Diagnostic accuracy of clinical indicators of Imbalanced nutrition in pediatric patients submitted to chemotherapy

To analyze the accuracy of clinical indicators of nursing diagnosis, Imbalanced nutrition: less than the body requirements in pediatric patients undergoing chemotherapy. A cross-sectional study was carried out in a pediatric oncohematology unit. A total of 123 children aged 5-18 years were evaluated. The Standards for Reporting Diagnostic Accuracy Studies (STARD) protocol was used. Latent class analysis was performed to obtain sensitivity and specificity of clinical indicators. The diagnosis was identified in six children (5.23%). The most frequent clinical indicator in the study was report of food intake less than recommended daily allowance (n = 61; 49.6%), followed by excessive hair loss (n = 49; 39.8%), misperception (n = 42; 34.1%), satiety immediately upon ingesting food (n = 32; 26%), lack of information (n = 30; 24.4%), and pale mucous membranes (n = 22; 17.9%). The 10 indicators that sensitivity and specificity were statistically superior to 50% were food intake less than recommended daily allowance, misperception, insufficient interest in food, lack of food, hyperactive bowel sounds, body weight 20% or more below ideal weight range, insufficient muscle tone, food aversion, abdominal cramping, and misinformation. The clinical indicators Food intake less than recommended daily allowance and Misperception can be considered the most important indicators for the initial inference of the diagnosis due to their high values of specificity and sensitivity. It is essential that nurses provide targeted and qualified assistance based on the signs and symptoms presented by patients, as they will be able to design appropriate interventions to obtain the desired results.

Clinical indicators and aetiological factors of sedentary lifestyle in patients with arterial hypertension

AIMS

The aim of this study is to verify the clinical validity of clinical indicators and aetiological factors of sedentary lifestyle in individuals with arterial hypertension.

BACKGROUND

Diagnostic validation is performed to expand nursing taxonomies and to revise or confirm the described concepts. New elements listed in the literature and those identified by the NANDA International definition for sedentary lifestyle need to be evaluated.

DESIGN

This is a cross-sectional and diagnostic validation study. The STROBE guidelines were used in this study.

METHODS

Two hundred and fifty subjects aged over 18 years were evaluated. The diagnostic status of the participants was obtained by latent class analysis. Logistic regression was used to identify aetiological factors with the manifestation of sedentary lifestyle, considering a significance level of 5%.

RESULTS

A total of 57.8% of the study participants met the diagnostic criteria for sedentary lifestyle. The clinical indicators with high sensitivity were as follows: "Average daily physical activity is less than recommended for gender and age"; "Does not perform physical activity during leisure time"; "Preference for activity low in physical activity" and "Overweight." The significantly related factors associated with the diagnosis of sedentary lifestyle were as follows: "Insufficient knowledge on physical activity," "Lack of time," "Negative self-perception of health," "Lack of security," "Lack of appropriate place," "Lack of motivation," "Activity intolerance," "Lack of sports ability," "Having a partner," "Using public transportation," "Perception of physical disability," "Pain," "Having a job/studying," "Laziness," "Impaired mobility," "Living in an urban area," "Education in a public institution," "Female gender," "Lack of confidence to practice physical exercise," "Education level," "Age" and "Lack of social support for the practice of physical exercise."

CONCLUSION

Four out of eight clinical indicators had a good adjustment by the latent class analysis. Of the 27 aetiological factors, 22 were significantly associated with sedentary lifestyle.

RELEVANCE TO PRACTICE

The correct identification of sedentary lifestyle and its elements supports care planning, especially for health promotion and disease prevention.

Prognostic Indicators of Delayed Surgical Recovery in Patients Undergoing Cardiac Surgery

PURPOSE

The purpose of this study was to analyze the prognostic capacity of the clinical indicators of a delayed surgical recovery nursing diagnosis throughout the hospital stay of patients having cardiac surgery.

DESIGN

A prospective cohort design was adopted. A sample of inpatients undergoing elective cardiac surgery was followed during the immediate preoperative period and hospitalization. This research was conducted in the southeast region of Brazil at a national reference institution that treats highly complex diseases and performs cardiac surgeries. Data were collected from July 2017 to July 2018.

METHODS

At the end of 1 year of data collection, 181 patients were followed in this study. The Kaplan-Meier method was used to calculate the survival time related to delayed surgical recovery. In addition, an extended Cox model of time-dependent covariates was adjusted to identify the clinical signs that influenced the change in the nursing diagnosis status.

