Diagnósticos de enfermagem em pacientes submetidos à hemodiálise: semelhanças entre o modelo de adaptação e a NANDA internacional

The nurses in the hemodialysis has an important role in the nursing process implementation, in the context of a theoretical referential. Among the nursing theories, highlights the Roy´s adaptations model, who considers a person as an holistic adaptive system that aims to adapt customers to different living conditions. Thus, it is believed that the Roy´s nursing process will guide nursing care to patients on dialysis. Therefore, the study aimed to analyze the nursing diagnosis present in patients with chronic kidney disease on hemodialysis based on the theoretical model of Roy and NANDA-International. Descriptive and cros-sectional study, performed at a dialysis center in a city in northeastern Brazil. Sample of 178 patients and consecutive sampling by convenience. Data collection ocurred from October/2011 until February/2012, through interview and physical examination forms. Data analysis was initiated by clinical reasoning, diagnosis judgment and similarity relation. Then, the data were entered into SPSS program, 16.0 version, generating descriptive statistics. The project was approved by the Ethics Research Committee (protocol nº 115/11) with a Presentation Certificate for Ethics Appreciation (in 0139.0.051.000-111) and was funded by the Universal edict MCT / CNPq 14/2010. The results revealed that most patients were male (52.2%), married (62.9%) and residents in the Natal´s metropolitan region (54.5%). The mean age was 46.6 years and the years of study, 8,5. Regarding nursing diagnosis obtained an average of 6.6, especially: Risk of Infection (100%), excessive fluid volume (99.4%) and hypothermia (61.8%). On the other hand the adaptive problems average was 6.4, and the most common: intracellular fluid retention (99.4%); Hyperkalemia (64.6%); Hypothermia (61.8%) and edema (53.9%). Were established 20 similarity relations between the NANDA-International nursing diagnosis and adaptive problems of Roy, namely: risk of falls / injury risk and potential for injury, impaired physical mobility and walking mobility and / or restricted coordination, dressing self-care deficit and loss of self-care ability; hypothermia and hypothermia; impaired skin integrity and impaired skin integrity; excessive fluid volume and intracellular fluid retention / Hyperkalemia / Hypocalcemia / edema; imbalanced nutrition: less than body requirements and Nutrition less than the body's needs; constipation and constipation, acute pain and acute pain, chronic pain and chronic pain, sensorial perception disturbed: visual, tactile and auditory disabilities and a primary sense: sight, hearing and tactile; sleep deprivation and insomnia, fatigue and intolerance to activities; ineffective self health and fails in the role; sexual dysfunction and sexual dysfunction; situational low self-esteem and low self-esteem, and diarrhea and diarrhea. We conclude that there is similarity between the typologies and was required a model´s analysis, because they present different ways to establish the nursing diagnosis. Moreover, the nursing process use, under the context of a theory and a classification system, subsidizes the care and contributes to the strengthening of nursing science

Processos de constituição de subjetividades em práticas discursivas institucionalizadas: entre a disciplina, a performatividade e a biopolítica

Esta es una pesquisa de naturaleza cualitativa de abordaje socio-histórico, con procedimientos etnográficos. Tiene como temática prácticas a constitución de subjetividades en relaciones interdiscursivas entre los discursos propalados por la Medicina Legal con prácticas discursivas de futuros(as) profesionales de la educación. En consecuencia de ese objeto de investigación, establecemos como cuestión central: ¿en qué medida prácticas discursivas producidas por la Medicina Legal producen sentidos en enunciados de alumnos y alumnas del curso de Pedagogía de UFRN, de modo a constituir subjetividades pautadas por el trastorno, por la anormalidad y por la enfermedad? En ese sentido, el objetivo de este trabajo es analizar prácticas discursivas institucionalizadas que constituyen subjetividades del género y sexualidad pautadas por efectos de sentidos que traducen las sexualidades disidentes como trastorno, perversión y anormalidad. Como herramientas teórico-analíticas actualizamos, principalmente, algunas reflexiones de Michel Foucault concernientes a la temática del biopoder y de la disciplina, algunas teorizaciones advenidas de los estudios Queer y nociones del Análisis del Discurso de línea francesa, como el discurso, memoria discursiva e interdiscurso. Los resultados de esta pesquisa demuestran que las subjetividades son constituidas en un proceso que alía el lenguaje de prácticas médicas, científicas, al habla de nuestros(as) colaboradores(as), en una relación interdiscursiva. Así, las subjetividades se constituyen pautadas por la anormalidad, por el trastorno, por la medicalización de las conductas y de los deseos. Todavía, percibimos el cruce de conductas biopolíticas y disciplinarizadoras en ese proceso de constitución de subjetividades, por medio de sanciones y posibles perjuicios que esos individuos anormales causan a la sociedad, justificadas tanto por los discursos de la Medicina Legal, como de los(as) colaboradores(as) de la pesquisa.

