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Müller S, Kluck R, Jagodzinski C, Brügelmann M, Hohenfellner K, Büscher A, Kemper MJ, Fröde K, Oh J, Billing H, Thumfart J, Weber LT, Acham-Roschitz B, Arbeiter K, Tönshoff B, Hagenberg M, Pavičić L, Haffner D, Zivicnjak M. Chest configuration in children and adolescents with infantile nephropathic cystinosis compared with other chronic kidney disease entities and its clinical determinants. Pediatr Nephrol 2023; 38:3989-3999. [PMID: 37415042 PMCID: PMC10584709 DOI: 10.1007/s00467-023-06058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Infantile nephropathic cystinosis (INC) is a systemic lysosomal storage disease causing intracellular cystine accumulation, resulting in renal Fanconi syndrome, progressive kidney disease (CKD), rickets, malnutrition, and myopathy. An INC-specific disproportionately diminished trunk length compared to leg length poses questions regarding the functionality of the trunk. METHODS Thus, we prospectively investigated thoracic dimensions and proportions, as well as their clinical determinants in 44 pediatric patients with INC with CKD stages 1-5 and 97 age-matched patients with CKD of other etiology between the ages of 2-17 years. A total of 92 and 221 annual measurements of patients with INC and CKD, respectively, were performed, and associations between anthropometric and clinical parameters were assessed using linear mixed-effects models. RESULTS Patients with INC exhibited altered chest dimensions that were distinct from CKD controls, characterized by markedly increased chest depth to height and chest depth to chest width ratio z-scores (> 1.0), while those of patients with CKD were only mildly affected (z-score within ± 1.0). Ratio z-scores differed significantly between both patient groups from 2-6 years of age onward. The degree of chest disproportion in INC patients was significantly associated with both the degree of CKD and tubular dysfunction (e.g., low serum phosphate and bicarbonate) across three different age groups (2-6, 7-12, and 13-17 years). CONCLUSION Our data show an INC-specific alteration in thoracic shape from early childhood onward, which is distinct from CKD of other etiologies, suggesting early childhood subclinical changes of the musculoskeletal unit of the thoracic cage, which are associated with kidney function. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Sophia Müller
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Rika Kluck
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Celina Jagodzinski
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Malina Brügelmann
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | | | - Anja Büscher
- Department of Pediatrics II, University Hospital Essen, Essen, Germany
| | | | - Kerstin Fröde
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jun Oh
- Division of Pediatric Nephrology, University Children's Hospital Hamburg, Hamburg, Germany
| | - Heiko Billing
- Clinic for Pediatric and Adolescent Medicine, RHK Clinic Ludwigsburg, Ludwigsburg, Germany
| | - Julia Thumfart
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | | | - Klaus Arbeiter
- Division of Pediatric Nephrology and Gastroenterology, Medical University Vienna, Vienna, Austria
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Martina Hagenberg
- Children's Hospital St. Elisabeth and St. Barbara, Halle (Saale), Germany
| | | | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Miroslav Zivicnjak
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Children's Hospital, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Pascoal LM, de Oliveira Lopes MV, da Silva VM, Diniz CM, Nunes MM, Guedes NG, de Menezes AP. Simultaneous concept analysis of nursing diagnoses related to respiratory function. Nurs Forum 2022; 57:1513-1522. [PMID: 36210479 DOI: 10.1111/nuf.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/24/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
AIM To perform a simultaneous concept analysis of the concepts associated to nursing diagnoses ineffective airway clearance, ineffective breathing pattern, and impaired gas exchange. BACKGROUND Concepts about respiratory manifestations need to be well defined, especially in the current pandemic scenario. For that, the simultaneous concept analysis can help in the clarity and differentiation of similar concepts. METHODS A concept analysis using the Walker and Avant approach and an integrative review. Data were collected by a group of nurses through a literature review. The group identified 10 articles that met the inclusion criteria and complemented the understanding of the concepts analysed through the sequential description of respiratory physiology in technical books. RESULTS The final list included 28, 22, and 21 clinical indicators for ineffective breathing pattern, impaired gas exchange, and ineffective airway clearance, respectively. The former, the final proposal incorporated 13 indicators that were pointed out by the group and 15 defining characteristics of NANDA-International. For Impaired gas exchange, the indicator "decreased oxygen saturation" was included; among the defining characteristics of NANDA-International, "abnormal arterial blood gases" was excluded, and "abnormal breathing pattern" was subdivided into "alterations in respiratory depth," "bradypnea," "tachypnea," and "change in respiratory rhythm." The latter, only the "wide-eyed" was removed from the final list of clinical indicators, which subsequently consisted of nine indicators suggested by the group and 12 defining characteristics. CONCLUSION This concept analysis may aid in the process of differentiation for ineffective airway clearance, ineffective breathing pattern, and impaired gas exchange, and aid in safer diagnostic inference. This concept analysis can support the understanding of respiratory nursing diagnoses, helping nurses to identify and differentiate them more safely.
