Nursing diagnoses identified in onco-hematologic patients: a
               cross-mapping study

Sousa, Renata Miranda de; Santo, Fátima Helena do Espírito; Santana, Rosimere Ferreira; Lopes, Marcos Venicius de Oliveira

doi:10.5935/1414-8145.20150008

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RESEARCH • Esc Anna Nery 19 (1) • Jan-Mar 2015 • https://doi.org/10.5935/1414-8145.20150008 copy

Nursing diagnoses identified in onco-hematologic patients: a cross-mapping study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

To compare free terms from nursing records with a standard nursing diagnosis classification. Cross mapping retrospective study of nursing records of 24 medical files of patients hospitalized in an onco-hematological clinic of a university hospital in the state of Rio de Janeiro. 507 matching terms corresponding to 30 nursing diagnoses were found, validated with 194 repetitions in the 24 records, with an average of 8.1 nursing diagnoses per patient. There were predominance of diagnoses of Ineffective Protection, Risk of infection, impaired oral mucosa, Hyperthermia, risk of bleeding, fatigue, acute pain and imbalanced nutrition: less than daily needs. Building clinical protocols from the terms and nursing diagnoses found in this study is recommended, aiming at the systematization of nursing care and onco-hematology patient nursing process.

Nursing Diagnosis; Oncologic Nursing; Hematology; Nursing processes; Oncology Hospital Service