RESULTS

A delayed surgical recovery nursing diagnosis was present in 23.2% of the sample studied. With an expected length of stay of 8 to 10 days, most new cases of delayed surgical recovery were observed on the 10th postoperative day, and the survival rate after this day was decreased until the 29th postoperative day, when the nursing diagnosis no longer appeared. Interrupted healing of the surgical area, loss of appetite, and atrial flutter were indicators related to an increased risk for delayed surgical recovery.

CONCLUSIONS

Timely recognition of selected clinical indicators demonstrates a promising prognostic capacity for delayed surgical recovery.

CLINICAL RELEVANCE

Accurate identification of prognostic factors allows nurses to identify early signs of postoperative complications. Consequently, the professional can develop an individualized plan of care, aiming at the satisfactory clinical recovery of the patient.

Content analysis of clinical indicators for Impaired gas exchange

OBJECTIVE

To analyze the relevance of clinical indicators and the clarity and precision of conceptual and operational definitions of the diagnosis Impaired gas exchange.

METHODS

Content analysis, by 39 nurse judges, divided into the phases of conceptual definition of the phenomenon of interest, construction of the structure of the phenomenon of interest and analysis of the judges on the built structure.

RESULTS

From the 22 indicators, 21 were considered relevant Impaired gas exchange. The indicators that obtained absolute relevance were Cyanosis, Hypercapnia, Hypoxemia and Tachycardia. The indicator Headache upon waking did not show any statistically significant relevance for the diagnosis. All conceptual and operational definitions were clear and precise.

CONCLUSION

The indicators listed for Impaired gas exchange were relevant to the phenomenon, except Headache upon waking because it does not correspond to a safe manifestation to identify the diagnosis, according to the analysis of the judges. Each conceptual and operational definition was adequate for its indicator.

The factors related to a sedentary lifestyle: A meta-analysis review

AIMS

To compare factors associated with the sedentary lifestyle described in the literature with the factors listed in NANDA International.

DESIGN

Systematic review with meta-analysis of factors associated with a sedentary lifestyle in adolescents, adults and older people.

DATA SOURCES

An electronic search of PubMed, Scopus, CINAHL and Latin America and the Caribbean Literature on Health and Science databases conducted in May 2016.

REVIEW METHODS

Descriptive data were extracted according to a standardized form. The odds ratios for each etiological factor associated with a sedentary lifestyle were extracted directly from the articles or calculated from the data described therein. The meta-analysis was conducted for factors that were investigated in more than one study.

RESULTS

Thirty-five articles were included. The statistically significant factors were: lack of social support, of physical space, of time, of motivation, of sports skills and of interest in physical activity, intolerance to activity, being retired, living in a low-income country, laziness, not having a job/studying, low socioeconomic status and level of knowledge about physical activity, female gender, living in an urban area, negative self-perception of health, using public transportation, being in the oldest age group in the study and perceived physical disability.

CONCLUSION

The new factors associated with a sedentary lifestyle and those already included in the NANDA International classification will lead to better clinical guidance for nurses.

IMPACT

Knowledge about these factors can contribute directly to public health policies.

A Middle-Range Theory for Nurses to Diagnose Ineffective Infant Feeding Patterns

PURPOSE

To construct a middle-range theory, based on the Roy adaptation model, for nurses can diagnose an ineffective infant feeding pattern.

DATA SOURCE

Scientific findings were used through a literature review and the concepts of the Roy model.

DATA SYNTHESIS

The theory indicated new elements for the diagnosis: 12 etiological factors and 13 clinical indicators. Most of those are not contained in the NANDA taxonomy.

CONCLUSION

The middle-range theory for these diagnoses highlights the need for a review of the components present in the taxonomy.

IMPLICATIONS FOR NURSING PRACTICE

This approach guides research on nursing diagnoses to revise the content of the theory and to expand its concepts and elements for the diagnosis of an ineffective infant feeding pattern.

A Content Analysis of Clinical Indicators of the Nursing Diagnosis Ineffective Breathing Pattern

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.

Nutritional Deficits In Children With Cancer: A Situation-Specific Theory

PURPOSE

To construct a situation-specific theory (SST) to represent nutritional deficits for assessing children with cancer.

DATA SOURCES

Literature review.

DATA SYNTHESIS

The SST included the definition of key concepts, a pictorial scheme, propositions, causal relationships, and evidence for nursing practice.

CONCLUSIONS

It was possible to characterize the elements as antecedent and consequent clinical factors to allow for an understanding of the existing relationships between them and their temporality. These elements differed considerably from those included in NANDA International.

IMPLICATIONS FOR NURSING PRACTICE

This study provides additional information so that nurses in clinical practice can infer the presence of nutritional deficits in children with cancer early, given the risk already inherent in the diagnosis of cancer and treatment.

