Diagnósticos de enfermagem em idosos com COVID-19 em uso de ventilação mecânica invasiva: um estudo longitudinal

The aims of this study were to validate the signs and symptoms of the respiratory nursing diagnoses impaired gas exchange, ineffective airway clearance and ineffective breathing pattern in patients under mechanical ventilation; to verify whether intubation time and ventilatory modalities were related factors for respiratory nursing diagnoses; to verify the occurrence of shared signs and symptoms in the diagnoses and compare them with North American Nursing Diagnosis Association's proposition and to ascertain whether respiratory nursing diagnoses occur in isolated or associated patterns. The need for mechanical ventilation is common in several patients admitted to intensive care units. Therefore, critical care nurses should identify the respiratory nursing diagnoses of high incidence. Descriptive observational study, with 177 evaluations of surgical and medical critically ill adult patients undergoing invasive mechanical ventilation. The study adopted Fehring's Modified Clinical Diagnostic Validity Model, with a suggested alteration. The critical signs and symptoms were the same as proposed by North American Nursing Diagnosis Association, when the diagnoses were separately identified, although no particular sign and symptom was found for ineffective breathing pattern. Impaired gas exchange and ineffective airway clearance were identified as having 88 (49.7%) evaluations sharing the critical signs and symptoms. Intubation time and ventilation modality were related factors for the development of ineffective airway clearance and ineffective breathing pattern. The critical signs and symptoms of impaired gas exchange were abnormal blood gases and hypoxemia. For ineffective airway clearance, they were rhonchi and decreased breath sounds. No highlights were found for ineffective breathing pattern signs and symptoms. Validation by experts has confirmed these findings. The interface between ineffective airway clearance and impaired gas exchange was confirmed by the presence of the shared critical signs and symptoms. Studies like this are relevant to clinical practice because they evaluate the adequacy of Taxonomy II for patients under mechanical ventilation in clinical practice, thus allowing for the intensive care nurses to go from one mechanical and routine practice to a critical, reflexive practice, committed to professional progress.

To perform a simultaneous concept analysis of the concepts associated to nursing diagnoses ineffective airway clearance, ineffective breathing pattern, and impaired gas exchange. Concepts about respiratory manifestations need to be well defined, especially in the current pandemic scenario. For that, the simultaneous concept analysis can help in the clarity and differentiation of similar concepts. A concept analysis using the Walker and Avant approach and an integrative review. Data were collected by a group of nurses through a literature review. The group identified 10 articles that met the inclusion criteria and complemented the understanding of the concepts analysed through the sequential description of respiratory physiology in technical books. The final list included 28, 22, and 21 clinical indicators for ineffective breathing pattern, impaired gas exchange, and ineffective airway clearance, respectively. The former, the final proposal incorporated 13 indicators that were pointed out by the group and 15 defining characteristics of NANDA-International. For Impaired gas exchange, the indicator "decreased oxygen saturation" was included; among the defining characteristics of NANDA-International, "abnormal arterial blood gases" was excluded, and "abnormal breathing pattern" was subdivided into "alterations in respiratory depth,""bradypnea,""tachypnea,"and "change in respiratory rhythm."The latter, only the "wide-eyed" was removed from the final list of clinical indicators, which subsequently consisted of nine indicators suggested by the group and 12 defining characteristics. This concept analysis may aid in the process of differentiation for ineffective airway clearance, ineffective breathing pattern, and impaired gas exchange, and aid in safer diagnostic inference. This concept analysis can support the understanding of respiratory nursing diagnoses, helping nurses to identify and differentiate them more safely.

