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Objective: to verify causes of inactivity in the Home Delivery Medicament Program, as referred by users from a Primary Health Care Service in São Paulo, comparing them to the causes registered in the program and analyzing them in the theoretical model Concept of Access to Health., Methods: cross-sectional study, interviewing 111 inactive users; and documentary study in the program records., Results: half of the users did not know the condition of inactivity. Discrepancies were found between the user's and the program's information, observing different levels of agreement: Absence of physician and administrative staff member 0%; Transfer to other service 25%; Death 50%; Option to quit 50%; Address change 57% and Change in therapeutic schedule 80%. The users' feeling of accepting the program was observed. In the health access concept, inactivity can be explained in the information dimension, in the degree of asymmetry between the patient's and the health professional's knowledge, identified through the indicators: education, knowledge and information sources., Conclusions: due to the low education level, the user does not assimilate the information on the steps of the program flowchart, does not return for the assessment that guarantees its continuity. Consequently, (s)he stops receiving the medication and spends a long time without treatment, increasing the cardiovascular risk of hypertensive (92% of the sample), diabetic (44%) and dyslipidemic patients (31%).

This is an exploratory, cross-sectional study of quantitative design that aimed to identify the communication strategies used and reported by the nursing staff in the care of aphasic patients after a stroke. The techniques used were the participant observation and interviews with 27 subjects of the nursing staff of neurological units in a general hospital. The most frequently mentioned strategies were gestures (100%), verbal communication (33.3%), written communication (29.6%) and the touch (18.5 %). Among the observed strategies, the gestures reached 40.7% and the touch was present in all situations, given its instrumental character essential to care. The findings show lack of knowledge of nonverbal, proxemics , kinesics and tacesics communication. No significant differences were observed among the professional categories depending on the length of experience with respect to the strategies reported by members of the nursing staff in the care for aphasic patients.

Objective: to identify, in 2011, rates of hypertension, cardiovascular and gestational problems in subjects presenting high blood pressure in 1982, when correct cuff size was used, according to the American Heart Association Arm Circumference/Cuff Width ratio of 0.40., Methods: high blood pressure was defined in 2011 as systolic = 115 mmHg and diastolic = 80mmHg, resulting in 20 subjects between 39 and 43 years old. (Risk Group). They were compared to 20 subjects from the original sample with lower blood pressure values (Control group)., Results: the rates of hypertension, cardiovascular and gestational problems were significantly higher (Fisher: p=0.02) in the Risk Group, with one case of cardiovascular death. Our findings arouse speculations about whether, if a proper cuff had been used in clinical practice, the complications and death could have been avoided., Conclusions: data suggest compliance with the use of cuff width corresponding to 40% of arm circumference, despite polemics concerning cuff availability and difficulties of using many sizes.

To avoid inaccurate blood pressure (BP) readings, the American Heart Association (AHA) recommends cuff width (CW) encircling 40% of the arm circumference (AC) and cuff length at least 80-100%. This study aimed to identify inpatients AC, the corresponding cuff size and the cuff size availability. In total, 81 AC were measured in the right arm. The cuff sizes to fit them were calculated according to AHA AC/CW width 0.40 ratio. The AC varied from 17.5 to 40.5 cm and the corresponding cuff width from 6 to 16 cm. The standard cuff 12 by 23 cm, the only size available in the clinics, was appropriate for only 17.3% of the subjects, whose AC varied between 32.5 and 34.3 cm. The lack of availability of different cuff sizes continues being a challenging problem to be faced. The standard cuff available, 12 cm large, did not fit 82.7% of the identified AC, resulting in over or underestimated BP registers.

In the previous issue of this journal the authors celebrated in an article the discovery of the Korotkoff sounds, in 1905, and presented the historical facts that determined the important role of the University of São Paulo's Nursing School (EEUSP) in the development of the oldest blood pressure research line in Brazilian Nursing: "Cuff Width Influence in Blood Pressure Measurement." This new article presents the scientific production derived from the studies carried out by nurses with a PhD from EEUSP during and after their doctoral programs in the area. The path each researcher followed in his/her group and laboratory is emphasized. The data presented is aimed at offering a number of qualitative and quantitative indicators that make possible to evaluate the impact of the research that they have carried out, as well as the development of knowledge in the area.

