Clinical validation of the nursing diagnostic proposition perioperative thirst

Nascimento, Leonel Alves do; Conchon, Marilia Ferrari; Garcia, Aline Korki Arrabal; Lopes, Marcos Venícios de Oliveira; Fonseca, Lígia Fahl

doi:10.1590/1518-8345.6621.3975

Acessibilidade / Reportar erro

Brasil

Revista Latino-Americana de Enfermagem

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Latino-Am. Enfermagem 31 • 2023 • https://doi.org/10.1590/1518-8345.6621.3975 copy

Clinical validation of the nursing diagnostic proposition perioperative thirst^* * Paper extracted from doctoral dissertation “Elaboration and validation of the proposal for the Perioperative Thirst nursing diagnosis”, presented to Programa de Pós-Graduação em Enfermagem, Universidade Estadual de Londrina, Londrina, PR, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to verify the clinical validity of the proposition of a new nursing diagnosis called perioperative thirst, based on the diagnostic accuracy of its clinical indicators, including the magnitude of effect of its etiological factors.

Method:

clinical diagnostic validation study with a total of 150 surgical patients at a university hospital. Sociodemographic variables and clinical indicators related to thirst were collected. The latent class analysis technique was used.

Results:

two models of latent classes were proposed for the defining characteristics. The model adjusted preoperatively included: dry lips, thick saliva, thick tongue, desire to drink water, caregiver report, dry throat and constant swallowing of saliva. In the postoperative period: dry throat, thick saliva, thick tongue, constant swallowing of saliva, desire to drink water, bad taste in the mouth. The factors related to “high ambient temperature” and “dry mouth” are associated with the presence of thirst, as well as the associated conditions “use of anticholinergics” and “intubation”. The prevalence of thirst was 62.6% in the pre and 50.2% in the immediate postoperative period.

Conclusion:

the diagnostic proposition of perioperative thirst showed good accuracy parameters for its clinical indicators and etiological effects. This proposition in a nursing taxonomy will allow greater visibility, appreciation and treatment of this symptom.

Descriptors:
Thirst; Perioperative Nursing; Clinical Decision-Making; Nursing Methodology Research; Nursing Diagnosis; Evidence-Based Nursing

Highlights:

(1) Evaluates the accuracy of the proposition of the nursing diagnosis perioperative thirst;

(2) Allows refined diagnosis for use in clinical practice, teaching and research;

(3) Strengthens the systematization of perioperative nursing care;

(4) Highlights thirst management as part of care, considering its high prevalence and discomfort;

(5) Presents a structure with good accuracy parameters which are representative of thirst.

