{"id":118026,"date":"2015-11-09T00:00:00","date_gmt":"2015-11-09T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/aportacion-de-la-enfermeria-y-mejora-de-la-calidad-asistencial-en-la-atencion-del-sa%c2%adndrome-confusional-agudo-en-los-pacientes-cra%c2%adticos\/"},"modified":"2015-11-09T00:00:00","modified_gmt":"2015-11-09T00:00:00","slug":"aportacion-de-la-enfermeria-y-mejora-de-la-calidad-asistencial-en-la-atencion-del-sa%c2%adndrome-confusional-agudo-en-los-pacientes-cra%c2%adticos","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/ciencias-medicas\/aportacion-de-la-enfermeria-y-mejora-de-la-calidad-asistencial-en-la-atencion-del-sa%c2%adndrome-confusional-agudo-en-los-pacientes-cra%c2%adticos\/","title":{"rendered":"Aportaci\u00f3n de la enfermer\u00eda y mejora de la calidad asistencial en la atenci\u00f3n del s\u00edndrome confusional agudo en los pacientes cr\u00edticos"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Juan  Jose Rodriguez Mondejar <\/strong><\/h2>\n<p>Aportaci\u00f3n de la enfermeria y mejora de la calidad asistencial en la atenci\u00f3n del s\u00edndrome confusional agudo en los pacientes cr\u00edticos  resumen  introducci\u00f3n y objetivos:   el s\u00edndrome confusional agudo (sca) es un proceso conocido, que se puede presentar tras el ingreso hospitalario, y puede ser definido como un s\u00edndrome mental transitorio, caracterizado por un trastorno global de la cognici\u00f3n y la atenci\u00f3n, un nivel de conciencia reducido, alteraci\u00f3n de la actividad psicomotora (por exceso o por defecto), y un desorden en el ciclo sue\u00f1o-vigilia. Su presentaci\u00f3n es aguda, inesperada, generalmente en la noche, a\u00f1adido a otros procesos org\u00e1nicos, y su duraci\u00f3n se considera relativamente breve (menos de 1 mes). objetivo: analizar la poblaci\u00f3n y sus caracter\u00edsticas sociodemogr\u00e1ficas y cl\u00ednicas en una unidad de cuidados intensivos (uci), y exponer la aportaci\u00f3n de enfermer\u00eda tras un ensayo cl\u00ednico sobre la actuaci\u00f3n en el sca.   material y metodolog\u00eda  tipo de estudio: ensayo cl\u00ednico, aleatorizado, no ciego, con  muestras paralelas, prospectivo, anal\u00edtico y longitudinal.   muestra: la poblaci\u00f3n que ha ido ingresando en la unidad y ha cumplido los requisitos solicitados.   caso: paciente que desarrolla el sca en uci y cumple criterios de inclusi\u00f3n y no tiene ning\u00fan criterio de exclusi\u00f3n.   lugar: unidad de cuidados intensivos (uci) de un hospital general universitario de nivel ii, en la regi\u00f3n de murcia.   temporalidad: 2 a\u00f1os de recogida de datos.  desarrollo: tras el ingreso del paciente en uci se realizar\u00e1 una recogida de datos general, implementando los factores de riesgo conocidos, datos sociodemogr\u00e1ficos y cl\u00ednicos, entre otros. Se suministrar\u00e1n cuestionarios validados como cam-uci, y escala de nivel sedaci\u00f3n (sas). Enfermer\u00eda implementar\u00e1 medidas de control medioambiental, reorientaci\u00f3n y otras intervenciones (nic) en grupo estudio.   procesamiento estad\u00edstico con ibm spss statistics v.20. Se ha realizado estad\u00edstica descriptiva con c\u00e1lculo de medias, desviaci\u00f3n est\u00e1ndar, para las variables cuantitativas, y de frecuencias y porcentajes para las cualitativas. La inferencia estad\u00edstica se ha hecho estimando un m\u00e1ximo de un 5% de error, y un 95% de confianza, aceptando significaci\u00f3n estad\u00edstica si p&lt;0,05. c\u00e1lculo de chi2 de pearson, con estudio de residuos corregidos. Ante las frecuencias esperadas menor de 5, se ha aplicado el estad\u00edstico exacto de fisher. Prueba de la t de student para comparaci\u00f3n de muestras independientes para la igualdad de medias. estimaciones \u00e9ticas: ha sido aprobado por el ceic del \u00e1rea de salud y de la umu.  resultados:   poblaci\u00f3n 1093 pacientes, edad 65,4 a\u00f1os de16, varones 64%, \u00edndice de gravedad apache ii 15 de 9, estancia en uci media 5,77 d\u00edas, en hospital 8,22. Exclusiones un 15%. Diagn\u00f3stico m\u00e1s frecuente s\u00edndrome coronario agudo sin elevaci\u00f3n del st (scasest). Desarrollan sca y cumplen criterios el 6,8%. Grupo control 34 (52%), grupo intervenci\u00f3n 33 (48%). Su estancia en uci ha oscilado entre 7 y 11 d\u00edas, y han presentado 5 factores predisponentes y 6-7 precipitantes. El sca ha durado entre 36 y 48h.  enfermer\u00eda realiza plan de cuidados espec\u00edfico en grupo intervenci\u00f3n, con 14 intervenciones de media por turno, y con una dedicaci\u00f3n de 43,71 minutos.  conclusiones:  el perfil epidemiol\u00f3gico del paciente que ha desarrollado el sca se corresponde con un var\u00f3n, de 74,4 a\u00f1os, independiente, jubilado, motivo de ingreso predominante de cardiopat\u00eda isqu\u00e9mica y\/o sepsis-shock s\u00e9ptico, con \u00edndices de gravedad medios-altos, con antecedentes de hta, diabetes tipo ii, dislipemias y acv. Tener h\u00e1bito tab\u00e1quico previo ha demostrado ser un factor influyente.  ha recibido haloperidol como f\u00e1rmaco de elecci\u00f3n para el control del delirio.  