Fatigue in patients with heart failure: A study of diagnostic accuracy fatigue in patients with heart failure.

PURPOSE: To analyze the accuracy of defining characteristics of the NANDA International nursing diagnosis, fatigue (00093), in patients with heart failure. METHODS: A cross-sectional study on the diagnostic accuracy of the defining characteristics of the nursing diagnosis. The sample consisted of 96 patients with heart failure in treatment in a public hospital. The latent class analysis method was used to test the accuracy measurements and estimate the prevalence of the diagnosis. The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte. RESULTS: The prevalence of the fatigue nursing diagnosis was 42.54%. Increased physical symptoms (0.9988) and tiredness (0.9988) were the sensitive defining characteristics. Disinterested in surroundings (0.9999) was the specific defining characteristics. CONCLUSIONS: A set of three defining characteristics of the nursing diagnosis of fatigue was accurate in patients with heart failure. Thus, this set can be used by nurses to confirm nursing diagnosis fatigue in patients with heart failure. IMPLICATIONS FOR NURSING PRACTICE: This research contributes by providing accurate defining characteristics of fatigue in patients with heart failure. Thus, nurses should recognize the nursing diagnosis of fatigue in patients with heart failure through accurate defining characteristics and propose rapid and effective nursing interventions that have positive health results.

Predictors of pressure ulcer risk in adult intensive care patients: A retrospective case-control study.

OBJECTIVES: To evaluate the predictive power of risk factors for pressure ulcers in adult intensive care patients. METHOD: A retrospective case-control study was performed utilising a heterogeneous sample group allocated into a case group with pressure ulcers (n=90) and a control group without pressure ulcers (n=90). The analysis explored the predictive power of risk factors for pressure ulcers using a hierarchical logistic regression model. RESULTS: The risk factors that predicted pressure ulcers were friction (OR=5.97), previous history of pressure ulcers (OR=5.43), prolonged intensive care unit stay (OR=3.92), dehydration (OR=3.18), elevated skin temperature by 1-2°C (OR=3.12) and treatment of other comorbidities (OR=2.79). CONCLUSION: Adult intensive care patients have an increased risk of developing a pressure ulcer. These risk factors are regarded as strong predictors for pressure ulceration. This study advances nursing knowledge in that it investigates additional risk factors for the development of pressure ulcers and it identifies a set of factors that best predict their occurrence, which may contribute to the nurses' diagnostic reasoning in the intensive care unit.

Clinical validation of the nursing diagnosis of ineffective protection in haemodialysis patients.

AIMS AND OBJECTIVES: To evaluate the clinical validity of indicators of the nursing diagnosis of "ineffective protection" in haemodialysis patients. BACKGROUND: Haemodialysis patients have reduced protection. Studies on the nursing diagnosis of "ineffective protection" are scarce in the literature. The use of indicators to diagnose "ineffective protection" could improve the care of haemodialysis patients. The clinical usefulness of the indicators requires clinical validation. DESIGN: This was a diagnostic accuracy study. METHOD: This study assessed a sample of 200 patients undergoing haemodialysis in a reference clinic for nephrology during the first half of 2015. Operational definitions were created for each clinical indicator based on concept analysis and content validation by experts for these indicators. Diagnostic accuracy measurement was performed with latent class analysis with randomised effects. RESULTS: The clinical indicator of "fatigue" had high sensitivity (p = .999) and specificity (p = 1.000) for the identification of "ineffective protection." Additionally, "maladaptive response to stress" (p = .711) and "coagulation change" (p = .653) were sensitive indicators. The main indicators that showed high specificity were "fever" (p = .987), "increased number of hospitalisations" (p = .911), "weakness" (p = .937), "infected vascular access" (p = .962) and "vascular access dysfunction" (p = .722). CONCLUSION: A set of nine clinical indicators of "ineffective protection" were accurate and statistically significant for haemodialysis patients. Three clinical indicators showed sensitivity, and six indicators showed specificity. RELEVANCE TO CLINICAL PRACTICE: Accurate measures for nursing diagnoses can help nurses confirm or rule out the probability of the occurrence of "ineffective protection" in patients undergoing haemodialysis.

Características psicológicas e cognitivas relacionadas aos aspectos clínicos e socioeconômicos dos pacientes em hemodiálise / Características psicológicas y cognitivas relacionadas con los aspectos clínicos y socioeconómicos de los pacientes en hemodiliásis / Psychological and cognitive characteristics related to clinical and socioeconomic aspects of hemodialysis patients

