The objective was to evaluate the Modified Early Warning Score in patients hospitalized for COVID-19 plus chronic disease. Methods: Retrospective observational study, 430 hospitalized patients with COVID-19 and chronic disease. Instrument, Modified Early Warning Score (MEWS). Data analysis, with Cox and logistic regression, to predict survival and risk. Results: Of 430 patients, 58.6% survived, and 41.4% did not. The risk was: low 53.5%, medium 23.7%, and high 22.8%. The MEWS score was similar between survivors 3.02, p 0.373 (95% CI: −0.225–0.597) and non-survivors 3.20 (95% CI: −0.224–0.597). There is a linear relationship between MEWS and mortality risk R 0.920, ANOVA 0.000, constant 4.713, and coefficient 4.406. The Cox Regression p 0.011, with a risk of deterioration of 0.325, with a positive coefficient, the higher the risk, the higher the mortality, while the invasive mechanical ventilation coefficient was negative −0.757. By providing oxygen and ventilation, mortality is lower. Conclusions: The predictive value of the modified early warning score in patients hospitalized for COVID-19 and chronic disease is not predictive with the MEWS scale. Additional assessment is required to prevent complications, especially when patients are assessed as low-risk.

Introducción. La cultura de seguridad del paciente permite trabajar de manera multidisciplinaria, identificar vulnerabilidades y modificar áreas de oportunidad para disminuir riesgos que pudieran propiciar un error que cause daño al paciente. Objetivo. Describir el grado de cultura de seguridad del paciente en un hospital de alta especialidad. Métodos. Estudio cuantitativo, descriptivo y transversal, con técnica de muestreo aleatorio simple. Se aplicó el cuestionario Hospital Survey on Patient Safety Culture, de la Agency for Healthcare Research and Quality. Bajo las pautas SQUIRE para mejorar la atención médica. Resultados. El porcentaje general del grado de cultura de seguridad del paciente fue 45.1%, la percepción del personal sobre el grado de seguridad global del paciente 8.1/ 10. La fortaleza principal: Trabajo en equipo con 75.3%. Variables críticas: Personal, dotación, suficiencia y gestión (28.8%), Problemas en cambios de turno (34.8%) y Respuesta no punitiva a errores (21.5%). Conclusiones. Toda institución debe identificar las fortalezas y áreas de oportunidad, con el objetivo de vigilar los procesos que conllevan a mejorar la seguridad en atención y disminuir los sesgos que propician el error.

Delusional parasitosis is a psychotic disorder where the patient has the delusion of being infested with some insect or parasite. In contrast, shared paranoid disorder or folie à deux is described when the same delusions affect two or more closely related people. It is common for these two situations to cause comorbidity in the family unit. This case report concerns a couple married for 37 years. The husband described that 2 years ago, he began with a tingling sensation throughout his body, related to the presence of parasites coming out from all his body orifices, with no evidence of self‐harm. Likewise, the wife reported symptoms of formication and the feeling that there were invisible animals, as mentioned by her husband, and that she felt the parasites running throughout her body. The husband was diagnosed with endoparasitic delusional parasitosis, which caused folie à deux in his wife due to ectoparasitic parasitosis. The patient’s treatment included sertraline and risperidone in oral dosage lasting 3 months reducing delirium, later biperidene was prescribed due to main treatment’s side effects such as akathisia and sialorrhea, however the patient could not take the medication due to economic reasons. The wife was asked to sleep in a separate room, and she reported that the sensory hallucinations disappeared as soon as she slept in a different room. We conclude that the pharmacological approach, the intervention in the family life, and the gradual reintegration of marital habits once the patient improves are crucial in the therapy of delusional disorder.