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Affiliation(s)
- Lívia M Pascoal
- Nursing Department, Center of Social Sciences, Health and Technology, Federal University of Maranhão, University Av., Dom Afonso Felipe Gregory, Imperatriz, Maranhão, Brazil
| | | | | | - Camila M Diniz
- Nursing Department, Federal University of Ceará, Ceará, Brazil
| | - Marília M Nunes
- Nursing Department, Federal University of Ceará, Ceará, Brazil
| | - Nirla G Guedes
- Nursing Department, Federal University of Ceará, Ceará, Brazil
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Maia Pascoal L, Lopes MVDO, Silva VMD, Maciel Diniz C, Mendes Nunes M, Amorim Beltrão B, Sousa Freire VECD. A Content Analysis of Clinical Indicators of the Nursing Diagnosis Ineffective Breathing Pattern. Int J Nurs Knowl 2020; 32:53-58. [PMID: 32476266 DOI: 10.1111/2047-3095.12290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/23/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To verify the relevance of the clinical indicators, the clarity and precision of the conceptual, and operational definitions for Ineffective breathing pattern (IBP). METHODS A content analysis by 39 judges. FINDINGS The results showed 28 clinical indicators for IBP. However, only seven were not considered relevant for the diagnosis. These are not listed in NANDA International taxonomy. All conceptual and operational definitions were adequate, according to the analysis of the judges. CONCLUSION The list of 28 clinical indicators of IBP was submitted for analysis by judges, which then resulted in the validation of 21 of these elements. IMPLICATIONS FOR NURSING PRACTICE This study clarifies that gaps in the structure of diagnoses, helping nurses' diagnostic reasoning process in clinical practice.
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Affiliation(s)
- Lívia Maia Pascoal
- Lívia Maia Pascoal, RN, is at Nursing department, Federal University of Maranhão, S/N, University Avenue, Dom Afonso Felipe Gregory, Imperatriz - MA, 65915240, Brazil
| | - Marcos Venícios de Oliveira Lopes
- Marcos Venícios de Oliveira Lopes, RN; Viviane Martins da Silva, RN; Camila Maciel Diniz, RN, MSc; Marília Mendes Nunes, RN, MSc; Beatriz Amorim Beltrão, RN; and Vanessa Emille Carvalho de Sousa Freire, RN, is at Nursing department, Federal University of Ceará, 1115 Alexandre Baraúna St, Rodolfo Teófilo., Fortaleza - CE, 60430-160, Brazil
| | - Viviane Martins da Silva
- Marcos Venícios de Oliveira Lopes, RN; Viviane Martins da Silva, RN; Camila Maciel Diniz, RN, MSc; Marília Mendes Nunes, RN, MSc; Beatriz Amorim Beltrão, RN; and Vanessa Emille Carvalho de Sousa Freire, RN, is at Nursing department, Federal University of Ceará, 1115 Alexandre Baraúna St, Rodolfo Teófilo., Fortaleza - CE, 60430-160, Brazil
| | - Camila Maciel Diniz
- Marcos Venícios de Oliveira Lopes, RN; Viviane Martins da Silva, RN; Camila Maciel Diniz, RN, MSc; Marília Mendes Nunes, RN, MSc; Beatriz Amorim Beltrão, RN; and Vanessa Emille Carvalho de Sousa Freire, RN, is at Nursing department, Federal University of Ceará, 1115 Alexandre Baraúna St, Rodolfo Teófilo., Fortaleza - CE, 60430-160, Brazil
| | - Marília Mendes Nunes
- Marcos Venícios de Oliveira Lopes, RN; Viviane Martins da Silva, RN; Camila Maciel Diniz, RN, MSc; Marília Mendes Nunes, RN, MSc; Beatriz Amorim Beltrão, RN; and Vanessa Emille Carvalho de Sousa Freire, RN, is at Nursing department, Federal University of Ceará, 1115 Alexandre Baraúna St, Rodolfo Teófilo., Fortaleza - CE, 60430-160, Brazil
| | - Beatriz Amorim Beltrão
- Marcos Venícios de Oliveira Lopes, RN; Viviane Martins da Silva, RN; Camila Maciel Diniz, RN, MSc; Marília Mendes Nunes, RN, MSc; Beatriz Amorim Beltrão, RN; and Vanessa Emille Carvalho de Sousa Freire, RN, is at Nursing department, Federal University of Ceará, 1115 Alexandre Baraúna St, Rodolfo Teófilo., Fortaleza - CE, 60430-160, Brazil
| | - Vanessa Emille Carvalho de Sousa Freire
- Marcos Venícios de Oliveira Lopes, RN; Viviane Martins da Silva, RN; Camila Maciel Diniz, RN, MSc; Marília Mendes Nunes, RN, MSc; Beatriz Amorim Beltrão, RN; and Vanessa Emille Carvalho de Sousa Freire, RN, is at Nursing department, Federal University of Ceará, 1115 Alexandre Baraúna St, Rodolfo Teófilo., Fortaleza - CE, 60430-160, Brazil
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Prado PRD, Bettencourt ARDC, Lopes JDL. Defining characteristics and related factors of the nursing diagnosis for ineffective breathing pattern. Rev Bras Enferm 2019; 72:221-230. [PMID: 30916289 DOI: 10.1590/0034-7167-2018-0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/21/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify in the literature the defining characteristics and related factors of the nursing diagnosis "ineffective breathing pattern". METHOD Integrative review with the steps: problem identification, literature search, evaluation and analysis of data and presentation of results. RESULTS Twenty articles and two dissertations were included. In children, the most prevalent related factor was bronchial secretion, followed by hyperventilation. The main defining characteristics were dyspnea, tachypnea, cough, use of accessory muscles to breathe, orthopnea and adventitious breath sounds. Bronchial secretion, cough and adventitious breath sounds are not included in the NANDA-International (NANDA-I). For adults and older adults, the related factors were fatigue, pain and obesity and the defining characteristics were dyspnea, orthopnea and tachypnea. CONCLUSION This diagnosis manifests differently according to the patients' age group. It was observed that some defining characteristics and related factors are not included in the NANDA-I. Their inclusion can improve this nursing diagnosis.
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Affiliation(s)
| | | | - Juliana de Lima Lopes
- Universidade Federal de São Paulo, Paulista Nursing School. São Paulo, São Paulo, Brazil
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