Úlcera de pressão em pacientes internados em um hospital universitário em Natal/RN: condições predisponentes e fatores de risco

The pressure ulcers (PU), also known as decubitus ulcers, are defined as injuries caused by the constant pressure exerted on a particular point of the body, causing impairment of blood supply with a decrease or interruption of tissue irrigation, causing occlusion of blood vessels and capillaries, ischemia and cell death. This is a descriptive study with longitudinal design, and panel type, with quantitative approach that aimed to examine the association between predisposing conditions (PC), intrinsic factors (IF) and extrinsic factors (EF) with the occurrence of PU, in hospitalized patients in the Intensive Care Unit (ICU), pain clinical, surgical clinical and neurology wards of a university hospital. The study population was composed of all patients who were restricted to bed during the period from December 2007 to February 2008. The study was approved by the Ethics Committee of HUOL / UFRN (No 135/07). The data-collection took place through a structured formulary of observation, data from medical records and physical examination of patients skins. The results were organized in SPSS 15.0 software, tabulated, categorized and analyzed by descriptive and inferential statistics. Of the 30 patients studied, 43.3% had been hospitalized in the pain clinical and surgical clinic wards, 20.0% in the ICU, 20.0% in the ICU / ward and 16.7% in neurology, being the length of hospitalization in those units of 7 to 18 days (63.3%) and from 19 to 30 days (36.7%), predominantly female and aged ≥ 60 years (60.0%). 19 PU were diagnosed in 43.3% of patients monitored, being 38.5% with one PU between 7 to 18 days and 46.2% with two or more between 19 to 30 days of hospitalization, showing significant relationship (ρ-value = 0029) between length of hospital stay and the number of PU. Was found an association of 35.7% of the PC (cardio-respiratory, hematological, metabolic and psychogenic), IF (age group, oedema, skin changes in humidity and change of body temperature) and EF (type of mattress and strength of body pressure) for all patients studied, statistically significant (ρ-value = 0001), between the average scores in patients with and without PU, with reason chance to 12.0 for the development of PU and there was moderate correlation ( r = 0618) in the presence of this association. Results show the influence of the multiplicity of factors and conditions on the occurrence of PU, which brings us to reflect on the assistance focused on prevention and reduction of these injuries which will encourage the reduction of hospitalization length, physical and psychological suffering, and the possibility of improving the clinical condition of the patient.

Assistência de enfermagem e o risco para úlceras de pressão medido pela Escala de Braden em unidade de terapia intensiva

The problem facing the incidence of pressure ulcers (UP) in the hospital environment especially in the intensive care unit (ICU), although it is an old and frequent event in our professional practice, it is not notified in the researches as much as it should be. We observed a tendency to invest in therapeutical and in studies about the production of sophisticated new bandages. Few, however, are the investments in research on preventive measures in order to prevent or at least slow down the development of lesions. In this sense, the study aimed to analyze the correlation between nursing care and the risk of developing UP measured by the Braden scale in ICU patients. This is a descriptive study of longitudinal quantitative approach. The project obtained a favourable opinion from the Ethics Committee of HUOL (no 486/10). Data collection was carried out in the Hospital of Unimed in Natal during six months in 2011. The sample was of 32 patients hospitalized in ICU for over four days. The results were processed in SPSS 15.0 for descriptive statistics and inferential statistics. We identified that, only 9.4% of our sample developed UP, being predominantly male, elderly people aged above 60 years, Caucasian, with diagnostic hypothesis at the time of hospitalization of sepsis, were clinical patients, who presented hemodynamic instability, using orotracheal tube (TOT), enteral probe (SNE), vesical probe delay (SVD) and had values of albumin and hemoglobin levels below normal. In addition, these patients had a longer hospital stay, longer usage of TOT, SNE, SVD, increased use of sedation and drain than those who did not develop UP and were all at risk for developing these injuries second Braden scores. 66.7% of the lesions developed were located in the sacral region, limiting the degree I and all patients that developed were considered serious, 100.0% of them have evolved since the death. Small were the differences between the averages of Braden scores between patients with and without UP, 11,9+2,4 against 12,4+2,6 with p = 0.627. The clinical aspects of the patients in the study were instrumental in the development of UP, once, these findings were statistically significant through the Mann-Whitney test, and appropriateness of nursing conduct was decisive for the prevention of pressure ulcers in critical patients, since many were those classified as at risk (28) and few who have developed lesions (03)

