Trabajos de Titulación - Enfermería
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Item type: Ítem , Access status: Acceso Abierto , Eventos centinelas por abuso de opioides en profesionales de enfermería: factores contribuyentes y preventivos. Scoping Review(Universidad Católica de Cuenca., 2026) Lucero Picón, Ana CristinaOral opioids are primarily used to treat moderate to severe cancer pain. Although the misuse and abuse of opioid analgesics remain a major public health concern, opioids continue to be an important option for pain management in some patients. This study aimed to identify sentinel events associated with opioid abuse through a scoping review to understand the contributing and preventive factors related to opioid abuse. The study adopts a qualitative, descriptive-analytical approach, in which sentinel events associated with opioid abuse are identified through a scoping review of relevant scientific literature. The results show that sentinel events associated with opioid abuse arise from the interaction of individual, healthcare-related, and pharmacological factors. The latter are associated with abuse-deterrent formulations, which, although they do not eliminate the risk of abuse, reduce rates of intentional abuse, serious adverse effects, and death. It is concluded that the risk of sentinel events associated with opioid abuse depends not only on the characteristics of the drug but also on mental health conditions, a history of overdose, and patterns of use and administration. Therefore, strengthening clinical surveillance and promoting preventive measures are essential to ensure safe treatment and reduce complications associated with the inappropriate use of these medications. Early risk detection and professional follow-up can also support safe therapeutic decisions and ensure that each patient receives appropriate care throughout pharmacological treatment. Keywords: sentinel events, opioids, prevention, risk.Item type: Ítem , Access status: Acceso Abierto , Panorama de la cobertura de vacunación infantil y oportunidades perdidas en América Latina tras la pandemia de covid-19(Universidad Católica de Cuenca., 2026) Sánchez Peralta , Diana GabrielaIn Latin America, childhood vaccination coverage showed a downward trend before the COVID-19 pandemic, which worsened during the pandemic. This review aimed to analyze changes in coverage, completion of vaccination schedules, and missed opportunities for vaccination in children aged up to five years during and after the pandemic, compared with the pre-pandemic period. A descriptive and analytical systematic review with narrative synthesis was conducted and reported in accordance with the PRISMA 2020 guidelines. The search covered studies published between 2020 and 2025 in PubMed, Scopus, Web of Science, SciELO, and Taylor & Francis. Forty studies were included in the main synthesis, and their methodological quality and risk of bias were assessed using tools developed by the Joanna Briggs Institute (JBI). The results showed varying declines across countries, vaccines, doses, and time periods, with a greater impact on later doses and booster doses. Missed opportunities were related to inadequate checking of the vaccination card, stock-outs, false contraindications, and inappropriate decisions during health care encounters, although specific evidence on this phenomenon was limited. Microplanning, active case-finding, follow-up of incomplete vaccination schedules, and outreach activities were associated with improvements in vaccination indicators, but recovery was uneven. The evidence showed that the pandemic worsened the pre-existing decline in childhood vaccination. These findings support the need to strengthen the completion of vaccination schedules, reduce missed opportunities, and improve nursing follow-up to restore and sustain vaccination coverage. Keywords: Childhood vaccination; COVID-19; Vaccination delay; Latin America.Item type: Ítem , Access status: Acceso Abierto , Antropometría y composición corporal en personas mayores de 60 años: evaluación con bioimpedancia multifrecuencia en parroquias rurales ecuatorianas 2025-2026(Universidad Católica de Cuenca., 2026) Campoverde Peñaranda, Ana Emilia; Robles Avila, Wilson OrlandoWith the aging of the rural population in Ecuador, this population is exposed to malnutrition, sarcopenia, and functional decline, associated with difficulty accessing health services and poor socioeconomic conditions. Electrical bioimpedance (BIA) allows estimating body composition; the Mini Nutritional Assessment (MNA) establishes the nutritional risk of older adults. To examine the association between body composition, nutritional status, functionality, and chronic diseases in older adults from three rural parishes of Cuenca, Ecuador. Cross-sectional study in 302 older adults, with a mean age of 74.3 ± 7.6 years. Two body composition profiles were established using the k-means technique in cluster analysis. Comparison tests, Spearman correlations, and ROC were used for associations and predictive capacity. 