| Resumo: |
Introduction: Patients hospitalized after a stroke may have an increased risk of Pressure Injury (PI), nutritional deficiencies and in-hospital malnutrition. Objective: Verify predisposing factors associated with the risk of developing PI in hospitalized patients after stroke. Methods: This is a longitudinal study with a quantitative approach. The samples were consisted of the adults and elderly of both genders, after being hospitalized with a stroke. Patients underwent a nutritional evaluation within 72 h after hospitalization, consisting of: anthropometry such as weight, height, Body Mass Index (BMI), circumferences and skin folds; dietetics: the evaluation of acceptance of hospital diets was made based on the previous day's food record. To quantify calories, macronutrients and micronutrients (zinc, vitamin C, selenium and copper), the preparations for each diet were monitored at the hospital's nutrition and dietary service and technical data sheets were prepared. To calculate the record of each patient, the registration of the technical files in the Nutrisoft Brazil program was made, in which it was possible to quantify the amount of calories, macronutrients and micronutrients (zinc, vitamin C, selenium and copper) of each patient. To assess the daily intake of these nutrients in patients with exclusive Enteral Nutritional Therapy (ENT) indication, the infused volume of enteral diet and the nutritional composition of enteral diets were evaluated; biochemistry: the tests analyzed were the routine tests requested by professionals. The risk of PI was evaluated using the Braden scale. Anova, a Spearman path and correlation, was applied, Wilcoxon test, t test and Kruskal-Wallis adjusted by Bonferroni or Anova with post hoc Tukey were applied. Results: Bedridden patients have a higher risk of PI at admission (P< 0,001) and seven days later (P <0,001) compared to those patients who could ambulate. Patients without dysphagia had a lower risk of PI (P = 0,002) compared to dysphagia. At admission, patients with better dietary acceptance had a lower risk of PI (p = 0,01; p = 0,0006) compared to patients with low acceptance. Weight, calf circumference (CC) and triceps skinfold (TSF) decreased in patients at high risk of PI compared to patients at moderate risk (P = 0,04; P = 0,007, P = 0,038; P = 0,048). The hemoglobin and hematocrit of patients with moderate and high risk of PI was statistically lower compared to patients with low risk of PI. On the sixth day of hospitalization, the patients presented an increase in the scores of sensory perception (p = 0,02), nutrition (p = 0,005) and a decrease in weight (p 0,001); BMI (p 0,001); CC (p = 0,01), mid upper arm circumference (MUAC) (p = 0,04); subscapular skinfold (SSF) (p = 0,003) and TSF (0,001). During the follow-up, patients at high risk had a significantly lower daily consumption of calories, macronutrients and micronutrients (zinc, selenium and copper) compared to low and moderate patients. Conclusion: Predisposing and nutritional factors such as BMI, CC, TSF, lack of mobility, dysphagia, low dietary acceptance, low calorie intake, macronutrients and micronutrients (zinc, selenium and copper) and presence of anemia are associated with a higher risk of developing PI. |
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