Diagnósticos de enfermería en adultos y ancianos en el preoperatorio: estudio comparativo

Monteiro, Luana Barbosa dos Santos; Souza, Priscilla Alfradique de; Almeida, Priscila Francisca; Bitencourt, Graziele Ribeiro; Fassarella, Cintia Silva

doi:10.1590/0034-7167-2017-0959

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 72 (suppl 2) • Nov 2019 • https://doi.org/10.1590/0034-7167-2017-0959 copiar

Diagnósticos de enfermería en adultos y ancianos en el preoperatorio: estudio comparativo

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

analizar los diagnósticos de enfermería de la taxonomía NANDA-I en adultos y ancianos hospitalizados en el preoperatorio de cirugía general y proctología.

Método:

estudio transversal exploratorio, abordaje cuantitativo, desarrollado en la sala de cirugía general entre marzo y agosto de 2017. Realizado análisis estadística inferencial con la prueba de Chi-cuadrado y Fisher, considerando valor de p <0,05 con intervalo de confianza 95%.

Resultados:

De 51 participantes, 32 (62,7%) fueron adultos y 19 (37,3%) ancianos. En adultos predominó: ansiedad (81,3%), miedo (50%), riesgo de infección (43,8%) y riesgo de retraso de la recuperación quirúrgica (37,5%). En los ancianos: ansiedad (68,4%), riesgo de infección (63,2%), incomodidad (57,9%) y riesgo de retraso en la recuperación quirúrgica (52,6%). Tuvieron significancia estadística los diagnósticos de ansiedad (p=0.028) en adultos, deterioro de la dentición (p=0.001) y incomodidad en ancianos (p=0.008).

Conclusión:

se evidenciaron especificidades del cuidado en el prequirúrgico raramente identificadas, relacionadas principalmente con el riesgo de infección y el riesgo de retraso en la recuperación quirúrgica.

Descriptores:
Enfermería Perioperatoria; Diagnóstico de Enfermería; Proceso de Enfermería; Cirugía General; Cirugía Colorrectal