Defining Characteristic	Operational Definition
Dry mouth	The patient is asked to open the mouth and stick out the tongue. Evidence of any apparent dryness, such as dry, sticky mucous membrane, frothy or sticky saliva, or no visible saliva, whitish appearance, or bleeding spots is evaluated. Complement your assessment by questioning the patients about their current perception of dryness in the mouth, comparing it with a condition in which he considers normal moisture in the mouth. Conclusion: If one or two evaluated conditions were met, the patient has a dry mouth.
Dry throat	Ask the patient to open his mouth. Assess the absence of moisture in the distal portion of the mouth with the aid of a flashlight. Complement your assessment by questioning the patients about their current perception of throat dryness, burning sensation, throat discomfort such as “scratching”, compared to a condition in which he considers throat moisture normal. Conclusion: If the patients have one or more of the evaluated characteristics, they have a dry throat.
Dry lips	Inspect the lips, assessing the presence of cracks, scaling, inflammation, bleeding, whitish or reddish coloration, and decreased mobility. Observe if during the evaluation the patient uses the tongue to moisten the lips. Complement your assessment by asking the patients if they feel their lips are dry compared to a condition where the lips are normal. Conclusion: If the patients have one or more of the evaluated characteristics, they have dry lips.
Thick saliva	Inspect the patient’s oral cavity. Observe whether the saliva has a thick appearance, with little fluidity. Complement your assessment by asking the patients if they feel that their saliva is thick, compared to a condition in which their saliva is normal. Conclusion: If the patients have one or more of the evaluated characteristics, they have thick saliva.
Thick tongue	Inspect the appearance of the patient’s tongue. Note if there is visible enlargement of the tongue, erythema, fissures. Complement your assessment by asking the patients if they feel that their tongue is thick compared to a condition where their tongue is normal. Conclusion: If the patients have one or more of the evaluated characteristics, they have a thick tongue.
Defining Characteristic	Operational Definition
Constant swallowing of saliva	Observe the swallowing movements. Actions of constant movement of the tongue in search of saliva, followed by an attempt to swallow. Supplement your assessment by asking the patients if they are trying to swallow saliva to moisten their throat. Conclusion: If the patients have one or more of the evaluated characteristics, they have constant swallowing of saliva.
Desire to drink water	Patient verbalizes the desire to drink water. Ask the patient if he feels like drinking water. Conclusion: If the patient responds affirmatively, consider this feature to be present.
Bad taste in the mouth	Ask the patient if he has a bad taste in his mouth. Conclusion: If the patient responds affirmatively, consider this feature to be present.
Caregiver’s report	The caregiver reports that the patient has signs that indicate that he is thirsty. Ask the caregiver or family member about the presence of signs that indicate that the patient is thirsty. Conclusion: If the caregiver answers in the affirmative, consider this characteristic to be present. Additionally, write down what characteristics he observed.
Related Factor	Operational Definition
Pre- and post-operative fasting	Evaluate the time the patient has been without ingesting solid foods and liquids. Ask the patient when his last intake of solid food and liquids was.
Oral breathing	Ask the patient to take a deep breath and watch for mouth breathing. He may have his mouth slightly open while breathing. Check for nasal obstruction.
Dehydration	Note the presence of dry mucous membranes, decreased salivary flow, decreased skin turgor, decreased urinary frequency. - Dry mucous membranes: The patient is asked to open his mouth and stick out his tongue. Evidence of any apparent dryness, such as dry, sticky mucosa, frothy or sticky saliva, or absence of visible saliva, is evaluated. To complement the assessment, the patient should be asked about his current perception of dryness in the mouth, comparing it with a condition in which he considers that the moisture in the mouth is normal. - Skin turgor: Make a fold on the back of the patient’s hand and observe the formation and maintenance of a skin fold. If the fold continues after the evaluator’s hand is removed, it is deduced that the skin turgor is reduced. - Evaluate fasting time - Water balance, if any - Assess blood loss - Water replacement In children Observe signs of dehydration in the child, such as: fatigue, dry mucous membranes, dry lips, return of the abdominal skinfold for more than 2 seconds, crying without tears, irritability, sunken eyes. Note fontanelles. Ask the caregiver about changes in the child related to dehydration (skin turgor, fontanelles, general aspects).
Insensible loss of moisture from respiration	In the postoperative period: Evaluate the inhalational anesthetic procedure and the use of oxygen supplementation by nasal catheter or mask without humidification.
Hypovolemia	Evaluate the description of bleeding during the surgical procedure or in the postoperative period. Check for hypotension, sweating, tachycardia, and other signs of shock. Anesthetic procedure: Use of spinal anesthesia results in vasodilation caused by sympathetic blockade. Agents employed in general anesthesia initially decrease the body’s ability to perform vasoconstriction. Write down which anesthetic procedure was used. Hypotension: Check blood pressure. Compare the current pressure with the preoperative baseline pressure: if it is 20% lower than the baseline pressure, the patient can be considered hypotensive. Heart rate: Check heart rate by palpating and counting the radial pulse. The patient will be tachycardic if the observed value is equal to or greater than 100 beats per minute. Blood loss: Check the documents that report the intraoperative period for the description of the bleeding: small, medium or large? Check the appearance of the dressing. Sweating: Check for sweating.
Dry mouth	Evaluation of the oral cavity. The patient is asked to open the mouth and stick out the tongue. Evidence of any apparent dryness, such as dry, sticky mucous membrane, frothy or sticky saliva, or no visible saliva, whitish appearance, or bleeding spots is evaluated. Complement your evaluation by questioning the patient about his current perception of dryness in the mouth, comparing it with a condition in which he considers normal moisture in the mouth. Conclusion: If one or two evaluated conditions were met, the patient has a dry mouth.
Habit of drinking water	Ask the patient how many times a day they usually drink fluids and in what quantity, supplementing with the information below: - Frequency of consumption: - Consumption/beverage preference: - Period of the day of greatest consumption: - Temperature preference:
High ambient temperature	Measure the ambient temperature. Ask if he’s hot.
Associated Conditions	Operational Definition
Intubation	Assess whether there was endotracheal intubation during the anesthetic procedure. Was there orotracheal intubation? What is the duration of the anesthetic procedure? - Beginning of the anesthetic procedure: - End of the anesthetic procedure:
Water restriction	Evaluate the existence of restriction of intake or infusion of liquids according to the patient’s report or in the medical record. Evaluate in the medical record or the patient’s report the existence of restriction of fluid intake or infusion.
Use of muscarinic and nicotinic anticholinergics	Assess whether anticholinergics were used during the anesthetic-surgical procedure. Anticholinergic drugs: atropine, biperiden, benactizine, buscopan, dicyclomine, homatropine, ipratropium, trihexaphenid, tropicamide