la aplicaci\u00f3n de la metodolog\u00eda enfermera con un plan de cuidados individual en el paciente con confusi\u00f3n aguda ha demostrado ser \u00fatil al disminuir el tiempo de duraci\u00f3n del sca en el paciente, y de la recuperaci\u00f3n del mismo.       contribution of nursing and improvement of healthcare quality regarding the assistance of patients with acute confusional syndrome abstract introduction and objectives. the acute confusional syndrome (acs) is a familiar process that may occur after hospitalisation and which can be defined as a transitory mental disorder, characterised by a global disturbance in cognition and attention as well as a low consciousness level, an alteration of psychomotor function and a disorder in the sleep-wake cycle. It appears in a sudden, acute way, specially at night, together with other organic processes and it has got a relatively short duration (less than a month) objective: to analyse the population and its demographic and clinical features in an intensive care unit (icu) and show nursing contribution after a clinical trial on actions in acs cases.  instruments and methodology type of research: clinical trial, randonized, &quot;not blind&quot; , with parallel samples, prospective, analytical and longitudinal. sample: patients hospitalized in the icu that comply with the required characteristics. case: patient who develops acs in the icu and who has all the inclusion requirements and has no exclusion ones. place : the icu of the &quot;hospital general universitario&quot; in the region of murcia.  timing : two years of field research. development: after the patient admission in the icu, general data is collected, implementing familiar risks factors, sociodemographic data and clinical data among others. Cam-icu and scale level of sedation (sas) validated questionnaires are provided to the nursing staff, who will implement environmental control measures, reorientation and other interventions in the study group. statistical processing : by means of ibm spss statistics v.20. A descriptive statistic with calculated weighted mean has been applied, together with standard deviation for the quantitative variables and frequencies and percentages for the qualitative ones. The statistical inference has been calculated on a maximum error of 5% and a 95% of reliability (confidence), accepting statistical meaning if p &lt;0,05. calculation of chi of pearson, with study of corrected non-valid data. For the expected lower frequences, the fisher exact statistics has been applied. The student t test has been used for the comparison of independent samples for the equality of means. ethical considerations : the study has been approved by the &quot;ceic&quot; of the health department and the &quot;umu&quot;  results: population: 1093 patients; age: 65,4 years of age, de16, male 64%; level of severity apache ii 15 out of 9; average icu stay: 5,77 days; discarded samples: 15%; most frequent diagnosis: acute coronary syndrome without st elevation (scasest). 6,8% develop sca and comply with requirements. Control group 34 (52%), intervention group 33 (48%). Their icu stay has ranged between 7 and 11 days, having 5 predisposing factors and 6-7 precipitating factors. the sca condition has lasted between 36 and 48 hours.  the nursing staff provide a specific planning care to the study group, with an average of 14 interventions in every working shift, devoting 43,71 minutes. conclusions: the epidemiologic profile of a patient with a sca condition is male, 74,4 years old, independent, retired whose reason for hospitalisation is coronary heart disease  and\/ or sepsis\/septic shock with a low-medium level of severity, with a medical history of ath, type 2 diabetes, dyslipidemia and stroke. Previous smoking habits have also proved to be an influential factor. the patients have been treated with &quot;haloperidol&quot; for delirium control. the application of nursing methodology together with an individual care plan on these patients have been highly effective as it has reduced both the sca process and patient recovery time.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Aportaci\u00f3n de la enfermer\u00eda y mejora de la calidad asistencial en la atenci\u00f3n del s\u00edndrome confusional agudo en los pacientes cr\u00edticos<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Aportaci\u00f3n de la enfermer\u00eda y mejora de la calidad asistencial en la atenci\u00f3n del s\u00edndrome confusional agudo en los pacientes cr\u00edticos <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Juan  Jose Rodriguez Mondejar <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 11\/09\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Mar\u00eda Jos\u00e9 L\u00f3pez Montesinos<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: david Armero barranco <\/li>\n<li>pilar Delgado hito (vocal)<\/li>\n<li>  (vocal)<\/li>\n<li>  (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Juan Jose Rodriguez Mondejar Aportaci\u00f3n de la enfermeria y mejora de la calidad asistencial en la atenci\u00f3n 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