Validação de instrumentos para avaliação da habilidade e do conhecimento acerca da medida da pressão arterial

This study aimed to validate tools for evaluating the ability and knowledge about blood pressure (BP) among nursing students. It is a cross-sectional, descriptive, quantitative and methodological study accomplished at the Universidade Federal do Rio Grande do Norte (UFRN), Universidade do Estado do Rio Grande do Norte (UERN) and a private university of the state. The sample consisted of 27 judges of research selected from the inclusion criteria: nursing, teachers of the semiology and/or semiotics discipline, with at least 1 year of experience, being from UFRN, EEN, UERN and private university of the state and and agree to participate voluntarily with the signing of the consent form. The research was development in three stages: construction of two instruments based on the scientific literature, resulting in a structured checklist consists of 28 items and a knowledge questionnaire with 12 questions; submission of the instruments to the judges, in the period from June to September 2012, which should evaluate each item in appropriate , appropriate with changes and inappropriate , addition to making an overall assessment of each instrument based on 10 requirements; validation and verification to the level of agreement among the judges, through the application of Kappa and Content Validity Index (CVI). Was used the consensus level greater than 0.61 (good) to the Kappa index and greater than 0.75 for CVI. Was approved by the Ethics in Research / HUOL. After being coded and tabulated, the data were analyzed using descriptive statistics. Of the 27 judges who evaluated the instrument, 77.8% are female, with a mean age of 36.6 (± 9.0) years, 63.0% worked in UFRN, 74.1% had academic master and 63.0% worked exclusively on teaching. Average length of teaching experience was 7.9 (± 8.0) years and in the semiology and/or semiotics discipline of 5.5 (± 6.7) years. In the judgment of structured checklist and questionnaire of knowledge about blood pressure mensurement any item/question was considered inappropriate since all obtained level of agreement within the indices established (CVI> 0,75 E Kappa> 0.61). In relation to structured checklist, of those 28 items present, 9 showed perfect concordance index (CVI = 1.00, Kappa = 1.00) and another 19 were considered appropriate with changes, especially with regard to clarity and vocabulary. In the questionnaire of knowledge, among the 12 questions that comprised, 7 had perfect concordance index and the others were considered appropriate with changes as requirements as clarity, vocabulary, and feasible sequence of instructional topics. In terms of a overall evaluating of instruments, the structured checklist got CVI of 0.94 and Kappa of 0.89 and the knowledge questionnaire, CVI of 0.97 and a kappa of 0.94. Both instruments proved to be valid as to their content, configuring it as clear and objective tools of assessment of knowledge and ability on blood pressure, being of nursing students as well as others students and health professionals, since the use of valid measures seeking to reduce the risk of distorting the results

Úlceras de pressão: um estudo com pacientes de unidade de terapia intensiva

To characterize patients according to gender, age category, internment time, diagnostical hypothesis and location of the pressure ulcer; to identify the susceptibility conditions, intrinsical and extrinsical factors present on ICU patients and to verify on the existence of association between the susceptibility conditions and the intrinsecal and extrinsecal factors on the occurrence of PU. Methods: It is a descriptive study, of longitudinal design of the panel type, with quantitative approach, performed on two ICU s of a private hospital located in Natal/RN, with 40 patients interned at these units. The data collection was performed on all three shifts through a structured observation and physical exam of the patients' skin form seeking to identify the presence of PU. Results: The greatest occurence of PU was on individuals of the male gender (70%) when compared to the female gender (30%), that difference being statistically significant (p=0,0267), with the male gender presenting 4,3 times greater chance of developing PU than the female; the predominant age category was from 60 years of age on (85%), 60,0% presented 1 to 2 PU s after 7 (seven) days of permanence in the ICU s, the predominant diagnostical hypothesis on the patients with PU were the respiratory diseases (42,3%) and the most frequent locations of PU were the sacral region (40,0%) and heels (36,0%). 25 PU s of stage I were diagnosed on 50,0% of the followed patients, with general incidence of 50,0% on both ICUs. from the 88 variables researched, 75 were identified on the patients from the study, being the predominant conditions (anemia, hypotension, leukocytosis, other diseases hypertension blood pressure, cardiac insuffience, pneumonia - and ansiolythic), the intrinsecal factors (diminished muscular strenght and/or mass, discrete edema, totally compromised mobile coordination and total inability for movement on the bed) and the extrinsecal factors (inadequate mattress type, permanence on a single position for >2 hours, shearing/friction force, bed clothes with folds that leave marks on the body, pressure force) predominated on patients with PU. The male gender variables (p=0,0267,OR=4,3), sedation (p=0,0006,OR=4,1), psychomotive agitation (p=0,0375,OR=5,8) and leukocytosis (p=0,0285,OR=5,0) presented a significant statistical diference when analyzed independently. We verified an association of 17,3%, statistically significant (p=0,0384), between the susceptibility conditions (anemia, leukocytosis and hypotension), the intrinsecal factors (age equal or above 60 years, diminished/absent pain sensibility and smooth, fine or delicate skin) and the extrinsecal factors (inadequate mattress, pressure forces, shearing/friction force, permanence on a single position for more than 2 hours, elevation between 30 to 45 degrees and inadequate bed clothes' conditions), with a chance ratio of 4,6 times the risk of occurrence of PU on the patients that presented the referred association. Conclusion: The incidence of PU detected on the ICU-interned patients was high and we made evident the existence of association between the susceptibility conditions, the intrinsecal and extrinsecal factors on the occurrence of PU s on the ICUinterned patients, and thus we accept the alternative hypothesis proposed on the study

