Análisis del concepto sobrecarga de líquidos en pacientes con enfermedad renal crónica en terapia dialítica: revisión integrativa

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo Analizar el concepto sobrecarga de líquidos en pacientes con enfermedad renal crónica en terapia dialítica y compararlo al diagnóstico de enfermería Volumen de líquidos excesivo presente en la NANDA Internacional.

Método Revisión integrativa de la literatura llevada a cabo en las bases LILACS, CINAHL y SCOPUS.

Resultados Se obtuvo una muestra de 22 artículos. Los atributos definidores del concepto fueron: retención de fluidos, acumulación de fluidos en el cuerpo y ganancia de peso en un corto período de tiempo, y compusieron la definición: retención de fluidos en el cuerpo (espacio intracelular/extracelular), expresado por la ganancia de peso en un corto período. Fueron identificados 21 antecedentes y 22 consecuentes de la sobrecarga de líquidos en pacientes con enfermedad renal crónica en terapia dialítica.

Conclusión La definición evidenciada por la taxonomía de la NANDA Internacional para el diagnóstico de enfermería Volumen de líquidos excesivo y los componentes de ese diagnóstico carecen de una complementación, con vistas a un mejor direccionamiento del cuidado al público con enfermedad renal en terapia dialítica.

Diagnóstico de Enfermería; Enfermedad Renal Crónica; Diálisis Renal; Revisión

Year	Country	Method	Evidence Level	Cases	Age group	Type of dialysis	Concept Uses	Concept Attributes
1992⁽⁸⁾	Germany	Quasi-experimental	Level 2	18	Children and adolescents	Hemodialysis	Medicine	-
1995⁽⁹⁾	USA	Cross-sectional study	Level 4	42	Adults	Hemodialysis	Medicine	Fluid accumulation in the body; Weight gain over a short period of time.
2002⁽¹⁰⁾	USA	Clinical pseudo essay	Level 1	468	Adults	Hemodialysis	Medicine	Weight gain over a short period of time.
2005⁽¹¹⁾	Greece	Cross-sectional study	Level 4	70	Adults	Hemodialysis	Nursing	Weight gain over a short period of time.
2005⁽¹²⁾	China	Quasi-experimental	Level 2	58	Adults	Peritoneal dialysis	Medicine	Weight gain over a short period of time.
2006⁽¹³⁾	USA	Case study	Level 4	01	Adults	Hemodialysis	Nursing	Fluid retention.
2006⁽¹⁴⁾	Brazil	Cross-sectional study	Level 4	74	Adults	Hemodialysis	Nursing	-
2007⁽¹⁵⁾	USA	Case study	Level 4	01	Adults	Hemodialysis	Nursing	Fluid accumulation; Increased extracellular/intracellular volume; Weight gain over a short period of time.
2009⁽¹⁶⁾	USA	Cohort study	Level 3	34,107	Adults	Hemodialysis	Medicine	Fluid retention; Weight gain over a short period of time.
2009⁽¹⁷⁾	Sweden	Retrospective observational study	Level 3	4,498	Adults	Hemodialysis	Medicine	Fluid retention; Weight gain over a short period of time.
2010⁽¹⁸⁾	Sweden	Cross-sectional study	Level 4	133	Adults	Hemodialysis	Nursing	Weight gain over a short period of time.
2010⁽¹⁹⁾	United Kingdom	Qualitative study	Level 4	30	Adults	Hemodialysis	Nursing	-
2011⁽²⁰⁾	Ireland	Cross-sectional study	Level 4	79	Adults	Hemodialysis	Nursing	Fluid retention.
2012⁽²¹⁾	England	Cross-sectional study	Level 4	115	Adults	Peritoneal dialysis	Medicine	-
2012⁽²²⁾	South Korea	Observational study	Level 3	172	Adults	Hemodialysis	Medicine	Fluid retention; Weight gain over a short period of time.
2012⁽²³⁾	Iran	Quasi-experimental study	Level 2	63	Adults	Hemodialysis	Nursing	Fluid accumulation in the body; Fluid retention; Weight gain over a short period of time.
2012⁽²⁴⁾	Canada	Cross-sectional study	Level 4	26	Adults	Hemodialysis	Medicine	Fluid retention.
2013⁽²⁵⁾	Austria	Cross-sectional study	Level 4	244	Adults	Hemodialysis	Medicine	-
2013⁽²⁶⁾	China	Cross-sectional study	Level 4	112	Adults	Hemodialysis	Medicine	-
2014⁽²⁷⁾	Taiwan	Observational study	Level 3	472	Adults	Hemodialysis	Medicine	-
2015⁽²⁸⁾	USA	Observational study	Level 3	39,256	Adults	Hemodialysis	Medicine	Fluid retention; Weight gain over a short period of time.
2017⁽²⁹⁾	Multi-centric	Cohort study	Level 3	21,919	Adults	Hemodialysis	Medicine	Weight gain over a short period of time.

