ABSTRACT BACKGROUND: Diabetic ketoacidosis is the most frequent hyperglycemic complication in the evolution of diabetes mellitus. Common precipitating factors include newly diagnosed diabetes mellitus, noncompliance with therapy and infections. However, few studies have been conducted in Brazil and none were prospective in design. OBJECTIVE: To describe the incidence, clinical and laboratory characteristics and precipitating factors of diabetic ketoacidosis among emergency department patients in a tertiary-level teaching hospital in Brazil. We also aimed to identify immediate and long-term mortality within two years. DESIGN AND SETTING: Prospective prognosis cohort study conduct at a tertiary-level teaching hospital in São Paulo, Brazil. METHODS: All patients > 12 years old presenting diabetic ketoacidosis who were admitted to the emergency department from June 2015 to May 2016 were invited to participate. RESULTS: The incidence of diabetic ketoacidosis per 1,000 admissions was 8.7. Treatment noncompliance and infection were the most common causes of diabetic ketoacidosis. The immediate mortality rate was 5.8%, while the six-month, one-year and two-year mortality rates were 9.6%, 13.5% and 19.2%, respectively. Death occurring within two years was associated with age, type 2 diabetes, hypoalbuminemia, infection at presentation and higher sequential organ failure assessment (SOFA) score at admission. CONCLUSIONS: Diabetic ketoacidosis among patients presenting to the emergency department was relatively frequent in our hospital. Treatment noncompliance and infection were major precipitating factors and presence of diabetic ketoacidosis was associated with immediate and long-term risk of death.

This descriptive study from a qualitative approach aims to describe how the nursing team understands pain assessment and management in newborns at a Neonatal Intensive Care Unit (NICU). The subjects are 16 nursing professionals. The nursing staff identifies pain when behavioral and physiological changes are present. They use the NIPS scale, although it is not effective in clinical practice. Subjects reveal difficulties in making a difference between pain and stress responses in daily work. They are worried about correct pain management in newborns. The search of knowledge about pain is still incipient, and subjects mostly obtain it through their experiences in newborn care and by exchanging experiences with other professionals. The nursing team needs greater access to specific literature about neonatal pain and training courses that can optimize pain management, thus contributing to a better care capacity and to the newborn's quality of life.

La finalidad de este estudio descriptivo con aproximación cualitativa es describir como los profesionales de enfermería comprenden la cuestión del dolor, su evaluación y manejo en recién-nacidos (RNs) sometidos al cuidado intensivo. Participaron del estudio 16 profesionales de enfermería. La enfermería identifica el dolor por medio de alteraciones comportamentales y fisiológicas. Utilizan la escala NIPS, a pesar de que esta no es considerada eficaz en la práctica clínica. Los participantes muestran dificultades para diferenciar manifestaciones de dolor y estrés en el día a día del trabajo. Tienen preocupación por el manejo adecuado del dolor en los RNs. La búsqueda de conocimiento sobre el dolor todavía ocurre de manera incipiente y se obtiene, en la mayoría de las veces mediante la vivencia adquirida en el cuidado de los RNs y el cambio de experiencias con otros profesionales. Es necesario instrumentalizar mejor al equipo de enfermería del hospital escuela a través del mayor acceso a la literatura específica sobre el dolor neonatal y de cursos de capacitación para que puedan optimizar el manejo del dolor en la unidad neonatal, contribuyendo con la mejoría de la atención y con la calidad de vida de los bebés.

Estudo descritivo qualitativo buscou descrever a compreensão, a avaliação e o manejo da dor no RN sob cuidado intensivo. Dezesseis profissionais de enfermagem identificaram a dor mediante alterações comportamentais e fisiológicas. Consideram ineficaz o uso da escala NIPS na prática clínica. Apontam dificuldades em diferenciar manifestações de dor e estresse no cotidiano profissional. Preocupam-se com o manejo adequado da dor e buscam o conhecimento desta temática ainda de maneira incipiente, em sua maioria, mediante a vivência adquirida no cuidado neonatal e a troca de experiências com outros profissionais. Assim, acredita-se que a instrumentalização através de acesso à literatura específica e cursos de capacitação sobre a temática otimizariam o manejo, contribuindo na melhoria da assistência e qualidade de vida dos bebês.

Estudo descritivo qualitativo buscou descrever a compreensão, a avaliação e o manejo da dor no RN sob cuidado intensivo. Dezesseis profissionais de enfermagem identificaram a dor mediante alterações comportamentais e fisiológicas. Consideram ineficaz o uso da escala NIPS na prática clínica. Apontam dificuldades em diferenciar manifestações de dor e estresse no cotidiano profissional. Preocupam-se com o manejo adequado da dor e buscam o conhecimento desta temática ainda de maneira incipiente, em sua maioria, mediante a vivência adquirida no cuidado neonatal e a troca de experiências com outros profissionais. Assim, acredita-se que a instrumentalização através de acesso à literatura específica e cursos de capacitação sobre a temática otimizariam o manejo, contribuindo na melhoria da assistência e qualidade de vida dos bebês.

This descriptive study from a qualitative approach aims to describe how the nursing team understands pain assessment and management in newborns at a Neonatal Intensive Care Unit (NICU). The subjects are 16 nursing professionals. The nursing staff identifies pain when behavioral and physiological changes are present. They use the NIPS scale, although it is not effective in clinical practice. Subjects reveal difficulties in making a difference between pain and stress responses in daily work. They are worried about correct pain management in newborns. The search of knowledge about pain is still incipient, and subjects mostly obtain it through their experiences in newborn care and by exchanging experiences with other professionals. The nursing team needs greater access to specific literature about neonatal pain and training courses that can optimize pain management, thus contributing to a better care capacity and to the newborn's quality of life.

La finalidad de este estudio descriptivo con aproximación cualitativa es describir como los profesionales de enfermería comprenden la cuestión del dolor, su evaluación y manejo en recién-nacidos (RNs) sometidos al cuidado intensivo. Participaron del estudio 16 profesionales de enfermería. La enfermería identifica el dolor por medio de alteraciones comportamentales y fisiológicas. Utilizan la escala NIPS, a pesar de que esta no es considerada eficaz en la práctica clínica. Los participantes muestran dificultades para diferenciar manifestaciones de dolor y estrés en el día a día del trabajo. Tienen preocupación por el manejo adecuado del dolor en los RNs. La búsqueda de conocimiento sobre el dolor todavía ocurre de manera incipiente y se obtiene, en la mayoría de las veces mediante la vivencia adquirida en el cuidado de los RNs y el cambio de experiencias con otros profesionales. Es necesario instrumentalizar mejor al equipo de enfermería del hospital escuela a través del mayor acceso a la literatura específica sobre el dolor neonatal y de cursos de capacitación para que puedan optimizar el manejo del dolor en la unidad neonatal, contribuyendo con la mejoría de la atención y con la calidad de vida de los bebés.