56.5% presented risk of malnutrition according to the MNA. Body composition showed no significant correlations with the MNA or discriminative capacity for predicting nutritional risk (AUC: 0.479–0.540). Nutritional risk was significantly associated with worse balance and gait, as well as with greater risk of falls and functional dependence. BMI and fat mass were associated with hypertension and diabetes, while lower lean mass and skeletal muscle were associated with greater functional dependence. In this Andean rural population, BIA allowed identification of overweight, obesity, and associations with cardiometabolic diseases, although it should not be considered an adequate isolated indicator of malnutrition risk. Comprehensive geriatric assessment, and especially functional status and fall risk, should accompany nutritional screening in primary rural care to guide preventive decisions and improve appropriate clinical follow-up. Keywords: older adults; electrical bioimpedance; nutritional status; functional capacity; risk of falls; rural area; Ecuador.Item type: Ítem , Access status: Acceso Abierto , Estilos de vida y síntomas depresivos en adultos mayores en parroquias rurales ecuatoriana 2025-2026(Universidad Católica de Cuenca., 2026) Bueno Tacuri , Adriana Abigail; Quizhpi Peralta, Mariuxi CarolinaDepressive symptoms represent a priority public health concern among older adults. In Ecuador, evidence regarding their prevalence and the role of lifestyle factors in rural settings remains limited. To estimate the prevalence of depressive symptoms and assess their association with lifestyle factors among older adults living in rural parishes of Cuenca Canton. A cross-sectional study was conducted among 302 older adults (≥65 years) residing in the rural parishes of Sinincay, Ricaurte, and El Valle. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15), while lifestyle was evaluated using the Health-Promoting Lifestyle Profile (PEPS-I). Multivariable logistic regression was performed to identify independent factors associated with depressive symptoms. Overall, 43.0% of participants presented depressive symptoms. The mean PEPS-I score was significantly lower among participants with depressive symptoms than among those without them (130.6 ± 28.5 vs. 140.0 ± 26.9; p = 0.002). The interpersonal support, self-actualization, and stress management subscales showed the largest differences between groups (p < 0.001). In the adjusted model, an unhealthy lifestyle (OR: 2.25; 95% CI: 1.23–4.11), low income (OR: 2.26; 95% CI: 1.35–3.79), and chronic disease (OR: 2.08; 95% CI: 1.26–3.46) were significantly associated with depressive symptoms. Depressive symptoms affected nearly half of the older adults studied. An unhealthy lifestyle was associated with approximately twice the odds of depressive symptoms, independently of sociodemographic and clinical factors. These findings highlight the need for community-based interventions focused on strengthening healthy lifestyle behaviors, social support networks, and coping strategies for managing the emotional challenges experienced in later life. Keywords: Depressive symptoms; older adults; PEPS-I; lifestyle; rural areas; Ecuador; GDS-15, chronic disease.Item type: Ítem , Access status: Acceso Abierto , Soledad, depresión y deterioro cognitivo en adultos mayores en parroquias rurales ecuatorianas 2025-2026: análisis multivariado(Universidad Católica de Cuenca., 2026) Medina Gahona, Nayeli ElizabethAbstract To identify the link between feelings of loneliness and various health indicators among rural older adults in the province of Cuenca, with the aim of determining which cognitive, emotional, functional, or lifestyle traits might be associated with greater decline. A total of 314 participants (68.7% women; mean age 74.30 ± 6.25 years) from three municipalities (Sinincay, Ricaurte, and El Valle) were analyzed using tools such as the ESTE Loneliness Scale (ESTE-R), the Yesavage Geriatric Depression Scale, the Mini-Mental State Examination (MMSE), the Tinetti Balance and Gait Scale, the Lawton and Brody Instrumental Activities of Daily Living Scale, the Existential Crisis Scale, and the Health-Promoting Lifestyle Profile; a k-means cluster analysis was also applied. Advanced age, reduced cognitive capacity, higher fall risk, and functional dependence were associated with lower levels of loneliness; additionally, depression was significantly linked to a greater sense of existential crisis and increased functional instability (balance and gait). No significant relationship was found between feelings of loneliness and cognitive capacity or physical function; however, advanced age and unhealthy lifestyles appear to influence functional and cognitive decline. These results highlight the need to implement community-based lifestyle programs for older adults—tailored to the specific characteristics of each group—aimed at improving their physical and mental well-being. Keywords: loneliness; cognitive dysfunction; rural aging; geriatric