Associations between respiratory nursing diagnoses and nursing interventions in patients submitted to thoracic or upper abdominal surgery

OBJECTIVE

To determine associations between respiratory nursing diagnoses and nursing interventions in patients submitted to thoracic or upper abdominal surgery.

METHOD

Cross sectional quantitative study. Participants were 312 adult patients within the first 48 hours after thoracic or upper abdominal surgery. Patients were examined by the research team using an instrument with variables related to the respiratory function. The research team established the presence/absence of three nursing diagnoses and proposed interventions using the NANDA-I classification and the Nursing Interventions Classification. Correlations were tested using the chi-square or Fisher's test.

RESULTS

From the total 312 examinations, ineffective airway clearance was present in 185 (59.3%) assessments, ineffective breathing pattern in 123 (39.4%), and impaired gas exchange in 141 (45.4%). Significant correlations showed that patients with ineffective airway clearance were more likely to require pain management (or: 2.27), chest physiotherapy (or: 2.96), and positioning (or:1.8), while patients with impaired gas exchange were less likely to require airway management (or: 0.13) and chest physiotherapy (or: 0.28).

CONCLUSIONS

Patients with ineffective airway clearance had more chances of requiring pain management, chest physiotherapy, and positioning, while the nursing diagnosis impaired gas exchange was related with airway management and chest physiotherapy. The findings provide basis for nurses to develop effective care plans and to minimize postoperative respiratory complications.

Accuracy of the defining characteristics of the nursing diagnosis for fatigue in women under radiotherapy

ABSTRACT Objective: To evaluate the accuracy of the defining characteristics of the nursing diagnosis for “fatigue in women with breast cancer under radiotherapy”. Method: Study of diagnostic accuracy, with cross-sectional design, performed in 130 women with breast cancer under radiation treatment. A data collection instrument was used to evaluate clinical socio-demographics and to investigate the presence or absence of defining characteristics for fatigue. The latent class analysis model was applied to assess accuracy measurements of the characteristics identified. Results: Fatigue diagnosis was present in 21.9% of the women. The characteristic which showed the highest sensitivity was “Impaired capacity in maintaining the usual level of physical activity”, while “Impaired capacity in maintaining usual routines” and “Lack of interest about the surrounding environment” presented greater specificity. Conclusion: Accurate diagnostics allow devising an action plan directed to the patients' real needs.

Respiratory status of adult patients in the postoperative period of thoracic or upper abdominal surgeries

Objective:

to evaluate the respiratory status of postoperative adult patients by assessing the nursing outcome Respiratory Status.

Method:

descriptive, cross-sectional study developed with 312 patients. Eighteen NOC indicators were assessed and rated using a Likert-scale questionnaire and definitions. Descriptive and correlative analysis were conducted.

Results:

the most compromised clinical indicators were coughing (65.5%), auscultated breath sounds (55%), and respiratory rate (51.3%). Factors associated with worse NOC ratings in specific clinical indicators were sex, age, pain, and general anesthesia.

Conclusions:

certain clinical indicators of respiratory status were more compromised than others in postoperative patients. Patient and context-related variables can affect the level of respiratory compromise.

Ineffective airway clearance in adult patients after thoracic and upper abdominal surgery

AIM

The aim of this study is to analyze the accuracy of the defining characteristics of ineffective airway clearance (IAC) in patients after thoracic and upper abdominal surgery.

BACKGROUND

Although numerous studies have described the most prevalent respiratory NANDA-I diagnoses, only few investigates the precision of nursing assessments.

METHODS

A cross-sectional study was conducted with 192 patients in a surgical clinic. Accuracy measures were obtained by the latent class analysis method.

RESULTS

IAC was present in 46.73% of the sample. The defining characteristics with better predictive capacity were changes in respiratory rate and changes in respiratory rhythm. However, other defining characteristics also had high specificity, such as restlessness, cyanosis, excessive sputum, wide-eyed, orthopnea, adventitious breathing sounds, ineffective cough, and difficulty vocalizing.

CONCLUSION

Results can contribute to the improvement of nursing assessments by providing information about the key clinical indicators of IAC.

Defining the key clinical indicators for ineffective breathing pattern in paediatric patients: a meta-analysis of accuracy studies

AIMS AND OBJECTIVES

The purpose of this study was to identify the key clinical indicators of ineffective breathing pattern among paediatric patients.

BACKGROUND

When nurses perform clinical reasoning, certain characteristics represent the clinical indicators necessary to confirm the presence of a particular diagnosis. Some quantitative studies have reported the prevalence of ineffective breathing pattern in different samples of patients. However, these findings should be synthesised.

DESIGN

Meta-analysis of quantitative nursing studies.

METHODS

Studies were identified via systematic searches of CINAHL, LILACS, PubMed and Scopus using the key search terms 'ineffective', 'breathing' and 'pattern'. Additional quality-related inclusion criteria were gleaned from the Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy, the Standards for Reporting of Diagnostic Accuracy and the Quality Assessment of Diagnostic Accuracy Studies. The pertinent results from each study were extracted and analysed via meta-analysis.

RESULTS

Six studies using paediatric populations met the inclusion criteria. Summary measures indicated that the following defining characteristics had the highest accuracy values for ineffective breathing pattern among children: bradypnoea, dyspnoea, nasal flaring, orthopnoea, tachypnoea and the use of accessory muscles to breathe.

CONCLUSION

This meta-analysis provides information regarding the accuracy of the clinical indicators of ineffective breathing pattern from studies sampling diverse paediatric populations.

RELEVANCE TO CLINICAL PRACTICE

Nurses can better use clinical indicators to infer the presence of ineffective breathing pattern when they are aware of the most relevant defining characteristics. Nursing students and professionals can also improve their critical thinking abilities and diagnostic reasoning based on these findings.

