Impaired Spontaneous Ventilation Research Articles

Ações de cuidado e diagnósticos de enfermagem ao paciente com oxigenação por membrana extracorpórea: translação do conhecimento

Abstract Objective to map diagnoses and nursing actions for the care of adult patients with extracorporeal oxygenation membrane, considering a protocol and a computerized prescription system and the inclusion of new care actions, in a process of translating knowledge to clinical practice. Methods descriptive and exploratory study, with cross-mapping between a care protocol and a computerized system of at a university hospital, from 2014 to 2018. Two meetings were held with the nursing manager and members of the extracorporeal oxygenation membrane team to validate the actions. Results most common diagnoses used in the 45 medical records of patients with extracorporeal membrane oxygenation were: Risk of infection (100%); Impaired spontaneous ventilation (93.33%); Self-care deficit syndrome (93.33%). Conclusion and implications for practice The mapping included 25 new actions, associated with 14 nursing diagnoses in the computerized system, aiming to disseminate knowledge and its application in real care for patients with extracorporeal oxygenation membrane.

Concept Analysis of the Nursing Diagnosis of Impaired Spontaneous Ventilation in Critical Patients

Introduction: In nursing practice, this concept has been identified in studies that address the nursing diagnosis of impaired spontaneous ventilation. Nursing performance facing this unwanted human response is considered essential for the maintenance and control of vital signs, cardiovascular monitoring, gas exchange and respiratory pattern, as well as constant surveillance aimed at signs of hypoventilation and inadequate ventilation. Objective: To analyze the concept of impaired spontaneous ventilation in critically ill patients in an intensive care unit. Methodology: This study is a concept analysis, according to Walker’s and Avant’s method, conducted using an integrative review. All the referential steps were followed: concept selection, determining the objectives and proposals for concept analysis, identifying the possible uses of the concept, determining the defining attributes, identifying a model case, identifying a contrary case, and identifying the precedents and consequences of the concept. Results: A sample of 38 studies was selected. The following were identified as attributes: distress and fatigue, respiratory distress, tachycardia, hemodynamic instability, altered mental status, abnormal arterial blood gas results, dyspnea, anxiety, agitation, sweating, hypoxemia and hypercapnia. Antecedents: sex, age, oxygen saturation lower than 90%, diseases of the respiratory, cardiovascular, neurological, gastrointestinal, neuromuscular, and metabolic systems, respiratory infections, trauma, poisons, toxins, and sedatives. Consequences: increased heart rate, decreased partial oxygen saturation, increased use of respiratory muscles, dyspnea, increased metabolic rate and restlessness. The model case and the contrary case were used to illustrate the attributes, antecedents, and consequences. Conclusion: The study directed the strengthening of evidence about the phenomenon and demonstrated a strong occurrence in patients who need assistance in intensive care units, thus demanding critical care.

RESPIRATORY AND CIRCULATORY PROBLEMS OF COVID-19 IN THE CONTEXT OF ESTABLISHING INTENSIVE CARE UNIT NURSING DIAGNOSIS

Introduction: The novel coronavirus disease 2019 (COVID-19) is a virus that attacks the respiratory tract with rapid spread and high mortality. Initial reports that COVID-19 associated with critical care due to the severity of the disease requiring mechanical assistive devices in its treatment. The purpose to identify the nursing diagnosis related to respiratory and circulatory problems of COVID-19 in the critical care unit.
 Method: An integrative review highlights the issue that nursing problems related to respiratory and circulatory in COVID-19 patients admitted to the Intensive Care Unit (ICU). This study focuses on papers published from 2020 to 2021 using the keyword "clinical manifestation of COVID-19" which was accessed through the Pubmed database.
 Result: The results showed that findings in articles that were reviewed and integrated with the SDKI. Nursing diagnosis related to respiratory problems such as 1) Ineffective airway clearance; 2) Dysfunctional ventilatory weaning response; 3) Impaired gas exchange; 4) Impaired spontaneous ventilation. Nursing diagnosis related to circulatory problems such as 1) Risk / decreased cardiac output; 2) Risk for bleeding; 3) Risk for effective renal perfusion; 4) Risk for ineffective cerebral perfusion.
 Conclusion: Critical care nurses carry out a series of treatments based on the nursing process stages, one of which is the enforcement of a nursing diagnosis. The nursing diagnosis is needed to develop nursing plans and strategies for implementation so that the goals of nursing care are achieved.
 Keywords: covid-19, nursing diagnosis, intensive care unit

