Acurácia do diagnóstico de enfermagem desobstrução ineficaz das vias aéreas em pacientes internados em Unidade de Terapia Intensiva

Abstract

Nursing diagnosis Ineffective airway clearance is common among critically ill patients admitted to the intensive care unit. The adequate inference, by the nurse, of this diagnosis becomes necessary to provide a more qualified nursing care. Thus, the present study aims to analyze the accuracy of the clinical indicators of the nursing diagnosis Ineffective airway clearance in adult patients admitted to the intensive care unit. This is a cross-sectional diagnostic accuracy study. The sample consisted of 104 critically ill patients, who were consecutively and conveniently selected in a university hospital, in the northeastern Brazil. The data collection instrument was a structured script of interview and physical examination, applied from June to October 2019. To measure the accuracy of the clinical indicators of the referred diagnosis, the latent class analysis model was used. The study was approved by the Research Ethics Committee of the responsible institution, under opinion number 3,241,219 and Certificate of Presentation for Ethical Appreciation 09901619.0.0000.5537. The results indicate that the most frequent clinical indicators were dyspnea and ineffective cough and the most frequent related factors were smoking and passive smoking. The condition associated with infection was also identified in the survey as the most frequent. The sociodemographic and clinical variables that obtained a statistical association with the diagnosis were: Chronic renal failure, Chronic obstructive pulmonary disease, “Other diseases”, Eupnea and Tachypnea. Because it is also an associated condition, chronic obstructive pulmonary disease also showed a statistical association with the diagnosis. The nursing diagnosis Ineffective airway clearance had a prevalence of 36.54% in the investigated clientele. The clinical indicators specific to the diagnosis were: Change in respiratory rate; Change in breathing pattern; Absence of cough; Orthopnea; Adventitious sounds and decreased respiratory sounds. The sensitive indicators were: Change in respiratory rate and Change in breathing pattern. It is concluded that the clinical indicators Alteration of the respiratory rate and Alteration of the respiratory pattern presented better measures of accuracy for the inference of the nursing diagnosis Ineffective airway clearance in adult patients admitted to the intensive care unit. Furthermore, these results contribute to the nurse's accurate diagnostic inference process in order to improve nursing care for critically ill patients.