Protocolo assistencial de enfermagem: cuidados intra-hospitalares ao paciente vítima de amputação traumática primária de extremidades

Abstract

The prevalence of traumatic amputation of extremities is high, being its main occurrance due to external causes (laboral and traffic accidents, violences, amongst other causes). The objectives of this work were to elaborate a nursing health care protocol for the caring of patients undergoing traumatic amputation of extremities in the First-aid Hospital of Porto Alegre and to investigate high quality evidences for the nursing care of patients undergoing traumatic amputation of extremities. To do so, an integrative review was undertaken and, by using the acronym PICOT, the research question was defined as, “What are the best evidences preconized to the nursing care of patients undergoing traumatic amputation of extremities due to trauma?”. The search for studies was taken in the Virtual Library for Health – including data bases such as Latin-American and Caribbean Literature in Health Science, MEDLINE and Nursing Data Base (BDENF) –,in the Cumulative Index to Nursing and Allied Health Literature (CINAHL) – accessed via EBSCO – and in the MEDLINE – via digital archives of biomedicine and health sciences of the US National Institute of Health (PubMed).The languages included were Portuguese, English and Spanish.Controlled descriptors in Social Science (DeSC): Amputação Traumática; Cuidados de Enfermagem; Cotos de Amputação; Membro fantasma; Choque; Infecção. Medical Subject Headings (MeSH): Amputation, Traumatic; Nursing Care; Amputation Stumps; Phantom Limb; Shock; Focal.CINAHL headings: Amputation, Traumatic; Nursing Care Plans; Amputation Stumps; Phantom Limb; Shock; Infection. Inclusive criterias were: publications about nursing care of patients undergoing traumatic amputation due to extremity trauma and works written in English, Portuguese or Spanish language.There was no criteria estabilishing a period of time for the publications. Exclusive criteria: articles that were not fully available online; resumes published in congresses’ annals; monographies.213 publications were found and, after applied the criterias of inclusion and exclusion, only 12 articles were chosen. The found evidences were classified in levels of Melnyk and Fineout-Overholt.To elaborate the Nursing Health Care Protocol: Intra-hospital Caring of Patients Undergoing Traumatic Amputation of Extremities, the 12 steps proposed by Pimenta et al.(2017) were followed. Four fluxograms systematizing the nursing care were elaborated: first intra-hospital treatment of patient undergoing traumatic amputation of extremities; nursing care – in the first 24 hours – of the stump of a patient who underwent traumatic amputation of extremity; nursing care – during the hospitalization – of the stump of a patient who underwent traumatic amputation of extremity; preparing the patient who underwent traumatic amputation to his discharge from hospital. The motivation for the creation of that protocol came from the researcher’s everyday practice while taking care of patients that underwent traumatic amputation in the First-aid Hospital of Porto Alegre – a hospital reference in traumatology. Amongst the possibilities of the protocol applicability and its impact in the nursing daily practice, it is highlighted: the systematization of caring acting based in scientific evidence regarding the subject, what might contribute to assign nursing conducts in the first intra-hospital treatment of patients with traumatic amputation of extremities in order to recognize hypovolemic schocks and to maintain a continuous analgesia aiming to minimize infection risks and phantom limb pain in the future; the usage of bandaging technics to moldthe stump since the immediate postoperative; the access to information about caring networks for the amputee in the state of Rio Grande do Sul (RS) and in the city of Porto Alegre/RS. Apart of its validation, this is a source of research and evidence divulgation regarding the subject. Nursing health care protocol: in-hospital care of the patient victim of primary traumatic amputation of extremities.Fluxograms: First intra-hospital treatment of patient undergoing traumatic amputation of extremities; Nursing care – in the first 24 hours – of the stump of a patient who underwent traumatic amputation of extremity; Nursing care – during the hospitalization – of the stump of a patient who underwent traumatic amputation of extremity; Preparing the patient who underwent traumatic amputation to his discharge from hospital.