Variables			n*		%^†		95%CI^‡
Gender
Female			89		59.3		51.0 – 67.1
Male			61		40.7		32.8 – 48.9
Color or race
White			84		56.0		47.6 – 64.0
Brown			45		30.0		22.9 – 38.1
Black			20		13.3		08.5 – 20.0
Yellow			01		00.7		0.00 – 04.2
Education
No schooling			05		03.3		01.2 – 08.0
Elementary School			71		47.3		39.1 – 55.6
High school			54		36.0		28.4 – 44.2
University education			17		11.3		06.9 – 17.7
Did not answer			03		02.0		0.5 – 06.1
Scheduling modality
Elective			98		65.3		57.0 – 72.7
Urgency			52		34.7		27.2 – 42.9
Classification
ASA^§ 1			55		36.7		29.0 – 44.9
ASA^§ 2			88		58.7		50.3 – 66.5
ASA^§ 3			05		03.3		01.2 – 08.0
Absent			02		01.3		0.2 – 05.2
Intraoperative bleeding
Small			123		82.0		74.7 – 87.6
Average			23		15.3		10.1 – 22.3
Big			03		02.0		0.5 – 06.1
Absent			1		0.7		0.00 – 04.2
Variables	Mean	Standard Derivation		Median		IIQ^\|\|		P-value^¶
Age	43.1	18.5		41.5		33.00		<0.001
Weight (Kg)	77.36	18.85		75.00		21		0.001
Height (Centimeters)	164.7	8.83		165.00		14		0.006
Fasting time (Hours)	13:10	5:11		12:50		5:52		0.000
Intensity of thirst	4.62	3.6		5		8		0.000
Thirst discomfort	4.88	3.9		4		14		0.000

Defining Characteristics	Preoperative			Immediate Postoperative
Defining Characteristics	n*	%^†	95%CI^‡	n*	%^†	95%CI^‡
Dry mouth	113	75.3	67.5 – 81.8	130	86.7	79.9 – 91.4
Dry lips	107	71.3	63.2 – 78.2	124	82.7	75.4 – 88.1
Desire to drink water	96	64.0	55.7 – 71.5	109	72.7	64.6 – 79.4
Constant swallowing of saliva	94	62.7	54.3 – 70.3	105	70.0	61.8 – 77.0
Dry throat	87	58.0	49.6 – 65.9	108	72.0	63.9 – 78.8
Thick saliva	73	48.7	40.4 – 56.9	80	53.3	45.0 – 61.4
Thick tongue	69	46.0	37.9 – 54.3	82	54.7	46.3 – 62.7
Bad taste in the mouth	62	41.3	33.4 – 49.6	69	46.0	37.9 – 54.3
Caregiver’s report	01	0.7	0.00 – 04.2	01	0.7	0.00 – 04.2
Related Factors	Preoperative			Immediate Postoperative
Related Factors	n*	% ^†	95%CI ^‡	n*	% ^†	95%CI ^‡
Pre- and post-operative fasting	150	100	96.8 – 100.0	150	100	96.8 – 100.0
Habit of drinking water	120	80.0	72.5 – 85.9	120	80.0	72.5 – 85.9
Dry mouth	115	76.7	68.9 – 83.0	128	85.3	78.4 – 90.3
High ambient temperature	28	18.7	12.9 – 26.0	16	10.7	06.4 – 17.0
Oral breathing	04	2.7	0.00 – 07.1	07	4.7	02.0 – 09.7
Dehydration	-	-	-	02	1.3	0.2 – 5.2
Insensible loss of moisture from respiration	-	-	-	29	19.3	13.5 – 26.7
Hypovolemia	-	-	-	03	2.0	0.5 – 06.1
Associated Conditions	Preoperative			Immediate Postoperative
Associated Conditions	n*	% ^†	95%CI ^‡	n*	% ^†	95%CI ^‡
Water restriction	1	0.7	0.00 – 04.2	1	0.7	0.00 – 04.2
Use of anticholinergics	-	-	-	27	18.0	12.3 – 25.2
Intubation	-	-	-	37	24.7	18.1 – 32.4

