the existence of the cuff at the distal end of this definitive airway, increases the probability of associated complications related to its pressure and incorrect monitoring by nurses, where their intervention is autonomous. It is therefore imperative to implement nursing vigilance that promotes safe care, through prevention and rapid recognition of changes in the patient being cared for, as well as the development of specific protocols to guide the monitoring of cuff pressure. The development of this document, within the scope of the Master's Degree in Nursing in the Specialization Area of Person in Critical Situation, aims to reflect the culmination of a journey of development and acquisition of master’s and specialist nurse skills in the care of persons in critical situations, specifically patients under endotracheal intubation. The path taken was supported by tutorial guidance sessions, the elaboration of an integrative literature review, internships in two clinical contexts specialized at taking care of patients in critical condition and investment in individual study and reflection to support learning needs. All these stages were guided by Meyer and Lavin's (2005) vigilance theory.
Description
Keywords
Enfermagem de cuidados intensivos Intubação intratraqueal Cuidados críticos Resultado do tratamento Cuidados de enfermagem Insuflação Pressão