Validação conceitual das características definidoras de diagnósticos de enfermagem respiratórios em neonatos

OBJECTIVE:To develop and validate conceptual and operational definitions for the defining characteristics of the respiratory nursing diagnoses, ineffective breathing pattern, impaired gas exchange and impaired spontaneous ventilation, in newborns.METHODS:This was a methodological study of conceptual validation of the defining characteristics of three respiratory nursing diagnoses, by consensus analysis of a committee of five specialist nurses, and then a group of five non-nursing professionals, using the Delphi technique.RESULTS:After two rounds of evaluation, consensus was obtained that was equal to or greater than 80% on all of the definitions, which were then considered validated.CONCLUSION:The definitions developed for the defining characteristics of three nursing diagnoses were validated with a high level of consensus.OBJETIVO:Elaborar e validar definições conceituais e operacionais para as características definidoras dos diagnósticos de enfermagem respiratórios, Padrão Respiratório Ineficaz, Troca de Gases Prejudicada e Ventilação Espontânea Prejudicada em recém-nascidos.MÉTODOS:Estudo metodológico, de validação conceitual das características definidoras dos três diagnósticos de enfermagem respiratórios por meio da análise de consenso de um comitê de cinco enfermeiras especialistas e de cinco profissionais não enfermeiros, utilizando a técnica Delphi.RESULTADOS:Após duas rodadas de avaliação, obteve-se consenso igual ou superior a 80% na totalidade das definições, sendo consideradas validadas.CONCLUSÃO:As definições elaboradas para as características definidoras dos três diagnósticos de enfermagem foram validadas com elevado grau de consenso.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de EnfermagemUNIFESP, EPESciEL

Alternate Splicing of Interleukin-1 Receptor Type II (IL1R2) In Vitro Correlates with Clinical Glucocorticoid Responsiveness in Patients with AIED

Autoimmune Inner Ear Disease (AIED) is poorly characterized clinically, with no definitive laboratory test. All patients suspected of having AIED are given glucocorticoids during periods of acute hearing loss, however, only half initially respond, and still fewer respond over time

Analysis of ineffective breathing pattern and impaired spontaneous ventilation of adults with oxygen therapy

ABSTRACT Objective: to analyze the manifestation of the defining characteristics of the nursing diagnoses of ineffective breathing pattern and impaired spontaneous ventilation, of the NANDA International and the defining characteristics identified in the literature for the concept of “ventilation” in adult patients hospitalized in an intensive care unit with use of oxygen therapy. Method: clinical diagnostic validation study, conducted with 626 patients in intensive care using oxygen therapy, in three different modalities. Multiple correspondence analysis was used to verify the discriminative capacity of the defining characteristics and latent class analysis to determine the diagnostic accuracy of them, based on the severity level defined by the ventilatory mode used. Results: in the multiple correspondence analysis, it was demonstrated that the majority of the defining characteristics presented low discriminative capacity and low percentage of explained variance for the two dimensions (diagnoses). Latent class models, separately adjusted for the two diagnoses, presented a worse fit, with sharing of some defining characteristics. Models adjusted by level of severity (ventilation mode) presented better fit and structure of the component defining characteristics. Conclusion: clinical evidence obtained in the present study seems to demonstrate that the set of defining characteristics of the two nursing diagnoses studied fit better in a single construct

Impaired gas exchange: accuracy of defining characteristics in children with acute respiratory infection

OBJECTIVE: to analyze the accuracy of the defining characteristics of the Impaired gas exchange nursing diagnosis in children with acute respiratory infection.METHOD: open prospective cohort study conducted with 136 children monitored for a consecutive period of at least six days and not more than ten days. An instrument based on the defining characteristics of the Impaired gas exchange diagnosis and on literature addressing pulmonary assessment was used to collect data. The accuracy means of all the defining characteristics under study were computed.RESULTS: the Impaired gas exchange diagnosis was present in 42.6% of the children in the first assessment. Hypoxemia was the characteristic that presented the best measures of accuracy. Abnormal breathing presented high sensitivity, while restlessness, cyanosis, and abnormal skin color showed high specificity. All the characteristics presented negative predictive values of 70% and cyanosis stood out by its high positive predictive value.CONCLUSION: hypoxemia was the defining characteristic that presented the best predictive ability to determine Impaired gas exchange. Studies of this nature enable nurses to minimize variability in clinical situations presented by the patient and to identify more precisely the nursing diagnosis that represents the patient's true clinical condition

Guia de cuidados de enfermagem na prevenção da extubação acidental Conductas de enfermería para la prevención de la extubación accidental Guideline for nursing care in the prevention of accidental extubation

