Children with kidney diseases: association between nursing diagnoses and their diagnostic indicators

Silva, Richardson Augusto Rosendo da; Bezerra, Moiziara Xavier; Souza, Vinicius Lino de; Mororo, Deborah Dinorah Sa; Andrade, Itaìsa Cardoso Fernandes de

doi:10.1590/1982-0194201700011

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Acta Paulista de Enfermagem

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Original Article • Acta Paul Enferm. 30 (1) • Jan 2017 • https://doi.org/10.1590/1982-0194201700011 copy

Children with kidney diseases: association between nursing diagnoses and their diagnostic indicators

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To identify the nursing diagnoses in children with kidney diseases, and to analyze the association between these diagnoses, their defining characteristics, related or risk factors.

Methods

A cross-sectional, quantitative study, conducted with 68 hospitalized children in a university hospital in northeastern Brazil. An interview guide and physical examination was used to collect data. The selection of diagnoses was procedural, and the data were analyzed using descriptive and inferential statistics.

Results

Thirteen diagnoses were identified. The most frequent diagnoses presented statistically significant association with their diagnostic indicators and were found in the domains of health promotion, elimination/exchange, nutrition, safety/protection and activity/rest.

Conclusion

The most prevalent nursing diagnoses were: excess fluid volume, risk for infection, impaired urinary elimination, fatigue, and ineffective protection. In general, the defining characteristics and the related/risk factors of the diagnosis showed significant association.

Nursing process; Nursing diagnosis; Pediatric nursing; Kidney disease; Child; Interview

Nursing diagnoses	n(%)
Excess fluid volume	62(91.17)
Risk for infection	60(88.23)
Impaired urinary elimination	55(80.88)
Ineffective protection	40(58.82)
Fatigue	35(51.47)
Hyperthermia	25(36.76)
Acute pain	20(29.41)
Risk for disproportionate growth.	16(23.52)
Risk for delayed child development	16(23.52)
Disturbed sleep pattern	14(20.58)
Constipation	10(14.70)
Imbalanced nutrition: less than body requirements	10(14.70)
Diarrhea	08(11.76)

Nursing diagnoses	Defining characteristics	Present(%)	Absent(%)	p-value
Excess fluid volume	Weight gain over short period of time	60(96.77)	2(03.23)	0.001*
	Edema	60(96.77)	2(03.23)	0.001 ^†
	Alteration in blood pressure	25(40.32)	37(59.68)	0.001^†
	Anasarca	6(09.68)	56(90.32)	0.004^†
Impaired urinary elimination	Dysuria	53(96.36)	2(03.64)	0.002^†
	Urinary retention	50(90.90)	5(09.10)	0.001^†
	Hesitancy	50(90.90)	5(09.10)	0.002^†
	Urinary urgency	2(03.64)	53(96.36)	0.004^†
Ineffective protection	Deficient immunity	36(90.00)	4(10.00)	0.001^†
	Fatigue	32(80.00)	8(20.00)	0.002^†
	Weakness	32(80.00)	8(20.00)	0.001^†
Fatigue	Tiredness	32(91.43)	3(08.57)	0.001^†
Fatigue	Insufficient energy	26(74.28)	9(25.72)	0.002^†
Hyperthermia	Skin warm to touch	25(100.0)	0(00.00)	0.301^†
Hyperthermia	Irritability	18(72.00)	7(28.00)	0.079^†
Acute pain	Expressive behavior	19(95.00)	1(05.00)	0.082^†
	Facial expression of pain	19(95.00)	1(05.00)	0.232^†
	Proxy report of pain behavior/ activity changes	14(70.00)	6(30.00)	0.087^†
Disturbed sleep pattern	Alteration in sleep pattern	10(71.43)	4(28.57)	0.079^†
Disturbed sleep pattern	Difficulty initiating sleep	8(57.14)	6(42.86)	0.240^†
Constipation	Abdominal pain	8(40.00)	2(60.00)	0.318^†
Imbalanced nutrition: less than body requirements	Insufficient interest in food	9(90.00)	1(10.00)	0.160^†
	Pale mucous membranes	9(90.00)	1(10.00)	0.071^†
	Diarrhea	8(80.00)	2(20.00)	0.096^†
	Food intake less than recommended daily allowance	8(80.00)	2(20.00)	0.452^†
	Abdominal pain	8(80.00)	2(20.00)	0.182^†
Diarrhea	Loose liquid stools > 3 in 24 hours	8(100)	0(00.00)	0.160^†
Diarrhea	Abdominal pain	8(100)	0(00.00)	0.452^†

Nursing diagnoses	Related / risk factors	Present(%)	Absent(%)	p-value
Excess fluid volume	Compromised regulatory mechanism	60(96.77)	2(03.23)	0.001*
Risk for infection	Invasive procedure	45(75.00)	15(25.00)	0.001^†
	Immunosuppression	36(60.00)	24(40.00)	0.001^†
	Decrease in hemoglobin	23(38.33)	37(61.67)	0.001^†
	Alteration in skin integrity	17(28.33)	43(71.67)	0.003^†
	Chronic Illness	17(28.33)	43(71.67)	0.004^†
Impaired urinary elimination	Multiple causality	48(87.27)	7(12.73)	0.001^†
Impaired urinary elimination	Urinary tract infection	8(14.54)	47(85.46)	0.002^†
Ineffective protection	Abnormal blood profile	23(57.50)	17(42.50)	0.001^†
Ineffective protection	Immune disorder	36 (90.00)	4(10.00)	0.001^†
Fatigue	Physiological condition	32(91.43)	3(08.57)	0.001^†
Fatigue	Environmental barrier	8(22.85)	27(77.15)	0.003^†
Hyperthermia	Illness	25(100)	0(00.00)	0.099^†
Acute pain	Biological injury agent	14(70.00)	6(30.00)	0.247^†
Risk for disproportionate growth	Chronic illness	16(100)	0(00.00)	0.507^†
	Economically disadvantaged	10(62.50)	6(37.50)	0.085^†
	Infection	8(50.00)	8(50.00)	0.096^†
Risk for delayed development	Chronic illness	16(100)	0(00.00)	0.507^†
	Treatment regimen	16(100)	0(00.00)	0.085^†
	Inadequate nutrition	10(62.50)	6(37.50)	0.146^†
Disturbed sleep pattern	Environmental barrier	8(57.14)	6(42.86)	0.829^†
Constipation	Pharmaceutical agent	8(40.00)	2(60.0)	0.365^†
Constipation	Recent environmental change	8(40.00)	2(60.0)	0.118^†
Imbalanced nutrition: less than body requirements	Insufficient dietary intake	8(80.00)	2(20.00)	0.160^†
Diarrhea	Infection	8(100)	0(00.00)	0.790^†
Diarrhea	Treatment regimen	8(100)	0(00.00)	0.143^†

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author. Richardson Augusto Rosendo da Silva. Senador Salgado Filho Avenue, 3000, 59078-970, Natal, RN, Brazil. rirosendo@yahoo.com.br