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Gestão da dor no doente com enfarte agudo do miocárdio na primeira abordagem no serviço de urgência
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Introdução: O Enfarte Agudo do Miocárdio (EAM) constitui uma emergência médica associada a elevada morbilidade e mortalidade, sendo a dor um dos principais sintomas na sua apresentação clínica. Em contextos de elevada complexidade, como o Serviço de Urgência (SU) e as Unidades de Cuidados Intensivos (UCI), a avaliação e gestão adequadas da dor na primeira abordagem assumem particular relevância, uma vez que a dor não controlada pode desencadear respostas fisiológicas adversas, comprometendo a estabilidade clínica da pessoa em situação crítica. A vivência em contexto de estágio nestes serviços permitiu aprofundar a reflexão sobre a prática clínica do enfermeiro especialista, nomeadamente no que respeita à gestão da dor associada ao EAM.
Objetivos: Explanar e refletir acerca das competências comuns e específicas do enfermeiro especialista em Enfermagem Médico-Cirúrgica (EMC) à pessoa em situação crítica; descrever as atividades desenvolvidas promotoras da concretização dos objetivos estabelecidos; analisar a gestão da dor na pessoa com EAM na primeira abordagem no SU.
Metodologia: Relatório de estágio desenvolvido em contexto de Cuidados Intensivos e de SU, integrando um estudo observacional, quantitativo e retrospetivo, de natureza descritiva, realizado a partir da análise de processos clínicos de doentes com idade igual ou superior a 18 anos, admitidos no SU com diagnóstico de EAM, entre janeiro de 2023 e dezembro de 2024. Os dados foram analisados através de estatística descritiva, recorrendo a frequências absolutas e relativas.
Resultados: A amostra foi constituída por 253 doentes. Evidenciaram-se fragilidades na avaliação e documentação da intensidade da dor no momento da triagem e na avaliação final, verificando-se uma redução dos registos ao longo do episódio de urgência de 54,9% no momento da triagem para 37,5% na avaliação final. Apesar de a uma proporção significativa de doentes ter sido administrada analgesia (64,9%), constatou-se a existência de práticas heterogéneas na gestão farmacológica da dor. A inconsistência dos registos impossibilitou a análise da variação individual da intensidade da dor e a avaliação da associação entre as intervenções analgésicas e a intensidade da dor. Paralelamente, o estágio permitiu o desenvolvimento e consolidação de competências especializadas do enfermeiro na abordagem à pessoa em situação crítica em contextos de elevada complexidade.
Conclusão: A gestão da dor na pessoa com EAM em contexto de SU apresenta oportunidades de melhoria, particularmente no que respeita à avaliação sistemática e à documentação da intensidade da dor. A experiência de estágio e os resultados do estudo reforçam o papel do enfermeiro, em especial do enfermeiro especialista em EMC, na promoção de cuidados de enfermagem de qualidade, seguros e baseados na evidência à pessoa em situação crítica.
Palavras-chave: Enfarte Agudo do Miocárdio; Dor; Gestão da dor; Serviço de Urgência; Enfermagem; Avaliação da Dor.
Abstract Context: Acute Myocardial Infarction (AMI) is a medical emergency associated with high morbidity and mortality, with pain being one of the main symptoms of its clinical presentation. In highly complex settings, such as the Emergency Department (ED) and Intensive Care Units, appropriate pain assessment and management during the initial approach are particularly relevant, as uncontrolled pain may trigger adverse physiological responses, compromising the clinical stability of the critically ill patient. The internship experience in these settings enabled a deeper reflection on the clinical practice of the specialist nurse, particularly regarding pain management associated with AMI. Objective: To explain and reflect on the common and specific competencies of the specialist nurse in Medical-Surgical Nursing in the area of the Critically Ill Patient; to describe the activities developed to promote the achievement of the established objectives; analyse pain management in patients with AMI during the initial approach in the ED. Methodology: Internship report developed in Intensive Care and Emergency Department settings, integrating an observational, quantitative, retrospective, and descriptive study, based on the analysis of clinical records of patients aged 18 years or older, admitted to the ED with a diagnosis of AMI between January 2023 and December 2024. Data were analysed using descriptive statistics, including absolute and relative frequencies. Results: The sample consisted of 253 patients. Weaknesses were identified in the assessment and documentation of pain intensity at triage and at the final assessment, with a reduction in pain records throughout the emergency episode from 54.9% at triage to 37.5% at the final assessment. Although a significant proportion of patients received analgesia (64.9%), heterogeneous practices in pharmacological pain management were observed. Inconsistent documentation precluded the analysis of individual pain intensity variation and the assessment of associations between analgesic interventions and pain intensity. Simultaneously, the internship allowed for the development and consolidation of specialised nursing competencies in the care of critically ill patients in highly complex contexts. Conclusion: Pain management in patients with AMI in the ED setting presents opportunities for improvement, particularly regarding systematic pain assessment and documentation. The internship experience and the study findings reinforce the role of nurses—especially specialist nurses in Medical-Surgical Nursing—in promoting high-quality, safe, and evidence-based nursing care for critically ill patients. Keywords: Acute Myocardial Infarction; Pain; Pain management; Emergency Department; Nursing; Pain Assessment.
Abstract Context: Acute Myocardial Infarction (AMI) is a medical emergency associated with high morbidity and mortality, with pain being one of the main symptoms of its clinical presentation. In highly complex settings, such as the Emergency Department (ED) and Intensive Care Units, appropriate pain assessment and management during the initial approach are particularly relevant, as uncontrolled pain may trigger adverse physiological responses, compromising the clinical stability of the critically ill patient. The internship experience in these settings enabled a deeper reflection on the clinical practice of the specialist nurse, particularly regarding pain management associated with AMI. Objective: To explain and reflect on the common and specific competencies of the specialist nurse in Medical-Surgical Nursing in the area of the Critically Ill Patient; to describe the activities developed to promote the achievement of the established objectives; analyse pain management in patients with AMI during the initial approach in the ED. Methodology: Internship report developed in Intensive Care and Emergency Department settings, integrating an observational, quantitative, retrospective, and descriptive study, based on the analysis of clinical records of patients aged 18 years or older, admitted to the ED with a diagnosis of AMI between January 2023 and December 2024. Data were analysed using descriptive statistics, including absolute and relative frequencies. Results: The sample consisted of 253 patients. Weaknesses were identified in the assessment and documentation of pain intensity at triage and at the final assessment, with a reduction in pain records throughout the emergency episode from 54.9% at triage to 37.5% at the final assessment. Although a significant proportion of patients received analgesia (64.9%), heterogeneous practices in pharmacological pain management were observed. Inconsistent documentation precluded the analysis of individual pain intensity variation and the assessment of associations between analgesic interventions and pain intensity. Simultaneously, the internship allowed for the development and consolidation of specialised nursing competencies in the care of critically ill patients in highly complex contexts. Conclusion: Pain management in patients with AMI in the ED setting presents opportunities for improvement, particularly regarding systematic pain assessment and documentation. The internship experience and the study findings reinforce the role of nurses—especially specialist nurses in Medical-Surgical Nursing—in promoting high-quality, safe, and evidence-based nursing care for critically ill patients. Keywords: Acute Myocardial Infarction; Pain; Pain management; Emergency Department; Nursing; Pain Assessment.
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Palavras-chave
Cuidados de enfermagem Dor Enfarte do miocárdio Enfermagem médico cirúrgica Gestão da dor Medição da dor Serviço de urgência hospitalar Emergency service hospital Medical surgical nursing Myocardial infarction Nursing care Pain Pain management Pain measurement