Domain	Evaluation
Health Promotion	Did you get any information about the surgical procedure? Y ( ) N ( ) Did you sign the Informed Consent Form? Y ( ) N ( ) Do you have surgical risk in medical records? Y ( ) N ( )
Nutrition	Weight: _____ Height: ____ BMI:_____ Do you wear dental prostheses? Y ( ) N( ) Do you have any difficulty eating? Y ( ) N ( ) Which ones? ______ Are you oriented towards the maintenance of perioperative fast? Y ( ) N ( )
Elimination and exchange	Breathing:____________ Sudoresis: Normal ( ) Altered ( ) Diuresis: Spontaneous ( ) Diapers ( ) Bedpans or urinal ( ) Nefrostomy ( ) Urinary Catheter: Aspect: __________ Smell: ______ Urinary alterations: __________. Evacuations: Normal ( ) Altered ( ) Absent for ___ days ( ) Device Use: Characteristics: ( ) Consistent ( ) Pasty ( ) Semi-liquid ( ) Liquid ( ) Mucus ( ) Enterorrhagia ( ) Others: ____________ Vomit: Y ( ) N ( )____ X/days Nausea: Y ( ) N ( ) Characteristics: ( ) Food ( ) Mucous ( ) Bilious ( ) Fecaloid ( ) Hemorrhagic
Activity and rest	Walking: Normal ( ) With restrictions ( ) Which ones? ___________________ Immobility: Y ( ) N( ) Why?_________________________ Sleep pattern: Good ( ) Regular ( ) Absent ( ) Number of hours in 24 hours: _
Perception and cognition	Orientation level: Oriented ( ) Desoriented ( ) Confused ( ) Unconscious ( ) Altered memory ( ) Behavior: High anxiety ( ) Ansiety ( ) Agitated ( ) Calm ( ) Apathetic ( ) Interested ( ) Hearing: Normal ( ) Decreased ( ) Absent ( ) Orthosis ( ) Vision: Normal ( ) Absent ( ) Decreased ( ) Obs.:______________________ Comunication: Normal Talk ( ) Refusal to talk ( ) Dysphasia ( ) Aphasia ( )
Self-perception	Has/expresses negative feelings? Y ( ) N ( ) Which ones?______________ Feeling about the surgical procedure _______________
Role relationship	Present/refer to changes in relationships? Y ( ) N ( ) Which ones?_______
Sexuality	Any alteration? Y ( ) N ( ) Which one?_______________________________
Coping and stress tolerance	Any recent changes? Y ( ) N ( ) If the answer is Yes, which one? ________________ Anxiety: because of ______________ Fear: because of ___________ Living under stress? Y ( ) N ( ) If the answer is Yes, which one? ____________________ Do you plan your daily activities? Y ( ) N ( ) If not, why not? ____________
Safety and protection	Alteration in skin integrity: Intact skin ( ) Intact mucosa ( ) Edema: Y ( ) N ( ) Open Lesion: Erythema ( ) Pressure Ulcer ( ) Pustules: Y ( ) N ( ) Hygiene: Adequate ( ) Satisfactory ( ) Regular ( ) Poor ( ) Note: _________ Invasive equipment? Y ( ) N ( ) Note: _______________________ Presence of Stoma: Y ( ) N ( ) Body part and aspect________________________ Comorbidities: Y ( ) N ( ) Which ones? _________________________________ Daily use medication: __________________ Did you bring the medication to the nursery? Which ones? _________________ Allergy: _______________ Ethylism: Y ( ) N ( ) Ex-Ethylist: Y ( ) N ( ) Time not using:______ Smoker: Y ( ) N ( ) Ex-smoker: Y ( ) N ( ) Time not using:______ Illicit drug use: Y ( ) N ( ) Which ones?________________ Time not using:_______ Precaution: S ( ) N ( ) Contact( ) Air ( ) Droplet ( ) Reason:______
Comfort	Displays some discomfort: Y ( ) N ( ) Type:________________________ Pain: Y ( ) N ( ) Numerical pain intensity scale (1 to 10): _____ Body part: ______

Sociodemographic data	Adults n (%)	Elderlies n (%)	p value test χ²
Sex			0.055
Female	19 (59.4)	6 (31.6)
Male	13 (40.6)	13 (68.4)
Age			0.013^* * p-value ≤ 0.05.
20 - 39	8 (25)	-
40 - 49	7 (21.9)	-
50 - 59	17 (53.1)	-
60 - 69	-	11 (57.9)
70 - 79	-	7 (36.8)
80 - 89	-	1 (5.3)
Education Level			0.001^* * p-value ≤ 0.05.
Did not finish elementary school	6 (18.8)	11 (57.9)
Primary school	2 (6.2)	7 (36.8)
Did not finish high school	4 (12.5)	-
High school	14 (43.8)	1 (5.3)
Did not finish college	1 (3.1)	-
College	4 (12.5)	-
Postgraduation	1 (3.1)	-
Occupation			0.001^* * p-value ≤ 0.05.
Retired	5 (15.6)	14 (73.7)
Unemployed	2 (6.2)	-
Formal Work	14 (43.8)	4 (21.1)
Informal Work	10 (31.2)	-
Domestic work	1 (3.1)	1 (5.3)