Esquizofrenia: intervenção em Instituição Pública de Saúde

Les premiers concepts de schizophrénie comprenaient des définitions non-spécifiques sur le trouble schizophrénique. Ce n est qu en 1980 que Crow a proposé la classification la plus connue pour ce trouble: la distinction en soustypes I et II, de symptomatologie positive ou négative, les symptômes du syndrome positif correspondant aux hallucinations et aux délires et ceux du syndrome négatif au repli affectif et à la pauvreté du discours. Bien que la thérapie médicamenteuse présente des avancées dans le traitement de la maladie, la psychothérapie est la plus indiquée pour remédier aux préjudices sociaux et interpersonnels que celle-ci provoque. L objectif de cette étude est de relater une intervention comportementale, dans un Centre de Soins Psychosocial, auprès d une patiente de 19 ans, en utilisant des Exercices de Réadaptation Psychosociale (SAT) en tant que la possibilité de traitement de la schizophrénie. Ce processus a contribué à une réduction du stéréotype de la maladie chez la jeune patiente, considérant qu elle a élargi son répertoire social et a rendu possible des avancées dans les sphères psychologique, sociale et professionnelle.

Efeitos do manejo comportamental de incontinência fecal em adolescente

A incontinência fecal, também conhecida como encoprese, é um transtorno de evacuação que acarreta prejuízos ao desenvolvimento psicossocial e orgânico da criança e do adolescente, e que demanda atenção e cuidado de pais e profissionais de saúde. No amplo contexto de tratamento da encoprese, a psicoterapia constitui importante recurso, sendo a terapia comportamental apontada como uma das modalidades mais promissoras e eficazes para o tratamento dessa dificuldade de eliminação. Este artigo apresenta o estudo dos efeitos do manejo comportamental de quadro de incontinência fecal em um adolescente de 14 anos, atendido em clínica-escola de Psicologia do interior do Estado de São Paulo durante 14 meses. A partir do referencial teórico da análise do comportamento, foi desenvolvido, em contexto psicoterápico, um conjunto de estratégias comportamentais com o cliente, bem como orientações aos pais, visando à gradativa extinção encoprética. No decorrer desse processo, o cliente apresentou significativas aquisições comportamentais de uso regular do banheiro e adequado controle esfincteriano, monitoradas semanalmente, que possibilitaram a plena extinção das ocorrências de sujidade, sendo avaliado o efeito em follow-up realizado três meses após o encerramento dessa intervenção.

Análise de grafos aplicada a relatos de sonhos: ferramenta diagnóstica objetiva e diferencial para psicose esquizofrênica e bipolar

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Avaliação comportamental e neuroquímica de ratos em dessincronização forçada: possíveis implicações para um modelo animal de oscilações no humor

Bipolar disorder has been growing in several countries. It is a disease with high mortality and has been responsible by the social isolation of the patients. Bipolar patients have alterations in circadian timing system, showing a phase shift in various physiological variables. There are several arguments demonstrating alterations in circadian rhythms may be part of the bipolar disorder pathophysiology. Given the necessity for further elucidation, the goal of this study was to validate the forced desynchronization protocol as an animal model for bipolar disorder. To do this, Wistar rats were submitted to a forced desynchronization protocol which consists in a symmetrical light dark cycle with 22h. Under this protocol, rats dissociate the locomotor activity rhythm into two components: one synchronized to the light / dark cycle with 22h, and another component with period longer than 24 hours following the animal endogenous period. These rhythms with different periods sometimes there is coincidence, which we named CAP (Coincidence Active Phase) and the opposite phase, non-coincidence, called NCAP (Non-Concidence Active Phase). The hypothesis is that in CAP animals present a mania-like behavior and animals in NCAP depressive-like behavior. We found some evidence described in detail throughout this thesis. In sum, the animals under forced desynchronization protocol were more stressed, showed an increase in stereotypic behaviors such as grooming and reduction in other behaviors such as risk assessment and vertical exploration when compared to the control group. The CAP animals showed increased locomotor activity, especially during the dark phase when compared to controls (rats under T24) and less depressive behavior in the forced swim test. The animals in NCAP showed a higher anxiety in elevated plus maze, but they don t have ahnedonia. The animals under dissociation have more labeled 5HT1A cells at the amygdala area, which appoint that they have more amygdala inhibition. Taking these data together, we could partially validated the forced desynchronization protocol as an animal model for mood oscillations