Mapeamento de ambientes estruturados com extração de informações geométricas através de dados sensoriais

The objective of this thesis is proposes a method for a mobile robot to build a hybrid map of an indoor, semi-structured environment. The topological part of this map deals with spatial relationships among rooms and corridors. It is a topology-based map, where the edges of the graph are rooms or corridors, and each link between two distinct edges represents a door. The metric part of the map consists in a set of parameters. These parameters describe a geometric figure which adapts to the free space of the local environment. This figure is calculated by a set of points which sample the boundaries of the local free space. These points are obtained with range sensors and with knowledge about the robot s pose. A method based on generalized Hough transform is applied to this set of points in order to obtain the geomtric figure. The building of the hybrid map is an incremental procedure. It is accomplished while the robot explores the environment. Each room is associated with a metric local map and, consequently, with an edge of the topo-logical map. During the mapping procedure, the robot may use recent metric information of the environment to improve its global or relative pose

Localização e mapeamento simultâneos de ambientes planos usando visão monocular e representação híbrida do ambiente

The goal of this work is to propose a SLAM (Simultaneous Localization and Mapping) solution based on Extended Kalman Filter (EKF) in order to make possible a robot navigates along the environment using information from odometry and pre-existing lines on the floor. Initially, a segmentation step is necessary to classify parts of the image in floor or non floor . Then the image processing identifies floor lines and the parameters of these lines are mapped to world using a homography matrix. Finally, the identified lines are used in SLAM as landmarks in order to build a feature map. In parallel, using the corrected robot pose, the uncertainty about the pose and also the part non floor of the image, it is possible to build an occupancy grid map and generate a metric map with the obstacle s description. A greater autonomy for the robot is attained by using the two types of obtained map (the metric map and the features map). Thus, it is possible to run path planning tasks in parallel with localization and mapping. Practical results are presented to validate the proposal

Mapeamento robótico 2,5-D com representação em grade de ocupação-elevação

This work introduces a new method for environment mapping with three-dimensional information from visual information for robotic accurate navigation. Many approaches of 3D mapping using occupancy grid typically requires high computacional effort to both build and store the map. We introduce an 2.5-D occupancy-elevation grid mapping, which is a discrete mapping approach, where each cell stores the occupancy probability, the height of the terrain at current place in the environment and the variance of this height. This 2.5-dimensional representation allows that a mobile robot to know whether a place in the environment is occupied by an obstacle and the height of this obstacle, thus, it can decide if is possible to traverse the obstacle. Sensorial informations necessary to construct the map is provided by a stereo vision system, which has been modeled with a robust probabilistic approach, considering the noise present in the stereo processing. The resulting maps favors the execution of tasks like decision making in the autonomous navigation, exploration, localization and path planning. Experiments carried out with a real mobile robots demonstrates that this proposed approach yields useful maps for robot autonomous navigation

Mapeamento com Sonar Usando Grade de Ocupação baseado em Modelagem Probabilística

