Construção de protocolo de cuidados de enfermagem a pacientes submetidas a reconstrução microcirúrgica de mama

Larissa Sydor Victor; Lia Híria Campozana; Francine Dutra Mattei; Marcia Regina Cubas

Authors

Larissa Sydor Victor Pontifícia Universidade Católica do Paraná – Curitiba (PR), Brazil. ,https://ror.org/02x1vjk79 https://orcid.org/0000-0002-9592-9909
Lia Híria Campozana Pontifícia Universidade Católica do Paraná – Curitiba (PR), Brazil. ,https://ror.org/02x1vjk79 https://orcid.org/0009-0008-8610-3137
Francine Dutra Mattei Pontifícia Universidade Católica do Paraná – Curitiba (PR), Brazil. ,https://ror.org/02x1vjk79 https://orcid.org/0000-0001-7180-3669
Marcia Regina Cubas Pontifícia Universidade Católica do Paraná – Curitiba (PR), Brazil. ,https://ror.org/02x1vjk79 https://orcid.org/0000-0002-2484-9354

Abstract

Objective: To develop a nursing protocol for the care of patients undergoing microsurgical breast reconstruction. Method: This methodological study used a qualitative approach and adopted the Transitions Theory as its theoretical framework. The protocol development followed the criteria established by the Federal Nursing Council and the phases of Convergent Care Research, with the participation of three nurses and the use of data from 25 women. The International Classification for Nursing Practice (ICNP®) was used as the terminology system for documentation. Results: The protocol comprises 17 nursing diagnoses, 17 nursing outcomes, and 29 nursing interventions mapped according to the ICNP®. In addition, it includes guidance for the care of patients in the postoperative period following microsurgical breast reconstruction. Conclusion: The protocol is a technological tool with the potential to contribute to the field. Its use is expected to enhance patient safety by preventing complications and hospital readmissions. The use of standardized terminology for documentation should also enhance the visibility of nurses’ work.

Downloads

Download data is not yet available.

References

Brasil. Instituto Nacional de Câncer. Estimativa 2023: incidência de câncer no Brasil. Rio de Janeiro: INCA; 2022.

Cruz IL, Siqueira PFOM, Cantuaria LRMP, Câmara ACB, Branquinho RC, Lira TMT, et al. Câncer de mama em mulheres no Brasil: epidemiologia, fisiopatologia, diagnóstico e tratamento: uma revisão narrativa. Braz J Dev. 2023;9(2):7579-89. https://doi.org/10.34117/bjdv9n2-096

Carvalho CV, Marin AT, Silva ALF, Morais MR, Barbosa THF. Os avanços da microcirurgia na reconstrução mamária. Cuad Educación y Desarrollo. 2024;16(12):1-14. https://doi.org/10.55905/cuadv16n12-006

Sugnkar A, Yarso KY, Nugroho DF, Wahid DI, Permatasari CA. Patient’ satisfaction after breast reconstruction surgery using autologous versus implants: a meta-analysis. Asian Pac J Cancer Prev. 2024;25(4):1205-12. https://doi.org/10.31557/APJCP.2024.25.4.1205

Brandão BL, Silva ACB, Francisquini IN, Gouvêa MM, Lobão LM. Importância da cirurgia plástica para mulheres mastectomizadas e o papel do Sistema Único de Saúde: revisão integrativa. Rev Bras Cir Plást. 2021;36(4):452-9. https://doi.org/10.5935/2177-1235.2021RBCP0132

Conselho Federal de Enfermagem. Resolução COFEN no 429, de 8 de junho de 2012. Dispõe sobre o registro das ações profissionais no prontuário do paciente, e em outros documentos próprios da enfermagem, independente do meio de suporte – tradicional ou eletrônico [Internet]. Brasília: COFEN; 2012 [citado em 30 Set. 2024]. Disponível em: http://www.cofen.gov.br/resoluo-cofen-n-4292012_9263.html

Bertocchi L, Dante A, La Cerra C, Masotta V, Marcotullio A, Jones D, et al. Impact of standardized nursing terminologies on patient and organizational outcomes: a systematic review and meta-analysis. J Nurs Scholarsh. 2023;55(6):1126-53. https://doi.org/10.1111/jnu.12894

International Council of Nurses. Guidelines for ICNP® catalogue development. Geneva: Switzerland: International Council of Nurses; 2008.

Meleis AI. Transitions theory: middle range and situation specific theories in nursing research and practice. New York: Springer Publishing Company; 2010.

Pimenta CAM, Pastana ICASS, Sichieri K, Solha RKT, Souza W. Guia para a construção de protocolos assistenciais de enfermagem. São Paulo: COREN-SP; 2015.

Trentini M, Paim L, Silva DGV, Peres MAA. Convergent care research and its qualification as scientific research. Rev Bras Enferm. 2021;74(1):e20190657. https://doi.org/10.1590/0034-7167-2019-0657

Ronnau LB, Torres FBG, Oliveira LES, Gomes DC, Cubas MR, Moro C. Automatic mapping between Brazilian Portuguese clinical terms and International Classification for Nursing Practice. Stud Health Technol Inform. 2019;264:1552-3. https://doi.org/10.3233/SHTI190530

European Organization for Nuclear Research. About Zenodo [Internet]. Geneva: CERN; 2013 [citado em 06 Nov. 2025]. Disponível em: https://about.zenodo.org/.