Antidepressivos modificam a extinção de uma memória aversiva em ratas

Treatment of major depression, posttraumatic stress disorder and other psychopathologies with antidepressants can be associated with improvement of the cognitive deficits related to these disorders. Although the mechanisms of these effects are not completely elucidated, alterations in extinction of aversive memories are believed to be present in these psychopathologies. Moreover, researches with laboratory animals usually focus on male subjects, and we have recently verified that extinction of an aversive task is reduced in female rats when compared to males. In the present study, female rats were long-term treated with clinically used antidepressants (fluoxetine, nortriptyline or mirtazapine) and tested in the plus-maze discriminative avoidance and forced swimming tests in order to evaluate learning, memory, extinction, anxiety and depression-related behaviors. All groups learned the task, but learning was somewhat faster in nortriptyline and mirtazapine-treated animals . Task retrieval was also showed by all experimental groups. Chronic treatment with fluoxetine, but not with the other antidepressants, increased extinction of the discriminative task. In the forced swimming test, animals treated with fluoxetine and mirtazapine showed decreased immobility duration. In conclusion, antidepressants interfere with learning and female rats treated with fluoxetine presented increased extinction of the aversive memory task. On the other hand, both fluoxetine and mirtazapine were effective in the forced swimming test, suggesting dissociation between the antidepressant effects and the extinction of aversive memories

Efeitos do tratamento com lítio na memória aversiva, comportamentos relacionados à ansiedade e depressão e na expressão de BDNF em ratos

Lithium (Li) is the first choice to treat bipolar disorder, a psychiatric illness characterized by mood oscillations between mania and depression. However, studies have demonstrated that this drug might influence mnemonic process due to its neuroprotector, antiapoptotic and neurogenic effects. The use of Li in the treatment of cognitive deficits caused by brain injury or neurodegenerative disorders have been widely studied, and this drug shows to be effective in preventing or even alleviating the memory impairment. The effects of Li on anxiety and depression are controversial and the relationship of the effects of lithium on memory, anxiety and depression remain unknown. In this context, this study aims to: evaluate the effects of acute and chronic administration of lithium carbonate in aversive memory and anxiety, simultaneously, using the plus maze discriminative avoidance task (PMDAT); test the antidepressant effect of the drug through the forced swimming test (FS) and analyze brainderived neurotrophic factor (BDNF) expression in structures related to memory and emotion. To evaluation of the acute effects, male Wistar rats were submitted to i.p. administration of lithium carbonate (50, 100 or 200 mg/kg) one hour before the training session (PMDAT) or lithium carbonate (50 or 100 mg/kg) one hour before the test session (FS). To evaluation of the chronic effects, the doses administered were 50 or 100 mg/kg or vehicle once a day for 21 days before the beginning of behavioral tasks (PMDAT and FS). Afterwards, the animals were euthanized and their brains removed and submitted to immunohistochemistry procedure to quantify BDNF. The animals that received acute treatment with 100 and 200 mg/kg of Li did not discriminated between the enclosed arms (aversive and non-aversive) in the training session of PMDAT, showing that these animal did not learned the task. This lack of discrimination was also observed in the test session, showing that the animals did not recall the aversive task. We also observed an increased exploration of the open arms of these same groups, indicating an anxiolytic effect. The same groups showed a reduction of locomotor activity, however, this effect does not seem to be related with the anxiolytic effect of the drug. Chronic treatment with Li did not promote alterations on learning or memory processes. Nevertheless, we observed a reduction of open arms exploration by animals treated with 50 mg/kg when compared to the other groups, showing an anxiogenic effect caused by this dose. This effect it is not related to locomotor alterations since there were no alterations in these parameters. Both acute and chronic treatment were ineffective in the FS. Chronic treatment with lithium was not able to modify BDNF expression in hippocampus, amygdala and pre-frontal cortex. These results suggest that acute administration of lithium promote impairments on learning in an aversive task, blocking the occurrence of memory consolidation and retrieval. The reduction of anxiety following acute treatment may have prevented the learning of the aversive task, as it has been found that optimum levels of anxiety are necessary for the occurrence of learning with emotional context. With continued, treatment the animals recover the ability to learn and recall the task. Indeed, they do not show differences in relation to control group, and the lack of alterations on BDNF expression corroborates this result. Possibly, the regimen of treatment used was not able to promote cognitive improvement. Li showed acute anxiolytic effect, however chronic administration 4 promoted the opposite effect. More studies are necessary to clarify the potential beneficial effect of Li on aversive memory

