Validation of the nursing interventions and activities for patients on hemodialytic therapy

Lucena, Amália de Fátima; Magro, Cecília Zys; Proença, Maria Conceição da Costa; Pires, Ananda Ughini Bertoldo; Moraes, Vítor Monteiro; Aliti, Graziella Badin

doi:10.1590/1983-1447.2017.03.66789

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Original Papers • Rev. Gaúcha Enferm. (Online) 38 (3) • 2017 • https://doi.org/10.1590/1983-1447.2017.03.66789 copy

Validation of the nursing interventions and activities for patients on hemodialytic therapy

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To validate interventions and nursing activities proposed by the Nursing Interventions Classification for patients with acute renal failure or acute chronic renal disease in hemodialysis therapy with the Excess Fluid Volume and Risk for Imbalanced Fluid Volume nursing diagnoses.

Methods

Validation of content with 19 expert nurses from a university hospital. The data collection was made from September to November 2011 through instruments that contained the interventions and nursing activities in study. The data analysis considered the average of scores obtained in the validation process.

Results

The Fluid Management was validated as a priority intervention (mean ≥ 0.8), with eight main activities for the Excess Fluid Volume nursing diagnosis and eight for the Risk for Imbalanced Fluid Volume nursing diagnosis.

Conclusion

The validated intervation of the Fluid Management enables the monitoring of the hydric balance and facilitates the prevention of complications, which are important activities in the nursing care of the patients in hemodialysis therapy.

Keywords
Renal dialysis; Hospital hemodialysis units; Critical care; Nursing care; Nursing diagnosis; Validation studies

EXCESS FLUID VOLUME (00026)
Interventions and numeric code (NIC)	Average	Validation level
Fluid Management (4120)	0.86	Priority
Hypervolemia Control (4170)	0.70	Complementary
Fluid Monitoring (4130)	0.66	Complementary
Electrolyte Monitoring (2020)	0.53	Complementary

RISK FOR IMBALANCED FLUID VOLUME (00025)
Interventions and numeric code (NIC)	Average	Validation level
Fluid Management (4120)	0.80	Priority
Fluid Monitoring (4130)	0.72	Complementary
Intravenous (IV) Therapy (4200)	0.72	Complementary
Electrolyte Monitoring (2020)	0.50	Complementary

ND - EXCESS FLUID VOLUME (00026)
Intervention - Fluid Management (4120)
Activities	Average	Validation level
Monitor vital signs, as appropriate	0.96	P
Maintain accurate intake and output record	0.91	P
Assess the location and extent of edema, if present	0.89	P
Consult physician if signs and symptoms of fluid volume excess persist or worsen	0.88	P
Distribute the fluid intake over 24 hours, as appropriate	0.87	P
Monitor for indications of fluid overload/retention (e.g., crackles, elevated central venous pressure or pulmonary capillary wedge pressure, edema, neck vein distension, and ascites), as appropriate	0.86	P
Monitor patient's weight change before and after dialysis, if appropriate	0.80	P
Monitor hydration status (e.g., moist mucous membranes, adequacy of pulses, and orthostatic blood pressure), as appropriate	0.80	P
Weigh daily and monitor trends	0.75	C
Instruct patient on nothing by mouth (NPO) status, as appropriate	0.75	C
Encourage significant other to assist patient with feedings, as appropriate	0.75	C
Count or weigh diapers, as appropriate	0.74	C
Monitor hemodynamic status, including central venous pressure (CVP), mean arterial pressure (MAP), pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP), if available	0.74	C
Monitor the patient's response to prescribed electrolyte therapy	0.74	C
Arrange availability of blood products for transfusion, if necessary	0.72	C
Administer blood products (e.g., platelets and fresh frozen plasma), as appropriate	0.70	C
Give fluids, as appropriate	0.68	C
Monitor laboratory results relevant to fluid retention (e.g., increased specific gravity, increased BUN, decreased hematocrit and increased urine osmolality levels)	0.67	C
Monitor foods/fluids ingested and calculate daily caloric intake, as appropriate	0.63	C
Offer snacks (e.g. frequent drinks and fresh fruits/fruit juice), as appropriate	0.61	C
Insert urinary catheter, if appropriate	0.61	C
Administer IV therapy, as prescribed	0.53	C
Administer prescribed diuretics, as appropriate	0.53	C
Administer IV fluids at room temperature	0.51	C
Restrict free water intake in the presence of dilutional hyponatremia with serum Na level below 130 mEq per liter	0.49	NE
Monitor nutrition status	0.46	NE
Promote oral intake (e.g., provide a drinking straw, offer fluids between meals, change ice water routinely, make freezer pops using child's favorite juice, cut gelatin into fun squares, use small medicine cups), as appropriate	0.41	NE
Administer prescribed nasogastric replacement based on output, as appropriate	0.30	NE

