Diagnósticos de enfermagem respiratórios em crianças com cardiopatia congênita em evolução pós-operatória

Abstract

Studies that address the defining characteristics (DC) can contribute to the improvement of diagnostic reasoning, directly influencing the choice of nursing diagnoses most suitable for clinical situation of the patient. This study examined how nursing diagnoses ineffective breathing pattern (IBP), ineffective airway clearance (IAC), impaired gas exchange (IGE) and impaired spontaneous ventilation (ISV) presented themselves during the post-operative period in children with congenital heart diseases and showed the measures of accuracy of the defining characteristics. It was developed an cohort study in a hospital in the public network in Fortaleza-CE. The sample was consisted of 54 children aged 5-17 years with congenital heart diseases in post-operative of cardiac surgery. The children were followed for a minimum period of five and maximum of ten days. To collect the data, it was used an instrument based on the characteristics of the diagnostics studied and some relevant literature about the lung evaluation. The data were collected through examination of the child and interview with their parents. The information obtained were analyzed by the researcher to determine the presence or absence of DC of nursing diagnoses IBP, IAC, IGE e ISV and data was organized into spreadsheets. After, the spreadsheets were sent to nurses diagnosticians that performed the diagnostic inference process. It was used Excel and PASW software for organizing and analyzing statistical data. The level of significance was 5%. Among children evaluated, 30 (55,5%) developed IAC, 25 (46,3%) developed IGE e 21 (38,8%) developed IBP during the monitoring period. In order to infer IAC, the DC most accurate was respiratory rales and to IBP the characteristic that presented the highest accuracy measurements was use of accessory muscles to breathe. As for the inference IGE, the characteristic most accurate was hypoxemia. For the nursing diagnosis ISV, was not possible to establish statistically significant accuracy of defining characteristics. Based on the analysis of multiple matches, the best characteristics that assist in differentiating between the diagnoses IBP, IAC e IGE were: change in respiratory rate, excessive amount of mucus, respiratory rales, cough absent and tachypnea to IAC; dyspnea, nasal flaring, change in respiratory rate and use of accessory muscles breathing to IBP e carbon dioxide decreased, abnormal arterial blood gases, abnormal arterial pH e PO2 decreased to IGE. The results helped identify the DC more representative of IBP, IAC e IGE in children with congenital heart diseases in post-operative period. Studies of this nature are important for providing information about the predictive ability of the defining characteristics and the temporal evolution and characteristics of the respiratory nursing diagnoses.