Fortalecer el cuidado en pacientes con ciclos de pronación para disminuir las lesiones de piel en una unidad de cuidado intensivo de un hospital de segundo nivel de Pacho-Cundinamarca

Abstract

Es un hecho notorio que la pandemia de COVID 19 nos trajo muchos cambios importantes en el cuidado de la salud, las estrategias utilizadas para salvar la vida de los paciente como el decúbito prono (DP), el cual hasta la fecha ha sido efectivo para el cuidado del paciente con síndrome respiratorio agudo; por cuanto esta estrategia contribuye al aumento de la capacidad funcional residual, mejora la ventilación/perfusión, favorece la mecánica pulmonar, torácica y diafragmática, libera los pulmones del peso de las estructuras mediastínicas y aumenta la salida de secreciones, pero ha generado alteración en el sistema tegumentario en el pabellón auricular, pómulos, acromion, mamas, codos, genitales masculinos, rodillas y dedos de los pies dadas por la isquemia secundaria a exceso de presión y cizallamiento que se dan entre el paciente y la superficie de apoyo produciendo lesiones por presión en prominencias óseas y cara que pueden ser predictores de mortalidad, aumentan los costos de hospitalización y disminuye el índice de calidad de cada institución. Por eso nuestro proyecto tiene como finalidad sensibilizar a los profesionales de enfermería sobre la importancia del conocimiento y su protocolización de la técnica, para prevenir el síndrome de falla multiorgánica y la muerte.

Introduction: it is a notorious fact that the COVID 19 pandemic brought us many important changes in health care, the strategies used to save the lives of patients such as the prone position (PD), which to date has been effective for the care of the patient with acute respiratory syndrome; as this strategy contributes to the increase of residual functional capacity, improves ventilation / perfusion, favors pulmonary, thoracic and diaphragmatic mechanics, relieves the lungs of the weight of the mediastinal structures and increases secretion output, but has generated alteration in the integumentary system in the pinna, cheekbones, acromion, breasts, elbows, male genitalia, knees and toes caused by ischemia secondary to excess pressure and shearing that occur between the patient and the support surface producing pressure injuries in bony prominences and face that can be predictors of mortality, hospitalization costs increase and the quality index of each institution decreases. That is why our project aims to sensitize nursing professionals about the importance of knowledge and its protocolization of the technique, to prevent multi-organ failure syndrome and death. Objective: Strengthen care in patients with pronation cycles to reduce skin lesions in the intensive care unit of the second level hospital in Pacho - Cundinamarca. Methodology: For the strategy, a search for information and support for skin lesions care was carried out, taking the GNEAP guide on skin lesions as the main reference and with which a format of nursing assessment, first a knowledge survey was carried out with the health personnel and later the nursing personnel were trained by means of a knowledge flipchart, finally the tool used and the perception that it seemed useful for its application was evaluated. Results: 75% of the ICU nursing staff were trained efficiently and addressing the needs evidenced by the surveys carried out.It was evidenced that the staff needed to strengthen their care practices in patients with pronation cycles, on the other hand, strategies provided in the staff training were positively accepted and were also rated satisfactorily in 81%, rating it as clear, objective and dynamic Conclusions: The care strategy was carried out in order to inform the nursing staff of the steps and guidelines to perform a good assessment and care of the skin in patients with pronation cycles, being this perceived effectively. Basic knowledge about skin care was evidenced. The applications of the care practices are not carried out in a recurrent and satisfactory manner given the number of personnel and the number of patients in charge.