RISK FOR IMBALANCED FLUID VOLUME (00025)
Intervention - Fluid Management (4120)
Activities	Average	Validation level
Monitor vital signs, as appropriate.^* * Activities also validated for ND Excess fluid volume.	0.97	P
Assess the location and extent of edema, if present ^* * Activities also validated for ND Excess fluid volume.	0.95	P
Distribute the fluid intake over 24 hours, as appropriate ^* * Activities also validated for ND Excess fluid volume.	0.86	P
Consult physician if signs and symptoms of fluid volume excess persist or worsen^* * Activities also validated for ND Excess fluid volume.	0.86	P
Monitor for indications of fluid overload/retention (e.g., crackles, elevated central venous pressure or pulmonary capillary wedge pressure, edema, neck vein distension, and ascites), as appropriate ^* * Activities also validated for ND Excess fluid volume.	0.82	P
Monitor hydration status (e.g., moist mucous membranes, adequacy of pulses, and orthostatic blood pressure), as appropriate ^* * Activities also validated for ND Excess fluid volume.	0.80	P
Administer blood products (e.g., platelets and fresh frozen plasma), as appropriate	0.80	P
Encourage significant other to assist patient with feedings, as appropriate	0.80	P
Maintain accurate intake and output record	0.76	C
Monitor hemodynamic status, including central venous pressure (CVP), mean arterial pressure (MAP), pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP), if available	0.75	C
Arrange availability of blood products for transfusion, if necessary	0.75	C
Monitor patient's weight change before and after dialysis, if appropriate	0.71	C
Give fluids, as appropriate	0.71	C
Count or weigh diapers, as appropriate	0.68	C
Monitor the patient's response to prescribed electrolyte therapy	0.67	C
Weigh daily and monitor trends	0.66	C
Monitor laboratory results relevant to fluid retention (e.g., increased specific gravity, increased BUN, decreased hematocrit and increased urine osmolality levels)	0.66	C
Instruct patient on nothing by mouth (NPO) status, as appropriate	0.64	C
Monitor foods/fluids ingested and calculate daily caloric intake, as appropriate	0.62	C
Administer IV therapy, as prescribed	0.61	C
Administer IV fluids at room temperature	0.59	C
Offer snacks (e.g. frequent drinks and fresh fruits/fruit juice), as appropriate	0.58	C
Administer prescribed diuretics, as appropriate	0.55	C
Insert urinary catheter, if appropriate	0.53	C
Restrict free water intake in the presence of dilutional hyponatremia with serum Na level below 130 mEq per liter	0.50	C
Monitor nutrition status	0.49	NE
Promote oral intake (e.g., provide a drinking straw, offer fluids between meals, change ice water routinely, make freezer pops using child's favorite juice, cut gelatin into fun squares, use small medicine cups), as appropriate	0.45	NE
Administer prescribed nasogastric replacement based on output, as appropriate	0.35	NE

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[1] Corresponding author: Graziella Badin Aliti E-mail: grazialiti2@gmail.com