Artigo que relata a experiência do emprego de um guia preventivo da extubação acidental que ocorre associada ao cuidado de enfermagem para os quatro momentos de maior incidência e que são: banho no leito, transporte, troca de fixação e mudança de decúbito. O conteúdo do guia está pautado nas recomendações encontradas em levantamento bibliográfico no MedLine e na experiência profissional. O guia vem sendo aplicado desde setembro de 2005. Espera-se que o guia contribua para diminuir cada vez mais a incidência da extubação acidental e por tanto seja uma ferramenta para desenvolver um indicador de qualidade na Unidade de Terapia Intensiva, assim como, seja capaz de oferecer uma assistência que objetive a segurança do paciente.<br>És un artículo que trata del empleo de un guía para orientar los cuidados de enfermería e evitar la extubación que ocurre con más frecuencia en cuatro tiempos: en el baño, la transferencia del enfermo, el cambio de la fixación y los cambios de posición en la cama. Su contenido se apoyo en la experiencia y en levantamiento bibliográfico en el Medline.Se ha venido usando desde septiembre de 2005 y hemos tenido solo dos extubaciones. Creemos que sirva para atender al enfermo con más seguranza así también como un indicador de calidad de enfermería.<br>Article reports the experience of the use of a preventive guideline for the prevention of accidental extubation that occurs associated nursing care for the four moments of bigger incidence that are: bath in the stream bed, transportation, exchange of setting and change of decubitus. The content of the guide is based in the recommendations found in bibliographical survey in the MedLine and in the professional experience. The guideline is being used since September, 2005. This contribution aims at decreasing extubation incidence and to be a tool to develop a quality indicator in Intensive Care Units as well as for offering an assistance that aims patient safety

Endotracheal and upper airways suctioning: changes in newborns’ physiological parameters Aspiración del tubo endotraqueal y de las vías aéreas superiores: alteraciones en los parámetros fisiológicos en recién nacidos Aspiração do tubo orotraqueal e de vias aéreas superiores: alterações nos parâmetros fisiológicos em recém-nascidos

This study investigated which physiological parameters change when endotracheal and upper airway suctioning is performed immediately before, immediately after and five minutes after this procedure is performed in newborns hospitalized in a Neonatal Intensive Care Unit (NICU). This is a quantitative and longitudinal study, before and after type, performed in the NICU of a public institution in the city of Fortaleza, CE, Brazil. The sample was composed of 104 newborns using oxigenotherapy and who needed endotracheal and upper airway suctioning. The results showed significant alterations in respiratory and heart rates (p<0.05) in neonates using Oxyhood and nasal CPAP while the pulse significantly changed (p<0.05) in newborns placed in oxyhood, using nasal CPAP and Mechanical Ventilation; oxygen saturation was the only parameter that did not alter significantly. We propose that nurses develop non-pharmacological interventions to reduce potential alterations caused in newborns’ physiological parameters due to this procedure.<br>Se objetivó investigar cuales son los parámetros fisiológicos que se alteran en la ejecución de la aspiración del tubo endotraqueal (TOT) y de las vías aéreas superiores (VAS), comparándolos inmediatamente antes, inmediatamente después y cinco minutos después de la realización del referido procedimiento. Se trata de un estudio cuantitativo, longitudinal, del tipo antes y después, realizado en una Unidad de Terapia Intensiva Neonatal (UTIN) de una institución pública en Fortaleza, CE, Brasil. La muestra constó de 104 recién nacidos que usaban oxigenoterapia, y que necesitaron de aspiración del tubo endotraqueal y de las vías aéreas superiores. Los resultados mostraron, alteraciones significativas (p<0,05) en las frecuencias respiratorias (FR) y cardíaca (FC) de los recién nacidos en uso de Oxi-Hood y CPAP nasal, y también del pulso (p<0,05) para los recién nacidos en Oxi-Hood, CPAP nasal y Ventilación Mecánica (VM), siendo la saturación de oxígeno (SpO2), el único parámetro que no fue estadísticamente significativo. Se propone a los enfermeros desarrollar intervenciones no farmacológicas para reducir posibles alteraciones de los parámetros fisiológicos de los recién nacidos provenientes de este procedimiento.<br>Objetivou-se investigar quais são os parâmetros fisiológicos que se alteram na execução da aspiração do tubo orotraqueal (TOT) e das vias aéreas superiores (VAS), comparando-os imediatamente antes, imediatamente depois e cinco minutos após a realização do referido procedimento. Trata-se de estudo quantitativo, longitudinal, do tipo antes e depois, realizado em Unidade de Terapia Intensiva Neonatal (Utin) de uma instituição pública em Fortaleza, CE, Brasil. A amostra constou de 104 recém-nascidos em uso de oxigenoterapia, e que necessitaram de aspiração do tubo orotraqueal e das vias aéreas superiores. Os resultados mostraram alterações significativas (p<0,05) nas frequências respiratória (FR) e cardíaca (FC) dos recém-nascidos, em uso de tenda de oxigênio (Oxi-Hood) e pressão contínua das vias aéreas (CPAP nasal), e também de pulso (p<0,05) para os recém-nascidos em Oxi-Hood, CPAP nasal e ventilação mecânica (VM), sendo a saturação de oxigênio (SpO2) o único parâmetro que não foi estatisticamente significante. Propõe-se aos profissionais enfermeiros o desenvolvimento de intervenções não farmacológicas para reduzir possíveis alterações dos parâmetros fisiológicos dos recém-nascidos, decorrentes desse procedimento