This cross-sectional study characterizes patients at risk of Pressure Ulcers (PUs) and identifies their corresponding Nursing Diagnoses (NDs). The sample consisted of 219 hospitalizations of adult patients at risk for developing a PU established through the Braden Scale. Data concerning the results of the application of the Braden Scale were retrospectively collected from the patients’ medical files and statistically analyzed. Most patients were elderly women hospitalized for an average of nine days, affected by cancer, cerebrovascular, lung, cardiovascular and metabolic diseases. The most frequent NDs were Risk for infection, Self-care deficit syndrome, Bathing/hygiene self-care deficit, Impaired physical mobility, Imbalanced nutrition: less than body requirements, Ineffective breathing pattern, Impaired tissue integrity, Acute pain, Impaired urinary elimination, Impaired skin integrity, and Risk for impaired skin integrity. We conclude that most NDs are common in clinical nursing practice.

Aim: to identify the ten most frequent nursing diagnosis in hospitalized patients in a Pediatric Intensive Care Unit. Method: cross-sectional study with 30 patients in a Pediatric Intensive Care Unit. The data were collected during the January and February 2013. Results: the nursing diagnosis, according to the taxonomy of North American Nursing Diagnosis Association: Risk of infection (86,67%), Dysfunctional gastrointestinal motility (60%), Ineffective airway clearance (53,3%), Risk of impaired skin integrity (40%), Risk of vascular trauma (40%), Risk of electrolyte imbalance (36,67%), Impaired spontaneous ventilation (36,67%), Acute pain (33,3%), Constipation (33,3%), Impaired skin integrity (26,67%). Conclusions: the identification of the nursing diagnosis can contribute to implementation of the Nursing Care Systematization at the Pediatric Intensive Care Unit, allowing that assistance to be targeted and specified to actual and potential health problems of the subject to be cared

Associations between respiratory nursing diagnoses and nursing interventions in patients submitted to thoracic or upper abdominal surgery

Associations between respiratory nursing diagnoses and nursing interventions in patients submitted to thoracic or upper abdominal surgery.

Objective: To identify in the scientific literature nursing diagnoses for patients with HIV/AIDS. Methods: This was an integrative review of literature carried out in the databases Virtual Health Library, Lilacs, SciELO, PubMED, CINAHL, between June and July 2014. The following descriptors were used: Acquired Immune Deficiency Syndrome, Safe Sex, HIV, Nursing Diagnosis and Nursing Care. After a refined search, the articles were selected based on inclusion and exclusion criteria and underwent analysis and standardization. A total of four articles were selected in the final review. These articles followed the nomenclature adopted by the North American Nursing Diagnosis Association - NANDA for the establishment of nursing diagnoses. Results: The nursing diagnoses were: Ineffective breathing pattern; risk of impaired skin integrity; impaired religiosity; defensive coping characterized by denial of problems or obvious weaknesses and refusal to get help; risk of powerlessness related to disease and inadequate coping patterns. A total of 24 interventions and 13 expected outcomes were established. Conclusion: Nursing diagnosis guide the development of interventions and outcomes prioritizing the needs of the patient with HIV/AIDS. With this, we note that the nursing process constitutes an essential instrument for effectiveness of an organized nursing care based on basic human needs. DESCRIPTORS Acquired Immunodeficiency Syndrome. Safe Sex. HIV. Nursing Diagnosis.Nursing Care.

Clinical Pathway is an integrated service planning concept that summarizes each step are given to patients according to the standard of service, the standard of nursing care, and other health personnel service standards, based on evidence with results that can be measured and within a certain period (Depkes, 2014). Problems that occur in the hospital, nurses do not know what should be included in the template of clinical pathways because they do not know what should be documented. Most of nurses just do and write as documentation from other professions e.g., (1) taking a blood sample, (2) access IV-line, (3) administered drugs (4) Catheterization, and (5)measure vital signs. The aim of this study was developing format of clinical pathway using standard nursing diagnosis based on Indonesian Nursing Diagnosis Standart (SDKI). Method of this study was analytical descriptive study that conducted to 50 health record for tracer study, 10 nurses at ward and 25 articles for literature review. The result showed that the appropriate nursing diagnosis based on SDKI for clinical pathway of Diabetic Mellitus were : unstable glucose level, activity intolerance, deficit of nutrition. For thrombotic Stroke were : decrease of adaptive intracranial capacity, physical mobility impairment, ineffective breathing pattern. For pneumonia were : ineffective airway clearance, activity intolerance, hyperthermia. For acute myocardial infarction were decreased of cardiac output, activity intolerance, spontaneous, circulation impairment. The next study will be good for issued not only diagnosis but also intervention on nursing Keywords—clinical pathway; nursing diagnosis; SDKI