Domains	Titles of nursing diagnoses	Adults n (%)	Elderlies n (%)	p value test χ²
Nutrition	Overweight	9 (28.1)	4 (21.1)	0,038^F F Exact Fisher Test.
	Obesity	8 (25)	2 (10.5)	0,022^F F Exact Fisher Test.
Activity/Rest	Disturbed sleep pattern	12 (37.5)	5 (26.3)	0,038^F F Exact Fisher Test.
Coping / Stress Tolerance	Anxiety	26 (81.3)	13 (68.4)	0,028
	Fear	16 (50)	7 (36.8)	0,029
	Relocation Stress Syndrome	12 (37.5)	4 (21.1)	0,026^F F Exact Fisher Test.
	Stress overload	8 (25)	1 (5.3)	0,006^F F Exact Fisher Test.
Safety and protection	Risk for infection	14 (43.8)	12 (63.2)	0,016
	Risk for delayed surgical recovery	12 (37.5)	10 (52.6)	0,016
	Impaired Skin Integrity	9 (28.1)	6 (31.6)	0,041^F F Exact Fisher Test.
	Risk for allergic reaction	8 (25)	3 (15.8)	0,024^F F Exact Fisher Test.
	Risk for perioperative positioning injury	8 (25)	2 (10.5)	0,022^F F Exact Fisher Test.
	Impaired dentition	2 (6.3)	7 (36.8)	0,001^F F Exact Fisher Test.
Comfort	Impaired comfort	11 (34.4)	11 (57.9)	0,008
	Acute pain	9 (28.1)	5 (26.3)	0,035^F F Exact Fisher Test.
Total	15	164	92

Nursing diagnosis	Defining characteristics	Adults	Elderlies
Nursing diagnosis	Defining characteristics	n (%)	n (%)
Overweight	BMI > 25kg/m2	9 (28.1)	4 (21.1)
Obesity	BMI > 30 kg/m2	8 (25)	2 (10.5)
Disturbed sleep pattern	Dissatisfaction with sleep	10 (31.3)	4 (21.1)
	Alteration in sleep pattern	7 (21.9)	3 (15.8)
Anxiety	Restlessness	8 (25)	2 (10.5)
	Apprehensiveness	7 (21.9)	1 (5.3)
	Fear	5 (15.7)	1 (5.3)
	Preoccupation	16 (50)	9 (47.4)
	Worried about change in life event	17 (53.1)	8 (42.1)
	Anguish	5 (15.7)	1 (5.3)
	Alteration in sleep pattern	5 (15.7)	2 (10.5)
Fear	Apprehensiveness	8 (25)	2 (10.5)
	Feeling of fear	9 (28.1)	3 (15.8)
	Feeling of dread	8 (25)	4 (21.1)
Stress overload	Stress	6 (18.8)	1 (5.3)
Relocation stress syndrome	Anxiety	9 (28.1)	2 (10.5)
	Alteration in sleep pattern	5 (15.7)	2 (10.5)
	Concern about relocation	6 (18.8)	2 (10.5)
	Preoccupation	6 (18.8)	2 (10.5)
Impaired skin integrity	Alteration in skin integrity	5 (15.7)	4 (21.1)
Impaired skin integrity	Foreign matter piercing skin	7 (21.9)	4 (21.1)
Impaired dentition	Absence of teeth	2 (6.3)	7 (36.8)
Impaired comfort	Feeling of discomfort	10 (31.3)	10 (52.6)
Acute pain	Self-report of intensity using standardized pain scale	9 (28.1)	5 (26.3)
Total	24	187	85

Nursing diagnosis	Related factor	Adults n (%)	Elderlies n (%)
Anxiety	Threat to current status	8 (25)	3 (15.8)
	Important change in health condition	20 (62.5)	11 (57.9)
	Situational crisis	14 (43.8)	6 (31.6)
Fear	Learned response	10 (31.3)	6 (31.6)
Risk for delayed surgical recovery	Obesity	6 (18.8)	2 (10.5)
Risk for delayed surgical recovery	Pharmaceutical Agent	2 (6.3)	4 (21.1)
Risk for infection	Chronic illness	8 (25)	9 (47.4)
	Alteration in skin integrity	5 (15.7)	5 (26.3)
Impaired comfort	Illness-related symptoms	11 (34.4)	8 (42.1)
	Treatment regimen	4 (12.5)	5 (26.3)
Total	10	88	59

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[1] Corresponding Author: Luana Barbosa dos Santos Monteiro E-mail: luana.bds.enf@gmail.com