PURPOSE: Clinically validate (using Fehring's model) characteristics of the nursing diagnosis (ND) of decreased cardiac output (DCO) in 29 patients with decompensated heart failure.
METHODS: Cross-sectional study conducted in a Brazilian university hospital.
FINDINGS: According to the reliability rate (R) between the experts, the major characteristics (R ≥ 0.80) were fatigue, dyspnea, edema, orthopnea, paroxysmal nocturnal dyspnea, and elevated central venous pressure, and the secondary characteristics were weight gain, hepatomegaly, jugular vein distension, palpitations, crackles, oliguria, coughing, clammy skin, and skin color changes.
CONCLUSION: Characteristics with R > 0.50 and ≤1 were valid in the ND of DCO. Implications for the nursing practice: Clinical validation studies are necessary to determine the adequacy of this diagnosis and its determining characteristics with Taxonomy II.
OBJETIVO: Validar clinicamente, segundo o modelo proposto por Fehring, as características definidoras do diagnostico de enfermagem (DE) débito cardíaco diminuído (DCD) em 29 pacientes com insuficiência cardíaca congestiva descompensada.
MÉTODOS: Estudo transversal conduzido em um hospital universitário no sul do Brazil.
RESULTADOS: De acordo com a taxa de fidedignidade de Fehring (R) obtidas entre as peritas, as características definidoras consideradas maiores (R ≥ 0.80) foram fadiga, dispnéia, edema, ortopnéia, dispnéia paroxística noturna e pressão venosa central aumentada; e características secundárias foram ganho de peso, hepatomegalia, distensão da veia jugular, palpitações, crepitações, oliguria, tosse, pele fria e pegajosa e mudanças na cor da pele.
CONCLUSÃO: Características com R > 0.50 e ≤1 foram validadas para o diagnóstico débito cardíaco diminuído (DCD).
IMPLICAÇÕES PARA PRÁTICA DE ENFERMAGEM: Estudos de validação clínica são necessários para evidenciar a adequação deste diagnóstico e suas características definidoras a Taxonomia II.
BarretoS. M.JohnB. A. (2005). Sistema respiratório. InBarrosE.De AlbuquerqueG. C.PinheiroC. T. S.CzepielewskiM. A. (Eds.), Exame Clínico: Consulta rápida (2nd ed., pp.135–162). Porto Alegre, RS: Artmed.
2.
Beck-da-SilvaL.MielniczukL.LabergeM.AnselmA.FraserM.WilliamsK. (2004). Persistent orthopnea and the prognosis of patients in the heart failure clinic. Congestive Heart Failure, 10, 177–180.
3.
BioloA.NettoR.DoraJ. M.PolanczykC. A. (2005). Exame do sistema cardiovascular. InBarrosE. J. G.De AlbuquerqueG. C.PinheiroC. T. S.CzepielewskiM. A. (Eds.), Exame Clínico (pp.163–182). Porto Alegre, RS: Artmed.
4.
BoeryR. N. S. O.QuatriniH. C. P. G.BarrosA. L. B. L. (2005). Definições operacionais das características definidoras do diagnóstico de enfermagem volume de líquidos excessivo. Acta Paulista de Enfermagem, 18(2), 197–202.
5.
BraunwaldE.BristowM. R. (2000). Congestive heart failure: Fifty years of progress. Circulation, 102(Suppl. 4), 14–23.
6.
CarelsR. A. (2004). The association between disease severity, functional status, depression and daily quality of life in congestive heart failure patients. Quality Life Research, 13(1), 63–72.
7.
CarlsonK. J. L. D.GorollA. H.LeahyM.JohnsonR. A. (1985). An analysis of physicians' reasons for prescribing long-term digitalis therapy in outpatients. Journal of Chronic Diseases, 38(9), 733–739.
8.
CruzD. A. L. M.PimentaC. A. M. (2005). Prática baseada em evidências aplicada ao raciocínio diagnóstico. Revista Latino-Americana de Enfermagem, 13(3), 415–422.
9.
DianeM. F. B. (2005). Critical thinking and patient outcomes: A review. Nursing Outlook, 53(2), 59–65.
10.
DoughertyC. M. (1985). The nursing diagnosis of decreased cardiac output. Nursing Clinics of North America, 20(4), 787–799.
11.
DraznerM. H.RameE.PhilM.StevensonL. W.DriesD. L. (2001). Prognostic importance of elevated jugular pressure and a third heart sound in patients with heart failure. New England Journal of Medicine, 345(8), 574–581.
12.
FalkK.SwedbergK.Gaston-JohanssonF.EkmanI. (2007). Fatigue is a prevalent and severe symptom associated with uncertainty and sense of coherence in patients with chronic heart failure. European Journal of Cardiovascular Nursing, 6(2), 99–104.
FriedmanM. M.KingK. B. (1995). Correlates of fatigue in older women with heart failure. Heart & Lung, 24(6), 512–518.
15.
GarciaT. R. (1998). Modelos metodológicos para validação de diagnósticos de enfermagem. ACTA Paulista de Enfermagem, 11(3), 24–31.
16.