Ajuda mútua nos CAPS: o papel dos serviços no empoderamento dos usuários

The research objective is explore practices to mutual help between CAPS users from the east and west regions of the city of Natal, RN, in Brazil. In the mental health field, we observe the care from substitutive services is based on technical knowledge where the person of the mental health professional is predominant. The Brazilian psychiatry reform invests in equipments and mental health care protocols, but it is necessary to invest more vigorously in new strategies and actors capable of obtaining resources to achieve this goal, such as the users. If one cornerstone of the psychiatric reform consists of changing the type of relationship established with the person with mental disorders, why this relationship, nowadays, is still dominated by technique and unevenness, where on one side we have a person who knows something and who needs take care of someone, and on other side we have another who knows nothing and thus needs to be cared for? Starting from this problematization of the traditional methods of health/mental health care, an attempt was made to investigate in what ways the mutual help practices between people with mental disorders can realize potential avenues not yet explored within the scope of psychiatric reform. The objective of this research was to map possible mutual help practices among the users, and the technical understanding of such practices. For that, we took part in the daily activities of the CAPS, mapping the experiences of mutual help among users. In addition, we accompanied the users in external activities (such as return home, trips, etc), and we had roundtables with the professionals. The research was guided by theoretical methodological references of the institutional analysis. The results pointed to a lack of behaviors of mutual help or support among users, something that can probably be explained by the service work dynamics, as well as the relationship between technicians and users, which has a tendency to create hurdles for meetings among users, as well as being non-conducive to theirempowerment

Aplicabilidade do Rorshach na avaliação psicológica do autismo

This study investigates the applicability of the Rorschach Method for evaluating the personality of people with Autism Spectrum Disorder (ASD).The relevance of this study is justified by the limited number of investigations published in the research literature concerning the use of psychological tests used for evaluating the personality of individuals with ASD. The Rorschach Method was chosen as an appropriate instrument considering it reveals the personality s basic structure, including characteristics of the affectivity, sensuality, inner life, mental resources, psychic energy and general characteristics and intellectual state of the individual. The general objective of this investigation consisted of verifying the applicability of the use the Rorschach Method in the evaluation of the characteristics of people's personality with autism spectrum disorder (ASD).The study also sought to identify perceptive factors of the personality structure of individuals with ASD, provide contributions of the understanding of this syndrome, seeking the establishment of possible therapeutic interventions starting from diagnostic by Rorschach Method. In addition, this investigation aims at verifying the adequacy of using the Rorschach Method as an instrument for evaluating the personality characteristics of individuals with ASD and its possible use in Brazil, starting from preliminary normative results. Participants consisted of 44 youngsters and adults, both genders with age range 14 - 39 years-old (average: 23.5 years-old) distributed in 2 groups. Group 1: composed with 22 youngsters and adults with clinical diagnosis of autism spectrum disorder (communication impairments, social interaction deficits, restricted and repetitive interests and activities); Group 2: composed with 22 youngsters and adults with typical behavior. The participants were paired to gender and age, individually. The Mann-Whitney and Wilcoxon tests were applied to evaluate statistical differences between the groups, considering demographic and social data. The results indicate the presence of restricted interest or difficulty in the expression of the social and affective interaction of people with ASD. However, the need of broader normative studies concerning the use of personality evaluation instruments for people with ASD is warranted. These investigations could help understand the psychic dynamism of this population, offering subsidies that can be added to the current techniques of diagnosis. The Rorschach Method is susceptible to application but it is necessary to respect the individual limitations of these people and to establish more criterions about the spectrum

Indicadores de transtornos de estresse pós-traumático em bombeiros militares

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Contrastes e contrastes encobertos na produção da fala de crianças

