Sistematização da assistência de enfermagem na coinfecção Leishmaniose Visceral / HIV.

Abstract

Visceral Leishmaniasis (VL) is a chronic disease caused by a protozoan of the Leishmania genus. It can be fatal when the proper treatment is not early estabilished, mainly when it affects a patient infected with Human Immunodeficiency Virus (HIV). The most common clinical presentation of VL are hepatosplenomegaly, fever and biologic signs (anemia, leukopenia, thrombocytopenia, hypergamaglobulinemia and hypoalbuminemia), similarly to that observed in VL/HIV coinfection. From this perspective, we propose the development of the Nursing Care Systematization (NCS) to patients with VL/HIV coinfection based on records problems. This is a descriptive/exploratory research, which was conducted at the Infectious Disease Hospital Dr. Clementino Fraga, in Joao Pessoa/Paraiba. The sample included 12 medical records. In the period between 2000 and 2010, 19 patients were admitted with VL, 17 of which had the VL/HIV coinfection. We found all patients had fever, inappetence, weakness, anemia, pale skin and mucous, weight loss, hepatosplenomegaly, abdominal pain on palpation and distended abdomen. Sadness, fear and anxiety were evidenced in all patients. Regarding the laboratory findings, pancytopenia, hyperglobulinemia, hypoalbuminemia, hyperuricemia, high creatinine and liver enzimes levels were found. The related nursing diagnosis were ineffective breathing pattern, activiaty intolerance, ineffective protection, pain, imbalanced nutrition, diarrhea, hyperthermia, excessive fluid volume, impaired physical mobility, nausea, ineffective therapeutic control, low self-esteem, anxiety, risk for infection, risk of impaired integrity skin and constipation risk. The suggested interventions were based on monitoring through vital signs, physical examination assessment, patient comfort and positioning, medication administration and implementation of nursing procedures, infection control, proper diet and treatment, psychological support, multiprofessional teamwork and guidelines on health education. The interventions were proposed, through the development of NCS, in order to provide the patient general improvement. Thus, on patient VL/HIV care, the nurse must work focusing on NCS, since this instrument can provide grants for developing the interdisciplinary and humanized practice.