Juvé-Udina, Maria-Eulàlia; Fabrellas-Padrés, Núria; Adamuz-Tomás, Jordi; Cadenas-González, Sònia; Gonzalez-Samartino, Maribel; Cueva Ariza, Laura de la; Delgado-Hito, Pilar

doi:10.1590/S1980-220X2017004703286

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 51 • 2017 • https://doi.org/10.1590/S1980-220X2017004703286 copiar

Diagnósticos de enfermagem de vigilância, avaliação contínua e resultados em pacientes que sofreram uma parada cardiorrespiratória

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo

Determinar a frequência de registro eletrônico de diagnósticos e intervenções de vigilância no plano de cuidados para pacientes que sofreram uma parada cardíaca durante a admissão e avaliar se existem diferenças com base no perfil do paciente, medidas de monitoramento e resultados.

Método

Estudo descritivo, observacional, retrospectivo, transversal, que incluiu dados dos registros eletrônicos de pacientes internados em uma das 107 unidades de oito hospitais de cuidados agudos. Para análise dos dados foram utilizados estatísticos descritivos. Os valores de p foram relatados em dois ramos.

Resultados

Foram obtidos dados de 492 documentos de enfermagem de pacientes que sofreram uma parada cardíaca. Quase 60% dos prontuários eletrônicos incluídos na análise continham um ou mais diagnósticos de vigilância. Diferenças significativas foram encontradas entre os pacientes com e sem registro desses diagnósticos, no que se refere à frequência das medições dos sinais vitais e aos resultados finais.

Conclusão

Os diagnósticos de vigilância podem desempenhar um papel importante na prevenção de deterioração aguda em pacientes adultos hospitalizados.

Diagnósticos de Enfermagem; Parada Cardíaca; Terminologia Padronizada em Enfermagem; Vigilância; Sinais Vitais

Nursing diagnosis

Nursing Intervention

A nursing diagnosis is a clinical judgment – or the conclusion of several judgments – on the health status of an individual (or group), and the actual or potential consequences and reactions within the different dimensions of the individual and their integrality, in the context of their environment and particular Experience, and within the scope of professional nursing accountability, including shared responsibility with the care beneficiaries and with other healthcare providers ⁽¹⁶16. Juvé-Udina ME. ATIC: eje diagnóstico. Barcelona: Naaxpot SLU; 2016.^-¹⁷17. Juvé-Udina ME. What patients’ problems do nurses e-chart? Longitudinal study to evaluate the usability of an interface terminology. Int J Nurs Stud. 2013;50(12):1698-710.⁾ .

A nursing intervention is a prescription of nursing care that derives from the diagnosis of a patient’s problem or response and reflects nursing management for its prevention, solving or palliation. Nursing interventions do not include the description of procedures, rather they are care prescription statements that may be detailed by adding activities or specifications aimed at clarifying or informing remarkable aspects of that intervention to assure patient safety, quality or continuity of care, or to respond to regulations, legal, ethical or cost-efficiency requirements ⁽¹⁸18. Juvé-Udina ME, Zuriguel-Perez E, Fabrellas-Padres N, Gonzalez-Samartino M, Castellà-Creus, Romero-García M, et al. Basic nursing care: retrospective evaluation of communication and psychosocial interventions documented by nurses in the acute care setting. J Nurs Scholarsh. 2014;46(1):65-72.⁾ .

Surveillance-oriented nursing diagnoses	N	%
Risk of arrhythmia	56	21.4
Risk of acute pulmonary edema	33	12.6
Risk of atelectasis	33	12.6
Risk of sepsis	33	12.6
Risk of arrhythmia progression/recurrence	25	9.5
Risk of ischemia/hemorrhage progression/recurrence	25	9.5
Risk of pulmonary aspiration	21	8.0
Risk of hemorrhage progression/recurrence	21	8.0
Risk of hypovolemia	20	7.6
Risk of ischemia progression/recurrence	17	6.5
Risk of increased intracranial pressure	17	6.5
Risk of vasospasm	13	4.9
Risk of hypovolemic shock	10	3.8
Risk of respiratory failure progression/recurrence	9	3.4
Risk of respiratory failure	7	2.6
Risk of hemorrhage	5	1.9
Risk of ischemia/hemorrhage	5	1.9
Risk of septic shock	5	1.9
Risk of systemic inflammatory response syndrome	5	1.9
Risk of airway obstruction	4	1.5
Risk of cardiogenic shock	4	1.5
Risk of hyper/hypovolemia	4	1.5

SOND Group	No SOND Group

Variable	Mean	SD	Mean	SD	p-value
Age	73.01	(13.7)	78.18	(12.3)	0.001
AACI	6.83	(2.3)	7.01	(2.15)	0.540

	N	%	N	%	p-value

Male Gender	143	54.8	93	49.4	0.504
Previous ICU stay	54	21.0	28	11.4	0.074
Conditions for admission Cardiovascular	85	32.5	23	12.1	<0.001
Respiratory	30	11.5	29	15.3	0.428
Neurologic	48	18.3	7	3.7	<0.001
Trauma	13	4.9	41	21.6	<0.001
Digestive	19	7.2	19	10.0	0.483
Infectious	17	6.5	20	10.5	0.341
Hematology	21	8.0	11	5.8	0.619
Oncology	10	3.8	17	8.9	0.178
Nephrourinary	10	3.8	15	7.9	0.158
Metabolic	8	3.0	6	3.1	0.959
Other	0	0.0	1	0.5	0.419

Outcome	N	%	N	%	p-value

Death	154	59.0	163	86.2	<0.001
Transferred to ICU	58	22.2	11	5.8	0.001
Continuity of care at floor	49	18.7	15	7.9	0.035

SOND Group	No SOND Group				p-value

Variable	Mean	SD	Mean	SD
Mental status	259	99.2	187	99.0	0.816
Heart rate	261	100	189	100	1.000
Blood pressure	261	100	189	100	1.000
Respiratory rate	112	42.9	9	4.71	<0.001
SpaO₂	243	93.2	159	84.2	0.047
Temperature	259	99.2	189	100	0.395
Capillary glycaemia	142	54.7	88	46.5	0.284
Urine output	218	83.5	124	65.6	0.003
Micturition	251	96.2	169	89.5	0.058

Frequency of measurements
Every 12 hours or more	6	2.2	91	48.0	<0.001
Every 9-10 hours	2	0.7	23	12.1	<0.001
Every 7-8 hours	57	21.8	45	23.9	0.842
Every 5-6 hours	88	33.7	25	13.3	0.001
Every 3-4 hours	75	28.7	5	2.5	<0.001
Every 1-2 hours	33	12.6	0	0.0	<0.001

SOND Group	No SOND Group

	N	%	N	%	p
Frequency of ABPP measurements
Exceeding 6 hours	65	24.9	159	84.2	<0.001
Less than 6 hours	196	75.1	30	15.6	<0.001

Outcome
Deceased	154	59.0	163	86.2	<0.001
Transferred to ICU	58	22.2	11	5.8	0.001
Continuity of care at floor	49	18.7	15	7.9	0.035

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Maria-Eulàlia Juvé Udina, Universitat de Barcelona, IDIBELL Institute of Research, Campus de Bellvitge, Escola Universitària d’Infermeria, Departament d’Infermeria Fonamental i Medicoquirúrgica, Feixa Llarga s/n, 08907 Hospitalet de Llobregat, Barcelona, Spain. ejuve@ub.edu