TEMA: análise acústica da fala. OBJETIVO: analisar acusticamente as substituições envolvendo o contraste entre /t/ e /k/ na fala de crianças em aquisição típica e desviante do contraste acima referido, a fim de identificar e quantificar a existência de contrastes encobertos. MÉTODO: foi elaborado um experimento de produção de fala que envolveu a repetição de palavras, que combinavam /t/ e /k/ com /a/ e /u/ na posição acentuada, por 9 crianças divididas em três grupos: crianças em processo de aquisição do contraste investigado (G1); crianças com transtorno fonológico (G2) e crianças com produções típicas (G3). Com o uso do software Praat, as produções foram editadas e analisadas de acordo com os seguintes parâmetros acústicos: características espectrais do burst; transição CV e características temporais. Os testes estatísticos utilizados foram ANOVA de Friedman e Manova. A significância estatística adotada foi menor que 0,05. RESULTADOS: tanto nas produções das crianças do G2 quanto nas produções das crianças do G1, detectamos, em grande medida (80% e 57,4%, respectivamente), a presença de contrastes encobertos nos erros de substituição das oclusivas investigadas. Adicionalmente, a análise acústica revelou diferenças em como as crianças utilizam as pistas fonético-acústicas para marcarem a distinção entre /t/ e /k/. CONCLUSÃO: muitas das substituições presentes da produção de fala de crianças em processo de aquisição típico e desviante tratam-se na verdade de contrastes fônicos encobertos. Além disso, o uso da análise acústica permitiu a detecção de diferenças sutis da produção da fala das crianças.

Testes de escuta dicótica em escolares com distúrbio de aprendizagem

O transtorno do processamento auditivo é uma entidade clínica que pode estar associado a diversos distúrbios da comunicação humana, entre estes o distúrbio de aprendizagem. OBJETIVO: Caracterizar e comparar o desempenho de escolares com e sem distúrbio de aprendizagem nos testes de Fala com Ruído e Escuta Dicótica de Dígitos e Verbal. MATERIAL E MÉTODO: Participaram 40 escolares, de ambos os gêneros, com faixa etária de 8 a 12 anos, divididos em dois grupos: GI: composto por 20 escolares com diagnóstico de distúrbio de Aprendizagem e GII: composto por 20 escolares com bom desempenho escolar, pareados segundo gênero, faixa etária e escolaridade com GI. Foram realizadas avaliações audiológicas básicas e Testes de Dicótico de Dígitos, Dissílabos Alternados (SSW) e Fala com Ruído. FORMA DE ESTUDO: Estudo transversal com corte histórica. RESULTADOS: Os escolares de GI apresentaram desempenho inferior ao dos escolares de GII, nos testes Dicótico de Dígitos e Dissílabos Alternados e desempenho sem diferença estatisticamente significante no Teste de fala com Ruído. CONCLUSÃO: Os achados sugerem que o grupo de escolares com distúrbio de aprendizagem apresenta desempenho inferior em relação ao grupo sem dificuldades, refletindo dificuldades no processamento das informações auditivas.

Terapia de linguagem no espectro autístico: a interferência do ambiente terapêutico

OBJETIVO: Analisar o perfil funcional da comunicação de crianças e adolescentes com distúrbios do espectro autístico em dois ambientes de terapia de linguagem, que se diferenciam quanto ao aspecto físico. MÉTODOS: Participaram dez sujeitos com distúrbios do espectro autístico, seis do gênero masculino e quatro do gênero feminino, com idades entre 4 e 13 anos. Na coleta de dados, foram realizadas filmagens de oito sessões de terapia de linguagem individual com duração de 30 minutos, sendo quatro sessões em uma sala comum e quatro em uma sala com ambientação específica (sala NIC), intercaladamente, durante um mês. Para a análise dos dados foi empregado o Protocolo de Pragmática, e os resultados receberam tratamento estatístico. RESULTADOS: Verificou-se que não houve diferença significativa entre o perfil pragmático apresentado pelos dez sujeitos na sala comum e na sala NIC. CONCLUSÃO: O contexto físico aqui estudado não influenciou significativamente no perfil funcional da comunicação de indivíduos do espectro autístico, ainda que se tenha verificado tendências individuais apresentando melhor desempenho em uma sala ou em outra.

Alterações dos processos fonológicos e índice de gravidade entre escolares com dislexia e escolares com bom desempenho acadêmico

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)