Sanhueza Muñoz MP, Paravic-Klijn T, Lagos Garrido ME. La teoría de las transiciones como paradigma de apoyo al automanejo en personas con condiciones crónicas. Enfermería Actual Costa Rica. 2024;28(46):58603. http://dx.doi.org/10.15517/enferm.actual.cr.i46.53066

Conselho Federal de Enfermagem. Resolução COFEN no 736, de 17 de janeiro de 2024. Dispõe sobre a implementação do Processo de Enfermagem em todo contexto socioambiental onde ocorre o cuidado de Enfermagem [Internet]. Brasília: COFEN; 2024 [citado em 30 Set. 2024]. Disponível em: https://www.cofen.gov.br/wp-content/uploads/2024/01/Resolucao-Cofen-no-736-2024-Dispoe-sobre-a-implementacao-do-Processo-de-Enfermagem-em-todo-contexto-socioambiental-onde-ocorre-o-cuidado-de-enfermagem.pdf

Leão DCMR, Pereira ER, Silva RMCRA, Rocha RCNP, Cruz-Quintana F, García-Caro MP. Spiritual and emotional experience with a diagnosis of breast cancer: a scoping review. Cancer Nurs. 2021;45(3):224-35. https://doi.org/10.1097/NCC.0000000000000936

Thiruchelvam PTR, Leff DR, Godden AR, Cleator S, Wood SH, Kirby AM, et al. Primary radiotherapy and deep inferior epigastric perforator flap reconstruction for patients with breast cancer (PRADA): a multicentre, prospective, non-randomised, feasibility study. Lancet Oncol. 2022;23(5):682-90. https://doi.org/10.1016/S1470-2045(22)00145-0

Zuchetto MA, Engel FD, Medeiros LSP, Hammerschmidt KSA, Schoeller SD. Empatia no processo de cuidado em enfermagem sob a ótica da teoria do reconhecimento: síntese reflexiva. Rev Cuid. 2019;10(3):e624. https://doi.org/10.15649/cuidarte.v10i3.624

Freitas RA, Menezes TMO, Silva GTR, Guerrero-Castañeda RF, Moura HCGB, Oliveira ES, et al. Implementing nursing diagnoses and care for the spiritual dimension of people with cancer: educational actions. Rev Esc Enferm USP. 2023:57:e20230141. https://doi.org/10.1590/1980-220X-REEUSP-2023-0141en

Wu SS, Raymer C, Culbert A, Schafer R, Bernard S, Djohan R, et al. Predictors of complications in autologous breast reconstruction using DIEP flaps: implications for management. Plast Reconstr Surg 2023;152(4):566e-577e. https://doi.org/10.1097/PRS.0000000000010343

Fritzen A, Santos DP, Rocha BS, Jost MT, Caregnato RCA, Linch GFC. Implementation of transoperative and immediate postoperative nursing diagnoses in the computerized management system. Rev Esc Enferm USP. 2023;57:e20220123. https://doi.org/10.1590/1980-220X-REEUSP-2022-0123en

Foppiani J, Valentine L, Hernandez Alvarez A, Weidman A, Stearns S, Foster L, et al. Comparing microsurgical breast reconstruction outcomes following postoperative monitoring techniques: a systematic review and meta-analysis of 2529 patients. Plast Aesthet Res. 2023;10:53. https://doi.org/10.20517/2347-9264.2022.137

Vanags I, Stepanovs J, Ozolina A, Mukans M, Bjertnaes LJ, Mamaja B. Thromboelastometry for assessing risks of free flap thrombosis in patients undergoing microvascular surgery. Front Med (Lausanne). 2020;7:289. https://doi.org/10.3389/fmed.2020.00289

Aljindan F, Allababidi NH, Mortada H, Alhumaid F, Alzaidi SA. The preoperative management of oral contraceptive pills in aesthetic plastic surgery practice in Saudi Arabia. Cureus. 2022;14(11):e31121. https://doi.org/10.7759/cureus.31121

Preventing venous thromboembolism in hospitalized plastic surgery patients [Internet]. American Society of Plastic Surgeons; 2023 [citado em 18 Ago. 2025]. Disponível em: https://www.plasticsurgery.org/documents/Health-Policy/Resources/2023-vte-prevention-hospitalized-patients.pdf

Sousa LCS, Silva AF, Figueiredo BQ, Coury BF, Soares FA, Caixeta NC, et al. Prevention of venous thromboembolism in plastic surgery: a literature review. Res Soc Dev. 2021;10(11):e267101119687. https://doi.org/10.33448/rsd-v10i11.19687

Biermann N, Chak JC, Wiesmeier A, Klein SM, Ruewe M, Spoerl S, et al. Evidence-based approaches to anticoagulation in reconstructive microsurgery–a systematic literature review. Life (Basel). 2024;14(1):82. https://doi.org/10.3390/life14010082

Campos MPA, Dantas DV, Silva LSL, Santana JFNB, Oliveira DC, Fontes LL. Complicações na sala de recuperação pós-anestésica: uma revisão integrativa. Rev SOBECC. 2018;23(3):160-8. https://doi.org/10.5327/Z1414-4425201800030008

Teixeira GL, Marques DG, Santos EA, Hortense P, Napoleão AA, Carvalho EC, et al. Efeitos mediadores do medo e ansiedade pré-operatórios na intensidade da dor pós-operatória. Acta Paul Enferm. 2024;37:eAPE02305. https://doi.org/10.37689/acta-ape/2024AO00002305