Antecedents	Related Factors (NANDA International)⁽¹⁾
Increased renin-angiotensin-aldosterone in the blood (1 article)⁽¹³⁾	-
Increase in the sodium concentration of the dialysate (1 article)⁽²⁹⁾
Low self-efficacy (1 article)⁽¹⁸⁾	-
Comorbidities (1 article)⁽²⁵⁾	-
Diabetes (4 articles)⁽¹²^,¹⁶^-¹⁷^,²²⁾	-
Diet high in sodium (4 articles)⁽¹³^,¹⁴^-¹⁵^,²²⁾	Excess sodium intake
Difficulty in adherence to the restrictions of fluids (3 articles)⁽¹⁷^,²⁰^,²³⁾	-
Decreased glomerular filtration rate (4 articles)⁽¹³^,¹⁸^,²³^,²⁷⁾	Compromised regulatory mechanism
Daily stress (1 article)⁽⁹⁾	-
Lack of guidelines by the nutritionist (1 article)⁽¹¹⁾	-
Intermittent hemodialysis (1 article)⁽²⁸⁾	-
Men (1 article)⁽¹⁶⁾	-
High protein intake (1 article)⁽¹⁶⁾	-
Young individuals (2 articles)⁽¹⁴^,¹⁷⁾	-
Excess fluid intake (8 articles)⁽⁹^,¹³^-¹⁸^,²²⁾	Excess fluid intake
Greater experience in dialysis treatment (1 article)⁽¹⁷⁾	-
Lower body mass index (1 article)⁽¹⁷⁾	-
Lower education level (1 article)⁽¹¹⁾	-
Non-adherence to hemodialysis (1 article)⁽²⁸⁾	-
Inaccurate dry weight prescription (1 article)⁽¹⁵⁾	-
Proteinuria (1 article)⁽¹³⁾	-

Consequents	Defining characteristics (NANDA International)
Obstructive sleep apnea (1 article)⁽²⁴⁾	-
Increased Blood Pressure (10 articles)⁽⁸^-¹⁰^,¹²^-¹⁵^,¹⁷^,²⁰^,²⁸⁾	Alteration in blood pressure
Increased D-dimer (1 article)⁽²⁵⁾	-
Increased atrial natriuretic peptide in plasma (2 articles)⁽⁸^,²⁵⁾	-
Increased Cerebral Natriuretic peptide in plasma (1 article)⁽²¹⁾	-
Pulmonary congestion (5 articles)⁽⁸^,¹³^,¹⁵^,²⁰^,²⁸⁾	Pulmonary congestion
Pulmonary crackles (1 article)⁽¹³⁾	Adventitious breath sound
Decrease in hemoglobin (1 article)⁽²²⁾	Decrease in hemoglobin
Decrease in oxygen partial pressure (PaO2) (1 article)⁽¹³⁾	-
Dyspnea (6 articles)⁽⁸^-⁹^,¹⁵^,¹⁹^-²⁰^,²³⁾	Dyspnea
Cardiovascular diseases (7 articles)⁽⁹^,¹³^,¹⁹^,²³^,²⁵^-²⁶^,²⁸⁾	-
Generalized edema (1 article)⁽²³⁾	Anasarca
Peripheral edema (6 articles)⁽⁸^,¹²^-¹³^,¹⁴^-¹⁵^,¹⁹⁾	Edema
Endotoxemia (1 article)⁽¹⁴⁾	-
Weight gain over a short period of time (12 articles)⁽⁹^-¹²^,¹⁵^-¹⁸^,²²^-²³^,²⁸^-²⁹⁾	Weight gain over a short period of time
Low levels of serum albumin (1 article)⁽²⁵⁾	-
Electrolyte levels: hyponatremia and increase in phosphorus (2 articles)⁽¹³^,²²⁾	Electrolyte imbalance
Presence of S3 (1 article)⁽¹³⁾	Presence of S3 heart sound
Presence of Troponin T (1 article)⁽²⁵⁾	-
Tachycardia (2 articles)⁽⁸^,¹³⁾	-
Tachypnea (2 articles)⁽¹³^,¹⁵⁾	-
Cough (1 article)⁽¹⁵⁾	-

Model case

Contrary case

J. C., male patient, 50 years old, with Chronic Kidney Disease and on hemodialysis for 16 years. He presented a weight gain in the last 48 hours, blood pressure of 222/142 mm of mercury, heart rate of 110 per minute and respiratory rate of 24 movements per minute; the presence of fine crackles in pulmonary auscultation; flat abdomen with hydroaeric noises present, no visceromegalias; edema in the lower limb (+2/+4). The electrocardiogram revealed left ventricular hypertrophy.

J. B., male patient, 22 years old, with Chronic Kidney Disease and hemodialysis treatment for 2 years. He presented azotemia, weight loss of 0.5 kilograms in the last 48 hours and reports of diarrhea. Upon examination he demonstrated to be conscious, oriented, normocardial, normotensive, eupneic and afebrile; cardiac auscultation showed two-beat normo-phonemic sounds without blows; pulmonary auscultation showed the presence of vesicular murmurs throughout the pulmonary extension; percussion showed clear lung sounds; palpation showed good pulmonary expansion; flat abdomen, hepatomegaly to deep palpation, normoactive hydroaeric noises; edema-free limbs.

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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