Start studying Escala de aldrete. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Em relação à dor, a cada incremento de uma unidade na escala numérica (0 a . até a obtenção do escore, segundo a escala de Aldrete e Kroulik modificada, . INFLUÊNCIA DA ESCALA DE ALDRETE E KROULIK NAS ESTRATÉGIAS DE GESTÃO DA SALA DE RECUPERAÇÃO PÓS-ANESTÉSICA. Article. Full-text.
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Elaborating and applying a patient evaluation instrument in the immediate postoperative period IPOP after general anesthesia, based on the Advanced Trauma Life Support protocol.
An instrument was created, based on the Trauma ABCDE and applied in the post-anesthetic recovery room in all adult patients submitted to surgeries under the effect of general anesthesia, from September to November, There were alterations in pulmonary auscultation in A statistically significant difference was also observed, suggesting that women have better recovery conditions than men.
Postoperative period; Nursing Care; Wounds and injuries. The purpose of post-anesthetic recovery room PARR is to receive patients immediately after surgical procedures have been concluded, still under the effect of anesthesia, where they are intensively controlled until the possibilities of developing complications related to the cardiorespiratory, neurologic and osteomuscular systems are absent 1.
The period known as immediate postoperative period IPOP begins at the discharge of the patient from the operation room until up to 12 to 24 hours after the surgery. However, patients are known to present the main complications in the first hours after the surgical-anesthetic procedures, and thus need continuous observation and specific care, justifying the necessity of being referred to the anesthetic recovery room 2.
This period is characterized by physiological changes, including unconsciousness and cardiorespiratory depression in patients submitted to general anesthesia, and absence of sensitivity and sympathetic tonus in those submitted to regional anesthesia 3.
Other complications include neurological and kidney alterations, pain, hypothermia, nausea and vomiting, abdominal distensions and hiccups 4.
In an exploratory descriptive study performed with children and adults in a PARR, 32 complications were found in adults and five in children.
The main complications analyzed were related to anesthesia, which suggests the implementation of nursing care directed to prevention and early detection of such complications 5.
A safe and efficient evaluation about this patient is necessary, in which endocrine and metabolic alterations, consequent of the surgical-anesthetical trauma, can be considered.
Also, the creation of evaluation standards and criteria for the care provided to the patient in this period, as well as their validation 6. This scale considers the assessment of physiological conditions, and was inspired in Apgar’s scale for the evaluation of newborns. This scale was changed inwhen it started to evaluate oxygen esccala instead of skin coloration, as predicted in the original scale.
Its scores can vary from 0 to 10, and it analyzes the following aspects of the patient: The score indicated for intra-hospital discharge lies between 8 and 10 7.
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Some authors 6,8 concluded that this index does not guarantee a safe evaluation, because it has an isolated evaluation of some parameters, which yields a score higher than seven.
This would result in discharging patients who do not present a stable condition from the PARR. Another relevant aspect is the difference of recovery in the IPOP when the patient’s gender is considered. A Australian study shows that women have faster recoveries when separate analysis are performed on recoveries from escla anesthesia 9. The Trauma ABCDE protocol was elaborated in the United States of America by the American College of Surgeons with the purpose of improving the care for polytrauma patients, in order to detect early the physiological alterations that put the person at risk of death The Trauma ABCDE is a systematization of service for trauma victims proposed by ATLS with the goal of standardizing the actions that will be performed for this patient, and it is divided in alddrete stages: The mnemonic ABCDE method arose because traumas were seen to kill people according to a predictable chronology.
For example, obstruction of the airways kills faster than aldretr loss of breathing ability, which kills faster than the reduction of the circulating amount of blood, with the next most lethal problem being the presence of massive expansive intra-cranial injuries. dde
Therefore, the method is as follows: This is a cross-section, exploratory, quantitative study performed at the PARR of a university hospital in the city of Londrina-PR, after the research project was approved alvrete the Review Board of the institution.
Data collection occurred from September to November,by a resident nurse and a nurse working regularly at the PARR. Of these, The study sample was selected at random, determined by the time of data collection, from 7 AM to 7 PM during two months.
It consisted of 77 adult patients of both genders, submitted to general anesthesia, and who, during the pre-operatory visit, agreed to sign the term of consent. Three nurses were chosen to evaluate the instrument contents 12with knowledge in the area of anesthetic recovery and trauma, with the purpose of refining the definition of the items and evaluate their pertinence.
After the adjustments performed according to the nurses’ judgment, the instrument acquired a new format, being pre-tested next. This procedure evaluated the difficulties in the application of the instrument, interpretation and conception of the scoring system for the results, being performed by the authors, who started data collection after making the changes suggested at this stage.
