Medidas de acurácia dos indicadores clínicos dos diagnósticos de enfermagem respiratórios em crianças com asma

Abstract

The planning to lead the care and to support the nursing knowledge in specific clinical situations is based on the use of accurate nursing diagnoses. The use of good clinical indicators for predicting diagnosis is essential in order to reach this precision. This study aimed at determining the measures of accuracy of clinical indicators for nursing diagnosis, such as: Ineffective airway clearance, Ineffective breathing pattern, Impaired gas exchange and Impaired spontaneous ventilation in asthmatic children through a cross-sectional study held in a secondary level public hospital in Fortaleza (CE), from April to September 2013. The sample consisted of 205 children with asthma whose data were collected through a pulmonary assessment and interviews with their parents. The data were analyzed by the researcher to determine the presence or absence of: Ineffective airway clearance; Ineffective breathing pattern; Impaired gas exchange and Impaired spontaneous ventilation indicators based on a research protocol and then diagnostician nurses analyzed this information for diagnostic inference. For statistical analysis, SPSS and Excel were used with a significance level of 5 %. The study adopted the ethical principles and received the assent of the Federal University of Ceará Ethics and Research (opinion No. 237.389/13). There was a slight prevalence for males (52.3 %) and average age of 36 months. 89.3% of the children assessed developed Ineffective airway clearance; 86.8 % developed Ineffective breathing pattern; 28.8 % developed Impaired gas exchange and 5.9 % of the children developed Impaired spontaneous ventilation. Ineffective airway clearance presented dyspnea, change in respiratory rate, change in respiratory rhythm, orthopnea, rales and ineffective cough as the most prevalent indicators. Change in respiratory rate, change in respiratory rhythm, orthopnea, respiratory rales, decreased breath sounds and ineffective cough showed a significant association with this diagnosis whereas ineffective cough and respiratory rales appeared as the most accurate indicators. Ineffective breathing pattern had orthopnea, tachypnea and use of accessory muscles to breathe as the most prevalent indicator. A statistically significant association between changes in respiratory depth, tachypnea, accessory muscle use and orthopnea with Ineffective breathing pattern was also observed in this study. The Use of accessory muscles for breathing, changes in respiratory depth and orthopnea were observed as more accurate for Ineffective breathing pattern. Impaired gas exchange presented dyspnea, abnormal breathing, tachycardia and hypoxemia as the most prevalent indicators. Hypoxemia was the only indicator that showed a statistically significant association, and were seen as more accurate for Impaired gas exchange. For Impaired spontaneous ventilation dyspnea, increased heart rate and decreased SaO2 were the most prevalent indicators. Decreased cooperation, decreased SaO2 and increased use of accessory muscles to breathe were significantly associated with Impaired spontaneous ventilation and increased use of accessory muscles to breathe was presented with better accuracy. For the association between diagnoses, Ineffective airway clearance remained related to Ineffective breathing pattern and Impaired gas exchange and Ineffective breathing pattern remained related to Impaired gas exchange. Impaired spontaneous ventilation showed no association. It is believed that knowledge of the diagnostic profile of specific populations may contribute to nursing interventions so that they are guided by diagnostic decisions, thus facilitating the choice of the most appropriate actions.