Eficácia das intervenções de enfermagem no acidente vascular cerebral isquêmico

Abstract

In 2019, strokes were the second leading cause of death worldwide, and 62.4% of these were ischemic. Nurses play an essential role in caring for patients with ischemic strokes, by preventing complications, promoting patient/family care and managing the activities of the multidisciplinary team. In order to provide effective care, the Standardized Language Systems for Nursing are used to apply the stages of the Nursing Process. For this study, the NANDA-International languages that classify diagnoses, the Nursing Outcomes Classification (NOC) and the Nursing Interventions Classification (NIC) were considered. Objective: to evaluate the effectiveness of nursing interventions for stroke patients based on the NOC taxonomy and to identify the epidemiological profile of the patients. This was a quasi-experimental study carried out in the Neurology department of a public hospital in the western region of Santa Catarina, from July to September 2023, with 24 patients diagnosed with stroke. Data was collected at three different times (on the day of admission/pre-test; 24 hours after admission and on the day of discharge/post-test). The dependent variables were extracted using the following instruments: 1-Nursing outcome indicators from the NOC taxonomy; 2- data from the Glasgow coma scale and 3- data from the Medical Research Council (MRC) scale for assessing muscle strength. The independent variables were sociodemographic and clinical data. The qualitative variables were described by absolute and relative frequency, while the quantitative variables were described by mean and standard deviation. Repeated measures ANOVA was used to compare the magnitudes of the indicators between the three periods. Differences where the probability of rejecting the null hypothesis was less than 5% (p<0.05) were considered statistically significant. For all participants, ethical guidelines were ensured in accordance with Resolution 466/12 of the National Health Council. As epidemiological results, 16 (66.6%) were female, their age ranged from 31 to 87 years, 11 (45.83%) had no formal literacy. The main risk factor was systemic arterial hypertension and the most obvious etiologies were thromboembolism and atherosclerosis, mainly affecting the bifurcation of the internal carotid artery. According to the indicators analyzed at the three time points, significance was found in the indicator communication appropriate to the situation (p=0.002) and in the MRC scale variables for the upper limbs (p=0.047) and lower limbs (p=0.029). The following indicators improved on average: consciousness, motor control, respiratory rate, autonomic function and communication. The indicators: pupillary reactivity, pupil size, heart rate, blood pressure, respiratory pattern, 9 hyperthermia, headache and swallowing showed a decline in the average on the second day and an improvement on the third. The blood glucose indicator showed a progressive worsening of the average. It can be concluded that the methodology used was able to determine the effectiveness of the communication indicator appropriate to the situation. Monitoring, which was used as the main intervention in the study, is essential for controlling symptoms, especially on the second day of hospitalization.