Clinical indicators, nursing diagnoses, and mortality risk in critically ill patients with COVID-19: a retrospective cohort

Abstract

Objective: To identify clinical indicators and nursing diagnoses with the highest risk of mortality in critically ill patients with COVID-19. Method: Retrospective cohort with the population of adults and elderly people with COVID-19 from an Intensive Care Unit. Categorical variables were described using absolute and relative frequencies and risk factors for mortality using Cox regression, with a confidence interval of 95%. Results: The main clinical indicators of COVID-19 patients were dyspnea, fever, fatigue, cough, among others, and the Nursing Diagnoses at higher risk of mortality were Ineffective protection, Ineffective tissue perfusion, Contamination, Ineffective Breathing Pattern, Impaired spontaneous ventilation, Acute confusion, Frailty syndrome, Obesity, and Decreased cardiac output. It is worth mentioning that there was little information about the diagnoses of Domains 9, 10, and 12. Conclusion: This research infers the need to monitor the clinical indicators dyspnea, fever, fatigue, cough, among others, and the Nursing Diagnoses with the highest risk of mortality Ineffective protection, Ineffective tissue perfusion, Contamination, Ineffective Breathing Pattern, Impaired spontaneous ventilation in critically ill patients.

Nursing diagnoses in patients with COVID-19 admitted to the intensive care unit: CROSS-MAPPING

“…The findings of this study align with previous research conducted with patients affected by SARS-CoV-2, which also reported a high prevalence of risk nursing diagnoses such as Risk for adult pressure injury and Risk for infection [ [4] , [5] , [6] ]. Research conducted in the Brazilian Amazon region involving ICU patients hospitalized with COVID-19 complications from March to December 2020 revealed that the nursing diagnosis "Risk for infection" was documented in 100% of the nurses' records and "Risk for adult pressure injury" was documented in 97% of them [ 5 ].…”

“…Nevertheless, it was observed that in many hospital units, there is a tendency to adopt a more free-form approach to nursing care, where the care plan is formulated based on the individual nurse's clinical experiences. This practice reflects a resistance to standardization, which goes against the principles of the SNC [ 5 ]. Overcoming this challenge requires collaborative efforts from both health management and the nursing profession to promote the adoption of SNTs in nursing care.…”

“…These diagnoses can be effectively addressed through early identification of patients' susceptibility to undesirable responses to their clinical condition and the implementation of individualized care that addresses their basic human needs. Among these diagnoses, the risk diagnoses stand out as they primarily involve risk factors and do not include other types of diagnostic indicators such as related factors and defining characteristics [ 3 , 5 , 21 ].…”

“…Individuals affected by COVID-19 exhibit a wide range of clinical manifestations, varying from mild to severe, which contribute to the disease being characterized as a complex entity with diverse behaviors. Given the pandemic context, the role of nurses in the intensive care unit (ICU) has assumed an even more significant position due to their responsibility to accurately identify the signs and symptoms and provide prompt and effective nursing care to critical patients [ [3] , [4] , [5] , [6] ].…”

Progress in Biosensors for the Point-of-Care Diagnosis of COVID-19

“…COVID-19 is a viral respiratory disease with increasing mortality with increasing age of patients and occurring comorbidities such as obesity, diabetes and immune deficiency [ 15 , 16 , 17 ]. The disease has typical indicators of shortness of breath (dyspnea), fever, fatigue and cough, but other manifestations can occur depending on the variant of COVID-19 and individual dispositions, and some post-COVID-19 syndromes can remain even after the infection resolves [ 18 , 19 , 20 , 21 , 22 , 23 ]. An increase in inflammatory cytokines and the appearance of symptoms after inflammation is also typical for COVID-19 [ 24 , 25 , 26 , 27 , 28 ].…”