This study analyzed the accuracy of clinical indicators of ineffective health management in hemodialysis patients. A diagnostic accuracy study was performed in 200 chronic kidney disease patients undergoing hemodialysis during the first half of 2015. Measures of sensitivity and specificity were calculated using latent class analysis. Ineffective health management was present in 66.28% of patients. Accurate clinical indicators included expressed nonadherence to treatment, daily life choices ineffective to achieve health goals, expression of difficulty with prescribed regimens, inappropriate use of medicines, lack of expression of willingness to control the disease, irregular attendance of dialysis sessions, and infection. Hemodialysis may trigger a set of clinical indicators that predict the presence of ineffective health management. This knowledge provides evidence to clinical practices for hemodialysis patients and contributes to the best clinical performance of nurse practitioners.
Objective: To analyze the content of the diagnostic proposition risk of excessive fluid volume in patients undergoing hemodialysis. Method: Content validity study, with 48 judges who assessed the content of the diagnostic proposition risk of excessive fluid volume, using an electronic data collection instrument. The judges’ answers were analyzed through the calculation of the Content Validity Index and the T test. Results: The risk of excessive fluid volume was considered adequate, containing 23 risk factors: increased sodium concentration in the dialysate; missing hemodialysis sessions; insufficient water; low self-efficacy for fluid restriction; deficient knowledge; altered body mass index; excessive intake of fluids, proteins and sodium; lower kt/v index; inadequate removal of fluids in hemodialysis; thirst; xerostomia; older people; comorbidities; renal function decline; decreased urinary volume; inflammatory status; hospitalization; low serum level of albumin and lymphocytes, and high level of phosphorus; and use of antihypertensive drugs. Conclusion: The content of the diagnostic proposition risk of excessive fluid volume was considered adequate by the judges.
A new proposal was developed for the diagnosis under study after the analysis of experts.
RESUMO Objetivo construir uma teoria de médio alcance para o desenvolvimento da proposição diagnóstica risco de volume de líquidos excessivo em pacientes em hemodiálise. Método trata-se de um estudo metodológico, desenvolvido para a validade teórico-causal de um diagnóstico de enfermagem. O estudo foi realizado em quatro etapas: seleção dos estudos, identificação dos conceitos principais da teoria, construção do pictograma e elaboração das proposições. Essas etapas foram operacionalizadas por meio de uma revisão integrativa da literatura, com uma amostra de 82 artigos selecionados nas bases de dados Web of Science, PubMed, CINAHL, Scopus e Science Direct. Resultados os dados extraídos dos artigos da amostra possibilitaram a identificação de cinco termos essenciais para a definição do risco de volume de líquidos excessivo. Além disso, foram identificados 31 fatores etiológicos do risco de volume de líquidos excessivo, além de construídos um pictograma e 12 proposições. Conclusão e implicações para a prática a construção de uma teoria de médio alcance voltada para o risco de volume de líquidos excessivo em pacientes em hemodiálise refina as terminologias e amplia a compreensão dos fenômenos da enfermagem. Assim, os dados desta pesquisa fornecerão conhecimentos claros e robustos para a condução das ações do enfermeiro na prática clínica.
Objectives: to analyze the accuracy of the clinical indicators of ineffective airway clearance in adult intensive care unit patients. Methods: diagnostic accuracy study, performed in the intensive care unit of a university hospital in northeastern Brazil. The sample consisted of 104 patients hospitalized between June and October 2019. Results: the prevalence of ineffective airway clearance was 36.54%. The indicators with high specificity included absence of cough (0.8326), orthopnea (0.6817), adventitious breath sounds (0.8175), and diminished breath sounds (0.8326). The clinical indicators with high sensitivity and specificity were alteration in respiratory rate (0.9999) and alteration in respiratory pattern (0.9999). Conclusions: six clinical indicators provided an accurate identification of ineffective airway clearance. The clinical indicators alteration in respiratory rate and alteration in respiratory pattern were the most accurate for critical adult patients. The findings of this study contribute to accurate diagnostic inferences and to prevention of respiratory complications in these patients.
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