Atuação do enfermeiro na assistência de enfermagem ao paciente com lesão por pressão, A : relato de caso

Abstract

Introduction: Wounds are a serious public health problem in Brazil and their treatment requires quality theoretical and practical knowledge from the health team to indicate the best treatment. In this context, the role of nurses in nursing care for patients with pressure injuries, allows comprehensive and equitable assistance to patients. Objective: Describe the importance of the Nurse as an integrating agent of comprehensive care for patients with pressure injuries. Methodology: This is a single case study, of the instrumental and descriptive type, with a qualitative approach, carried out in home care in the Municipality of Sinop - MT, with a patient from the area covered by UBS Jacarandás. Data were collected from the medical records, after signing the Free and Informed Consent Form by the person responsible for the patient. The research was approved by CEP/UFMT/CUS. Results: Female patient, 97 years old, retired, totally dependent on activities of daily living, confined to bed, hypertensive, diabetic, with nasoenteric tube, admitted on 09/19/2022 with 2 pressure injuries (PI) in the sacral region (F1 - unstageable and F2 - stage 3) and PI in L calcaneus (F3 - unstageable). The therapeutic plan was initially based on enzymatic and conservative instrumental debridement of F1 and F2, and autolytic debridement of F3, PHMB 0.1% solution for cleaning and occlusive dressing, with papain 8% as primary coverage in coagulation necrosis and liquefaction in F1 and F2, and hydrogel in F3, in addition, barrier cream on the edges and perilesional skin of all lesions. Secondary coverage of gauze moistened with warm SS 0.9%, followed by dry gauze and fixation with micropore. It was associated with laser therapy (red laser/660 nm and infrared/820 nm) and topical ozone therapy (bye bag). After removal of necrotic tissues, 4% papain was applied as primary coverage on granulation tissue and subsequently changed to 2% papain. Thus, total healing of F1 was obtained in 6 months and 8 days, of F2 in 42 days and F3 in 4 months and 11 days. The reported case made it possible to demonstrate that the role of the Nurse in the prevention and treatment of wounds goes beyond the context of patient assessment with a view to choosing an appropriate topical therapy, as it was possible to highlight four possible dimensions that emerged from the contribution of the study, which they highlight among themselves the role of the Nurse as: Integrator of multi-professional care; Mediator of the implementation of Integrative and Complementary Practices for SUS users; Integrator of the teaching-service-community axis, as well as in health education for caregivers of patients with PI in Primary Care. Conclusion: The results obtained through this study indicate that the Nurse acts as an integral integrator for the patient with pressure injury, and that the therapeutic approaches adopted contributed successfully to the outcome of the reported case.