Semi Fowler Position Adjustment to Treat Ventilation Disorders In Post Craniotomy Meningioma Patients

Meningiomas are one of the most common types of brain tumors. Interventions that can be done in cases of meningiomas are craniotomy, which is a surgical procedure performed by opening a portion of the skull bone to access the brain directly, and this will be directly related to the nerves. Impaired spontaneous ventilation is the most common problem and if it does not get treatment quickly it will be fatal, namely death. The method used in this research is descriptive with a case study approach. The results showed that after setting the semi-Fowler's position in post-craniotama patients for three days, the patient's condition had not changed, which could be seen from the absence of changes in ventilation disturbances seen from the absence of an increase in patient awareness. In conclusion, the application of semi-Fowler's position adjustment has not been able to overcome ventilation disorders that occur in post-craniotomy patients. This may be influenced by the patient's condition.

Clinical indicators, nursing diagnoses, and mortality risk in critically ill patients with COVID-19: a retrospective cohort.

To identify clinical indicators and nursing diagnoses with the highest risk of mortality in critically ill patients with COVID-19. Retrospective cohort with the population of adults and elderly people with COVID-19 from an Intensive Care Unit. Categorical variables were described using absolute and relative frequencies and risk factors for mortality using Cox regression, with a confidence interval of 95%. The main clinical indicators of COVID-19 patients were dyspnea, fever, fatigue, cough, among others, and the Nursing Diagnoses at higher risk of mortality were Ineffective protection, Ineffective tissue perfusion, Contamination, Ineffective Breathing Pattern, Impaired spontaneous ventilation, Acute confusion, Frailty syndrome, Obesity, and Decreased cardiac output. It is worth mentioning that there was little information about the diagnoses of Domains 9, 10, and 12. This research infers the need to monitor the clinical indicators dyspnea, fever, fatigue, cough, among others, and the Nursing Diagnoses with the highest risk of mortality Ineffective protection, Ineffective tissue perfusion, Contamination, Ineffective Breathing Pattern, Impaired spontaneous ventilation in critically ill patients.

NURSING CARE OF PATIENT WITH SEPSIS DUE TO BLAST INJURY

Blast injury is an injury due to the mechanism of barotrauma (involving excessive pressure) which results in organ trauma. Trauma and extensive injury can progress to sepsis condition to the patient. A man is hospitalized due to blast injury. The patient suffered a third-degree burn involving 18% total body surface area locate in the abdomen and right thigh, and right femoral trauma. The patient has right hip disarticulation and abdominal wound debridement surgery. After surgery, the patient has decreased consciousness and respiratory failure so that he was treated in the intensive care unit. The nursing assessment identified that patient has sepsis conditions. Nursing problems of the patient are ineffective airway clearance, impaired spontaneous ventilation, the risk for shock, and impaired tissue integrity. The nurse performs nursing care to maintain airway patency, provide adequate ventilation, maintain hemodynamic stability, and optimize the wound healing process of the patient.

Accuracy of Defining Characteristics for Nursing Diagnoses Related to Patients with Respiratory Deterioration.

To evaluate accuracy of defining characteristics (DCs) for impaired gas exchange (IGE), impaired spontaneous ventilation (ISV), and ineffective breathing pattern (IBP) in respiratory deterioration. This study is a retrospective analysis of medical records. The accuracy and predictive ability of DC or of clusters are calculated. In this study, 391 records were evaluated. For IGE, DCs or clusters with higher efficiency were "hypercapnia" (78%), "somnolence" (74.4%), and "hypercapnia+tachycardia" (88%); for ISV, the cluster with higher efficiency was "increased heart rate±decrease in cooperation" (70.1%); and for IBP, no DC or cluster exceeded 70% efficiency. These were confirmed by logistic regression. Few DCs had adequate efficiency for respiratory nursing diagnoses, while in some cases clusters accounted for higher efficiency. Clusters of DC may be relevant for respiratory diagnoses.