Chronic Kidney Disease (CKD) is a global health problem with an increase in the burden of disease of around 29%–41% in the last three decades. The prevalence of CKD in all stages (1–5) reached 13.4%, while advanced stages (3–5) were around 10.6%. Globally, around 788 million people live with CKD (±14.2%) and it is the 9th leading cause of death in the world (WHO, 2023; ISN, 2023). In Indonesia, the prevalence of CKD was 3.8% (Riskesdas), while in West Sumatra it was around 0.2%. Prof. H. Muhammad Yamin Regional General Hospital in 2025 recorded 335 cases of CKD with 16 deaths in CKD Stage V, indicating that CKD is still a serious problem, especially in advanced stages with complications of hypervolemia due to decreased kidney function. This study aims to describe medical-surgical nursing care for patients with CKD Stage V during 4 days of treatment. The method used was a descriptive case study on Mrs. S in the Internal Room of Prof. H. Muhammad Yamin Regional Hospital through interviews, observations, physical examinations, and documentation. The results established seven nursing diagnoses, namely, ineffective breathing patterns, hypervolemia, ineffective peripheral perfusion, activity intolerance, nausea, acute pain, and the risk of impaired skin/tissue integrity. Interventions focused on fluid management, respiratory optimization, activity intolerance, pain management, and prevention of impaired skin integrity. Evaluation showed temporary improvement in nausea and pain., ineffective breathing patterns, ineffective peripheral perfusion, and activity intolerance improved for a while, but decreased on the fourth day. The risk of impaired skin integrity was not found until the end of treatment, but the patient's condition worsened until he died on the fourth day due to the progression of terminal illness. The conclusion emphasized the need for close, comprehensive, and continuous monitoring in Stage V CKD patients and improvement of nursing service facilities.

To examine whether nursing diagnoses were associated with delirium in patients with sepsis. Nursing diagnosis is a nurse's clinical judgement about clients' current or potential health conditions. Delirium is regarded as an important nurse-sensitive outcome. Nonetheless, nursing diagnoses associated with delirium have not yet been identified. Retrospective correlational study. This study was carried out from December 2021 to January 2023. We analysed electronic health records of patients with sepsis admitted to the intensive care units (ICUs) of a tertiary hospital in Seoul, South Korea. Delirium was defined based on the Intensive Care Delirium Screening Checklist score. Nursing diagnoses established within 24 h of admission to the ICU were included and were based on the North American Nursing Diagnosis Association diagnostic classification. The data were analysed using logistic regression. Demographics, comorbidities, procedures and physiological measures were adjusted. Regression model was evaluated via receiver operating characteristic curve, Nagelkerke R2, accuracy and F1 score. The prevalence of delirium in patients with sepsis was 51.8%. Ineffective breathing patterns, decreased cardiac output and impaired skin integrity were significant nursing diagnoses related to delirium. Age ≥ 65 years, Acute Physiology and Chronic Health Evaluation II score, mechanical ventilation, continuous renal replacement therapy, physical restraint and comatose state were also associated with delirium in patients with sepsis. The area under the receiver operating characteristic curve was 0.806. Ineffective breathing patterns, decreased cardiac output and impaired skin integrity could manifest as prodromal symptoms of delirium among patients with sepsis. The prodromal symptoms of delirium revealed through nursing diagnoses can be efficiently used to identify high-risk groups for delirium. The use of nursing diagnosis system should be recommended in clinical practice caring for sepsis patients. STROBE checklist. No patient or public involvement.