RESUMO Introdução: a hemodiálise contribui para a eliminação de substâncias indesejáveis ao organismo, de modo a diminuir os efeitos do comprometimento da disfunção renal, mas algumas repercussões em diferentes áreas do corpo são percebidas, como as psicológicas e cognitivas. Objetivo: identificar a associação entre as características psicológicas e cognitivas do paciente em hemodiálise com seus dados clínicos e socioeconômicos. Métodos: pesquisa transversal, realizada com 100 pacientes em hemodiálise internados em um hospital universitário e atendidos em uma clínica de hemodiálise do Nordeste do Brasil. Os dados foram coletados, no período de dezembro de 2012 a abril de 2013, a partir de um formulário contendo dados socioeconômicos, clínicos, Mini Exame do Estado Mental, escala de ansiedade e critérios para a medição da agitação. Estudo aprovado pelo comitê de ética com protocolo 148.428 e Certificado de Apresentação para Apreciação Ética 08696212.7.0000.5537. Resultados: a maioria sexo feminino (52 porcento), idade média de 51,1 anos (±16,5), medianas de 6,5 anos de estudo e renda de dois salários mínimos. Dados laboratoriais: Ureia e creatinina alteradas em 100 porcento dos pacientes, potássio alterado em 73 porcento, hemoglobina (72 porcento) e hematócrito (95 porcento) diminuídos. Dados clínicos: 81 porcento hipertensos e 30 porcento diabéticos. Maioria dos pacientes ansiosa e agitada. Houve associação estatisticamente significativa entre: ansiedade e idade (p=0,030) e ansiedade e renda familiar (p=0,048). Conclusões: identificaram-se associações entre ansiedade e duas variáveis socioecômicas, idade e renda familiar, não sendo evidenciadas associações com as variáveis clínicas(AU)

RESUMEN Introducción: la hemodiálisis contribuye a la eliminación de sustancias indeseables en el cuerpo con el fin de reducir los efectos de la disfunción renal, pero algunos efectos en diferentes áreas del cuerpo se perciben como psicológico y cognitivo. Objetivo: identificar la asociación entre las características psicológicas y cognitivas del paciente en hemodiálisis con sus datos clínicos y socioeconómicos. Métodos: estudio transversal realizado con 100 pacientes de hemodiálisis en un hospital universitario y tratado en una clínica de hemodiálisis en el noreste de Brasil. Los datos fueron recolectados a partir de diciembre 2012 a abril 2013, a partir de un formulario que contiene datos socioeconómicos, clínicos, Mini Examen del Estado Mental, la escala de ansiedad y criterios para medir la agitación. Este estudio fue aprobado por el comité de ética con el protocolo 148.428 y Presentación Certificado de Evaluación Ética 08696212.7.0000.5537. Resultados: la mayoría fueron mujeres (52 por ciento), edad media 51,1 años (± 16,5), mediana de 6,5 años de estudio y de los ingresos de dos salarios mínimos. Datos de laboratorio: creatinina y urea alterada en el 100 por ciento de los pacientes, potasio modificados en 73 por ciento, disminución hemoglobina (72 por ciento) y hematocrito (95 por ciento). Datos clínicos: 81 por ciento eran hipertensos y 30 por ciento eran diabéticos. La mayoría de los pacientes estaban ansiosos y agitados. Hubo una asociación estadísticamente significativa entre: la ansiedad y la edad (p = 0,030) y la ansiedad y el ingreso familiar (p = 0,048). Conclusiones: fueron identificadas asociaciones entre la ansiedad y dos variables socioeconómicas: la edad y los ingresos familiares, no se evidenciaron asociaciones con variables clínicas(AU)

ABSTRACT Introduction: hemodialysis contributes to the elimination of undesirable substances to the body in order to reduce the effects of impaired renal dysfunction, but some effects on different body areas are perceived as psychological and cognitive. Objective: to identify the association between psychological and cognitive characteristics of the patient on hemodialysis with their clinical and socioeconomic data. Methods: cross-sectional survey conducted with 100 hemodialysis patients at a university hospital and treated at a hemodialysis clinic in northeastern Brazil. Data were collected from December 2012 to April 2013, from a form containing socioeconomic data, clinical data, Mini Mental State Examination, scale of anxiety and criteria for measuring the agitation. This study was approved by the ethics committee with protocol 148,428 and Presentation Certificate for Ethics Assessment 08696212.7.0000.5537. Results: most was female (52 percent), mean age 51.1 years (± 16.5), median of 6.5 years of study and income of two minimum salaries. Laboratory data: Urea and creatinine altered in 100 percent of patients, in 73 percent potassium modified, hemoglobin (72 percent) and hematocrit (95 percent) reduced. Clinical data: 81 percent were hypertensive and 30 percent were diabetics. Most were anxious and agitated patients. There was a statistically significant association between: anxiety and age (p = 0.030) and anxiety and family income (p = 0.048). Conclusions: there were associations between anxiety and two variables socioeconomics, age and family income, not being evidenced associations with clinical variables(AU)

Venous ulcer: risk factors and the Nursing Outcomes Classification.

OBJECTIVE: To explore the relationship between the risk factors for the development of venous ulcers and the indicators of tissue integrity from the Nursing Outcomes Classification. METHODOLOGY: A cross-sectional study conducted in 2013 in a university hospital in Natal/RN (Brazil). Fifty individuals selected by consecutive sampling participated in an interview and physical examination. RESULTS: The most important risk factors were: 44% presented with arterial hypertension, 26% allergy, 20% diabetes mellitus, 4% participated in some physical activity, 6% were smokers and 14% drank alcohol. There was a statistically significant association between diabetes mellitus and the texture of the lesion (p=0.015) and tissue perfusion (p=0.026); allergy and texture (p=0.034); physical activity and hydration (p = 0.034); smoking and thickness (p = 0.018); and alcoholism and exudate of the ulcer (p=0.045). CONCLUSION: . The relationship between risk factors and the nursing outcome indicators generated information relevant to the development of guidelines for the monitoring and treatment of venous ulcer information.