Teoría de medio alcance para el diagnóstico de enfermería Volumen de Liquidos Excesivo en gestantes

Fróes, Nathaly Bianka Moraes; Lopes, Marcos Venícios de Oliveira; Pontes, Cleide Maria; Ferreira, Gabriele Lima; Aquino, Priscila de Souza

doi:10.1590/0034-7167-2019-0334

Brasil

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REVIEW • Rev. Bras. Enferm. 73 (suppl 4) • 2020 • https://doi.org/10.1590/0034-7167-2019-0334 linkcopiar

Teoría de medio alcance para el diagnóstico de enfermería Volumen de Liquidos Excesivo en gestantes

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo: Establecer una teoría de medio alcance para la comprensión de los mecanismos causales y consecuencias clínicas del diagnóstico de enfermería Volumen de Líquidos Excesivo (00026) en gestantes.

Métodos: La teoría de medio alcance ha sido construida en cinco etapas: Definición del abordaje de construcción; Definición de los conceptos principales; Desarrollo de un esquema pictorial; Construcción de las proposiciones; y Establecimiento de las relaciones de causalidad y de evidencias para la práctica.

Resultados: Han sido identificados 14 indicadores clínicos y 6 factores causales de Volumen de Líquidos Excesivo. Ha sido construido un diagrama pictorial y establecidas relaciones entre los elementos de Volumen de Líquidos Excesivo, con seis proposiciones para ellos.

Conclusión: La teoría de medio alcance incluyó condiciones fisiológicas y patológicas para explicar el Volumen de Líquidos Excesivo; ella puede ayudar en la mejor comprensión de las interacciones entre los factores casuales e indicadores clínicos de Volumen de Líquidos Excesivo.

Descriptores: Diagnóstico de Enfermería; Embarazo; Teoría de Enfermería; Revisión; Salud de la Mujer

Clinical Indicators of Excess fluid volume found in the Integrative Review
Edema	Conceptual definition: Edema is the fluid retention in the interstitial space that might be local or generalized⁽¹⁵⁾.
Decreased hematocrit	Conceptual definition: Hematocrit indicates the percentage of red blood cells that is present in a certain amount of blood. During the gestational period, the increase of plasma on blood volume surpasses the increase of erythrocytes number, leading to hemodilution. Average values of hematocrit for pregnant women are between 35% and 48%. If the value is below average, it means that there is few number of erythrocytes for the blood volume⁽²⁾.
Decreased hemoglobin	Conceptual definition: Hemoglobin is a protein that is inside red blood cells and transports oxygen from the lungs to the body cells. During gestation, the phenomenon of hemodilution leads to a decrease of hemoglobin values in the pregnant women. The usual values of hemoglobin during pregnancy are above 11 g/dl⁽²⁾.
Dyspnea	Conceptual definition: Subjective feeling of respiratory difficulty or respiratory discomfort⁽⁵⁾.
Pulmonary congestion	Conceptual definition: Pulmonary congestion occurs when fluid infiltrates in the lungs faster than it is eliminated, this interferes with gas exchange at alveolar level⁽¹⁶⁾.
Excessive weight gain in a short period of time	Conceptual definition: During pregnancy, there are acceptable weight gain ranges in each gestational trimester and pregnant women nutritional status. Brasil (2012) stablishes the following values to weight gain in pregnant women:
		BMI (Body Mass Index)	Total Weight Gain on 1^st trimester	Weekly Weight Gain on 2^nd and 3^rd trimester	Total Weight Gain on gestation
		Low weight	2.3	0.5 kg	12.5-18 kg
		Adequate	1.6 kg	0.4 kg	11.5-16 kg
		Overweight	0.9 kg	0.3 kg	7-11.5 kg
		Obesity	-	0.3 kg	7 kg
	Source: Brasil, 2012.

