Características definidoras e fatores relacionados do diagnóstico de enfermagem “Perfusão Tissular Renal Ineficaz” em pacientes com insuficiência cardíaca

• Autor(a) principal: Zhao, Li Men [UNIFESP]
• Data de Publicação: 2018
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6439575; https://repositorio.unifesp.br/handle/11600/52992
• topic: Renal insufficiency; Acute kidney injury; Nursing care; Nursing diagnosis; Heart failure; Insuficiência renal; Lesão renal aguda; Cuidados de enfermagem; Diagnóstico de enfermagem; Insuficiência cardíaca

Objective: to identify the prevalence of the Nursing Diagnosis (ND) “Ineffective Renal Tissue Perfusion” (IRTP) in patients with Decompensated Chronic Heart Failure (HF). Methods: This is an observational, descriptive, crosssectional and retrospective study performed in a large public hospital, specialized in Cardiology in the city of São Paulo. The period for data collection was from August to December 2016. Sociodemographic and clinical data were collected through an instrumental developed by the researcher. The sample was consisted of 379 medical records of adult patients, admitted to the emergency department with decompensated chronic HF from January to December 2015. The sample was divided into two groups: those with IRTP (n=251, IRTP Group), and those without IRTP (n=128, Control Group). The criteria considered for the presence IRTP were: reduced Glomerular Filtration Rate (GFR), this is, GFR <60 mL/min/1.73m² and the presence of at least one or more related factors (ReF) of IRTP. The data are presented by means of descriptive statistics. For the qualitative measures were used through Fisher’s or ChiSquare tests and for the quantitative measures, the Student’st test or MannWhitney, being considered statistically significant when the p value was < 0.05. Results: the prevalence of ND “Ineffective Renal Tissue Perfusion” was 66% in patients with decompensated chronic HF. The DCs identified in the group of patients with decompensated chronic HF and the “Ineffective Renal Tissue Perfusion” were: elevated Creatinine and Urea rates (100%), reduced GFR (100%), oliguria (23,5%), and albuminuria (21,9%). The main related factors (ReFs) in the IRTP group were: the presence of comorbidities (98.4%), kidney disease (96.8%), advanced age (79.7%) and change in metabolism (27.9%). The main characteristics presented by patients of the IRTP group were: the average age 69 years, Dyslipidemia, Chronic Kidney Failure, Hypothyroidism, and using a pacemaker or implantable cardioverter defibrillator as personal background; prevalence of ischemic and chagasic etiologies of HF; inappetence, decreased urine output and the presence of nausea and vomiting as the main admission complaints; the physical examination findings were drowsiness and slow tissue perfusion; reduction in vital parameter values (blood pressure and heart rate); reduction in laboratory values of platelets and increase in potassium values, creatinine and urea levels; on chest radiography, cardiomegaly; left ventricular dysfunction by Transthoracic Echocardiography; and home use of carvedilol. There were longer hospital stays and mortality in the IRTP group. In the multiple regression analysis, it was observed that age, chronic kidney disease, nausea and vomiting, cardiomegaly and the levels of urea were clinical characteristics of great relevance for the identification of ND IRTP. Conclusions: There is a high prevalence of ND IRTP and its DCs and ReFs are indicators that should be evaluated by the nurse in these patients with decompensated chronic HF.