A Content Analysis of Clinical Indicators and Etiological Factors of Ineffective Infant Feeding Patterns

PURPOSE

To analyze the content of the concepts present in the nursing diagnosis of Ineffective infant feeding pattern.

DESIGN AND METHODS

Content validation of nursing diagnosis based on the predictive diversity model. A methodological study of the content validation of a nursing diagnosis was based on the predictive diversity model and performed in the following three stages: conceptual definition of the phenomenon of interest; organization of the phenomenon of interest; and analysis by judges of the concepts of the phenomenon of interest.

RESULTS

The first two stages identified 13 clinical indicators and 12 etiological factors, which were evaluated by 23 judges. The analyses of judgments were performed according to the level of expertise of the judges. All the clinical indicators were relevant to nursing diagnosis under study. Nine causal factors were analyzed, including the level of importance to the occurrence of Ineffective infant feeding pattern.

CONCLUSIONS

This study analyzed the diagnostic structure of Ineffective infant feeding pattern, which were considered representative of the phenomenon of interest after evaluation by the judges.

PRACTICE IMPLICATIONS

The use of nursing diagnosis with accurate elements facilitates clinical reasoning and favors the development of an adequate care plan.

Evaluation of color-coded drug labeling to identify endovenous medicines

OBJECTIVE

To analyze the opinion of nursing professionals on the design, practicality of use and the usefulness of color-coded drug labeling in a pediatric intensive care unit.

METHODS

A cross-sectional study with 42 nursing professionals. A structured questionnaire was used based on a five-level Likert scale. To assess the proportions, a binomial test was used.

RESULTS

Concordance ratio >0.8 for all propositions related to design, practicality and most of the propositions related to error prevention.

CONCLUSION

According to the opinion of the nursing team, the implemented technology has an adequate design, as well as being practical and useful in the prevention of medication errors in the population at the ICU.

Nursing diagnoses associated with the national policy for health promotion

OBJECTIVES

To identify the relationships between nursing diagnoses proposed by NANDA-I taxonomy II and the priority themes (PT) of the National Policy for Health Promotion (PNPS in Portuguse).

METHODS

An integrative literature review was carried out in the Scopus, Cinahl and SciELO databases, using the descriptors: health promotion, food habits, traffic accidents, drugs abuse, environment and public health. The search considered scientific articles published between 2000 and 2016.

RESULTS

Twelve articles were selected to identify and explore nursing actions related to PT. It was identified that although the said taxonomy offers a Domain called Health promotion, there is a need to relate the diagnoses of other domains to include the health actions described in the aforementioned Policy. It was observed that there is an attention and concern of the nursing professionals to address topics such as the training of managers and the promotion of healthy eating. In relation to the priority themes promotion of safe mobility and sustainable development, no nursing diagnoses were identified due to the scarcity of diagnoses related to them in the mentioned taxonomy.

CONCLUSIONS

Although the NANDA-I taxonomy presents a specific domain on health promotion, these are not sufficient to meet the needs of the priority themes proposed by PNPS.

Estilo de vida sedentário em indivíduos com hipertensão arterial

RESUMO Objetivo: identificar a prevalência do diagnóstico de enfermagem Estilo de Vida Sedentário (EVS) e analisar sua associação com os indicadores clínicos (IC) e fatores relacionados (FR) em indivíduos com hipertensão arterial (HA). Método: estudo transversal com 285 pacientes com HAS em um centro de referência em atendimento ambulatorial no nordeste do Brasil. Para a coleta de dados, utilizou-se instrumento baseado nas definições operacionais dos IC e FR validados anteriormente. Quatro enfermeiros classificaram EVS como presente ou ausente. Para avaliar a associação entre IC e FR com a presença de EVS aplicou-se o Teste de Qui-quadrado. Calculou-se a razão de prevalência e intervalo de confiança para verificar a magnitude do efeito entre FR e EVS. Resultados: identificou-se EVS em 55,8% da amostra. Cinco IC e seis FR apresentaram associação estatística significante com EVS. Conclusão: o estudo identificou os principais indicadores para inferência de EVS, bem como seus possíveis fatores causais entre pessoas com HAS.

Langerhans cell histiocytosis

The authors present a rare case of Langerhans cell histiocytosis in a 31 year old female patient with vulvar, peri-anal and oral lesions, diabetes insipidus, pulmonary skin and bone infiltrations. Skin biopsy immunohistochemistry presented positive S100 protein and vimentin, but the diagnosis was done with the demonstration of Birbeck granules with electronic microscopy. The treatment was based on systematical chemotherapy although vulvar lesion has a bad response to chemotherapy.