	For example, a weekly gestational weight gain of 400g during the second trimester on a pregnant woman with adequate BMI before pregnancy is something that needs to be assessed.
Alteration in blood pressure	Conceptual definition: Observation of absolute tensional levels equal or higher than 140mmHg of Systolic Pressure and equal or higher than 90mmHg of Diastolic Pressure, sustained in repeated measurements, under ideal conditions, in at least three occasions⁽¹⁷⁾.
Alteration in arterial pulmonary pressure	Conceptual definition: Arterial pulmonary pressure above usual values. Average value of systolic arterial pulmonary pressure is 25mmHg and average diastolic pulmonary pressure is 8mmHg, medium arterial pulmonary pressure is 15mmHg⁽²⁾.
Increase in central venous pressure	Conceptual definition: Central venous pressure is regulated by the balance between heart capacity of pumping the blood outside the right atrium and ventricle to the lungs and the tendency of the blood to flow from peripheral veins to the right atrium. Its normal values are 2-8mmHg (using pressure transducer) or 3-11 cmH2O (using saline solution scale)⁽²⁾.
Oligury	Conceptual definition: Decreased urinary output, despite regular fluid ingestion⁽⁵⁾.
Orthopnea	Conceptual definition: Respiratory difficulty that appears when patient is in supine position⁽⁵⁾.
Paroxysmal nocturnal dyspnea	Conceptual definition: Situation in which the patient has her sleep interrupted due to the breathing difficulty, needing to sit or stand up in order to obtain relief of the respiratory discomfort⁽¹⁸^-¹⁹⁾.
Anasarca	Conceptual definition: Generalized edema (face, upper and lower limbs), resulting from fluid retention in the tissues⁽¹⁷⁾.

Etiological factor	n	%
Chronic diseases	10	30
Vascular alterations related to pregnancy diseases	8	25
Excessive sodium intake	7	21
Hormonal changes	5	17
Mechanical factor	4	12
First pregnancy	3	9
Extremes of reproductive age	3	9
Clinical indicator	n	%
Edema	10	30
Decrease in hematocrit	4	12
Decrease in hemoglobin	4	12
Dyspnea	4	12
Pulmonary congestion	4	12
Weight gain over short period of time	4	12
Alteration in blood pressure	3	9
Alteration in pulmonary artery pressure	2	6
Increase in central venous pressure (CVP)	2	6
Oligury	2	6
Orthopnea	2	6
Paroxysmal nocturnal dyspnea	2	6
Anasarca	1	6

