Diagnostic accuracy of the defining characteristics of the excessive fluid volume diagnosis in hemodialysis patients

Abstract

Objective: to evaluate the accuracy of the defining characteristics of the excess fluid volume nursing diagnosis of NANDA International, in patients undergoing hemodialysis. Method: this was a study of diagnostic accuracy, with a cross-sectional design, performed in two stages. The first, involving 100 patients from a dialysis clinic and a university hospital in northeastern Brazil, investigated the presence and absence of the defining characteristics of excess fluid volume. In the second step, these characteristics were evaluated by diagnostic nurses, who judged the presence or absence of the diagnosis. To analyze the measures of accuracy, sensitivity, specificity, and positive and negative predictive values were calculated. Approval was given by the Research Ethics Committee under authorization No. 148.428. Results: the most sensitive indicator was edema and most specific were pulmonary congestion, adventitious breath sounds and restlessness. Conclusion: the more accurate defining characteristics, considered valid for the diagnostic inference of excess fluid volume in patients undergoing hemodialysis were edema, pulmonary congestion, adventitious breath sounds and restlessness. Thus, in the presence of these, the nurse may safely assume the presence of the diagnosis studied.

Acurácia dos diagnósticos de enfermagem de uma instituição de cardiologia

“…Instruments that allow the measurement of the diagnostic accuracy make it possible to differentiate the presence or absence of a particular nursing diagnosis, making the diagnosis. [6][7] An instrument was developed by an American researcher to estimate the diagnostic accuracy of nurses. When applied in Brazil, the results were not similar, but served as the basis for the creation of an instrument by Brazilian researchers.…”

“…Studies indicate that nurses participating in these programs, such as training on diagnostic accuracy and Nursing Care Systematization, presented better diagnostic accuracy results. 3,[5][6] Strategies of discussion of clinical case in group and presentations in the clinical scenario are proposed as ideal formats for individual and collaborative learning, as they stimulate the development of skills for clinical reasoning, axis of the Nursing process. The effective participation of nurses awakens in the professionals the development of clinical competences observed in the discussions of clinical cases with a higher accuracy in the elaboration of Nursing diagnoses, putting into practice what has just been learned in the individual discussions and in group also making it possible to use this strategy as a humanization action.…”

Conceptual definition of the Excessive Liquid Volume Nursing Diagnosis (00026)

“…For some, the prevalence of these indicators for patients with excessive fluid volume is shown (00026). 6,7,57,58 In one study, the most frequent NDs in chronic renal patients undergoing hemodialysis were identified and this diagnostic concept was present in 100% of the 28 selected patients. 6 In addition to the prevalence of ND, it is relevant to understand which clinical indicators have been validated in specific populations.…”

“…It was concluded that the most sensitive indicator was edema and the most specific indicators were pulmonary congestion, adventitious respiratory noise and agitation. 58 In a research conducted with 98 hospitalized adult patients undergoing hemodialysis, the presence of the DCs from the nursing consultation and physical examination, as well as from the evaluation of laboratory tests, was investigated. The determinant indicators in this analysis are known to be decreased hemoglobin and hematocrit, present in 97% of the sample, followed by electrolyte imbalance, in 62%; oliguria in 67% of patients; adventitious breathing noises, in 59%; edema and ingestion greater than elimination, in 52%, respectively.…”

“…These are abnormal sounds originating from the collision of air with tracheobronchial secretions; in this case, due to excess pulmonary fluid present in the respiratory tract. 37 These DC are known to be justified by another indicator present in this population, edema, considered in some studies as sensitive to the occurrence of excess fluid; 58,60 This is the most common cause of hospitalization of these patients, in addition to being directly associated with the indicators higher ingestion than debt, short-term weight gain and jugular distension caused by systemic congestion established in CKD. 21 This systemic congestion can interfere with the return of blood to the heart and cause numerous problems, such as respiratory distress, tachypnea, increased heart rate, fatigue and change in level of consciousness.…”