Subconjunto terminológico CIPE® para personas con úlcera de pie diabético en atención primaria de salud

Silva, Halene Cristina Dias de Armada e; Acioli, Sonia; Fuly, Patricia dos Santos Claro; Lins, Silvia Maria de Sá Basilio; Santos, Juliana Otaciana dos; Querido, Danielle Lemos; Camacho, Alessandra Conceição Leite Funchal; Menezes, Harlon França de

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 76 (5) • 2023 • https://doi.org/10.1590/0034-7167-2022-0668 copiar

Subconjunto terminológico CIPE® para personas con úlcera de pie diabético en atención primaria de salud

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

desarrollar un subconjunto terminológico de la CIPE® para personas con úlceras del pie diabético en la Atención Primaria de Salud.

Métodos:

estudio metodológico, que siguió cinco etapas: 1) identificación de términos relevantes para la clientela a través de una revisión integradora de literatura y documentos oficiales en el área; 2) mapeo de términos identificados con los términos CIPE®; 3) construcción de diagnósticos, resultados e intervenciones de enfermería; 4) estructuración del subconjunto terminológico con la Teoría del Déficit de Autocuidado; y 5) validación de contenido de enunciados construidos con enfermeros de un área programática de Rio de Janeiro.

Resultados:

el subconjunto desarrollado está compuesto por 81 diagnósticos/resultados y 583 intervenciones de enfermería, organizados en requisitos universales, de cambio y de desarrollo.

Conclusiones:

el subconjunto en pantalla estuvo compuesto predominantemente por declaraciones insertadas en los requisitos de autocuidado relacionados con cambios en la salud, lo que refuerza la importancia de la calidad de vida y la recuperación.

Descriptores:
Proceso de Enfermería; Terminología Normalizada de Enfermería; Diabetes Mellitus; Pie Diabético; Atención Primaria de Salud

Universal self-care requirements
Impaired Self Feeding (10000973); Positive Family Support (10045702); Impaired Capacity for Socialization; Impaired Cognition (10022321); Effective Social Support (10045794); Impaired Sexual Performance (10001288).
Self-care requirements related to health changes
Blister; Callus; Impaired Wound Healing; Altered Skin Color; Effective Pain Management; Absent Hair Growth; Pain (10023130); Peripheral Oedema (10027482); Impaired Balance (10047170); Rash (10016388); Fatigue (10000695); Weakness (10022880); Low Pedal Pulse Rate; Impaired Peripheral Neurovascular Function (10023153); Hematoma (10008931); Hyperglycaemia (10027550); Hyperthermia (10000757); Hypoglycaemia (10027566); Infection (10023032); Inflammation (10029927); Impaired Skin Integrity (10001290); Maceration (10011493); Impaired Gait (10001046); Impaired Metabolism; Dry Skin (10047073); Impaired Peripheral Tissue Perfusion (10044239); Altered Blood Pressure (10022954); Severe Plantar Pressure; Impaired Musculoskeletal System Process (10012773); Risk for Chills; Absent Pedial Pulse Rate Risk; Risk for Hyperthermia (10027328); Risk for Fall (10015122); Risk for Tachycardia; Ulcer Bleeding; Stress Overload (10021742); Overweight (10027300); Impaired Sleep (10027226); Impaired Diet Tolerance; Diabetic Ulcer (10042181); Impaired Vision (10022748).
Developmental self-care requirements
Impaired Acceptance of Health Status (10029480); Impaired Adaptation (10022027); Alcohol Abuse (10022234); Anxiety (10000477); Positive Care Attitude (10022275); Negative Self Image (10022724); Low Self Control (10027469); Impaired Community Capacity to Manage Regime (10000892); Ability to Perform Impaired Hygiene (10000987); Impaired Ability to Perform Leisure Activity (10040351); Impaired Ability to Participate in Care Planning (10035134); Aggressive Behavior; Impaired Communication (10023370); Risk Housing Condition; Impaired Health Knowledge; Lack of Knowledge of Diagnostic Test (10021987); Conflicting Cultural Belief (10022397); Conflicting Religious Belief (10021757); Self Care Deficit (10023410); Unrealistic Expectation about Treatment (10042357); Fear (10000703); Non Adherence to Exercise Regimen (10022657); Non Adherence to Therapeutic Regimen (10022155); High Care Need; Emotional Problem (10029839); Impaired Nail Care Regimen; Inadequate Income (10022563); Low Treatment Responsiveness; Risk for Self Destructive Behaviour (10015302); Risk for Negative Quality of Life (10040945); Risk for Suicide (10015356); Suffering (10025588); Tobacco Abuse (10022247); Increased Interdigital Humidity.