In this work, we propose a probabilistic mapping method with the mapped environment represented through a modified occupancy grid. The main idea of the proposed method is to allow a mobile robot to construct in a systematic and incremental way the geometry of the underlying space, obtaining at the end a complete environment map. As a consequence, the robot can move in the environment in a safe way, based on a confidence value of data obtained from its perceptive system. The map is represented in a coherent way, according to its sensory data, being these noisy or not, that comes from exterior and proprioceptive sensors of the robot. Characteristic noise incorporated in the data from these sensors are treated by probabilistic modeling in such a way that their effects can be visible in the final result of the mapping process. The results of performed experiments indicate the viability of the methodology and its applicability in the area of autonomous mobile robotics, thus being an contribution to the field

Proposta de algoritmo para detecção de vazamentos em oleodutos utilizando análise freqüencial de sinais de pressão

Pipeline leak detection is a matter of great interest for companies who transport petroleum and its derivatives, in face of rising exigencies of environmental policies in industrialized and industrializing countries. However, existing technologies are not yet fully consolidated and many studies have been accomplished in order to achieve better levels of sensitivity and reliability for pipeline leak detection in a wide range of flowing conditions. In this sense, this study presents the results obtained from frequency spectrum analysis of pressure signals from pipelines in several flowing conditions like normal flowing, leakages, pump switching, etc. The results show that is possible to distinguish between the frequency spectra of those different flowing conditions, allowing recognition and announce of liquid pipeline leakages from pressure monitoring. Based upon these results, a pipeline leak detection algorithm employing frequency analysis of pressure signals is proposed, along with a methodology for its tuning and calibration. The proposed algorithm and its tuning methodology are evaluated with data obtained from real leakages accomplished in pipelines transferring crude oil and water, in order to evaluate its sensitivity, reliability and applicability to different flowing conditions

Queda de pressão estática por meio de uma coluna de noz macadâmia

As unidades de beneficiamento de macadâmia adotam silos secadores distintos, para cada etapa de secagem, a fim de garantir a manutenção da qualidade do produto pela redução da umidade a níveis desejáveis. Diante da necessidade de quantificar a resistência apresentada pelas nozes, submetidas a diferentes fluxos de ar durante a secagem, bem como avaliar a possibilidade de utilização de modelos empíricos, que estimem o gradiente de pressão a partir da vazão de ar, conduziram-se vários testes em laboratório para obtenção de dados experimentais e ajuste de modelos. Frutos de macadâmia (M. integrifolia), com umidade de 0,11 b.s., após limpeza e classificação, foram colocados no interior de um protótipo constituído por uma coluna de chapa galvanizada (com tomadas para medição da pressão estática), plenum e ventilador, sendo submetidos a diferentes fluxos de ar. Os testes consistiram de três medidas por profundidade, para cada um dos três lotes de nozes, perfazendo um total de nove medidas de pressão estática por profundidade na coluna. Os resultados obtidos permitiram concluir que os fluxos de ar testados apresentaram efeito significativo sobre a queda de pressão estática na coluna de macadâmia, a qual aumentou linearmente com a profundidade. Os dados experimentais ajustaram-se muito bem aos modelos de Shedd e Hunter, sugerindo sua boa aplicabilidade para a macadâmia.

Comportamento compressivo de um nitossolo: efeito do tamanho de agregados, do teor de água e da pressão aplicada

A compactação do solo tem sido assunto de intensivas pesquisas nos últimos anos; no entanto, os mecanismos que implicam o processo de compactação dos solos agrícolas, ainda permanecem pouco conhecidos. A contribuição do tamanho de agregados do solo, bem como o efeito do teor de água e da pressão normal aplicada na compactação e pressão de pré-compactação do solo, foi investigada em um Nitossolo Vermelho eutrófico. Amostras de solo deformado, constituídas por agregados menores que 2,5 mm e de 9,3 a 19,4 mm, foram submetidas a ensaio de compressão uniaxial drenado. O índice de vazios e a pressão de pré-compactação foram avaliados. Os resultados obtidos mostram que o tamanho de agregados teve efeito no processo de compactação do solo. A mudança da compactação do solo pode ser prevista em função do estado inicial do solo, da pressão aplicada e do teor de água.

