Diagnósticos de enfermagem respiratórios para crianças com infecção respiratória aguda

Abstract

Objectives: To identify the prevalence of nursing diagnoses: ineffective breathing pattern (IBP) (00032), ineffective airway clearance (IAC) (00031), impaired gas exchange (IGE) (00030) and impaired spontaneous ventilation (ISP) (00033), their defining characteristics and related factors, in children with acute respiratory infection. Methods: A quantitative, transversal approach with 151 children. Data were collected by means of interviews and pulmonary evaluation. For data analysis, we used descriptive and inferential statistics. Results: The most prevalent diagnosis was IBP. Adventitious breath sounds and ineffective cough were the most prevalent defining characteristics. Adventitious breath sounds increased by 80% the chance for IAC. Among the related factors, the highlights were: secretions in the bronchi and retained secretions. Secretions in the bronchi favored in 80% the occurrence of IBP and in 60% of IAC. This verified a statistically significant association between the defining characteristics and related factors of the diagnoses studied. Conclusion: The four diagnoses were identified in children with acute respiratory infections, with different prevalences. Keywords: Respiratory tract infections/diagnosis; Child; Nursing diagnosis RESUMO Objetivos: Identificar a prevalência dos diagnósticos de enfermagem: Padrão respiratório ineficaz (PRI), Desobstrução ineficaz de vias aéreas (DIVA), Troca de gases prejudicada (TGP) e Ventilação espontânea prejudicada (VEP) suas características definidoras e fatores relacionados, em crianças com infecção respiratória aguda. Métodos: Estudo de abordagem quantitativa, transversal, com 151 crianças. Os dados foram coletados por meio de entrevista e de avaliação pulmonar. Para análise dos dados, foi utilizada a estatística descritiva e inferencial. Resultados: O diagnóstico mais prevalente foi PRI. Ruídos adventícios respiratórios e tosse ineficaz foram às características definidoras mais prevalentes. Ruídos adventícios respiratórios aumentam em 80% a chance para DIVA. Entre os fatores relacionados, destacaram-se: secreções nos brônquios e secreções retidas. Secreções nos brônquios favorecem em 80% a ocorrência de PRI e em 60% de DIVA. Verificou-se associação estatisticamente significante entre as características e fatores relacionados com os diagnósticos estudados. Conclusão: Os quatro diagnósticos foram identificados em crianças com infecções respiratórias agudas, apresentando prevalências distintas. Descritores: Infecções respiratórias/diagnóstico; Criança; Diagnóstico de enfermagem RESUMEN Objetivos: Identificar la prevalencia de los diagnósticos de enfermería: Patrón respiratorio ineficaz (PRI), Desobstrucción ineficaz de vías aéreas (DIVA), Intercambio de gases perjudicada (IGP) y Ventilación espontánea perjudicada (VEP) sus características definidoras y factores relacionados, en niños con infección respiratoria aguda. Métodos: Estudio de abordaje cuantitativo, transversal, realizado con 151 niños. Los datos fueron recolectados por medio de entrevista y de ...

Clinical Differentiation of Respiratory Nursing Diagnoses among Children with Acute Respiratory Infection

“…Another important relationship with IGE is the presence of hypercapnia, which exerts a stimulus on the adrenal medulla, increasing the secretion of catecholamines, epinephrine and norepinephrine, accelerating cell metabolism and the production of heat, and triggering diaphoresis (Guyton & Hall, 2011). Previous studies have demonstrated a high specificity of these three defining characteristics for the identification of IGE (Andrade et al, 2012;. In addition, a systematic review included three studies about the accuracy of defining characteristics for IGE and found statistically significant summary measures for restlessness and irritability, confirming the importance of these characteristics to diagnose changes in gas exchange processes (Sousa, Lopes, & Silva, 2014).…”

“…Although this fact may partially explain the trend of these indicators to group together in one dimension and delimit its ability to discriminate this diagnosis from others, previous studies have shown that the characteristics of difficulty verbalizing, excessive sputum, and absence of cough exhibit high specificity for IAC, while the presence of adventitious breath sounds demonstrates high sensitivity for this nursing diagnosis among children with respiratory problems (Andrade et al, 2012;Mendes, Cavalcante, Lopes, & Lima, 2012;Silveira et al, 2008). In addition, a recent systematic review of the diagnostic accuracy measures of the defining characteristics of IAC corroborated the findings of this study, showing that adventitious breath sounds and difficulty verbalizing presented statistical significance in the summary measures obtained from a meta-analysis that included five studies developed with children .…”

“…Abnormal breathing pattern is a characteristic recently added to IBP in the NANDA-I terminology; this diagnosis includes changes in the breathing frequency, rate and respiratory depth. Although its scope might hinder comparisons, previous studies show that clinical signs related to an abnormal breathing pattern are often found in children diagnosed with IBP and among children with asthma and (Andrade et al, 2012;Cavalcante, Mendes, Lopes, & Lima, 2010). Dyspnea is a defining feature that has been associated with early stages of IBP among children with different cardiac and respiratory conditions.…”

“…Dyspnea is a defining feature that has been associated with early stages of IBP among children with different cardiac and respiratory conditions. Previous studies have shown that dyspnea has high sensitivity in correctly identifying children with isolated ventilatory changes or in conjunction with other nursing diagnoses (Andrade et al, 2012;Beltrão et al, 2015;Cavalcante et al, 2010;Silveira, Lima, & Lopes, 2008). On the other hand, the defining characteristics "use of accessory muscles to breathe" and "orthopnea" have been associated with IBP as confirmatory diagnostic characteristics because they have low sensitivity and high specificity values between children with asthma and acute respiratory infections (Andrade et al, 2012;Cavalcante et al, 2010).…”

“…However, the isolated prevalence of each diagnosis reached 91.9% for IAC, 64% for IBP, and 42.6% for IGE. Another study that also evaluated children with ARI found a relatively high prevalence of IBP (59.6%), IAC, (37.7%), and IGE (27.2%), but it did not describe the percentage of children who presented concomitantly with the three diagnoses (Andrade, Chaves, Silva, Beltrão, & Lopes, 2012). ARI corresponded to the most common group of respiratory diseases of childhood (Silva, Paiva, Silva, & Nascimento, 2012) and caused changes that negatively impacted the respiratory system.…”