O perfil bacteriológico e as variáveis relacionadas a ferida neoplásica no paciente em cuidado paliativo

Abstract

Neoplastic wound is an important clinical burden for patients in palliative care, since it affects self-image, generates social isolation and clinical worsening. By the wound's own composition, it is common colonization by aerobic and anaerobic bacteria, which generate a direct impact on exudation, odor and pain. In clinical practice, the use of bactericidal substances has been used in an indiscriminate way, considering that sometimes the therapeutic decisions for the treatment of neoplastic wounds are based on the physical aspects of the lesions and not on the basis of bacteriological tests. The objective of this study is to verify if there is an association between the bacteriological profile and the variables related to the neoplastic wounds of patients undergoing palliative care; to identify the bacteriological profile existing in the neoplastic wounds of patients undergoing palliative care; to evaluate the variables such as: sex, Karnofsky Performance Status scale, pain scale, odor grade scale, lesion staging scale, location, primary tumor type, appearance classification, dressing coverage, antibiotic use, use of chemotherapy and palliative radiotherapy, and discuss the implications of possible outcomes for nursing care. It is an observational study, of the transversal type and quantitative nature. The sample consisted of 36 patients hospitalized in the infirmaries of the National Cancer Institute Jose Alencar Gomes da Silva - Unit IV. Data collection took place between October and December 2018, including the swab of the neoplastic wound bed and the completion of the research form. In the analysis of the data, we used descriptive measures and Fischer / chi-square test for the evaluation of the association of wound variables and the bacteriological profile. As for the results of the association analysis and the bacteriological profile, there was a strong relation between the palliative radiotherapy variable and the bacterium Pseudomonas sp., Since the treatment did not achieve the reduction of sufficient neoplastic mass to alter the environment. Also, it was evidenced that: the fact that the patient does not use the antibiotic does not favor the biofilm increase in the neoplastic wound. Palliative chemotherapy (due to low dosage) is not associated with any bacterial genus. The presence of metastasis and the Karnofsky Performance Status low, had association with the bacteria of the genera Enterobacter sp. and Providence stuartii sp. respectively. As to the bacterial profile of neoplastic wounds, 4: Pseudomonas sp., Morganella sp., Klebsiella sp. and Proteus sp. Regarding the Nursing care performed on the neoplastic wound, it is observed that choosing the dressing cover only by the physical characteristics of the wound can induce the error. It is recommended to collect swabs of all neoplastic wounds and perform the antibiogram analysis of the wounds