This article pays homage to Sergei Nicolai Korotkoff, for the centenary of the auscultatory method discovery. It refers to his discover of blood pressure auscultatory method in Russia, in 1905; presents the evidence that resulted in the development of sphygmomanometry studies in Brasil; describes the important contribution of the Nursing School of the University of São Paulo to the development of blood pressure measurement research; and analyses the results of the research field of "Cuff width influence in blood pressure measurement", created at the Nursing School of The University of São Paulo, in 1974. The scientific results of doctoral studies are presented, identifying the research groups that are contributing to defying knowledge in this area. The article demonstrates the consolidation of the results related to the initial doctoral program studies developed in the area. Confirmation of hypothesis in longitudinal studies is emphasized.

We compared intra-arterial to auscultation blood pressure values using correct (CCW) or standard (SCW) cuff widths. Intra-arterial values were obtained from the radial artery using a digital monitor. Measurements were simultaneously made by two observers: one recorded intra-arterial values, while the other registered values by auscultation (brachial artery). Systolic intra-arterial pressure (mmHg) values were 125.04 vs. 119.75 (CCW), and 124.84 vs 116.39 (SCW). Diastolic pressure values were 68.72 vs. 73.26 (CCW), and 68.63 vs. 70.56 (SCW). Auscultation underestimated systolic pressure, particularly when SCW was used, whereas it overestimated diastolic pressure, when CCW was used. Auscultation using CCW yielded higher agreement of systolic pressure values and lower agreement of diastolic pressure values as compared to intra-arterial blood pressure measurements.

Background: The correct evaluation of blood pressure (BP) during pregnancy is a crucial factor in the prevention of eclampsia. Following American Heart Association (AHA) guidelines to employ a correct cuff width (CCW), 20% larger than arm diameter, we demonstrate that the standard cuff width (SCW), 12 cm wide, is too large for lean women causing underestimation of BP., Aims: To identify the arm circumference (AC) in pregnant women and the corresponding cuff width; to compare BP records from CCW vs. SCW; and to identify under- and overestimation of BP in SCW reading., Design: A follow up study of BP was performed in 104 pregnant women using two cuffs widths (CCW vs. standard one). The investigation was carried out during all antenatal appointments and postpartum stage in two maternity hospitals. In every appointment BP was registered three times with each type of cuff; and the means of those three readings were compared., Methods: The CCW for each woman was selected according to AHA recommendation for cuff width size (20% larger than arm diameter), which was based on the classical European and North-American studies. Results. Arm circumference varied from 20 to 38 cm requiring a cuff width from 8 to 14 cm. The CCW most employed was 10 cm wide. The SCW (12 cm) was employed as CCW in only 13.4% of the subjects. Statistical difference was found on BP means when comparing both cuffs (P < 0.05), reaching 23 mmHg in systolic values and 20 in diastolic ones. Such differences showed a serious underestimation when SCW was employed in 80.8% of the subjects and overestimation in 5.8% of obese subjects., Conclusion: Our findings showed that the SCW underestimates BP of pregnant women. Our hypothesis is that such underestimation may lead to the misdiagnosis of pre-eclampsia, particularly in lean pregnant women.

The study was developed by clinical nurses specialized in cardiology and had the purpose to characterize the knowledge about the conceptual aspects and the anatomical and physiological factors that interfere in the marks of blood pressure.

Purpose: To examine the influence of a nursing diagnosis course on the information processing by undergraduate students., Methods: A quasi-experimental study conducted with two groups (experimental, n = 15; control, n = 22) of undergraduate nursing students, subjecting only one to a nursing diagnosis course. The students' ability to identify, cluster, and name clusters of relevant data were compared between and within groups., Findings: After the course, the experimental group performed better than the control group in the three activities studied., Conclusions: The results of this study suggest that the nursing diagnosis content in teaching favors clinical reasoning to determine the patient's nursing care.

According to the International Council of Nurses the measurement of blood pressure is the procedure most performed by nurses in all the world. The aim of this study is to analyse the polemical aspects of instruments used in blood pressure measurement. Considering the analyses of the literature and the American Heart Association Recommendations, the main source of errors when measuring blood pressure are discussed.