Data collection was performed by adopting the routine of the service: The data collection instrument consisted of two parts: The protocol was made up of the five phases of evaluation: Phases B and C have sub-items, with B consisting of oxygenotherapy, pulmonary auscultation and respiratory frequency.
C consists of oxygen saturation, blood pressure, heart rate, skin characteristics and presence of bandages or injuries. Scores eecala assigned to each phase of the evaluation. The scores were distributed according to the theoretical reference used in this study 8where phase A is more important than phase B, because the patient is more susceptible to death, and so on.
Therefore, phase A aldfete of five items of assessment that sum up to 30 points. Phase B consists of 13 items of assessment that sum up to 25 points, phase C consists of 21 items of assessment that sum up to 20 points, phase D consists of three items that sum up to 15 points, and phase E also has three items that sum up to 10 points. At the end of the evaluation, the results obtained in each of the stages, A, B, C, D and E total scorewith the highest aldreye score being 58 points and the worst possible score being 11 points.
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Kruskal Wallis’ non-parametric test was used for the comparative analysis of the differences found among the scores for admission and discharge in the PARR for the variables gender and age. Wilcoxon’s T test was used to compare the averages at the moment of admission and discharge from the PARR.
The adopted level of significance was 0. Seventy-seven patients were evaluated, who had eacala submitted to different types of surgical-anesthetic actions from the following a,drete Of these 77 patients, 39 The data collected in the admission first 15 minutes were compared with those collected at the discharge.
In phase A, The three sub-items were analyzed in phase B: For oxygenotherapy, it was verified that For pulmonary auscultation, There were no alterations in these data through pulmonary auscultation at the moment of discharge from the PARR.
As for the respiratory frequency, At discharge, these values were changed to At the moment of admission in the PARR, 50 patients At the moment of discharge, 70 Regarding heart rate, most patients, At discharge, the normocardic patients were Regarding skin characteristics, 55 Bandages were either clean and dry or were absent in 70 At discharge, clean and dry bandages were still the norm Those with bleedings increased to 12 This, in turn, evaluates the patients’ eye, verbal and motor responses, with a score varying from 3 to For the eye opening item, we observed that At discharge, these values were altered xldrete For verbal responses at admission, 35 At discharge, aldrehe For the motor response item, The average ECG score obtained by patients at admission was At 30 minutes, the average was And, at discharge, the average was The last phase of the instrument, phase E, evaluates body exposure with hypothermia control.
In the first 15 minutes, From the total scores the sum of the five phases obtained by the patients at admission, we found an average score of For discharge, these values were: The post-anesthetic recovery period has its own particularities, due to the effects of the surgical-anesthetic act in our organism 3and it is considered critical, a reason why the nursing care must be increased and documented, preferably in instruments that are adequate for this type of patient.
Authors 13 state that the nursing evolution must contain these items: As seen, all these data are important for the assessment of the patient are present in the instrument in question.
It is important to remember that the most common postoperative complications are: Among these, se respiratory tract disorders are the most common When we use an evaluation instrument with the Trauma ABCDE as its base, the first item to be evaluated is the respiratory tract phase Athus preventing its respective complications.
The method used in this study allowed for an ample, in-depth view of the general state of the patient in IPOP through the physical cephalic-caudal examination suggested by the Trauma ABCDE, ed enables the early identification of complications made evident during the presentation of the results, and that will be discussed next. It evaluates three clinical parameters: The author examined over 2, patients and concluded that this scale is an adequate and easy to use guide to monitor the patient at the PARR.
However, in this study, aspects that are also very important in the evaluation of the patient in the IPOP, such as breathing and ventilation, circulation and body temperature were not evaluated, which aldrege limits to it. In phase A, it was observed that 5. Airway obstruction, laryngospasm, accumulation of secretions and inadequate aaldrete exchanges can be present in the IPOP, resulting in hypoxemia, which constitutes a serious threat.
Most respiratory complications happen in the first hour after surgery, i. In the evaluation of the phase B item oxygenotherapy, Hypoventilation is commonly observed after anesthesia, during the depression of the central nervous system due to residual effects of potent anesthetics and analgesics The actual volume is lowered, the vital capacity and the forced respiratory volume are lowered and coughing is restricted by pain.
The saturation is observed to decrease, with the administration of oxygen to almost all patients alvrete the PARR being recommended, except in cases when this action is wscala advisable The auscultation of ronchi and hissing, associated to hypoxia, may suggest the diagnostic of aspiration of gastric contents Blood pressure evaluated in phase C made hypotension evident in This is a common and worrying complication in the postoperative period.