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Estudo de caso: Assistência de Enfermagem ao paciente com síndrome de wolff-Parkinson-White

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Assistência de Enfermagem ao paciente com síndrome de wolff-Parkinson-White

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Estudo de caso: Assistência de Enfermagem ao paciente com síndrome de wolff-Parkinson-White

  1. 1. PLANEJAMENTO DA ASSISTÊNCIA DE ENFERMAGEM AO PACIENTE COM SÍNDROME DE WOLFF-PARKINSON- WHITE Enfª R1 Mariana Barros Pronto Socorro Cardiológico de Pernambuco Profº Luiz Tavares Programa de Especialização em Cardiologia Modalidade Residência Julho, 2014
  2. 2. Objetivos • Compreender a fisiopatologia, manifestações clínicas e tratamento da Síndrome de WPW; • Relatar o caso de um paciente com a Síndrome de WPW; • Correlacionar a evolução clínica do caso apresentado com os achados da literatura; • Elaborar um plano de cuidados de enfermagem.
  3. 3. Introdução • 1930 -> Louis WOLFF, John PARKINSON e Paul WHITE • Incidência -> 2x mais em homens • Idade = qualquer faixa etária • Incidência: a cada 2 pessoas em 1000 • Pode estar associada a alguma cardiopatia prévia em 30%dos casos (doença de Ebstein, CIA, Tetralogia de Fallot)
  4. 4. Fisiopatologia 2 vias NAV Feixe de Kent
  5. 5. Alterações no ECG O intervalo PR < 0,12s
  6. 6. Alterações no ECG Complexo QRS alargado a mais de 0,11 s Aparecimento da onda delta
  7. 7. Arritmias Associadas Taquicardia Supraventricular Paroxística Fibrilação Atrial
  8. 8. Manifestações Clínicas Palpitações Desconforto Torácico Tonturas Dispneia Pré-síncope Extremidades Frias
  9. 9. Diagnóstico • ECG: para análise do padrão elétrico do coração • ECO: para descartar eventuais defeitos estruturais cardíacos associados e pode visualizar o caminho acessório • Holter de 24 horas • Teste ergométrico • Estudo eletrofisiológico
  10. 10. Tratamento • Medicações: amiodarona (Ancoron®), sotalol (Sotocor®). • Algumas medicações não podem ser utilizadas: beta-bloqueadores (propranolol, metoprolol) ou bloqueadores do canal de cálcio (verapamil, diltiazem). • Ablação: é um método de tratamento que utiliza cateteres para cauterizar, com energia de radiofreqüência, a via elétrica extra. É o método de tratamento de escolha para esses pacientes.
  11. 11. Restrição • Não podem exercer atividades físicas competitivas (futebol, vôlei, basquete) nem esportes radicais (mergulho, escalada, asa- delta). • Esses pacientes também não podem exercer profissões de risco (piloto, motorista, operador de máquinas pesadas). • Após ablação não há qualquer restrição para atividade física e qualquer profissão poderá ser exercida.
  12. 12. COLETA DE DADOS
  13. 13. Estudo de Caso  Coleta de dados: UTI Coronária I do Pronto-Socorro Cardiológico de Pernambuco - PROCAPE .  Período da coleta: junho de 2014  Procedimentos:  Anamnese  Exame físico  Prontuário clínico  Pesquisa literária
  14. 14. Anamnese • D.S.N, 19 anos, sexo masculino, negro, estudante, solteiro. • História da Doença Atual: Foi admitido no PROCAPE dia 27/05/2014 em PCR por FV com história de perda súbita da consciência há +/- 15 minutos antes da sua chegada ao hospital, foi reanimado por +/- 10 minutos. Pcte evoluiu com 2 novos episódios de PCR por FV durante 5 min e 10 min respectivamente, submetido à manobra de RCP + cardioversão, apresentando retorno de ritmo com BRD em escópio. E novo episódio de PCR por AESP.
  15. 15. Anamnese • Tinha história de dor torácica e dispneia quando jogava bola ou corria, tendo que parar durante os jogos e escondeu essa informação dos pais. Nasceu prematuro e genitora referiu que o mesmo tinha muitos episódios de cansaço quando criança, sem diagnóstico definido
  16. 16. Exame Físico • EGG, desperta ao chamado, não contactua, acianótico, anictérico, mucosa ocular hipocorada (+/4+), afebril (T= 36,5º), higienizado, hidratado, hipersecretivo, pouco adaptado ao VM, AVC em VSCD viabilizando DVA + ATB, dieta 0. • AR: MV+ em AHT com RA (roncos). • ACV: RCR em 2T, BNF, sem sopro, normocárdico (FC = 80 a 100 mmHg), normotenso (PA = 128 X 81 mmHg), pulsos de boa amplitude e simétricos em MMSS. • ABD: plano, depressível e indolor à palpação profunda, RHA (+), não identifico VMG. • AGU: diurese + por SVD, com coloração fisiológica.
  17. 17. Diagnóstico Final • Síndrome de WPW • BRD + BDPIE • EAP • ITR
  18. 18. Exames Laboratoriais EXAMES RESULTADOS VALORES DE REFERÊNCIA Ht 50 40 a 54 % Hb 18,1 12.8 a 17.8 Leuco 37.310 4.0 a 11.0 (103 /uL) Plaq 399.000 150.0oo a 450.000 uL Ur 28 0.0 – 50 Cr 1,21 0,50 – 1,2 K+ 3,69 3,50 – 5,1 Cl- 99 98 – 107 Na+ 136,6 136 – 145 mmol/L INR 2,19 </= 1,2
  19. 19. Onda Delta intervalo PR < 0,12s QRS alargado + de 0,11 s
  20. 20. Prescrição Médica • Noradrenalina (50ml/h) • Ancoron (10ml/h) • Tazocin 4,5mg • Vancomicina • Xarope de Kcl 6% • SF 0,9%
  21. 21. Diagnósticos de Enfermagem
  22. 22. Diagnósticos de Enfermagem
  23. 23. Conclusão • Estado atual do paciente • O estudo de caso mostrou-se efetivo no desenvolvimento do pensamento crítico e processo de enfermagem. Assim, fornecendo subsídio para iniciar a Sistematização da Assistência de Enfermagem (SAE), o diagnóstico, bem como a execução das práticas.
  24. 24. Caso Clínico
  25. 25. Caso Clínico
  26. 26. OBRIGADA
  27. 27. Referências • CARPENITO, L.J. Diagnóstico de enfermagem: Aplicação a prática clínica; trad. Ana Thorell. Ged. Porto Alegre, Artes Médicas, 2012. • MALCOLM, T. S. ECG Essencial: eletrocardiograma na prática diária. 7 ed. – Porto Alegre: Artmed, 2013. • OLIVEIRA, M.A.D.; REIS, A.H. Síndrome de Wolff- Parkinson-White. 2012. 41f. Dissertação de Mestrado Integrado em Medicina – Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto, 2012. • SMELTZER, S. C.; BARE, B. G. Brunner & Suddarth, tratado de enfermagem médico-cirúrgica. 10º ed. Rio de Janeiro: Guanabara Koogan, 2005.

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