Diagnósticos enfermeros de vigilancia, evaluación en curso y resultados en pacientes hospitalizados que sufrieron paro cardiorrespiratorio

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo Los objetivos de este estudio fueron examinar la frecuencia de los diagnósticos enfermeros basados en la vigilancia y las intervenciones documentadas en los planes de asistencia mediante sistema informático de pacientes que pasaron por paro cardiaco durante estancia hospitalaria y observar si existen diferencias en términos de perfil de los pacientes, medidas de vigilancia y resultados.

Método Descriptivo, observacional, retrospectivo, transversal, randomizado, incluyendo datos de documentación informática de pacientes que pasaron por paro cardiaco durante estancia hospitalaria en cualquiera de las 107 alas adultas de las ocho instalaciones de cuidados intensivos. Las estadísticas descriptivas fueron utilizadas para los análisis de datos. Valores P bilaterales fueron relatados.

Resultados Casi el 60% del los pacientes analizados por la gráfica electrónica tuvieron diagnóticos enfermeros de vigilancia representados en los planes de cuidados informatizados. Fueron encontradas diferencias significativas en pacientes que tuvieron dichos diagnósticos documentados y los que no los tuvieron en términos de frecuencia de mediciones de señales vitales y resultados finales.

Conclusión Los diagnósticos enfermeros de vigilancia pueden jugar un rol significativo en la prevención del deterioro agudo de pacientes adultos hospitalizados en las unidades de cuidados intensivos.

Diagnósticos de Enfermería; Paro Cardíaco; Terminología Normalizada de Enfermería; Vigilancia; Signos Vitales

Nursing diagnosis

Nursing Intervention

A nursing diagnosis is a clinical judgment – or the conclusion of several judgments – on the health status of an individual (or group), and the actual or potential consequences and reactions within the different dimensions of the individual and their integrality, in the context of their environment and particular Experience, and within the scope of professional nursing accountability, including shared responsibility with the care beneficiaries and with other healthcare providers ⁽¹⁶^-¹⁷⁾ .

A nursing intervention is a prescription of nursing care that derives from the diagnosis of a patient’s problem or response and reflects nursing management for its prevention, solving or palliation. Nursing interventions do not include the description of procedures, rather they are care prescription statements that may be detailed by adding activities or specifications aimed at clarifying or informing remarkable aspects of that intervention to assure patient safety, quality or continuity of care, or to respond to regulations, legal, ethical or cost-efficiency requirements ⁽¹⁸⁾ .

Surveillance-oriented nursing diagnoses	N	%
Risk of arrhythmia	56	21.4
Risk of acute pulmonary edema	33	12.6
Risk of atelectasis	33	12.6
Risk of sepsis	33	12.6
Risk of arrhythmia progression/recurrence	25	9.5
Risk of ischemia/hemorrhage progression/recurrence	25	9.5
Risk of pulmonary aspiration	21	8.0
Risk of hemorrhage progression/recurrence	21	8.0
Risk of hypovolemia	20	7.6
Risk of ischemia progression/recurrence	17	6.5
Risk of increased intracranial pressure	17	6.5
Risk of vasospasm	13	4.9
Risk of hypovolemic shock	10	3.8
Risk of respiratory failure progression/recurrence	9	3.4
Risk of respiratory failure	7	2.6
Risk of hemorrhage	5	1.9
Risk of ischemia/hemorrhage	5	1.9
Risk of septic shock	5	1.9
Risk of systemic inflammatory response syndrome	5	1.9
Risk of airway obstruction	4	1.5
Risk of cardiogenic shock	4	1.5
Risk of hyper/hypovolemia	4	1.5

SOND Group	No SOND Group

Variable	Mean	SD	Mean	SD	p-value
Age	73.01	(13.7)	78.18	(12.3)	0.001
AACI	6.83	(2.3)	7.01	(2.15)	0.540

	N	%	N	%	p-value

Male Gender	143	54.8	93	49.4	0.504
Previous ICU stay	54	21.0	28	11.4	0.074
Conditions for admission Cardiovascular	85	32.5	23	12.1	<0.001
Respiratory	30	11.5	29	15.3	0.428
Neurologic	48	18.3	7	3.7	<0.001
Trauma	13	4.9	41	21.6	<0.001
Digestive	19	7.2	19	10.0	0.483
Infectious	17	6.5	20	10.5	0.341
Hematology	21	8.0	11	5.8	0.619
Oncology	10	3.8	17	8.9	0.178
Nephrourinary	10	3.8	15	7.9	0.158
Metabolic	8	3.0	6	3.1	0.959
Other	0	0.0	1	0.5	0.419

Outcome	N	%	N	%	p-value

Death	154	59.0	163	86.2	<0.001
Transferred to ICU	58	22.2	11	5.8	0.001
Continuity of care at floor	49	18.7	15	7.9	0.035

SOND Group	No SOND Group				p-value

Variable	Mean	SD	Mean	SD
Mental status	259	99.2	187	99.0	0.816
Heart rate	261	100	189	100	1.000
Blood pressure	261	100	189	100	1.000
Respiratory rate	112	42.9	9	4.71	<0.001
SpaO₂	243	93.2	159	84.2	0.047
Temperature	259	99.2	189	100	0.395
Capillary glycaemia	142	54.7	88	46.5	0.284
Urine output	218	83.5	124	65.6	0.003
Micturition	251	96.2	169	89.5	0.058

Frequency of measurements
Every 12 hours or more	6	2.2	91	48.0	<0.001
Every 9-10 hours	2	0.7	23	12.1	<0.001
Every 7-8 hours	57	21.8	45	23.9	0.842
Every 5-6 hours	88	33.7	25	13.3	0.001
Every 3-4 hours	75	28.7	5	2.5	<0.001
Every 1-2 hours	33	12.6	0	0.0	<0.001

SOND Group	No SOND Group

	N	%	N	%	p
Frequency of ABPP measurements
Exceeding 6 hours	65	24.9	159	84.2	<0.001
Less than 6 hours	196	75.1	30	15.6	<0.001

Outcome
Deceased	154	59.0	163	86.2	<0.001
Transferred to ICU	58	22.2	11	5.8	0.001
Continuity of care at floor	49	18.7	15	7.9	0.035

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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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