Diagnósticos de enfermagem no perioperatório de cirurgia cardíaca

Abstract

Foram identificados os diagnósticos de enfermagem de pacientes no período perioperatório de cirurgia cardíaca e verificada a concordância ou não entre a primeira autora e outros enfermeiros na identificação desses diagnósticos. Dezessete pacientes admitidos para cirurgia cardíaca foram avaliados utilizando-se instrumentos para o período perioperatório. No pré-operatório, das nove categorias diagnósticas identificadas pela primeira autora, três apresentaram concordância com os enfermeiros (exemplo: Intolerância à atividade). No trans-operatório, sete categorias apresentaram concordância entre enfermeiros e primeira autora (exemplo: Risco para infecção). No pós-operatório imediato, 11 categorias apresentaram concordância entre enfermeiros e primeira autora (exemplo: Risco para disfunção neurovascular periférica).

Diagnósticos de enfermagem em pacientes no período pós-operatório de cirurgias cardíacas

“…In another research with cardiac surgery postoperative patients, 14 diagnoses related to immediate postoperative patients were identified, namely: Risk of Infection; Impaired Physical Mobility; Impaired Skin Integrity; Risk for Imbalanced Fluid Volume; Impaired Verbal Communication; Risk for Altered Body Temperature; Ineffective Airway Clearance; Impaired Gas Exchange and Pain (3) . The Impaired Gas Exchange diagnosis is defined as "excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane" (13) .…”

“…The Impaired Gas Exchange diagnosis is probably related to the fact that, during the transoperative, patients are induced to anesthetic coma, cardiac arrest, and the oxygenation and blood pumping occur artificially. Consequently, patients lose the vital ability of spontaneous breathing, requiring mechanical ventilation until spontaneous breathing is reestablished; such procedure occurs during the postoperative period, and depends on a constant assessment of patients' respiratory pattern (3) . Depending on an artificial airway means patients are unable to eliminate tracheobronchial secretions and need them to be sucked out, which justifies the Ineffective Airway Clearance diagnosis, possibly related to the fact patients depend to an artificial airway and do not have enough mobility in bed.…”

“…The defining characteristics include altered respiratory frequency and rhythm and adventitious respiratory sounds. Besides, the endotrachial intubation disables patients' verbal communication, and is related to the Impaired Verbal Communication, evidenced by patients' verbal expression inability, which can be observed in all patients who undergo cardiac surgeries, due to the anesthetic coma induction and the artificial airway needs during the transoperative (3)(4) . The Impaired Bed Mobility diagnosis, defined as "Limitation of movement in bed from one side to another" (13) , may be related to the restrictions due to the surgical procedure, the drains presence, restraining the body movements, and the pain sensation when moving.…”

“…Surgery is indicated when the survival probability is higher by means of the surgical treatment than the clinical treatment. Cardiac surgeries can be classified as corrective, when related to correcting ductus arteriosus, artrial or ventricular septum defects; reconstructive, with the purpose of myocardial revascularization, or cardiac valve repair; and substitutive, comprising the valve replacement and transplant procedures (2)(3)(4)(5) . The expressive cardiovascular disease incidence among the population and the technological advances for their treatment, as well as the complexity and details related to care required by patients who undergo cardiac surgeries, whose health conditions go through constant and abrupt changes, demand immediate and accurate nursing interventions, lacking of previous and scientifically based planning.…”

“…The expressive cardiovascular disease incidence among the population and the technological advances for their treatment, as well as the complexity and details related to care required by patients who undergo cardiac surgeries, whose health conditions go through constant and abrupt changes, demand immediate and accurate nursing interventions, lacking of previous and scientifically based planning. Several studies demonstrate a concern regarding the nursing diagnosis identification for specific groups, such as: inpatients of surgical practice (6) and medical practice (7) units; hospitalized elderly patients (8) ; medullary injury patients (9) , cardiac catheterization patients (10) , laparoscopic Cholecystectomy immediate postoperative patients (11) , patients during surgical preoperative, intraoperative, and postoperative (2)(3)(4)12) . Such studies emphasize the relevance of verifying clinical manifestations of common characteristic patient groups, enabling knowledge of the affected human needs, and thus contributing to the direct and individual nursing interventions development, resulting in the implementation of quick and effective actions to solve the identified problems.…”