Uso seguro de opioides no paciente queimado: proposta de barreiras pela enfermagem

• Autor(a) principal: Henrique, Danielle de Mendonça
• Data de Publicação: 2015
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/11142
• topic: Nursing; Burns; Opioid; Respiratory depression; Enfermagem; Queimaduras; Opioide; Depressão respiratória; CNPQ::CIENCIAS DA SAUDE::ENFERMAGEM

The thesis developed in this study considers that the respiratory depression (RD) in burned patients using opioids as pharmacological therapeutic for pain can be prevented through nursing actions that identify its predisposing factors; also, nurses should consider the pharmacological characteristics of drugs during the routine schedule to apply pharmacological therapeutic for pain, aiming to prevent drug interactions; and adequately they should monitor the burned patient to identify early signs of respiratory depression. Therefore, this study had as general objective to develop safety barriers with a focus on nursing actions to prevent respiratory depression in burned patients in use of opioids; those barriers were related to the pharmacology of opioids, to the predisposing factors for respiratory depression by opioid, and to the monitoring of respiratory depression. This is a retrospective study that analyzed 272 medical records of burned patients admitted into a Burn Treatment Center (BTC) of large federal public hospital in the city of Rio de Janeiro, Brazil, from 2011 to 2013. Among those records, 42 records met the selection criteria of this research; and the occurrence of respiratory depression was identified in 28.58% (n=12) of them. Young adult male patients were prevalent. The death predominated in the group with RD, as well as, in the group with burns of 2nd and 3rd degrees and about 50% burned body surface. The prevalent factors for respiratory depression were renal failure, hypoalbuminemia, and high blood pressure. In drug therapy of burn patients, opioid analgesics are the most used, predominantly tramadol (45.49%) and methadone (18.45%). Diazepam is the chosen benzodiazepine; and among antidepressants, imipramine is the most used, although gabapentin is classified as anticonvulsant; in burned patients, it is used in analgesic dose. Either in patients with or without RD, the prevalent drugs administration schedule was made at 10:00 p.m. and 6:00 a.m. Potential Drug Interaction (PDI) was evidenced in 66.6% of studied patients. Correlation between the PDI occurrence and the RD proved to be positive; patients who presented PDI have 2.5 times higher risk for developing RD. The pairs of prevalent drugs and that presented PDI in the group with RD were methadone with diazepam (n=5), tramadol with fentanyl (4), methadone with imipramine, and methadone with tramadol (n=3). In group without DR, the prevalent drugs were methadone and tramadol (n=8), tramadol with fentanyl (4), and methadone with diazepam (3). The oral and intravenous drugs administration was prevalent in patients with and without RD, and no positive correlation between the administration by these forms and the occurrence of RD was found, evidencing up that the administration form is not so important to the RD. In patients with RD, 83.3% had PDI, mainly in the schedules of 10:00 p.m. and 6:00 a.m., close to the occurrence times of RD. It is expected that this study can contribute to safe drug administration when using opioids, and in the prevention of serious adverse events like respiratory depression in burned patients.