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Maurício AB, Cavalcante AMRZ, de Sá ES, Bruni LG, Vieira LGD, Costa A, França LD, Lopes MVDO, de Barros ALBL, da Silva VM. Accuracy of the defining characteristics of respiratory nursing diagnoses in patients with COVID-19. Int J Nurs Knowl 2024. [PMID: 38951045 DOI: 10.1111/2047-3095.12481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/12/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE To analyze the accuracy of the defining characteristics of four respiratory nursing diagnoses (ND) in patients with COVID-19 and on oxygen therapy. METHODS This is a cross-sectional study conducted in four Brazilian public hospitals in two regions of the country. A total of 474 patients with COVID-19 receiving oxygen therapy were assessed. Latent-adjusted class analysis with random effects was used to establish the sensitivity (Se) and specificity (Sp) of the defining characteristics evaluated for each ND. RESULTS Among the ND that constituted the study (impaired spontaneous ventilatory, impaired gas exchange, ineffective airway clearance, and dysfunctional ventilatory weaning response), the following defining characteristics had the highest simultaneous Se and Sp (>0.8): decrease in tidal volume, confusion, irritability, dyspnea, decreased breath sounds, orthopnea, impaired ability to cooperate and respond to coaching, and decrease in the level of consciousness. CONCLUSIONS Recognizing the clinical signs that predict respiratory ND in patients affected by COVID-19 can contribute to the nurse's accurate diagnostic inference and designate the appropriate nursing interventions to achieve the desired results and avoid complications.
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Affiliation(s)
| | | | | | | | | | - Adriana Costa
- Paulista Nursing School, Federal University of São Paulo, São Paulo, Brazil
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Bento H, Fisk E, Johnson E, Goudelock B, Hunter M, Hoekstra D, Noren C, Hatton N, Magel J. Inspiratory Muscle Training While Hospitalized With Acute COVID-19 Respiratory Failure: A Randomized Controlled Trial. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2023; 14:134-142. [PMID: 37389410 PMCID: PMC10289076 DOI: 10.1097/jat.0000000000000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Although inspiratory muscle training (IMT) has been used in outpatient settings for patients who recovered from COVID-19 respiratory failure, little data exist to support earlier implementation in acute care hospitals. This study aimed to assess the safety and feasibility of IMT during the acute disease phase of COVID-19. Design Setting and Patients Sixty patients presenting with COVID-19 to a single academic medical center were randomized to control or intervention groups using systematic randomization. Measurements Participants in the control group had their maximal inspiratory pressure (MIP) measured at enrollment and hospital discharge. They were also asked for their rating of perceived exertion on the Revised Borg Scale for Grading Severity of Dyspnea and were scored by researchers on the Activity Measure for Post-Acute Care (AM-PAC) 6-Clicks Mobility Scale and the Intensive Care Unit Mobility Scale (IMS). Control group patients otherwise received standard care. Participants in the intervention group, in addition to the measures described previously, received inspiratory threshold trainers with the goal of doing 2 sessions daily with a physical therapist for the duration of their inpatient hospitalization. In these sessions, the patient completed 3 sets of 10 breaths with the trainer. Initial resistance was set at 30% of their MIP, with resistance increasing 1 level for the subsequent session if the patients rated their during-activity rating of perceived exertion as less than 2. Changes in functional outcome measures, amount of supplemental oxygen, hospital length of stay (LOS), discharge location, adverse events, and mortality were assessed in group comparisons. Results Of 60 enrolled patients, 41 (n = 19 in intervention and n = 22 in control) were included in the final data set, which required completion of the study, initial and discharge data points collected, and survival of hospitalization. Final groups were statistically similar. A total of 161 sessions of IMT were completed among the 19 patients in the intervention group. Mortality totaled 2 in the control group and 3 in the intervention group and adverse events during intervention occurred in only 3 (1.8%) sessions, all of which were minor oxygen desaturations. Sessions were unable to be completed for all potential reasons 11% of possible times. Dropout rate in the intervention group was 3 (10%). Both intervention and control groups demonstrated improved MIP, decreased supplemental oxygen requirements, improved function on the AM-PAC, and slightly decreased function on the IMS. Length of stay was shorter in the intervention group, and discharge disposition was similar between groups. Conclusions With a low number of recorded adverse events, similar mortality between groups, and successful completion of 161 exercise sessions, IMT may be a feasible and safe intervention for some hospitalized patients with COVID-19.
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Affiliation(s)
- Haley Bento
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Elizabeth Fisk
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Emma Johnson
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Bruce Goudelock
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Maxwell Hunter
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Deborah Hoekstra
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Christopher Noren
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Nathan Hatton
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - John Magel
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
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