Eficácia de intervenções de enfermagem no risco de sangramento pós alteplase no acidente vascular cerebral isquêmico

Abstract

Stroke (CVA) is increasing over the years. From 1990 to 2019, stroke cases rose drastically by 70%, along with a 43% increase in deaths and a 32% rise in disability-related deaths due to sequelae progression. In the care of stroke patients, the importance of the health professionals’ role in addressing this pathology is evident, promoting care for the patient and their family and consequently reducing complications. When treatment with Alteplase is defined for patients diagnosed with ischemic stroke, nursing care must have specificity related to the use of fibrinolytic therapy. To ensure adequate and effective care, Standardized Nursing Language Systems are utilized. For this study, the standardized languages considered were NANDA-International, which classifies diagnoses, the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC). NOC and NIC are defined based on clinical judgment developed during the application of the Nursing Process (NP). Objective: to evaluate the effectiveness of nursing interventions in ischemic stroke patients treated with Alteplase based on NOC taxonomy. The study adopted a quasi-experimental design conducted at the Western Regional Hospital, which is a high-complexity Neurology reference center with expertise in vascular clinics, from July 2023 to August 2024, involving 21 patients diagnosed with ischemic stroke and undergoing fibrinolytic treatment. One patient was excluded from the sample for staying less than three days in the ward, leaving 20 patients in the final sample. Data collection occurred at three points: immediately after Alteplase treatment/admission, 24 hours after admission, and on discharge day, regardless of the length of stay. Dependent variables were extracted from the nursing outcome indicators of the NOC taxonomy. Independent variables included sociodemographic and clinical data of participants. Qualitative variables were presented as absolute and relative frequencies, while quantitative variables were described using mean and standard deviation. Comparative analysis of indicator magnitudes at the three points used repeated-measures ANOVA. Statistically significant differences were considered when the probability of rejecting the null hypothesis was less than 5% (p<0.05). The study adhered to ethical guidelines established by Resolution No. 466/12 of the National Health Council, ensuring participant protection. Among epidemiological results, it was found that 14 (70%) of the patients were female, aged between 31 and 85 years. Three participants (15%) had no formal education. Systemic Arterial Hypertension stood out as the main risk factor. The primary identified etiologies were Thromboembolism and Atherosclerosis, with greater involvement of the internal carotid artery (right or left). Among the indicators evaluated at the three points, no statistical significance was observed, which may be attributed to the analysis software requiring a minimum sample of 30 participants to provide more robust and reliable results. Despite this, by analyzing the average results over the three points, improvements were identified in the Likert Scale magnitude for indicators such as prothrombin time, platelet count, and hematuria. On the other hand, blood pressure-related indicators showed a worsening in the average on the second day, followed by improvement on the third day. Meanwhile, indicators for petechiae, gingival bleeding, hemoptysis, and hematemesis remained unchanged during the hospitalization period. It is concluded that the methodology employed was effective in determining indicator evolution through mean analysis. Monitoring, used as a central intervention in the study, proved to be an essential tool for symptom control in the pathology, directly contributing to the clinical management and follow-up of ischemic stroke patients treated with Alteplase.