GordonM. (1994). Nursing diagnosis: Process and application. St. Louis, MO: Mosby.
17.
KennethD.Cohen-SolalA.FilippatosG.McMurrayJ. J. V.PonikowskiP.Poole-WilsonP. A., . . . SwedbergK. (2008). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. European Heart Journal, 29, 2388–2442.
18.
LunneyM. (2003). Critical thinking and accuracy of nurses' diagnoses. International journal of nursing terminologies and classifications, 14(3), 96–107.
19.
MaiselA.HollanderJ. E.GussD. M. P.NowakR.GreenG.SaltzbergM., . . . JesseR. (2004). Primary results of the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT). A multicenter study of B-type natriuretic peptide levels, emergency department decision making, and outcomes in patients presenting with shortness of breath. Journal of the American College of Cardiology, 44(6), 1328–1333.
20.
ManginiS.SilveiraF. S.SilvaC. P.GrativolP. S.SeguroL. F. B. d. a. C.FerreiraS. M. A., . . . BocchiE. A. (2008). Insuficiência Cardíaca Descompensada na Unidade de Emergência de Hospital Especializado em Cardiologia. Arquivos Brasileiros de Cardiologia, 90(6), 400–406.
NohriaA.TsangS. W.FangJ. C.LewisE. F.JarchoJ. A.MudgeG. H. (2003). Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. Journal of the American College of Cardiology, 41(10), 1797–1804.
24.
OlivaA. P.CruzD. A. M. (2002). Diagnóstico de Débito Cardíaco Diminuído: validação clínica no pós-operatório de cirurgia cardíaca. Ciência, Cuidado e Saúde, 1, 201–205.
25.
ParkerJ. L.FluckerC. J.HarveyN.MaguireA. M.RussellW. C.ThompsonJ. P. (2002). Comparison of external jugular and central venous pressures in mechanically ventilated patient. Anaesthesia, 57(6), 596–600.
26.
PeggyD. B. (2006). Sinais e Sintomas. Consedey CH, Trans. (1st ed.). Rio de Janeiro, RJ: Guanabara Koogan.
27.
PereiraA. (2006). Guia Prático de Utilização do SPSS: Análise de Dados Para Ciências Sociais e Psicologia. Lisboa, LX: Sílabo.
28.
PortillaD.ShaverM. J. (2005). Insuficiência renal aguda. InAndreoliT. E.CarpenterC. C. J.GringsR. C.LoscalzoJ. (Eds.), Cecil-Medicina Interna Básica (6th ed., pp.299–308). Rio de Janeiro, RJ: Elsevier.
29.
RabeloE. R.AlitiG. B.DominguesF. B.RuschelK. B.BrunA. O. (2007). What to teach to patients with heart failure and why: The role of nurses in heart failure clinics. Revista Latino-americana de Enfermagem, 15(1), 165–170.
30.
RabeloE. R.AlitiG. B.GoldraichL.DominguesF. B.ClausellN.RhodeL. E. (2006). Manejo não-farmacológico de pacientes com insuficiência cardíaca em Hospital Universitário. Arquivos Brasileiros de Cardiologia, 87(3), 317–323.
31.
RohdeL. E.Beck-da-SilvaL.GoldraichL.GrazziotinT. C.PalombiniD. V.PolanczykC. A., et al. (2004). Reliability and prognostic value of traditional signs and symptoms in outpatients with congestive heart failure. Canadian Journal of Cardiology, 20(7), 697–702.
32.
SarkarS.AmelungP. J. (2006). Evaluation of the dyspneic patient in the office. Primary Care, 33(3), 643–657.
33.
SauerJ.RabeloE. R.CastroR. A.GoldraichL.RohdeL. E.ClausellN., et al. (2010). Nurse's performance in classifying heart failure patients based on physical exam: Comparison with cardiologist's physical exam and levels of NT-ProBNP. Journal of Clinical Nursing, in press.
34.
ShahM. R.HasselbaldV.StinnettS. S.GheorhiadeM.SwedbergK.CaliffR. M., et al. (2001). Hemodynamic profiles of advanced heart failure: Association with clinical characteristics and long-term outcomes. Journal of Cardiac Failure, 7, 107–113.
35.
ShiberJ. R.SantanaJ. (2006). Dyspnea. Medical Clinics of North America, 90, 453–479.
36.
StevensonL. W.PerloffJ. K. (1989). The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. Journal of the American Medical Association, 10(6), 884–888.
37.
VinayakA. G.LevittJ.GehlbachB.PohlmanA. S.HallJ. B.KressJ. P. (2006). Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients. Archives of Internal Medicine, 166(19), 2132–2137.
38.
WangC. S.FitzGeraldJ. M.SchulzerM.MakE.AyasN. T. (2005). Does this dyspneic patient in the emergency department have congestive heart failure?Journal of the American Medical Association, 294(15), 1944–1956.
39.
ZeitounS. S.BarrosA. L. B. L. D.MichelJ. L. M.BettencourtA. R. C. D. (2007). Clinical validation of the signs and symptoms and the nature of the respiratory nursing diagnoses in patients under invasive mechanical ventilation. Journal of Clinical Nursing, 16, 1417–1426.
