Ineffective peripheral tissue perfusion in patients with diabetic foot: a mid-range theory

Silva, Lorrany Fontenele Moraes da; Pascoal, Livia Maia; Lima, Francisca Elisângela Teixeira; Santos, Floriacy Stabnow; Santos Neto, Marcelino; Brito, Paula dos Santos

doi:10.1590/0034-7167-2021-0113

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 74 (4) • 2021 • https://doi.org/10.1590/0034-7167-2021-0113 copy

Ineffective peripheral tissue perfusion in patients with diabetic foot: a mid-range theory

Perfusión de tejido periférico ineficaz en pacientes con pie diabético: una teoría de rango medio

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to develop a mid-range theory for nursing diagnosis ineffective peripheral tissue perfusion in patients with diabetic foot.

Method:

the theory construction was carried out in six stages: approach definition; theoretical-conceptual model definition; definition of the main concepts; pictogram development; construction of propositions and establishment of causal relationships evidence for practice.

Results:

twelve etiological factors and 22 clinical indicators were included in the theory, some of which were not listed in NANDA International (Inc.) and others were adapted to better characterize patients with diabetic foot. A pictogram was constructed and eight propositions were established to verify causal relationships and evidence for practice.

Conclusion:

medium-range theory made it possible to broaden the concepts and demonstrate the causal relationships between the elements of ineffective peripheral tissue perfusion, providing subsidies to minimize gaps in knowledge and assist clinical nursing practice.

Descriptors:
Nursing Diagnoses; Nursing Theory; Hyperglycemia; Diabetic Feet; Diabetic Vascular Complication

Components of Theory of Basic Human Needs	Mid-range theory elements
Psychobiological needs	Mid-range theory elements
Oxygenation	Cyanosis, decrease in oxygen supply
Hydration	Absence or reduction in sweating
Exercise and physical activity	Sedentary lifestyle
Body care	Smoking
Physical and cutaneous-mucosal integrity	History of pressure ulcer and previous amputation, cold foot, pallor, dystrophic nails, edema, absence of hair
Thermoregulation	Cold foot
Hormonal regulation	Diabetes diagnosis time, advanced age, dyslipidemia, increased liver enzyme
Immune regulation	Infection
Cell growth	Delay in peripheral wound healing
Vascular regulation	PAD, heart failure, rest pain, color does not return to lowered limb after 1 minute leg elevation, absence of peripheral pulses, intermittent claudication, alteration in skin color with limb elevation, ankle-brachial index<0.90, decrease in peripheral pulses, capillary refill time>3seconds, hallux-brachial index<0.7
Hydrosaline and electrolyte balance	Hypertension, decrease in blood pressure in extremities, edema
Neurological regulation, tactile and painful perception	Peripheral neuropathy, paresthesia
Motility and locomotion	Intermittent claudication
Therapy	Inadequate blood glucose monitoring
Psychosocial needs	Mid-range theory elements
Learning	Insufficient knowledge of disease
Self-esteem and self-image	Delay in peripheral wound healing, dystrophic nails, history of pressure ulcer, and previous amputation

NANDA-I⁽⁶6 Herdman TH, Kamitsuru S. Diagnósticos de Enfermagem da NANDA: definições e classificações 2018-2020. Porto Alegre: Artmed; 2018. 894p.⁾	Integrative review	Mid-range theory^* * Concepts of mid-range theory;
Insufficient knowledge of disease process	Insufficient knowledge of disease	Insufficient knowledge of disease^ Concepts adapted from NANDA-I.
Insufficient knowledge of modifiable risk factors	Insufficient knowledge of disease
Sedentary lifestyle	Sedentary lifestyle	Sedentary lifestyle
Smoking	Smoking	Smoking
Excessive sodium intake	Hypertension	Hypertension
Hypertension	Hypertension	Hypertension
Diabetes Mellitus	Inadequate blood glucose monitoring	Inadequate blood glucose monitoring
	Peripheral neuropathy	Peripheral neuropathy
	Diabetes diagnosis time	Diabetes diagnosis time
Endovascular procedure	Not identified	Excluded
Trauma	Not identified	Excluded
Not identified	Advanced age	Advanced age
Not identified	Dyslipidemia	Dyslipidemia
Not identified	Elevated liver enzymes	Elevated liver enzymes
Not identified	Peripheral arterial disease	Peripheral arterial disease
Not identified	Heart failure	Heart failure

NANDA-I⁽⁶6 Herdman TH, Kamitsuru S. Diagnósticos de Enfermagem da NANDA: definições e classificações 2018-2020. Porto Alegre: Artmed; 2018. 894p.⁾	Integrative review	Mid-range theory^* * Concepts of mid-range theory;
Color does not return to lowered limb after 1 minute leg elevation	Not identified	Color does not return to lowered limb after 1 minute leg elevation
Alteration in skin characteristic	Cold foot	Cold foot
	Cyanosis	Cyanosis
	Pallor	Pallor
	Absence of hair	Absence of hair
	Dystrophic nails	Dystrophic nails
Alteration in motor functioning	Not identified	Excluded
Absence of peripheral pulses	Absence of peripheral pulses	Absence of peripheral pulses
Intermittent claudication	Intermittent claudication	Intermittent claudication
Skin color pales with limb elevation	Alteration in skin color with limb elevation	Alteration in skin color with limb elevation^ Concepts adapted from NANDA-I.
Decrease in blood pressure in extremities	Not identified	Decrease in blood pressure in extremities
Distance in the 6-minute walk test below normal range	Not identified	Excluded
Decrease in pain-free distances achieved in the 6-minute walk test	Not identified	Excluded
Extremity pain	Rest pain	Rest pain^ Concepts adapted from NANDA-I.
Edema	Edema	Edema
Ankle-brachial index<0.900	Ankle-brachial index<0.90	Ankle-brachial index<0.90
Paresthesia	Paresthesia	Paresthesia
Decrease in peripheral pulses	Decrease in peripheral pulses	Decrease in peripheral pulses
Delay in peripheral wound healing	Delay in wound healing	Delay in peripheral wound healing
Femoral bruit	Not identified	Excluded
Capillary refill time>3seconds	Decrease in peripheral perfusion	Capillary refill time>3seconds
Not identified	Hallux-brachial index<0.75	Hallux-brachial index<0.75
Not identified	Absence or reduction in sweating	Absence or reduction in sweating
Not identified	Infection	Infection
Not identified	Decrease in oxygen supply	Decrease in oxygen supply
Not identified	History of pressure ulcer and previous amputation	History of pressure ulcer and previous amputation

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[1] Corresponding author: Lorrany Fontenele Moraes da Silva E-mail: lorranyfontinelle@hotmail.com