Prevalência dos diagnósticos de enfermagem respiratórios em Unidades de Terapia Intensiva Neonatal

Identificar a prevalência dos diagnósticos de enfermagem: Padrão respiratório ineficaz (PRI), Troca de gases prejudicada (TGP) e Ventilação espontânea prejudicada (VEP) e de seus indicadores clínicos em recém-nascidos internados em Unidades de Terapia Intensiva Neonatal. Estudo de abordagem quantitativa, transversal, com 154 recém-nascidos. Os dados foram coletados pela inspeção e avaliação da gasometria. Para análise, foram utilizados: Teste Qui-quadrado de Pearson e teste exato de Fisher. Os diagnósticos apresentaram prevalência elevada: VEP 94,2%; TGP 88,3% e PRI 87,7%. Dispneia e Uso aumentado de musculatura acessória foram os indicadores clínicos mais prevalentes de VEP e PRI. Para TGP, Dispneia e Cor da pele anormal. A associação evidenciou correlação significante para alguns indicadores prevalentes: dispneia, pressão parcial de oxigênio diminuída/hipoxemia, uso aumentado de musculatura acessória, padrão respiratório anormal, taquipneia, bradpneia, dióxido de carbono diminuído e gases sanguíneos arteriais.VEP, TGP e PRI apresentaram alta prevalência em recém-nascidos das Unidades de Terapia Intensiva.

SEQUÊNCIA DE ROBIN ISOLADA: DIAGNÓSTICOS DE ENFERMAGEM

RESUMO Objetivo: identificar os diagnósticos de enfermagem em lactentes com Sequência de Robin isolada. Método: estudo descritivo desenvolvido em um hospital especializado em anomalias craniofaciais e síndromes relacionadas, no período de novembro de 2015 a março de 2016. Participaram 20 lactentes com Sequência de Robin isolada. Para a coleta de dados utilizou-se o histórico de enfermagem. Os diagnósticos de enfermagem foram elencados segundo a Nanda-Internacional. Para confecção dos resultados utilizou-se a análise estatística descritiva. Resultados: foram identificados oito diagnósticos, sendo cinco com foco no problema e três de risco, incluindo: risco de aspiração (n=20, 100%); risco de infecção (n=20, 100%); amamentação ineficaz (n=19, 95%); nutrição desequilibrada: menor do que as necessidades corporais (n=19, 95%); padrão ineficaz de alimentação do lactente (n=19, 95%); risco de integridade da pele prejudicada (n=18, 90%); desobstrução ineficaz das vias aéreas (n=11, 55%) e ventilação espontânea prejudicada (n=11, 55%). Conclusão: lactentes com Sequência de Robin isolada apresentaram diagnósticos de enfermagem que se relacionaram a problemas respiratórios, alimentares, de segurança e conforto e favoreceram o planejamento e implementação dos cuidados de enfermagem ao traçarem um perfil assistencial.

Frequency of Respiratory Nursing Diagnoses and Accuracy of Clinical Indicators in Preterm Infants.

To identify the frequency of the nursing diagnoses, ineffective breathing pattern, impaired gas exchange and impaired spontaneous ventilation in newborns; and, to analyze the accuracy of diagnostic indicators identified for each of these diagnoses. This was a cross-sectional study conducted with a nonprobability sample of 92 infants. Data collected were represented by demographic and clinical variables, clinical indicators of the three respiratory nursing diagnoses from NANDA International, and were analyzed according to frequency and agreement between pairs of expert nurses (Kappa). Ineffective breathing pattern was identified in 74.5% of infants; impaired gas exchange was noted in 31.5%; impaired spontaneous ventilation was found in 16.8% of subjects. Use of accessory muscles to breathe showed the highest sensitivity for ineffective breathing pattern; abnormal blood gases had the best predictive value for impaired gas exchange. Use of accessory muscles to breathe had the highest sensitivity for impaired spontaneous ventilation. Ineffective breathing pattern was the most frequently identified; use of accessory muscles, alteration in depth of breathing, abnormal breathing, and dyspnea were the most representative signs/symptoms. Early recognition of respiratory conditions can support safe interventions to ensure appropriate outcomes.