El deterioro de la piel asociado con adhesivos de uso médico en dispositivos de acceso intravascular es un evento adverso que puede contribuir a la interrupción de la terapia de infusión intravascular. La Sociedad de enfermeras de infusión recomienda usar tecnologías de protección como apósito estéril para aseguramiento del catéter y cinta quirúrgica para aseguramiento complementario. Objetivo: Analizar las causas y prevalencia del deterioro de la piel asociado con aseguramiento del dispositivo de acceso intravascular. Métodos: Estudio analítico, de corte transversal. Para recolectar datos se empleó un formato digital y observación directa a pacientes hospitalizados (n=813) con algún dispositivo de aseguramiento en acceso intravascular central o periférico, y aseguramiento complementario con cinta quirúrgica, dando seguimiento durante 7 días en febrero 2020. Resultados: El deterioro de la piel incluyó desprendimiento de epidermis, maceración, dermatitis irritativa por contacto y alérgica, con prevalencia de 2.2%. Se atribuyeron a catéter venoso central (f=8), catéter venoso periférico (f=7) y cinta quirúrgica para aseguramiento complementario del apósito transparente (f=3). Discusión: Las causas de deterioro de la piel se debieron al tipo de dispositivo y material implementado para aseguramiento; en la mayoría de casos las lesiones se encontraron en accesos venosos periféricos, seguida de accesos venosos centrales, siendo el aseguramiento complementario la menor causa de deterioro de la piel. Conclusiones: La técnica correcta de aplicación y retiro de insumos adhesivos de estabilización y aseguramiento del catéter intravascular evitará el desprendimiento de los mismos, lesiones de piel e interrupción de la terapia de infusión intravascular.

COVID-19 affects the respiratory system, reducing the oxygen saturation level, leading to hypoxemia and increasing the metabolic oxygenation need. Objective: To describe the nursing interventions related to the need for oxygenation in hospitalized adults with severe COVID-19 disease in the Intensive Care Unit. Method: This was an observational, retrospective and descriptive study in a population of 2205 patients with a convenience sample of n = 430 and based on the North American Nursing Diagnosis Association (NANDA), the Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC). The analysis was performed with a non-parametric test to determine the association between the nursing interventions and the need for oxygenation. Results: The findings are aimed at improving nursing interventions with statistical associations as follow: oxygen therapy (p < 0.000), airway suctioning (p < 0.000), airway management (p = 0.029), invasive mechanical ventilation (p < 0.000) and non-invasive mechanical ventilation (p = 0.022). NOC taxonomy expected outcomes in ventilation, 34% (146), alteration in gas exchange, 33.7% (145), and respiratory status, 558.9% (253), were severely compromised. Conclusions: The nursing interventions to maintain the respiratory status are focused on airway care and oxygen therapy in order to increase the oxygen saturation level and decrease the severity of the need for oxygenation.

OBJECTIVE. This study examined the clinical utility of using two vascular access devices for intravenous infusions in women who experienced postpartum hemorrhage during cesarean section. METHODS. A case-control study was designed to evaluate the characteristics of the vascular access device used for intravenous infusions in 186 women selected by simple random sampling and assigned to two groups: the group that experienced hemorrhage (n=31) and the control or non-hemorrhage group (n=155). Linear regression assessed the relationship between hemorrhage and the predictors of intravascular therapy. RESULTS. During cesarean section, 31 women had hemorrhage, bleeding on average 1,129 ml with a dispersion of 560 ml, with a statistical difference of means between both groups in the t test of -14.74, and a p value of 0.001. The most commonly used vascular device was the 18-gauge peripheral catheter with 60%, and the 14-gauge was the least commonly used with 2.7%. In the group with hemorrhage, 83.9% used a peripheral catheter, 35.5% had two catheters, and 48.4% had the appropriate catheter (14 or 16 gauge). Linear regression with R 0.801 and ANOVA p 0.001, identifying a statistical relationship between the vascular device and hemorrhage. CONCLUSIONS. In evaluating the clinical utility of two vascular devices during postpartum hemorrhage, it was found that both groups mainly used the 18-gauge peripheral catheter and in cases of hemorrhage, only a third of the women had a double device and half had an appropriate large-caliber catheter for intravenous infusion.