depression; functional dependence; lifestyle; EcuadorItem type: Ítem , Access status: Acceso Abierto , Estilos de vida y riesgo de deterioro cognitivo: Estudio Transversal en adultos mayores(Universidad Católica de Cuenca., 2026) Arias Solis, Erika Alejandra; Rocano Brito, Mayra GabrielaBackground: Lifestyle factors, including smoking, alcohol consumption, physical activity, and social participation, influence the risk of cognitive impairment. However, evidence in older adults from rural areas of Ecuador is limited. Objective: To analyze lifestyle behavior patterns and their association with cognitive decline in older adults from rural communities in the canton of Cuenca. Methods: A cross-sectional observational study was conducted with 316 older adults from the rural parishes of Sinincay, Ricaurte, and El Valle (Cuenca, Ecuador), selected using non-probability convenience sampling. Lifestyle patterns were identified through latent class analysis, and cognitive function was assessed using the Mini-Mental State Examination. The association between these two variables was analyzed using multiple logistic regression. Results: Three lifestyle classes were identified: High Control–High Engagement (44.6%), High Control–Low Engagement (48.1%), and Low Control–Low Engagement (7.3%). The High control–High engagement group showed a lower risk of cognitive decline. In men, belonging to the High Control–Low Engagement class was associated with a higher probability of cognitive decline (OR = 17.0; 95% CI: 2.13–135.7). Conclusions: Low participation in physical and social activities was associated with a higher risk of cognitive decline. Community interventions that promote active aging and social participation are needed, especially among rural men. Keywords: lifestyle behaviors; cognitive dysfunction; cognitive impairment; older adults; rural population.Item type: Ítem , Access status: Acceso Abierto , Tolerancia farmacológica y falta de respuesta terapéutica tras el uso prolongado de alprazolam: reporte de un caso clínico(Universidad Católica de Cuenca., 2026) Chacha Pintado, Andrea EstefaniaProlonged use of benzodiazepines, especially alprazolam, has been associated with the development of pharmacological tolerance, dependence, and decreased therapeutic response, constituting a relevant clinical problem due to its physical, psychological, and social repercussions. This study presents a descriptive and retrospective case report of a 56-year-old female patient with a history of anxiety and chronic insomnia under long-term treatment with alprazolam. The methodology included a comprehensive nursing assessment, review of the patient's medical records, follow-up of the patient's progress, and comparison of the clinical findings with available scientific evidence. During the clinical course, a progressive loss of therapeutic efficacy was observed, manifested by an increase in anxiety symptoms, the need to increase the dose to achieve the same clinical effect, and the appearance of signs consistent with drug dependence. Sleep disturbances, daytime sleepiness, difficulty concentrating, mild withdrawal symptoms, and impaired work performance were also identified. The care plan focused on symptom management, monitoring for adverse effects, and education on the safe use of the medication. The patient's clinical progression demonstrated that prolonged use of alprazolam can promote the development of tolerance and dependence, compromising therapeutic efficacy and quality of life, which highlights the importance of early detection, continuous nursing follow-up, and the implementation of multidisciplinary strategies to promote the rational use of benzodiazepines and prevent complications associated with their prolonged use. Keywords: Alprazolam, Benzodiazepines, Drug tolerance, Substance-related disorders, Anxiety disorderItem type: Ítem , Access status: Acceso Abierto , Trastorno de estrés postraumático en enfermeras de áreas críticas durante la pandemia de COVID-19: una revisión de alcance(Universidad Católica de Cuenca., 2026) García Jiménez , Paula Nayeli; Guamán Pintado , Sthéfany TatianaIntroduction: The COVID-19 pandemic caused significant emotional distress among nursing staff, particularly those working in critical areas such as intensive care units (ICUs) and emergency medical services (EMS). Constant exposure to critically ill patients, fear of infection, excessive workload, and frequent contact with death contributed to the development of post-traumatic stress disorder (PTSD) and other mental health problems. Methodology: A scoping review was conducted in accordance with the PRISMA-ScR guidelines. The literature search was conducted in databases including PubMed, ScienceDirect, BVS, Scopus, and ProQuest. Terms related to PTSD, nursing, critical care, and COVID-19 were used. Studies published between 2022 and 2026 in English, Spanish, and Portuguese were included. A total of 18 studies were included in the final analysis. Results: Studies showed that PTSD was the primary psychological