Perfil de diagnósticos de enfermagem antes de iniciar o tratamento hemodialítico

Abstract

Tratou-se de um estudo inter-relacional retrospectivo,o qual teve como objetivo descrever o perfil dos diagnósticos de enfermagem de 31 pacientes em início de tratamento hemodialítico em uma clínica de hemodiálise na Zona Sul de São Paulo. A pesquisa foi realizada a partir de prontuários. Os dados utilizados incluíram: identificação do paciente, doença de base, dados do exame físico, anotações e evoluções multiprofissionais. Os diagnósticos de enfermagem mais prevalentes incluíram: perfusão tissular renal ineficaz (100,0%), risco para infecção (100,0%), proteção ineficaz (80,6%) e controle ineficaz do regime terapêutico (54,8%). Concluiu-se que a identificação do perfil de diagnósticos destes pacientes é essencial para o planejamento da assistência de enfermagem após o início do programa de hemodiálise.

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.…”

“…Although it is well known and well described, risk for anaphylactic response (14) does not seem to be recognized as an allergy response and therefore, it has not been considered in studies that identify diagnostic profiles. (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.…”

“…(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.…”

“…(13) The rapid removal of fluid can lead to intradialytic hypotension, which occurs in 25% to 50% of patients. (20) Chronic and acute pain are common among hemodialysis patients, (2,12,13) with emphasis to bone pain, (13) abdominal pain, (21) pain during the hemodialysis access puncture, (22) osteoarthritis, uremic arteriolopathy and peripheral neuropathy. (23) The intensity of pain and discomfort among patients are important, interfering with quality of sleep and daily living.…”

“…(24) Nausea, rated as a relevant diagnosis by the nurses, has been documented in hemodialysis patients. (12) Although it is multifactorial, this symptom is generally related to arterial hypotension and balance syndrome. (13) Diagnoses related to risk-prone health behavior and ineffective family therapeutic regimen management were considered relevant; however, no studies were found about their occurrence among hemodialysis patients.…”