To determine the prevalence and clustering of NANDA-International nursing diagnoses in patients assisted by pre-hospital emergency teams. Retrospective descriptive study of electronic record review. Episodes recorded during 2019, including at least a nursing diagnosis, were recovered from the electronic health records of a Spanish public emergency agency (N = 28,847). Descriptive statistics were used to characterize the sample and determine prevalence. A two-step cluster analysis was used to group nursing diagnoses. A comparison between clusters in sociodemographic and medical problems was performed. Data were accessed in November 2020. Risk for falls (00155) (27.3%), Anxiety (00146) (23.2%), Acute pain (00132), Fear (00148) and Ineffective breathing pattern (00032) represented 96.1% of all recorded diagnoses. A six-cluster solution (n = 26.788) was found. Five clusters had a single high-prevalence diagnosis predominance: Risk for falls (00155) in cluster 1, Anxiety (00146) in cluster 2, Fear (00148) in cluster 3, Acute pain (00132) in cluster 4 and Ineffective breathing pattern (00032) in cluster 6. Cluster 5 had several high prevalence diagnoses which co-occurred: Risk for unstable blood glucose level (00179), Ineffective coping (00069), Ineffective health management (00078), Impaired comfort (00214) and Impaired verbal communication (00051). Five nursing diagnoses accounted for almost the entire prevalence. The identified clusters showed that pre-hospital patients present six patterns of nursing diagnoses. Five clusters were predominated by a predominant nursing diagnosis related to patient safety, coping, comfort, and activity/rest, respectively. The sixth cluster grouped several nursing diagnoses applicable to exacerbations of chronic diseases. Knowing the prevalence and clustering of nursing diagnoses allows a better understanding of the human responses of patients attended by pre-hospital emergency teams and increases the evidence of individualized/standardized care plans in the pre-hospital clinical setting. What problem did the study address? There are different models of pre-hospital emergency care services. The use of standardized nursing languages in the pre-hospital setting is not homogeneous. Studies on NANDA-I nursing diagnoses in the pre-hospital context are scarce, and those available are conducted on small samples. What were the main findings? This paper reports the study with the largest sample among the few published on NANDA-I nursing diagnoses in the pre-hospital care setting. Five nursing diagnoses represented 96.1% of all recorded. These diagnoses were related to patients' safety/protection and coping/stress tolerance. Patients attended by pre-hospital care teams are grouped into six clusters based on the nursing diagnoses, and this classification is independent of the medical conditions the patient suffers. Where and on whom will the research have an impact? Knowing the prevalence of nursing diagnoses allows a better understanding of the human responses of patients treated in the pre-hospital setting, increasing the evidence of individualized and standardized care plans for pre-hospital care. STROBE checklist has been used as a reporting method. Only patients' records were reviewed without further involvement.

Clinical indicators of ineffective breathing pattern in children with congenital heart disease. To analyze the accuracy of clinical predictors of nursing diagnosis "Ineffective breathing pattern in children with congenital heart disease". 1:1 case-control study with 30 children with congenital heart disease. Fifteen children with the nursing diagnosis "Ineffective breathing pattern" (cases) were compared with other 15 without this diagnosis (controls). A total of 15 clinical indicators were analyzed for their sensibility, specificity, predictive values, likelihood ratios and area under the ROC curve. Four indicators showed an area under the ROC curve > 70%: chest x-ray findings (0.750), adventitious breath sounds (0.737), coughing (0.710) and asymmetric chest expansion (0.702). The indicators of the chest x-ray findings and adventitious breath sounds had a better overall performance for the identification of ineffective breathing pattern. These findings suggest that both indicators can be useful for inference of ineffective breathing pattern. Moreover, the presence of the diagnosis was associated with a greater likelihood of the presence of cough, and its absence with an increased probability of the absence of asymmetric chest expansion and percussive sounds. The comparison among populations with different diseases and carriers of the same nursing diagnosis shows that the predictive ability of clinical indicators can be influenced.