This study deals with the review of the literature regarding the indirect blood pressure measurement in normal pregnant women. It shows the changes that happened with the blood pressure due to pregnancy. Polemical aspects in the procedure of blood pressure measurement are discussed; for example, which one of the Korotkoff phases (4 or 5) that better represent the diastolic blood pressure and the use of Ambulatory Blood Pressure Monitoring in pregnancy. The recommendations from different societies are emphasized (American Heart Association, British Hypertension Society, Australasian Society, National High Blood Pressure Education Program and World Health Organization).

The goal of this study was to compare blood pressure measures using two sizes of cuffs: one standard width (12 cm) and other with correct width that is 0.38 of arm circumference as recommended by American Heart Association. The comparisons were done among surgical patients in mediate perioperative phase, reception area of operation room and postoperative phase during the staying of the patient in the recovery room. The results demonstrated that the arterial blood pressure was hypoestimated by the use of the standard width cuff, reaching values up 30 mmHg in the systolic arterial pressure and 30 mmHg in the diastolic ones.

This paper is intended to stress the nurse's responsibility in therapeutic drugs administration, mainly as related to her (or his) Knowledge of the pharmacological principles involved in drugs prescriptions. The Nursing Process regarding drug and client/patient assessment is herein presented as well as some example of nursing diagnosis. Planning and evaluation of nursing actions are also discussed and other issues are stressed that require a high degree of reasoning and research in the field.

The undertaking of an interview and physical examination in 30 inpatients with chronic Chagas cardiopathy, taking into account the health functional patterns approach, led us to data for establishing the nursing diagnosis of these patients.

The search of scientific answers to problems due to procedures involving professional actions is a permanent challenge to the nurses committed with the improving of nursing care. In face of the intensive muscle soreness provoked by penicillin G benzatin shots, an experimental evaluation of this procedure was carried out in order to observe the influences of concentration and volumes used. This evaluation could give some insights to improve the nursing care, particularly those linked to the manipulation of the penicillin injection. The study was performed in the Faculty of Medicine of the University of São Paulo, in 27 Male Wistar rats. After the injection of the drug or saline solution in the right and left limb, respectively, the animals were sacrificed and the muscles in which the solution were injected were histologically examined. The use of penicillin provoked intensive inflammatory reaction, the peak intensity being attained after 48 hours. A remaining effect lasted about thirty days. The inflammatory reaction was similar for the three concentrations of penicillin. Nevertheless, the present research does not bring data that should modify the current injection procedures.

This study followed blood pressure in 11 subjects 5 years after slight or established hypertension had been revealed using a cuff of the correct width (appropriate to arm circumference); at that time, the use of a standard-width cuff (12 cm) had shown a blood pressure within the normal range. For the present study, blood pressure was determined indirectly under very strict conditions so that a faithful comparison between the readings with both cuffs could be achieved. An important underestimate of blood pressure was detected in thin arms when the standard width cuff was used. The present measurements showed a consistent increase in blood pressure with standard-width cuff readings, confirming the hypertension that had been identified using the correct cuff width 5 years previously. These results support our previous hypothesis that early diagnosis of hypertension can be masked by the standard-width cuff, particularly in lean persons.

Pulse pressure was investigated by indirect sphygmomanometry using two different cuff widths, standard (12 cm) versus correct (20% wider than arm diameter). Following the American Heart Association's recommendation for arterial pressure measurements, 7 cuffs of various widths (8 to 14 cm) were used as correct cuffs on 900 subjects; in only 50 was the standard cuff appropriate. Pulse pressure as a function of cuff width was significantly lower (P less than 0.001) with the standard cuff on subjects with diastolic pressure less than 90 mmHg (36.4 +/- 0.3 mmHg vs 41.8 +/- 0.3 mmHg) and above 90 mmHg (39.6 +/- 1.2 mmHg vs 43.8 +/- 1.3 mmHg). Mean systolic and diastolic arterial pressures were underestimated by 12.7 mmHg and 7.7 mmHg, respectively. These results suggest that cuff width influences data obtained by indirect sphygmomanometry, producing over- or underestimates when the ratio of arm circumference to cuff width differs from 0.38.

This study deals with the indirect arterial blood pressure measurement, particularly the American Heart Association recommendations for sphygmomanometry References are made regarding the ratio arm circumference/cuff width and the errors caused by inadequate cuff size. Several variables involved in the procedure of arterial blood pressure measurement are discussed.