[Systematic review and meta-analysis of the accuracy of "impaired gas exchange" defining characteristics]

INTRODUCTION

Nursing diagnoses share some common defining characteristics.

OBJECTIVE

To identify key defining characteristics for the nursing diagnosis "Impaired gas exchange".

METHOD

Systematic review with meta-analysis of three studies in samples with different clinical profiles. The relevance and quality of the studies were assessed according the QUADAS protocol.

RESULTS

Two studies were on children with acute respiratory infection and one on adults with mechanical ventilation. The heterogeneity statistic test suggested that the studies are homogeneous. The defining characteristics with higher accuracy were: headaches upon waking, irritability and tachycardia.

DISCUSSION

The clinical indicators headache, irritability and tachycardia are signals secondary to hypoxia. Although of different magnitudes according to the age, they are the body's physiological responses.

CONCLUSIONS

A comparison of the defining characteristics of "Impaired gas exchange" showed their accuracy. Obtaining measures can contribute to a better identification of this nursing diagnosis.

Clinical indicators of 'caregiver role strain' in caregivers of stroke patients

The main objectives of this study were to investigate the prevalence of the nursing diagnosis caregiver role strain (CRS) in caregivers of patients with stroke and to identify the accuracy of this diagnosis's clinical indicators. A total of 42 stroke patient caregivers who provided in-home care services in a city in north-eastern Brazil. The sensitivity, specificity, and predictive value of clinical indicators of nursing diagnosis 'CRS' were analyzed. Study participants were mostly female, married and the daughters of stroke patients. CRS was present in 73.8% of caregivers. The presence of the clinical indicators, specifically, lack of time to meet personal needs (p = 0.011), increased emotional lability (p = 0.001), withdrawal from social life (p = 0.002), and changes in leisure activities (p = 0.002), presented high values for statistical measures of diagnostic accuracy.

[Situational low self-esteem in pregnant women: an analysis of accuracy]

To investigate the accuracy of defining characteristics of Situational low self-esteem we developed a cross-sectional study, with 52 pregnant women assisted in a family centre. The NANDA-I taxonomy was used as well as the Rosenberg's scale. The diagnosis was present in 32.7% of the sample and all characteristics presented statistical significance, except "Reports verbally situational challenge to its own value". The characteristics "Indecisive behavior" and "Helplessness expressions" had 82.35% of sensitivity. On the other hand, the characteristics "Expression of feelings of worthlessness" and "Reports verbally situational challenge to its own value" were the more specific, with 94.29% of specificity. These results can contribute with the nursing practice because the identification of accurate characteristics is essential to a secure inference.

[Scales for evaluation of the overload of caregivers of patients with stroke]

The objective of the study was to evaluate the available productions in literature about scales to measure the overload of caregivers of patients with stroke. It was carried out a bibliographical revision in three databases: LILACS, CINAHL and SCOPUS. In 23 works, 24 different scales were identified, and the most cited were: the Caregiver Strain Index, the Caregiver Burden Scale, the Caregiver Reaction Assessment, the Sense of Competence Questionnaire, the Relatives Stress Scale and the Zarit Burden Interview. The use of scales to measure the overload is an important tool to evaluate the context in which the caregiver is inserted, but is more trustworthy to use more than one measure instrument than use only one. Therefore, the validation of scales becomes important for this population.

Acurácia das características definidoras do diagnóstico controle familiar ineficaz do regime terapêutico

OBJETIVO: Investigar a acurácia das características definidoras do diagnóstico Controle familiar ineficaz do regime terapêutico. MÉTODOS: Estudo transversal, com 68 diabéticos atendidos em um Centro de Saúde da família. Foram calculadas as medidas de sensibilidade, especificidade e valores preditivos das características definidoras identificadas. RESULTADOS: O diagnóstico esteve presente em 36,8% e todas as características apresentaram significância estatística, exceto "Dificuldade em seguir o regime prescrito". A característica "Atividades familiares inadequadas para atingir o objetivo de um programa de tratamento ou prevenção" foi a mais sensível, enquanto "Aceleração dos sintomas da doença de um membro da família" e "Falta de atenção para a doença e suas seqüelas" foram as mais específicas. CONCLUSÃO: Os resultados chamam atenção para a necessidade de se trabalhar a adesão com uma perspectiva voltada à família, sobretudo considerando-se a complexidade do tratamento para o diabetes.

AVALIAÇÃO DA TROCA GASOSA DE PACIENTES COM INSUFICIÊNCIA CARDÍACA CONGESTIVA

A fisiopatologia da Insuficiência Cardíaca Congestiva (ICC) repercute em desequilíbrios na relação ventilação-perfusão, um prejuízo que pode interferir diretamente na sobrevida dos pacientes. A equipe de enfermagem pode monitorar e prevenir esta problemática com o uso das classificações de enfermagem, no entanto, pesquisas que abordem a utilização destes instrumentos são escassas. Este estudo transversal, descritivo-exploratório, objetivou avaliar o grau de comprometimento da troca gasosa de pacientes com ICC, com base na Classificação dos Resultados de Enfermagem. Foi realizado com 37 pacientes internados em um hospital especializado, com dados obtidos por meio de entrevista, exame físico e consulta ao prontuário. Os resultados demonstram que os indicadores clínicos profundidade e frequência respiratória, ortopneia, dores no peito, sonolência e ureia foram os mais comprometidos. O desenvolvimento de pesquisas com base nos resultados de enfermagem é relevante e pode contribuir para identificação coerente dos diagnósticos de enfermagem, direcionando os cuidados ao paciente.