Preoperative	Sens.^*	95%CI^†		Spec.^‡	95%CI^†
Dry lips	0.8918^§	0.6803	0.9607	0.5848	0.4331	0.7229
Desire to drink water	0.8771^§	0.7005	0.9473	0.7562	0.4882	0.8961
Constant swallowing of saliva	0.8171^§	0.7176	0.8860	0.6914^\|\|	0.5123	0.8223
Dry throat	0.7950^§	0.6806	0.8722	0.7792^\|\|	0.5858	0.8935
Thick saliva	0.7005^§	0.5719	0.7978	0.8706	0.4215	0.9758
Thick tongue	0.6742^§	0.5476	0.7755	0.8978	0.4981	0.9834
Caregiver’s report	0.0107	0.0003	0.9854	1.0000^\|\|	0.9996	1.0000
Prevalence: 62.6%	G^2¶: 75.5		GL^**:112	p^†† = 0.997	Entropia:0.77
Immediate Postoperative	Sens. ^*	95%CI ^†		Spec. ^‡	95%CI ^†
Dry throat	0.9998^§	0.9730	1.0000	0.5620	0.4317	0.6867
Thick tongue	0.9311	0.2357	0.9956	0.8409^\|\|	0.5452	0.9476
Thick saliva	0.8820	0.4759	0.9771	0.8144^\|\|	0.5172	0.9375
Desire to drink water	0.8520^§	0.7293	0.9236	0.3997	0.3002	0.5217
Constant swallowing of saliva	0.7538^§	0.6233	0.8364	0.3543	0.2561	0.4631
Bad taste in the mouth	0.6429^§	0.5153	0.7483	0.7243^\|\|	0.5925	0.8176
Prevalence: 50.2%	G^2¶: 59.1		GL^**: 50	p^†† = 0.177	Entropy: 0.82

	Preoperative					Immediate Postoperative
	Perioperative Thirst		Test statistics	Significance	OR (95%CI)*	Perioperative Thirst		Test statistics	Significance	OR (95%CI)*
	Present	Absent	Test statistics	Significance	OR (95%CI)*	Present	Absent	Test statistics	Significance	OR (95%CI)*
Related Factor: Pre and Postoperative Fasting
Present	100	50	-	-	-	77	73	-	-	-
Absent	0	0				0	0
Related Factor: Oral breathing
Present	3	1	<0.000	1.000^†	1.51 (0.12-81.13)	4	3	<0,000	1.000^†	1.28 (0.21-9.02)
Absent	97	49				73	70
Related Factor: Dehydration
Present	0	0	-	-	-	2	0	0.454	0.497^†	Inf^‡ (0.18-Inf^‡)
Absent	100	50				75	73
Related Factor: Insensible loss of moisture from respiration
Present	0	0	-	-	-	19	10	2.234	0.135^§	2.05 (0.83-5.38)
Absent	100	50				58	63
Related Factor: High ambient temperature
Present	24	4	4.616	0.025^†	3.60 (1.14-15.19)	12	4	3.025	0,063^†	3.16 (0.99-14.14)
Absent	76	46				65	69
Related Factor: Hypovolemia
Present	0	0	-	-	-	3	0	1.254	0.245^†	Inf^‡(0.39-Inf^‡)
Absent	100	50				74	73
Related Factor: Dry mouth
Present	96	19	59.483	>0.001^†	37.72 (11.56-164.36)	76	53	19.087	>0,001^†	28.20 (4.25-1196.76)
Absent	4	31				1	20
Related Factor: Habit of drinking water
Present	83	37	1.172	0.279^§	1.709 (0.69-4.19)	64	56	0.602	0,438^§	1.49 (0.62-3.66)
Absent	17	13				13	17
Associated Condition: Water restriction
Present	1	0	<0.000	1.000^†	Inf^‡ (0.02-Inf^‡)	1	0	<0,000	1.000^†	Inf^‡ (0.02-Inf^‡)
Absent	99	50				76	73
Associated Condition: Use of anticholinergics
Present	0	0	-	-	-	19	8	3.892	0.048^§	2.64 (1.01-7.54)
Absent	100	50				58	65
Associated Condition: Intubation
Present	0	0	-	-	-	28	9	10.392	0,001^§	4.03 (1.66-10.63)
Absent	100	50				49	64

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author:
Leonel Alves do Nascimento E-mail: leonel_lan@hotmail.com https://orcid.org/0000-0002-9590-6360