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

ABSTRACTObjective: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.

Nursing diagnoses and theoretical frameworks in neonatal units: a literature review.

To identify nursing diagnoses and theoretical frameworks used in neonatal units through a literature review. Cinahl, Medline and Lilacs, database were used to perform this study. The descriptors used were: "Nursing Diagnosis" AND "Models, Nursing" OR "Nursing Theory" AND "Infant" OR "Newborn". The search was limited to articles published from 2000 to November 2013. Studies were selected only if they were written in English, Spanish, Portuguese and Italian. In the literature review two taxonomies and six major theoretical frameworks were identified. The most frequently detected nursing diagnoses were: activity intolerance, impaired spontaneous ventilation, ineffective breathing pattern, risk for aspiration, delayed growth and development, Ineffective breastfeeding, Ineffective infant feeding pattern, hyperthermia / hypothermia, risk for infection, impaired tissue integrity, Interrupted family processes, risk for impaired parenting, risk for impaired attachment, interrupted family processes. Diagnoses applying to parents' psychosocial sphere were identified, enabling the newborn's integral evaluation, including the family. Nursing diagnoses provide nurses working in neonatal units the opportunity of an effective management of the care process as well as the availability of the needed data in order to continuously improve a quality-based nursing care. The use of one model or more reference models represents a way to help professional action.

Adecuación de las características definitorias en los diagnósticos de deterioro del intercambio de gases y de la ventilación espontánea en niños asmáticos

To determine the diagnostic accuracy measures of defining characteristics of respiratory nursing diagnoses "impaired gas exchange" and "impaired spontaneous ventilation" in asmathics children in emergency department. Observational, descriptive transversal study developed between April and September 2013 in a hospital in northeastern Brazil with a sample of 205 children. Diagnoses were established by nurses trained experts in this field. Measures of sensitivity, specificity, positive and negative value prediction right positive and negative likelihood ratio and diagnostic odds for the defining characteristics identified were calculated. 28.8% of the evaluated children had "impaired gas exchange". Dyspnea, abnormal breathing, tachycardia and hypoxemia had higher frequencies. Hypoxemia presented as clinical feature high sensitivity and specificity. 5.9% of the evaluated children had "impaired spontaneous ventilation" and their most frequent defining characteristics were dyspnea, increased heart rate and decreased SaO2. The increasing use of accessory muscles to breathe presented the best measures of validity for this diagnosis. The hypoxemia and increased use of accessory muscles presented the best measures of the validity respectively to "deterioration in gas exchange" and "impairment of spontaneous ventilation". These characteristics is necessary to provide for adequate definition and use of diagnostics in clinical practice.

Diagnósticos de enfermagem mais frequentes em uma unidade de terapia intensiva pediátrica

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

Conceptual validation of the defining characteristics of respiratory nursing diagnoses in neonates

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.

Nursing diagnoses in trauma victims with fatal outcomes in the emergency scenario

The objective of this study was to identify and analyze the nursing diagnoses that constitute risk factors for death in trauma victims in the first 6 hours post-event. This is a cross-sectional, descriptive and exploratory study using quantitative analysis. A total of 406 patients were evaluated over six months of data collection in a tertiary hospital in the municipality of São Paulo, according to an instrument created for this purpose. Of the total, 44 (10.7%) suffered death. Multivariate analysis indicated the nursing diagnoses ineffective respiratory pattern, impaired spontaneous ventilation, risk of bleeding and risk of ineffective gastrointestinal tissue perfusion as risk factors for death and ineffective airway clearance, impaired comfort, and acute pain as protective factors, data that can direct health teams for different interventionist actions faced with the complexity of the trauma.

