Acurácia das características definidoras dos diagnósticos de enfermagem hipotermia, hipertemia e termorregulação ineficaz em recém-nascidos

Abstract

The presence of the thermal changes have been identified in the literature as commonly occurring phenomena in infants with important contribution to morbidity and mortality. The presence of the thermal changes have been identified in the literature as commonly occurring phenomena in infants with important contribution to morbidity and mortality. The defining characteristics and clinical indicators are useful signs and symptoms to determine the presence or absence of the nursing diagnosis. Realizing that the use of accurate clinical indicators may reflect the interventions and health outcomes for these clients the objective of this study was to analyze the accuracy of the defining characteristics of the diagnosis Hypothermia, hyperthermia and thermoregulation ineffective to be established based on consistent clinical evidence, leading to completion of the diagnostic facing the reality of this population. We conducted an integrative review, through which 32 were identified defining characteristics; although some are not present in the NANDA-I for the diagnosis in question, those considered relevant were also evaluated in this study. Trata-se de um estudo de acurácia diagnóstica, com desenho transversal, desenvolvido em uma Maternidade pertencente à instituição pública federal, localizada em Fortaleza. The sample consisted of 216 newborns in the first week of life, admitted to the Care Units Neonatal Intermediate Conventional (CUNICo) and Neonatal Intensive Care Units (NICU). For data collection was used an instrument divided into clinical and physical examination to identify the defining characteristics of the three diagnoses. To standardize the collection was drawn up Standard Operating Procedure script containing operational definitions of each measured defining characteristic. Data were collected during the months of October 2015 to March 2016 by study researcher and graduate students. The collected data were analyzed by statistical package R version 3.1.1. We used the method of analysis of latent classes with random effects to calculate the sensitivity and specificity of each feature. The sample had a predominance of males, with a mean gestational age of 34.5 weeks and the weight 2152,7g. In addition to prematurity also noted it is high frequency of respiratory diseases. It was found that infants with less weight were associated with the presence of the characteristics defining respiratory distress, decreased ventilation, do not maintain suction, slow gastric emptying, insufficient weight gain, tachycardia, stupor. The cold skin characteristics and decreased capillary refill were more frequently found in females. RN in phototherapy use were more likely to express jaundice features and mottled skin. It was identified by latent class analysis the prevalence of only 1% and 0.7% for hypothermia and thermoregulation ineffective, respectively, and 2% to hyperthermia. The Hypothermia Diagnostic features with higher sensitivity and specificity were slow gastric emptying, cold skin, irritability and bradycardia. In diagnosis Thermoregulation ineffective the tachypnea features and skin hot to the touch had higher sensitivity and fluctuation of temperature higher level of specificity. Referring to hyperthermia diagnosis, characteristics with high specificity values were stupor, vasodilation, irritability and lethargy. It was evident that the responses of newborns, especially premature and low birth weight can be little robust when exposed to an increase or decrease in temperature compared to older children thus damaging estimate of the defining characteristics of the studied diagnoses.