Navegando por Palavras-chave "Terminologia Padronizada Em Enfermagem"

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    Fatores Preditores Do Diagnóstico De Enfermagem Padrão Respiratório Ineficaz Em Pacientes De Uma Unidade De Terapia Intensiva
    (Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Prado, Patricia Rezende Do [UNIFESP]; Lopes, Juliana De Lima [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To identify the prevalence, the related factors (RF), the defining characteristics (DC), the accuracy measures and the predictive factors of the nursing diagnosis of ineffective breathing pattern (IBP) in adults and elderly patients of an intensive care unit). Method: this thesis consists of two articles, an integrative review of the literature and a cross sectional paper. The integrative review aimed to identify the DC and RF of the IBP diagnosis. Articles were used between the years 1980 and 2016, which presented these indicators in newborns, children, adults and the elderly. The research question was formulated using the PICOT (Patient, Intervention, Comparation, Outcomes and Time) strategy. The quality of the articles was evaluated by the New Castle Ottawa scale. The cross-sectional study aimed to identify the prevalence, RF, DC, accuracy measures and predictive factors of IBP. For this, the sample consisted of adults and elderly patients hospitalized in an ICU in the city of Rio Branco, Acre. To be considered as having IBP, patients should present three or more defining characteristics (DC), as well as having a low inspiratory pressure obtained by the manovacuometer test. The patients were divided into two groups, with and without the IBP diagnosis. The independent variables were identified in the NANDA International classification (NANDA-I), literature (bronchial secretion, cough, decreased vesicular murmurs, altered respiratory depth and auscultation with adventitious sounds) and included some variables of interest identified in the clinical practice of researchers (age, medical diagnosis and smoking). Data were analyzed descriptively by means of absolute and relative frequencies. For all defining characteristics and related factors of dichotomous nature, accuracy measurements were presented through sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). In order to evaluate the simultaneous effects of the defining characteristics and related factors (predictor variables), on the presence of IBP (dependent variable), logistic regressions were adjusted. For the final model, having as predictors the related factors, the fitting adequacy of the final model was evaluated by Hosmer and Lemeshow test. Sensitivity and specificity were calculated from the ROC curve. Results: In the integrative literature review, the main RF identified in children was bronchial secretion (81.8%), followed by hyperventilation (22.4%). The main DC were: dyspnea (97,9%), tachypnea (82,9%), cough (74,3%), use of accessory breathing muscles (70,3 %), orthopnea (69,9%) and adventitious noise (67,5%). In adults, the main RF were fatigue (28.8%), pain (17.5%) and obesity (16.7%). The main DC were dyspnea (40.3%), tachypnea (16.7%) and orthopnea (15.6%). In the cross-sectional study, of the 120 patients, 67.5% presented IBP. In the univariate analysis, the variables that were associated with this nursing diagnosis were: group of disease (p = 0.008), RFs fatigue (p <0.001), obesity (p = 0.01) and secretion in the bronchi (p = 0.01), and the DC were changes in respiratory depth, auscultation with adventitious sounds, dyspnea, decreased vesicular murmurs, tachypnea, cough and use of accessory musculature to breathe, all with p-value <0.001. The DC decreased vesicular murmurs had high sensitivity (92.6%), specificity (97.4%), negative predictive value (86.4%) and positive (98.7%) and mean age of patients with positive IBP was higher than those with negative PRI (p = 0.003). The predictive factors of IBP in this ICU were: fatigue (OR = 61.96, p <0.001), age (OR = 1.06, p = 0.001) and group of diseases as the cardiocirculatory system (OR=0,07; p=0,02), trauma (OR=1; p=0,013) and other diagnoses (OR=0,15; p=0,009). Conclusion: Fatigue, age and group of diseases were predictors of IBP nursing diagnosis in this intensive care unit. Decreased vesicular murmurs, auscultation with adventitious sounds, and cough may be defining characteristics to be added in the NANDA-I classification, as well as secretion in the bronchi and group of disease as a related factor. It is emphasized the importance of investigating and identifying early these predictive factors with the intention of planning and implementing a care to improve the prognosis of patients with this nursing diagnosis.