Diagnósticos de enfermagem respiratórios para crianças com infecção respiratória aguda

OBJETIVOS: Identificar a prevalência dos diagnósticos de enfermagem: Padrão respiratório ineficaz (PRI), Desobstrução ineficaz de vias aéreas (DIVA), Troca de gases prejudicada (TGP) e Ventilação espontânea prejudicada (VEP) suas características definidoras e fatores relacionados, em crianças com infecção respiratória aguda. MÉTODOS: Estudo de abordagem quantitativa, transversal, com 151 crianças. Os dados foram coletados por meio de entrevista e de avaliação pulmonar. Para análise dos dados, foi utilizada a estatística descritiva e inferencial. RESULTADOS: O diagnóstico mais prevalente foi PRI. Ruídos adventícios respiratórios e tosse ineficaz foram às características definidoras mais prevalentes. Ruídos adventícios respiratórios aumentam em 80% a chance para DIVA. Entre os fatores relacionados, destacaram-se: secreções nos brônquios e secreções retidas. Secreções nos brônquios favorecem em 80% a ocorrência de PRI e em 60% de DIVA. Verificou-se associação estatisticamente significante entre as características e fatores relacionados com os diagnósticos estudados. CONCLUSÃO: Os quatro diagnósticos foram identificados em crianças com infecções respiratórias agudas, apresentando prevalências distintas.

Intervenção e atividades propostas para o diagnóstico de enfermagem: ventilação espontânea prejudicada

Este estudo teve como objetivo investigar as intervenções e atividades de enfermagem propostas pela literatura para o diagnóstico de enfermagem ventilação espontânea prejudicada. Trata-se de uma revisão integrativa da literatura, nos bancos de dados MEDLINE e LILACS, utilizando os unitermos: Ventilação Mecânica, Diagnóstico de Enfermagem, Cuidados Intensivos e Cuidados de Enfermagem. A amostra foi constituída de 15 artigos, em oito deles foram identificados 20 cuidados que poderiam se relacionar às intervenções e atividades de enfermagem aplicadas ao paciente em ventilação mecânica, propostas na Classificação das Intervenções de Enfermagem. Entre esses cuidados, apenas oito equivaleram-se às intervenções prioritárias. Mas, nas intervenções sugeridas existem atividades para praticamente todos os cuidados desta revisão. Este estudo demonstrou que, apesar da importância dos cuidados aplicados aos pacientes em ventilação mecânica, estes, não são considerados como específicos da enfermagem, e a maioria não está presente na literatura.

Ventilatory weaning: a case study of protracted weaning

Dysfunctional ventilatory weaning response (DVWR) is characterized by interrupted and prolonged weaning. This reflective analysis presents how using nursing diagnoses in critical care can raise awareness of, and provide strategies for, managing problems related to ventilatory weaning. To examine and reflect upon why one patient took so long to wean from the ventilator using the structured approach of instrumental case study and nursing diagnosis to explain aspects of the weaning process. This case study examines one patient's experiences around ventilatory weaning using selected nursing diagnoses, exploring the implications that physiological, social, emotional and psychological factors have on both weaning and healing processes in critical care. By using dialogue, an explicit texture is presented of how one patient felt, with particular resonance to the relationships she had and the impact they made. Various nursing diagnoses proved useful in determining why this patient had an extended weaning trajectory and included DVWR, ineffective breathing pattern, impaired spontaneous ventilation, anxiety and impaired verbal communication. There were specific points of interest, in particular her anxiety, which proved a major factor, and her significantly improved functional status after the critical care episode. A DVWR may be minimized by nursing presence, reassurance and respect for patient autonomy. Complex anatomy and physiology contributes to protracted weaning and a DVWR and is compounded by anxiety. Furthermore, there is a significant element of nursing care, timely reassurance and presence, which can have a positive impact on patient well-being. This reflective analysis highlights the benefits and importance of the nurse-patient relationship during what was a very protracted ventilatory wean. This shared trajectory enabled significant patient empowerment, and this case study gives the patient the voice she temporarily lost.