Acurácia dos indicadores clínicos do diagnóstico de enfermagem proteção ineficaz em adolescentes com câncer

Abstract

Adolescents with cancer are submitted to aggressive treatments that may compromise the ability to protect against invaders agent and/or injury and lead to the manifestation of nursing diagnosis Ineffective protection in this population. In this context, it is important to identify early changes in the protection system of these adolescents and expand the studies that address this change as a nursing phenomenon, given the small number of scientific research developed with this diagnosis in this particular population. This study aims to analyze the accuracy of clinical indicators of nursing diagnosis Ineffective protection in adolescents with cancer. It held an integrative literature review, through which were identified, in addition to those in NANDA-I classification, five other clinical indicators, of which three were also assessed in this study. Then a study of diagnostic accuracy, with naturalistic sampling was developed with a sample of 127 adolescents with cancer in October 2015 to January 2016 in a pediatric oncology unit of a public hospital in Ceará. Data were collected by the study author and academic nursing, after participating in a training on ineffective protection from the application of an instrument developed for research. This instrument is based on conceptual and operational definitions developed for clinical indicators evaluated in this study. Data analysis was performed with the R version 3.1.1 software and data were compiled in an Excel software (2010). It was used the method of analysis of latent classes with random effects to calculate the sensitivity and specificity of each indicator. Sociodemographic data showed small predominance of males in the sample and a mean age of 13.9 years. Acute lymphocytic leukemia, osteosarcoma and Hodgkin lymphoma subtypes were the most frequently found cancers. The most frequent clinical indicators were deficient immunity, weakness, alterations in clotting, coughing and anorexia. Adolescents evaluated in the hospitalization unit were more likely to express indicators alterations in coltting,anorexia, disorientation, fatigue, opportunistic infections and lesioned oral mucosa. Only two indicators were associated with fact of not attend school: neurosensory impairment and alteration in clotting. The latter indicator was also most identified in adolescents with fewer hospitalizations in the last 12 months. In addition, adolescents who experience fatigue were younger, while those who showed weakness were older. Lower family income was identified among adolescents with neurosensory impairment, anorexia and insomnia. Adolescents with family history of cancer had increased chance of manifesting the indicators anorexia, fatigue and itching. The prevalence of diagnosis was estimated by latent class model in 93.7%. Clinical indicators that included the final adjusted model showed high sensitivity values for deficient immunity and weakness, and specificity for recurrent infections, opportunistic infections, insomnia, lesioned oral mucosa and coughing. These findings become important to help nurses in the diagnostic reasoning process and thus contribute to the development of a care plan based on the peculiarities of adolescents with cancer.