Author/Year	Title	Study desing
Moura et al. (2010)⁽²¹⁾	Fatores de risco para síndrome hipertensiva específica da gestação entre mulheres hospitalizadas com pré-eclâmpsia.	Cross-sectional study
Leite, Nóbrega & Nóbrega (2009)⁽²²⁾	Diagnósticos de enfermagem em gestantes atendidas em unidade de saúde da família.	Retrospective study
Kojima et al. (2013)⁽²³⁾	Unusual clinical course of preeclampsia heralded by generalized edema.	Clinical case
Ponnapula & Boberg (2010)⁽²⁴⁾	Lower Extremity Changes Experienced During Pregnancy.	Retrospective study
Santana et al. (2015)⁽²⁵⁾	Food consumption patterns during pregnancy: a longitudinal study in a region of the North East of Brazil.	Prospective cohort study
Costa, Brum & Lima (2009)⁽²⁶⁾	Anemia e marcadores séricos da deficiência de ferro em grávidas atendidas na rede pública municipal de Manaus.	Descriptive transversal study
Gernand et al. (2012)⁽²⁷⁾	Maternal Nutritional Status in Early Pregnancy Is Associated with Body Water and Plasma Volume Changes in a Pregnancy Cohort in Rural Bangladesh.	Cluster randomized trial
Kaaja & Greer (2005)⁽²⁸⁾	Manifestations of chronic disease during pregnancy.	Integrative review
Abbas, Lester & Connolly (2005)⁽²⁹⁾	Pregnancy and the cardiovascular system.	Integrative review
Bauer & Cleary (2009)⁽³⁰⁾	Cardiopulmonary complications of pre-eclampsia.	Integrative review
Bobrowski (2010)⁽³¹⁾	Pulmonary physiology in pregnancy.	Integrative review
Higton, Whale & Musk (2009)⁽³²⁾	Pulmonary hypertension in pregnancy: two cases and review of the literature.	Clinical case
Gei & Rueda (2014)⁽³³⁾	Pulmonary Hypertension and Pregnancy: An Overview.	Overview
Mamun et al. (2011)⁽³⁴⁾	Associations of maternal pre-pregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay.	Cohort study
Belen, Tipi & Bayyigit (2015)⁽³⁵⁾	Concurrent early-onset peripartum cardiomyopathy in a preeclampsia patient with acute pulmonary edema.	Clinical case
Ko et al. (2005)⁽³⁶⁾	Massive ascites complicating pre-eclampsia.	Clinical case
Razeq (2011)⁽¹⁶⁾	Obstetric emergencies: Respiratory distress.	Update review
Poole & Spreen (2005)⁽³⁷⁾	Acute pulmonary edema in pregnancy.	Integrative review
Guimarães, Barros & Gutierrez (2000)⁽⁶⁾	Identificação das características definidoras do diagnóstico de enfermagem excesso de volume de líquidos.	Exploratory study
Coelho (2004)⁽¹³⁾	Mecanismos de formação de edemas.	Integrative review
Boery, Barros & Lucena (2005)⁽¹⁴⁾	Características definidoras do diagnóstico de enfermagem: volume de líquidos excessivo.	Exploratory study
Gil et al, (2010)⁽³⁸⁾	Prevalencia de los transtornos hipertensivos del embarazo em mujeres embarazadas controladas en Assbasalud E.S.E, Manizales (Colombia), 2006 a 2008.	Cross sectional study
Albino et al. (2011)⁽³⁹⁾	Modificações da força de propulsão da marcha durante a gravidez: efeito das alterações nas dimensões dos pés.	Case control
Henry et al. (2006)⁽⁴⁰⁾	Blood Vessel Changes during Pregnancy A Review	Integrative review
Katz et al. (2008)⁽⁴¹⁾	Perfil clínico, laboratorial e complicações de pacientes com síndrome HELLP admitidas em uma unidade de terapia intensiva obstétrica.	Secondary analysis of randomized clinical trial
Mochhoury et al. (2013)⁽⁴²⁾	Body Mass Index, Gestational Weight Gain, and Obstetric Complications in Moroccan Population.	Descriptive transversal study
Reiners et al. (2009)⁽⁴³⁾	Diagnósticos de enfermagem em gestantes hipertensas.	Descriptive exploratory study
Facco (2011)⁽⁴⁴⁾	Sleep-Disordered Breathing and Pregnancy.	Integrative review
Alexander & Wilson (2013)⁽⁴⁵⁾	Hypertensive emergencies of pregnancy.	Integrative review
Mighty (2010)⁽⁴⁶⁾	Acute respiratory failure in pregnancy.	Integrative review
Gyselaers et al. (2009)⁽⁴⁷⁾	Doppler assessment of maternal central venous hemodynamics during uncomplicated pregnancy: a comprehensive review.	Integrative review
Turner (2010)⁽⁴⁸⁾	Diagnosis and management of pre-eclampsia: an update. Int J Womens Health, Los Angeles, California, USA,	Update review
Assunção et al. (2007)⁽⁴⁹⁾	Ganho ponderal e desfechos gestacionais em mulheres atendidas pelo Programa de Saúde da Família em Campina Grande, PB (Brasil)	Prospective longitudinal study
Chummun (2009)⁽⁵⁰⁾	Hypertension - a contemporary approach to nursing care.	Integrative review

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Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
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