Nursing diagnosis/outcome	Nursing interventions
Self-care requirement related to health changes
Hypoglycemia	Fully Compensatory System: 1. Carry out glycemic test in consultations; 2. Assess patients’ knowledge about the therapeutic scheme of the drugs in use and the duration of action of each medication; Support System - Education: 3. Encourage patients to maintain glycemic control within normal standards; 4. Encourage self-monitoring of blood glucose levels; 5. Teach patients how to proceed in case of low blood glucose values; 6. Clarify symptoms of hypoglycemia and investigate individual symptoms; 7. Guide patients to seek a health unit in case of history of recurrent hypoglycemia to identify the causes and adjust the therapeutic regimen. 8. Guide patients to check capillary blood glucose before performing important daily tasks, if insulin dependent; 9. Warn patients about the importance of blood glucose monitoring before, during and after physical activity.
Overweight	Fully Compensatory System: 1. Monitor weight; 2. Interconsultation with a nutritionist; Partially Compensatory System: 3. Obtain data on food and fluid intake behavior; 4. Establish with patients a food plan suited to their lifestyle; Support System - Education: 5. Encourage food intake according to nutritional needs and food preferences, respecting the nutritionist’s prescription; 6. Clarify the negative consequences of excessive food intake to patients; 7. Guide patients to control weight; 8. Discuss with patients about the importance of adhering to healthy eating; 9. Teach patients how to select food away from home; 10. Assess the causes of impaired nutritional intake; 11. Assess the need to change eating habits; 12. Advise patients on the importance of maintaining the proper weight; 13. Clarify possible complications in case of overweight; 14. Assess possible anxiety disorder.
Developmental self-care requirement
Impaired Nail Care Regimen	Fully Compensatory System: 1. Prescribe nail care regimen; 2. Assess nail trimming; 3. Assess the presence of ingrown toenails; 4. Assess the need for correction of ingrown toenails; Support System - Education: 5. Instruct patients to cut the nails straight and not too close, preferably after bathing with round-tipped scissors; 6. Guide patients not to scratch the skin; 7. Instruct patients not to try to correct the ingrown toenails on their own.

Nursing diagnosis/outcome	Nursing interventions
Self-care requirement related to health changes
Blister	Fully Compensatory System: 1. Investigate the presence of blisters at every appointment; Support System - Education: 2. Guide the patients to self-examination in search of blisters; 3. Guide prevention of blisters; 4. Advise not to pop blisters.
Callus	Fully Compensatory System: 1. Investigate the presence of calluses at every appointment; 2. Assess the need for callus removal; 3. Forward to the occupational therapist to make suitable shoes; Support System - Education: 4. Encourage patients to perform self-examination in search of calluses; 5. Explain to patients not to use chemical agents or plasters to remove calluses; 6. Advise patients not to remove calluses.
Absent Hair Growth	Fully Compensatory System: 1. Observe hair distribution; 2. Correlate the absence of hair with other symptoms that indicate reduced blood perfusion; 3. Monitor hair loss or absence; Support System - Education: 4. Explain causes of reduced hairiness; 5. Stimulate adherence to treatment to improve blood perfusion.
Maceration	Fully Compensatory System: 1. Avoid excessive skin moisture, paying attention to the use of solutions and dressings only in the area of the lesion; 2. Do not perform debridement in the macerated area; 3. Pay attention to the removal of the adhesive tape when changing dressings so as not to increase the lesion; Support System - Education: 4. Guide patients and family regarding the correct performance of the dressing.
Altered Skin Color	Fully Compensatory System: 1. Investigate causes for altered skin color such as peripheral artery disease; Support System - Education: 2. Teach patients and family members in groups, consultations or home visits to monitor skin with signs of cyanosis, redness and shine.
Developmental self-care requirement
Increased Interdigital Wetness	Fully Compensatory System: 1. Perform inspection of patients’ feet at each appointment; 2. Investigate the presence of interdigital moisture; Support System - Education: 3. Guide the drying of the feet as well as the interdigital spaces after bathing; 4. Inform patients not to use moisturizer in the interdigital spaces.

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Halene Cristina Dias de Armada e Silva, E-mail: halenearmada@gmail.com