Sistematización de la asistencia de enfermería: enfoque en un paciente portador de úlcera venosa. Estudio de caso.

Abstract

Venous ulcers account for about 70% to 90% of leg ulcer cases and are associated with chronic venous insufficiency. The study was aimed to demonstrate the importance of nursing care towards patients with venous ulcers. The case study was developed in a hospital in Fortaleza, Ceara, Brazil, during the month of March 2010, with a patient with venous insufficiency and venous ulcers in the left leg. To obtain the data the Systematization of Nursing Care (SNC) was used as a basis. An Interview was performed with the patient and attendant, with consultations to medical records and the physical examination of the patient, who was informed about the objectives and importance of the study. The problems were raised and identified following nursing diagnoses according to NANDA Taxonomy 2007-2008: impaired tissular integrity related to impaired circulation and mechanical factors, impaired ambulation related to cognitive impairment, neuromuscular and musculoskeletal and muscular strength insufficient; chronic pain related to chronic physical disability, anxiety related to impaired health; and body image disturbance in connection with the injury. Later were planned nursing interventions. It is essential to the role of nurse care to patients with venous ulcers because it is a chronic disease with a slow recovery and with the possibility of recurrence and potential major implications for the patient's life.