Children with Congenital Zika Syndrome: the complexity of nursing care during hospitalization

Novaes, Mariana Cardim; Azevedo, Monique de Sales Norte; Falsett, Carolina Fernandes; Reis, Adriana Teixeira

doi:10.1590/0034-7167-2020-0122

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 74 (3) • 2021 • https://doi.org/10.1590/0034-7167-2020-0122 copy

Children with Congenital Zika Syndrome: the complexity of nursing care during hospitalization

Niños con Síndrome de Zika Congénito: la complejidad de la atención de enfermería durante la hospitalización

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to classify the degree of dependence on nursing care required by children with Congenital Zika Syndrome during hospitalization and to analyze their complexity.

Methods:

this is a descriptive, observational and quantitative study carried out in a pediatric ward of a public hospital in Rio de Janeiro. Data were collected from hospitalization records between June 2017 and April 2018.

Results:

54% of the population studied showed a degree of dependence equivalent to semi-intensive care. On 37.5% of hospitalization days, patients required non-invasive or invasive mechanical ventilation; 31.5% had spontaneous breathing requiring airway clearance by aspiration and/or oxygen therapy.

Conclusion:

Congenital Zika Syndrome represents a challenge for health professionals due to its uniqueness. In this study, it is expressed by demands for complex and continuous care in hospitalization and in preparation for discharge, requiring semi-intensive nursing care.

Descriptors:
Zika Virus Infection; Pediatric Nursing; Nursing Care; Child; Hospitalization

Variables	Frequency	%
Sex
Male	26	63.4
Female	15	36.6
Age group
Infants	38	92.7
Preschoolers	3	7.3
Length of stay
1 to 5 days	10	24.4
6 to 10 days	13	31.7
11 to 20 days	09	21.95
21 to 35 days	05	12.2
> 36 days	04	9.75
Reasons for hospitalizations
Gastrointestinal tract	13	31
Respiratory system	11	27
Nervous system	6	15
Urinary system	2	4
Others	9	23

Care demand category	Frequency	%
High dependence care	299	37.5
Semi-intensive care	430	54
Intensive care	68	8.5

Domain: Family		Frequency	%
Companion's participation:
1.	Companion recognizes the physical and emotional needs of pediatric patients and manages to meet them.	620	77.8
2.	Companion demonstrates availability to incorporate new information and skills for pediatric patient care.	52	6.5
3.	Companion demonstrates difficulties or unavailability to incorporate new information and skills for caring of pediatric patients and/ or manifests anxiety and/or fear and/or anger and/or withdrawal behaviors.	105	13.2
4.	Companion absent or who demonstrates unavailability or aggressiveness to care for patients and/or patients requiring highly complex technical care.	20	2.5
Support network and family support:
1.	Presence of a companion involved in providing and planning care at all times.	656	82.3
2.	Presence of a companion involved in providing and planning care for more than 12 hours a day.	48	6.1
3.	Presence of a companion involved in providing and planning care for less than 12 hours a day.	9	1.1
4.	Absence of family support or psychiatric illness of a companion or presence of a companion that demonstrates stress or alienation from the provision of patient care.	84	10.5

Domain: Patient		Frequency	%
Activity:
1.	Demonstration of affection and interest in stimuli and activities compatible with the age group.	-	-
2.	Demonstration of affection and interest in stimuli, with limitation for carrying out activities compatible with the age group.	-	-
3.	Disinterest in stimuli due to pain, sadness, anger, psychomotor agitation or apathy; language difficulty; visual impairment or developmental deficit.	797	100
4.	Severe cerebral palsy or coma vigil or unconscious or totally sedated.	-	-
Oxygenation:
1.	Spontaneous breathing, without the need for oxygen therapy or airway clearance.	222	27.9
2.	Spontaneous breathing, with the need to clear the airways by installing a saline serum.	25	3.1
3.	Spontaneous breathing requiring airway clearance due to aspiration of secretions and/or oxygen therapy.	251	31.5
4.	Mechanical ventilation (Non-invasive or invasive).	299	37.5
Mobility and walking:
1.	Walking without assistance.	-	-
2.	Rest in bed and mobilize without assistance.	-	-
3.	Rest in bed and mobilize with assistance or walk with direct supervision.	277	34.8
4.	Restricted in bed, totally dependent on changing position.	520	65.2
Food and hydration:
1.	Orally independently or effective breastfeeding.	-	-
2.	Orally with assistance and collaborative patient.	30	3.8
3.	Orally with a non-collaborative patient or at risk of aspiration or at probes or ineffective breastfeeding.	736	92.3
4.	Parenteral nutrition/hydration.	31	3.9
Eliminations:
1.	Toilet without assistance.	-	-
2.	Toilet with assistance.	-	-
3.	Use of diapers or through bedpan or urinal.	774	97.1
4.	Bladder catheter or stoma.	23	2.9
Hygiene or body care:
1.	Shower bath without assistance.	-	-
2.	Shower bath with partial aid.	-	-
3.	Immersion bath or shower bath in chair or with total assistance.	176	22.1
4.	Bed or in incubator or heated crib bath.	621	77.9

Domain: Therapeutic Procedures		Frequency	%
Vital signs and others controls calibration interval:
1.	6/6 hours.	231	29
2.	4/4 hours.	05	0.6
3.	2/2 hours.	-	-
4.	Less than 2 hours interval or continuous monitoring.	561	70.4
Drug therapy:
1.	Do not need medication.	-	-
2.	Topical, ocular and/or oral medications with a collaborative patient.	36	4.5
3.	Medicines via parenteral, enteral, inhalation or topical, ocular or oral routes with non-collaborative patient.	720	90.3
4.	Blood products and/or chemotherapy and/or Absolute indication for the use of an infusion pump.	41	5.2
Skin-mucosa integrity:
1.	Whole skin throughout the body area.	-	-
2.	Need for low complexity care: skin hydration, treatment of simple dermatitis, renewal of peripheral venous catheter fixation.	176	22.1
3.	Need for medium complexity care, such as dressings in: wounds limited to the dermis, drain insertions, tracheostomy, gastrostomy or central venous catheter.	585	73.4
4.	Need for highly complex care, such as: debridement, disseminated dermatitis, extensive burns; complex stomas or deep wounds.	36	4.5

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[1] Corresponding author: Mariana Cardim Novaes. E-mail: mariana.cardim@iff.fiocruz.br