Nursing diagnoses in chronic renal failure patients on hemodialysis

Abstract

Objective: To identify the most frequent nursing diagnoses in chronic renal failure patients on hemodialysis. Methods: A cross-sectional study including 178 patients, selected by convenience sample, consecutively recruited. For data collection, interview guides and physical examination were used. An individual process of clinical judgment for the nursing diagnoses was performed and, for better accuracy, the results obtained underwent a process of paired review among the authors. Results: Twenty-four nursing diagnoses were identified, of which the most frequent were: risk for infection (100%); excessive fluid volume (99.4%); and, hypothermia (61.8%). Conclusion: The most frequent diagnoses identified were included in the safety / protection and nutrition domains of NANDA-I. ResumoObjetivo: identificar os diagnósticos de enfermagem mais frequentes em pacientes renais crônicos em hemodiálise. Métodos: Estudo transversal com a inclusão de 178 pacientes, selecionados por amostragem de conveniência do tipo consecutiva. Para a coleta foram utilizados roteiros de entrevista e exame físico. Foi realizado um processo individual de julgamento clínico dos diagnósticos de enfermagem e os resultados obtidos passaram por processo de revisão de forma pareada entre os autores, para maior acurácia. Resultados: Identificaram-se 24 diagnósticos de enfermagem, sendo os mais frequentes: risco de infecção (100%); volume de líquidos excessivo (99,4%); e hipotermia (61,8%). Conclusão: Os diagnósticos mais frequentes identificados estão inseridos nos domínios segurança/proteção e nutrição.

Enfermeiros atuantes em hemodiálise indicam diagnósticos de enfermagem relevantes na prática clínica

“…(1)(2)(3)8,12) This risk is associated with immunosuppression, venous access for prolonged periods, a high amount of invasive procedures, transmission of infectious agents through different routes, and multiple hospital stays. (13) Arteriovenous fistula puncture infection is common, with Staphylococcus aureus representing the most frequent etiological agent.…”

“…(17) Risk for shock was also considered relevant, in agreement with the findings of studies that identified this diagnosis with a prevalence of 100%. (9) Risk for falls has also been reported, (1,2) which can be caused by the hemodynamic oscillations that occur during hemodialysis. (13,14) Risk for allergy response was a highly valued diagnosis (RI=0.80).…”

“…(8,12) In the Nutrition domain, the five diagnoses considered most relevant (RI≥ 0.80) to clinical practice have been identified in the context of hemodialysis, with an occurrence of >80%. (1,10) Fluid volume alterations in hemodialysis patients develop due to fluid overload and edema and electrolytic alterations such as hyperkalemia. (13) Excess fluid is associated with cardiovascular mortions, guide the action of nursing managers in these services to plan appropriate staff size, and to elaborate strategies to assess the quality of the care provided.…”

“…(18) In the Activity and Rest domain, risk for ineffective renal perfusion and decreased cardiac tissue perfusion were considered relevant. In the literature, the prevalence of risk for ineffective renal perfusion is 100%; (1,12) however, there is no mention of decreased cardiac tissue perfusion. Hypotension is common during hemodialysis, caused by the removal of fluid from the intravascular space via the ultrafiltration mechanism.…”

“…In Brazil, most studies on the topic are based on the clinical assessment of researchers. (1,2) An experience report produced in Portugal identified nursing diagnoses, interventions and outcomes based on the assessment of nurses who worked in a hemodialysis service. (3) There is yet no broader study involving nurses from different institutions.…”