disorder experienced by nursing staff working in critical care areas during the COVID-19 pandemic. The main contributing factors were the work environment, work overload, staff shortages, emotional exhaustion, and continuous exposure to suffering. Furthermore, resilience, family support, and social and organizational support were identified as protective factors against PTSD. Conclusions: PTSD significantly impacted nursing staff in critical care areas during the pandemic. The findings demonstrate the importance of strengthening the psychological support network, improving working conditions, and promoting spaces for emotional support and/or follow-up. Keywords: nursing, Post-traumatic stress disorder, Critical care nursing, Intensive care units, COVID-19.Item type: Ítem , Access status: Acceso Abierto , Efectos de la intervención nutricional en adultos mayores en Latinoamérica: Una revisión de alcance(Universidad Católica de Cuenca., 2026) Brito Vintimilla, Evelyn Dayana; Parra Peralta, Poleth AntonellaTo explore the scientific literature on the effects of nutritional interventions in older adults in Latin America: a scoping review. The methodology was conducted in accordance with the PRISMA guidelines, with inclusion and exclusion criteria defined across the SciELO, Latindex, LILACS, Dialnet, Redalyc, PubMed, and Mediagraphic databases. Twenty-two studies were selected that address how nutritional interventions improve nutritional status, muscle mass, and quality of life in older adults, particularly when combined with education, supplementation, and exercise. However, these findings have methodological limitations, including small sample sizes and a lack of standardization, which restrict the generalizability of the results and long-term evaluation. It is concluded that nutritional interventions among older adults in Latin America can improve nutritional status, function, and quality of life provided that they are implemented as components of an integrated approach that includes nutrition education, supplementation, and physical activity. Keywords: older adults; intervention; nutrition; quality; Latin America.Item type: Ítem , Access status: Embargo , EMBARGADO POR MOTIVOS DE INVESTIGACIÓN(Universidad Católica de Cuenca., 2026) Andrade Lazo, Mateo Alexander; Guayanay Lapo, Lissbeth Carolina...Item type: Ítem , Access status: Embargo , EMBARGADO POR MOTIVOS DE INVESTIGACIÓN(Universidad Católica de Cuenca., 2026) Mejia Ordoñez, Esther Olivia; Pugo Tacuri, Juan Gabriel...Item type: Ítem , Access status: Embargo , EMBARGADO POR MOTIVOS DE INVESTIGACIÓN(Universidad Católica de Cuenca., 2026) Morillo Ordoñez, Joseph Isaías...Item type: Ítem , Access status: Embargo , EMBARGADO POR MOTIVOS DE INVESTIGACIÓN(Universidad Católica de Cuenca., 2026) Miranda Riera, Johanna Marisol...Item type: Ítem , Access status: Acceso Abierto , EMBARGADO POR MOTIVOS DE INVESTIGACIÓN(Universidad Católica de Cuenca., 2026) Naula Chabla, Daysi Mariela...Item type: Ítem , Access status: Embargo , EMBARGADO POR MOTIVOS DE INVESTIGACIÓN(Universidad Católica de Cuenca., 2026) Sanango García, Ana Estefania; Quizhpi Paucar, Jessica Elizabeth...Item type: Ítem , Access status: Embargo , EMBARGADO POR MOTIVOS DE INVESTIGACIÓN(Universidad Católica de Cuenca., 2026) León Siguencia, Wilmer Alexander...Item type: Ítem , Access status: Embargo , Proyecto de titulación embargado con fines publicación. Estará disponible a la fecha de publicación o de cierre de embargo.(Universidad Católica de Cuenca., 2026) Toapanta Fernández, Gabriela CarolinaTrabajo de titulación embargado con fines de publicación.Item type: Ítem , Access status: Acceso Abierto , Encefalitis por Anticuerpos Anti-NMDA y Otras Variantes Autoinmunes: Perspectiva Clínica y Terapéutica(Universidad Católica de Cuenca., 2025) Castro López, Danae JanicceAutoimmune encephalitis mediated by antibodies against the N-methyl-D-aspartate receptor (antiNMDA) is a serious neurological disorder of immunological origin that most commonly affects young women and is characterized by nonspecific neuropsychiatric symptoms. Its multiphase clinical presentation makes early diagnosis difficult, as it can be confused with primary psychiatric disorders, delaying treatment and worsening the prognosis. Objective: Analyze the clinical case of anti-NMDA autoimmune encephalitis in the context of nursing practice, integrating evidence-based information to strengthen the approach and management of this type of pathology. Methodology: The type of research was a descriptive, retrospective clinical case study. The technique used to collect information was through a review of medical records, and the pathology was described by compiling articles extracted from recognized databases such as Scopus, PorQuest, PubMed, Web of Science, LILACS, etc. The inclusion criteria covered articles published in the last five years, in Spanish and English. A review of scientific publications was carried out to construct the theoretical framework. The report follows the general principles of health