A visita domiciliar com instrumento de avaliação da adesão e prevenção de peritonites a pacientes em diálise peritoneal.
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2019-12-17
Autores
Marinho, Laudilene Cristina Rebello
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Universidade Estadual Paulista (Unesp)
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MARINHO. L, C. R. A visita domiciliar como instrumento de avaliação da adesão e prevenção de peritonites a pacientes em diálise peritoneal. 2019. 109f. Dissertação (Mestrado) - Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, 2019. Introdução: A doença renal crônica (DRC) resulta da deterioração progressiva e irreversível da função renal. Os métodos de tratamento para DRCT são: hemodiálise, diálise peritoneal ou transplante renal. A educação do paciente com DRC começa assim que o diagnóstico é feito e nunca termina. A visita domiciliar (VD) tem sido uma prática institucional que contribui satisfatoriamente para o seguimento da diálise peritoneal domiciliar, possibilita conhecer e acompanhar a realidade, permitindo intervir o mais rápido possível em falhas detectadas e esclarecimento de dúvidas. Objetivos: Elaborar revisão integrativa sobre o tema. Identificar o perfil epidemiológico dos pacientes em diálise peritoneal submetidos à VD. Identificar as variáveis quantitativas e qualitativas descritas nos formulários de VD e relacionar as variáveis ao desfecho de peritonite. Demonstrar a VD como instrumento de avaliação da adesão e prevenção de peritonites a pacientes em DP. Método: Trata-se de estudo observacional quantitativo do tipo coorte retrospectivo com dados provenientes de formulários de VD continuada de uma unidade de diálise em um hospital público no interior do Estado de São Paulo no período de janeiro de 2015 a janeiro de 2018. Os critérios de inclusão foram formulários preenchidos na íntegra de VD de pacientes com idade maior ou igual de 18 anos. A ocorrência de peritonite foi obtida através do registro em prontuário médico, durante o período do estudo. As variáveis preditoras avaliadas foram sócio demográficas, clínicas e relacionadas à técnica do tratamento. Foi realizada análise estatística descritiva dos dados com frequência e porcentagem para as variáveis qualitativas, média e mediana e desvio padrão para as variáveis quantitativas. Teste-Chi-quadrado ou Exato de Fisher e regressão logística para verificar a associação do desfecho peritonite com as variáveis explanatórias qualitativas (categóricas). Foi considerado p<0,05 como nível de significância. Resultados: Foram avaliados 234 formulários de VD de 120 pacientes, sendo que 48(39,3%) apresentaram pelo menos um episódio de peritonite ao longo do seguimento. Observou-se que através da análise univariada por regressão logística das variáveis: sociodemograficas que as variáveis, renda per capita OR = 0,999 P < 0,0021 e religião OR =0.492 P < 0,0261 foram preditoras independentes do desfecho questão; e também que análise univariada das variavéis relacionadas ao domicílio: presença de falhas no tratamento OR = 1,983 P< 0,0346 e falha na técnica OR= 5,747 P< 0,0098 foram preditoras independentes do desfecho peritonite. Através da regressão logística múltipla as variáveis, renda per capita OR = 0,999 - P = 0,0069 e falha na técnica da realização do procedimento de DP OR = 2,073 - P = 0,0302 foram preditoras independentes do desfecho peritonite. Conclusão: A VD mostrou-se um valioso instrumento de avaliação proporcionando oportunidade de reconhecer e corrigir possíveis falhas mantendo um padrão adequado de tratamento no domicílio de acordo com a realidade de cada paciente e família. Permite a enfermeira observar se o paciente mantém sua autonomia, se as modificações ou adaptações realizadas ao longo do tratamento não trazem riscos durante a aplicação da técnica.