Controlador preditivo generalizado multi-modelo aplicado ao controle de pressão arterial

Postsurgical complication of hypertension may occur in cardiac patients. To decrease the chances of complication it is necessary to reduce elevated blood pressure as soon as possible. Continuous infusion of vasodilator drugs, such as sodium nitroprusside (Nipride), would quickly lower the blood pressure in most patients. However, each patient has a different sensitivity to infusion of Nipride. The parameters and the time delays of the system are initially unknown. Moreover, the parameters of the transfer function associated with a particular patient are time varying. the objective of the study is to develop a procedure for blood pressure control i the presence of uncertainty of parameters and considerable time delays. So, a methodology was developed multi-model, and for each such model a Preditive Controller can be a priori designed. An adaptive mechanism is then needed for deciding which controller should be dominant for a given plant

Desenvolvimento de equipamentos para o mapeamento de áreas infestadas por macrófitas aquáticas imersas

Foi desenvolvido um conjunto de equipamentos com o objetivo de mapear as áreas infestadas por macrófitas aquáticas, auxiliando operações de manejo mecânico, as quais são realizadas por uma colhedora desenvolvida especificamente para essa finalidade. O conjunto de equipamentos foi constituído por um GPS com programa de correção diferencial, acoplado a um palmtop, um sistema com dois teclados ligados em dataloggers e um transdutor de deslocamento linear LT. O GPS, através do palmtop, proporcionava o mapeamento da área de deslocamento, auxiliando o operador na movimentação da máquina, otimizando a operação e evitando, dessa forma, a sobreposição das faixas de coleta na área a ser manejada. Um dos teclados monitorava a movimentação e operação da colhedora, além da presença de obstáculos, como tocos e bancos de areia, enquanto o outro gerava dados sobre a presença de determinada espécie de planta, como E. densa, E. najas e C. demersum, além do nível de infestação destas plantas. O transdutor, instalado na plataforma frontal da colhedora, se movimentava linearmente, gerando informações sobre a profundidade da coleta realizada. Dessa forma, pôde-se observar que o desenvolvimento desse conjunto de equipamentos foi de grande utilidade e auxiliou a operação de controle mecânico de áreas infestadas por macrófitas aquáticas imersas, possibilitando, assim, o planejamento de operações de manejo e controle subseqüentes.

Técnicas visuais de localização e mapeamento simultâneos sem extração de primitivas geométricas da imagem

In Simultaneous Localization and Mapping (SLAM - Simultaneous Localization and Mapping), a robot placed in an unknown location in any environment must be able to create a perspective of this environment (a map) and is situated in the same simultaneously, using only information captured by the robot s sensors and control signals known. Recently, driven by the advance of computing power, work in this area have proposed to use video camera as a sensor and it came so Visual SLAM. This has several approaches and the vast majority of them work basically extracting features of the environment, calculating the necessary correspondence and through these estimate the required parameters. This work presented a monocular visual SLAM system that uses direct image registration to calculate the image reprojection error and optimization methods that minimize this error and thus obtain the parameters for the robot pose and map of the environment directly from the pixels of the images. Thus the steps of extracting and matching features are not needed, enabling our system works well in environments where traditional approaches have difficulty. Moreover, when addressing the problem of SLAM as proposed in this work we avoid a very common problem in traditional approaches, known as error propagation. Worrying about the high computational cost of this approach have been tested several types of optimization methods in order to find a good balance between good estimates and processing time. The results presented in this work show the success of this system in different environments

Qualidade da silagem de grão úmido em função da temperatura ambiente e pressão interna de armazenagem

Visando estabelecer a contribuição dos parâmetros físicos na qualidade final da silagem de grãos úmidos de milho, foi conduzido experimento, no interior de câmara climatizada, simulando cinco condições de temperatura ambiente (5ºC 24h-1 por dia; 25ºC 24h-1 por dia; 40ºC 24h-1 por dia; 20ºC 16h-1 por dia + 5ºC 8h-1 por dia; 30ºC 16h-1 por dia + 20ºC 8h-1 por dia) e duas condições de pressão no interior dos tambores de armazenagem (com e sem pressão interna). Para se determinar os efeitos sobre o grau de disponibilidade do amido na silagem pronta, procedeu-se a análises para avaliar a qualidade final da silagem (teor de umidade, pH, ácidos orgânicos, amido total e granulometria). O delineamento estatístico utilizado foi o inteiramente ao acaso, num fatorial 5 x 2, com três repetições. Os resultados obtidos indicaram influência significativa tanto da temperatura quanto da pressão, sendo os efeitos mais benéficos verificados nos tratamentos '30ºC 16h-1 por dia + 20ºC 8h-1 por dia', '25ºC 24h-1 por dia' e 'ausência de pressão'.