writing, related to the Vancouver structure and style: definition of the pathology, pathophysiology, risk factors, diagnosis, signs and symptoms, consequences, nursing care plan, and medical treatment. Results: The patient received immunotherapy and multidisciplinary support, achieving a favorable outcome with partial recovery. Conclusion: Anti-NMDA autoimmune encephalitis represents a clinical challenge due to its onset with nonspecific neuropsychiatric symptoms that delay diagnosis. The case analyzed highlights the importance of early recognition and the use of specific tests to improve prognosis. Nursing staff play an essential role in monitoring, managing complications, and educating families. Continuous training of the healthcare team and psychoeducational support for caregivers were shown to be key pillars for optimizing recovery and quality of care. Keywords: Encephalitis; NMDA receptor antagonist; neuropathology, neuropsychiatry; immunotherapy; neurological disorders.Item type: Ítem , Access status: Acceso Abierto , Deleción Cromosómica 1q44 y su Impacto Multisistémico: A Propósito de un Caso Clínico(Universidad Católica de Cuenca., 2025) Cango González, Yuri ThalíaThis study presents a case of terminal deletion in 1q44, associated with alterations in fatty acid metabolism, delayed cognitive development, epilepsy, and hypopituitarism. The influence of a home nursing care program on the patient's treatment is also analyzed. Objective: To describe the nursing care implemented/provided to a minor diagnosed with a chromosomal deletion that shows evidence of a fatty acid metabolic disorder, global neurodevelopmental delay, epilepsy, hypothyroidism, and hypopituitarism, and to evaluate its impact on her quality of life. Methodology: Clinical follow-up was conducted between 2019 and 2024 through a review of medical records and bibliographic analysis. The protocol included nursing interventions aimed at metabolic control, seizure management, neurosensory stimulation, and strengthening family support. Results: Glucose stabilization, a 60% decrease in the frequency of epileptic seizures, improvements in muscle tone, sensory responses, and sleep quality were observed. Likewise, the role of the family as the center of care was strengthened. These benefits were maintained until the patient's death. Conclusion: A comprehensive and palliative approach in the home environment is an effective strategy for improving quality of life and preserving dignity in the treatment of complex genetic diseases, demonstrating the relevance of specialized nursing care in the family setting. Keywords: Microdeletion, metabolism, development, epilepsy, hypopituitarismItem type: Ítem , Access status: Acceso Abierto , Accidente Cerebrovascular Isquémico: Perspectiva Clínica Y Tratamiento: Caso Clínico Ilustrativo(Universidad Católica de Cuenca., 2025) Chocho Sumba , Johanna FernandaIschemic stroke (IS) is a medical emergency caused by the obstruction of a cerebral artery, leading to an interruption in blood flow and, consequently, neurological deficits that vary depending on the affected region. This condition is one of the leading causes of disability and mortality worldwide, making early diagnosis and a comprehensive approach by the healthcare team crucial, especially the role of intensive care nursing. Objective: To analyze a case of ischemic stroke to highlight relevant data on the disease and the most important nursing care. Methodology: Retrospective descriptive study of a clinical case of ischemic stroke, with a holistic approach that integrates healthcare, teaching, and research experience from admission to discharge. A systematic review of the medical record was performed, and a search was conducted in high-impact databases (Scopus, PubMed, WoS, LILACS, and ProQuest) for literature published in the last five years. The case is presented chronologically, detailing clinical findings, laboratory and imaging studies, as well as medical and nursing interventions under an intensive and humanized care model. Inclusion criteria were applied based on complete records with informed consent and exclusion of insufficient data, ensuring confidentiality and ethical-scientific rigor. Results: A 72- year-old patient with clinical symptoms and neurological findings underwent a brain CT scan, which showed an extensive hypodense lesion in the right cerebellar hemisphere with involvement of the brain stem. These findings suggest clear signs of intracranial hypertension, which represents a life-threatening situation, especially considering his multiple comorbidities and the potential risk of acute deterioration. Conclusion: Early care and systematic reassessment were decisive in identifying and treating the cerebellar infarction before herniation. Multidisciplinary management, combining strict hemodynamic control, osmotic diuretics, and respiratory support, favored edema reduction and neurological stability. Keywords: Cerebral vascular disease; cerebral ischemia; cerebral ischemic vascular event; thrombectomy.