To describe the clinical validation of symptoms or defining characteristics of three respiratory diagnoses. The contributing factors or etiologies of the diagnoses were identified and the degree of importance of 30 nursing interventions, 15 direct care and 15 teaching, was rated for each diagnosis and each patient. Three nursing diagnoses--ineffective breathing pattern (IBP), ineffective airway clearance (IAC), and impaired gas exchange (IGE)--were among the most frequently used, yet no reported clinical studies validated the defining characteristics of these diagnoses. This study answers the research questions: What are the defining characteristics of IBP, IAC, and IGE? What are the etiologies of IBP, IAC, AND IGE? What are the most important interventions for IBP, IAC, and IGE? Standardized clinical validation using a convenience sample of 76 people hospitalized with medical and surgical diagnoses, in one U.S. city, and identified as having one of the three diagnoses. Data were collected in 1992-1993. A literature-based concept analysis generated 37 possible defining characteristics for the three diagnoses which were included in the instrument. The nurse experts conducted a health history and physical examination of each patients and decided (a) whether the 37 defining characteristics were present or absent, (b) the degree of importance of each possible defining characteristic for making one or more of the diagnoses, (c) the etiologies, and (d) which of the 30 nursing interventions were important for each diagnosis and patient. For each diagnosis, many of the 37 possible defining characteristics were judged as present but few reached the criterion of .50 as important for making one of the diagnoses. Two of the possible defining characteristics reached this criterion for IBP, seven for IAC, and two for IGE. In contrast to the defining characteristics approved by NANDA, the subjective cues of "expresses fatigue" and "expresses anxiety" were judged as important for making one or more of the diagnoses. Clinical validation methods allow discriminating among defining characteristics. Data that are present are not necessarily characteristic of a diagnosis, and the subjective cues of expresses fatigue or anxiety may be important for making these diagnoses.

One-hundred medical/surgical nurses from two hospitals participated in a study designed to determine which defining characteristics professional nurses working in acute-care settings associated with each of the three respiratory nursing diagnoses identified by the North American Nursing Diagnosis Association (NANDA). All NANDA defining characteristics for impaired gas exchange and ineffective airway clearance were selected by at least 63% and 67% of the study participants, respectively. Thirteen of the 15 NANDA defining characteristics for ineffective breathing pattern were selected by at least 68% of the study participants. Two characteristics of ineffective breathing pattern identified by NANDA, cough and fremitus, were selected by only 47% and 45% of respondents. This study was the first in a series of studies intended to validate the respiratory nursing diagnoses.

Pneumonia is a lower respiratory tract infection characterized by inflammation of the lung tissue due to bacterial, viral, fungal, or aspiration of foreign substances. This disease is one of the main causes of morbidity and mortality, especially in the elderly. This case study aims to provide a comprehensive overview of the implementation of nursing care for pneumonia patients treated in the isolation room of Bangkinang Regional Hospital in 2025. The approach used is the nursing process method which includes assessment, determination of nursing diagnosis, planning, implementation, and evaluation. The subject of the study was a 61-year-old male patient with the main complaint of coughing up phlegm accompanied by blood, shortness of breath, fever, and weakness. Based on the results of the assessment and supporting examinations, several nursing diagnoses were determined, including: ineffective airway clearance, hyperthermia, activity intolerance, ineffective breathing patterns, and risk of nutritional deficit. Nursing interventions were carried out in accordance with the Indonesian Nursing Intervention Standards (SIKI). Evaluation showed an improvement in the patient's condition after nursing actions were carried out for three days. This study emphasizes the importance of systematic and continuous nursing care to improve the health status of pneumonia patients.