MARINHO. L, C. R. Home visits as an instrument to assess adherence and prevent peritonitis in patients on peritoneal dialysis. 2019 109f. Thesis (Master) – Faculty of Medicine of Botucatu, Universidade Estadual Paulista, Botucatu, 2019. Introduction: Chronic kidney disease (CKD) results from the progressive and irreversible deterioration of renal function. Treatment methods for terminal chronic kidney disease (CKDT) are: hemodialysis, peritoneal dialysis or kidney transplantation. CKD patient education begins as soon as the diagnosis is made and never ends. The patient has to be advised about the disease, its treatment and especially about the chosen treatment modality. Home visit (HV) has been an institutional practice that contributes satisfactorily to the follow-up of home peritoneal dialysis, allowing to know and follow the reality, allowing to intervene as soon as possible in detected failures and clarification of doubts. Objectives: Develop an integrative review on the topic. Identify the epidemiological profile of patients on peritoneal dialysis initiated by the HV. Identify as quantitative and qualitative variables described in HV forms and relate as variables to the peritonitis outcome. Demonstrate HV as an instrument for assessing adherence and preventing peritonitis to PD patients.Method: This is a quantitative retrospective observational cohort study with data from continuous HV forms from a dialysis unit in a public hospital in the interior of the state of São Paulo from January 2015 to January 2018. Inclusion criteria were full forms of HV of patients aged 18 years or older. The occurrence of peritonitis was obtained through medical records during the study period. The predictor variables evaluated were socio demographic, clinical and related to the treatment technique. Descriptive statistical analysis of data was performed with frequency and percentage for qualitative, mean and median variables and standard deviation for quantitative variables. Chi-square or Fisher's exact test and logistic regression to verify the association of the peritonitis outcome with the qualitative (categorical) explanatory variables. It was considered p <0.05 as significance level. Results: A total of 234 HV forms from 120 patients were evaluated, and 48 (39.3%) had at least one episode of peritonitis during follow-up. Logistic regression showed that the variables, per capita income OR = 0.99 - P = 0.007 and failure to perform the PD procedure OR = 2.073 - P = 0.03 were independent predictors of the peritonitis outcome. Conclusion: The HV proved to be a valuable assessment tool providing the opportunity to recognize and correct possible failures while maintaining an adequate standard of treatment at home according to the reality of each patient and family. It allows the nurse to observe if the patient maintains his autonomy, if the modifications or adaptations made during the treatment do not bring risks during the application of the technique.
MARINHO. L, C. R. Home visits as an instrument to assess adherence and prevent peritonitis in patients on peritoneal dialysis. 2019 109f. Thesis (Master) – Faculty of Medicine of Botucatu, Universidade Estadual Paulista, Botucatu, 2019. Introduction: Chronic kidney disease (CKD) results from the progressive and irreversible deterioration of renal function. Treatment methods for terminal chronic kidney disease (CKDT) are: hemodialysis, peritoneal dialysis or kidney transplantation. CKD patient education begins as soon as the diagnosis is made and never ends. The patient has to be advised about the disease, its treatment and especially about the chosen treatment modality. Home visit (HV) has been an institutional practice that contributes satisfactorily to the follow-up of home peritoneal dialysis, allowing to know and follow the reality, allowing to intervene as soon as possible in detected failures and clarification of doubts. Objectives: Develop an integrative review on the topic. Identify the epidemiological profile of patients on peritoneal dialysis initiated by the HV. Identify as quantitative and qualitative variables described in HV forms and relate as variables to the peritonitis outcome. Demonstrate HV as an instrument for assessing adherence and preventing peritonitis to PD patients.Method: This is a quantitative retrospective observational cohort study with data from continuous HV forms from a dialysis unit in a public hospital in the interior of the state of São Paulo from January 2015 to January 2018. Inclusion criteria were full forms of HV of patients aged 18 years or older. The occurrence of peritonitis was obtained through medical records during the study period. The predictor variables evaluated were socio demographic, clinical and related to the treatment technique. Descriptive statistical analysis of data was performed with frequency and percentage for qualitative, mean and median variables and standard deviation for quantitative variables. Chi-square or Fisher's exact test and logistic regression to verify the association of the peritonitis outcome with the qualitative (categorical) explanatory variables. It was considered p <0.05 as significance level. Results: A total of 234 HV forms from 120 patients were evaluated, and 48 (39.3%) had at least one episode of peritonitis during follow-up. Logistic regression showed that the variables, per capita income OR = 0.99 - P = 0.007 and failure to perform the PD procedure OR = 2.073 - P = 0.03 were independent predictors of the peritonitis outcome. Conclusion: The HV proved to be a valuable assessment tool providing the opportunity to recognize and correct possible failures while maintaining an adequate standard of treatment at home according to the reality of each patient and family. It allows the nurse to observe if the patient maintains his autonomy, if the modifications or adaptations made during the treatment do not bring risks during the application of the technique.
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Palavras-chave
Diálise peritoneal, Visita domiciliar, Enfermagem, Autocuidado, Peritoneal dialysis, Home visit, Nursing, Self care