Medidas de acurácia das características definidoras do diagnóstico padrão respiratório ineficaz de crianças e adolescentes cardiopatas congênitos

Abstract

Studies which address the accuracy of the defining characteristics (DC) may contribute to the improvement of diagnostic reasoning, leading to the formulation of nursing diagnoses which are more consistent with the clinical situation of the patient. Thus, the study aimed to estimate the measures of accuracy of the DC of the nursing diagnosis Ineffective breathing pattern (IBP) in children and adolescents with congenital heart disease (CHD). The sample included 61 children and adolescents aged 5-17 years, diagnosed with CHD. These patients were examined by the researcher, who conducted a physical examination, focusing on the respiratory evaluation. Then the doctor who attended the patient was consulted to authorize the performance of pulmonary function tests (spirometry and manovacuometry). The information obtained from physical examination and from the tests were analyzed by the researcher to determine the presence or absence of DC of IBP, based on a previously established protocol. It is highlighted that 30 children and adolescents have not received medical approval to perform the pulmonary function tests. Despite this, these patients were sampled to determine the diagnosis just based on the DC from the interview and physical examination. Thus, two subsamples were formed, the first with 30 children and adolescents who did not perform such tests, and the second with 31 individuals who carried out such tests. The set of DC for each child and teenager was organized into 92 spreadsheets. In these, it was indicated the presence or absence of the DC. Each evaluation of the patients in the second subsample resulted in two spreadsheets, one only with the DC from the interview and clinical examination, and another with these same data added information from the pulmonary function tests. These spreadsheets were submitted to two nurses diagnosticians which determined the occurrence of IBP. The analysis of the inferences and the information on the occurrence of DC allowed the estimation of measures of accuracy. For the first subsample, the DC that showed better measures of accuracy was tachypnea. The inferences made for the second subsample, based on clinical data and interviews, presented as main DC: orthopnea and use of accessory muscles to breathe. When the results of pulmonary function tests were added, the inferences of the diagnosticians showed accuracy measures without statistical significance for all DC. With this, the results of this study raise questions about the importance of pulmonary function tests for the inference of the nursing diagnosis IBP. Furthermore, some DC showed no legitimacy for IBP, as follows: assumption of three point position, bradypnea, increased anterior-posterior diameter, decreased vital capacity, decreased expiratory pressure, and decreased minute ventilation. Thus, it is believed that further research is needed to confirm these findings, as well as to clarify the relationship of such DC with the diagnosis IBP. The measures of accuracy obtained helped identify which DC is more representative of IBP. Moreover, the results allowed to recognize which features are less used during the inference of this diagnosis in children and adolescents with congenital heart disease.