Terms/domains diagnosis %
Security/Protection
Hospitalization	Risk of infection	23	95.8
Peripheral venous access		22	91.6
Hemoglobin (5.5g/dL, 10.8g/dL)		21	87.5
Chemotherapy		18	75
Neutrophils (0.000/mm³-1,220/mm³)		11	45.8
Deep venous access		4	16.6
Bone marrow biopsy		3	12.5
Catheter and probe		2	8.3
Platelets (5 x 83 x 10³mm³-10³mm³)	Impaired oral mucous	16	66.6
Hemoglobin (5.3g/dL, 10.8g/dL)		15	62.5
Chemotherapy		14	58.3
Neutrophils (0.000/mm³-0.800/mm³)		9	37.5
Pale (+3/+4)		9	37.5
Coated tongue		7	29.1
Mucositis		6	25
Bleeding gums (Gingivitis)		5	20,8
Odynophagia		2	8.3
Dehydrated (+2/+4)		2	8.3
High body temperature (37.8º C-39.6º C)	Hyperthermia	15	62.5
Medicines	Risk of impaired skin integrity	4	16.6
Emaciate		2	8.3
Hemoglobin (5.3g/dL, 6.4g/dL)		2	8.3
Platelets (5 x 20 x 10³mm³-10³mm³)		2	8.3
High body temperature (37.6º C-39.6º C)		2	8.3
Pallor (+3/+4)		2	8.3
Neutrophils (0.700)		1	4.16
Skin turgor and elasticity decreased		1	4.16
Hypo-hydrated skin		1	4.16
Bedridden	Impaired skin integrity	2	8.3
Chemotherapy		1	4.16
Decreased turgor		1	4.16
Deep venous access		1	4.16
Lesion in the right lower limb		1	4.16
Pressure ulcers		1	4.16
Absence of some teeth	Impaired dentition	3	12.5
Poor oral hygiene		1	4.16
Teeth (in disrepair)		1	4.16
Syncope with fall	Risk of falling	3	12.5
Hemoglobin (6.2g/dL, 7.9g/dL)		2	8.3
Medications (furosemide and captopril)		2	8.3
Cough	Ineffective airway clearance	1	4.16
Tachypnea (24-44 breaths per minute)		1	4.16
Scattered crackles in both lungs		1	4.16
Reports the suicidal tendency to nurses	Suicide risk	1	4.16
Perception/cognition
Confused	Acute Confusion	1	4.16
Agitated		1	4.16
Periods of disorientation		1	4.16
Does not perceive hospitalization reason	Impaired knowledge	1	4.16
Elimination/protection
Absent evacuation for at least three days	Constipation	8	33.3
Bedridden		5	20.8
Medications: Rivotril, Tramal, Lasix, Morphine		4	16.6
Little appetite for dietary compliance		4	16.6
Nausea and vomiting		3	12.5
Rectal bleeding after a bowel movement		2	8.3
Rectal Pain (hemorrhoids)		1	4.16
Distended abdomen with decreased bowel sounds		1	4.16
Bedridden	Constipation risk	1	4.16
Rectal sensitivity with difficult of evacuation		1	4.16
Pain in the perianal region		1	4.16
10 hours without urinating	Urinary retention	1	4.16
Activity/rest
Platelets (4 x 69 x 10³mm³-10³mm³)	Risk of bleeding	15	62.5
Petechiae		5	20.8
Oral bleeding		3	12.5
Nosebleed		3	12.5
Hematoma		2	8.3
Palatal ecchymosis		1	4.16
Melena		1	4.16
Continuous epistaxis		1	4.16
Enterorrhagia		1	4.16
Metrorrhagia		1	4.16
Hematemesis		1	4.16
Hemorrhage in the left eye sclera		1	4.16
Hemoglobin (5.3g/dL, 9.6g/dL)	Fatigue	11	45.83
Fatigue and dyspnea upon exertion		9	37.5
Emaciate		5	20.8
Eager		5	20.8
Weakness and malaise		3	12.5
Multiples complaints		1	4.16
Depressed		1	4.16
Bedridden	Impaired physical mobility	1	4.16
Moves up wheelchair		1	4.16
On bed rest for deep vein thrombosis		1	4.16
Emaciate	Impaired Mobility in bed	1	4.16
Prostrate, necessitating changing positions		1	4.16
Bedridden, bed bath held		1	4.16
Assistance with ambulation due to edema in right foot	Impaired ambulation	1	4.16
Lesion in right foot with devitalized tissue	Impaired ambulation	1	4.16
Reports unsatisfactory night sleep due to oral pain	Pattern of sleep disturbance	1	4.16
Health Promotion
Leukemias	Ineffective protection	24	100
Hemoglobin (5.5g/dL-11.8g/dL)		21	87.5
Chemotherapy		18	75
Platelets (5 x 83 x 10³mm³-10³mm³)		11	45.8
Neutrophils (0.000/mm³-0.800/mm³)		11	45.8
Depressed mood	Self-neglect	1	4.16
Refused to make hygienic		1	4.16
Scabious		1	4.16
Comfort
Leukemia	Acute pain	15	62.5
Pain in upper and lower limbs		7	29.1
Abdominal pain		6	25
Intense pain in the lower back and posterior chest		4	16.6
Pain in the dorsal region		2	8.3
Painful swallowing		2	8.3
Generalized myalgia		2	8.3
Rectal pain during evacuation		1	4.16
Bone pain in the thoracolumbar region		1	4.16
Pain at the site of venipuncture		1	4.16
Chemotherapy	Nausea	8	33.3
Refers anorexia and nausea		8	33.3
Vomit		3	12.5
Widespread pain (more than 6 months)	Chronic Pain	1	4.16
Pain "twinge" in his left calf with phlogosis, erythema, pain, local redness (over 6 months)		1	4.16
Pain in the left inguinal region and left lower limb during ambulation (over 6 months)		1	4.16
Nutrition
Leukemia	Imbalanced nutrition: less than daily needs	16	66.6
Accepting diet partially		14	58.3
Mucositis		3	12.5
Loss of appetite		2	8.3
Fatigue and dyspnea upon exertion (tumor that prevents him from food and drinking water)		1	4.16
Odynophagia		1	4.16
Coping/tolerance to stress
Anxious/concerned with the diagnosis	Anxiety	5	20.8
Hospitalization		1	4.16
Tachycardia (> 124 beats per minute)		1	4.16
Left hospital without proper discharge	Behavior prone to health risk	1	4.16
Reports feeling homesick, pets, showing sad and tearful, prolonged treatment	Chronic sorrow	1	4.16
Life principles
Refused to receive haemotransfusion for religious reasons	Noncompliance	1	4.16
Total		507	-

Diagnostic/domain	Expert's evaluation		Total
Diagnostic/domain	Excellent Agreement (n)	Substantial Agreement (n)	n	%
Safety/protection
Ineffective protection	70	2	24	100
Infection risk	58	11	23	95.8
Impaired oral mucous	39	18	19	79.2
Hyperthermia	42	3	15	62.5
Risk for impaired skin integrity	11	1	4	16.7
Impaired skin integrity	7	2	3	12.5
Impaired dentition	6	3	3	12.5
Risk of falls	3	0	1	4.2
Ineffective airway clearance	2	1	1	4.2
Suicide risk	3	0	1	4.2
Perception/cognition
Acute confusion	1	2	1	4.2
Impaired knowledge	0	2	1	4.2
Elimination/protection
Constipation	14	10	8	33.3
Constipation risk	2	1	1	4.2
Urinary retention	2	1	1	4.2
Activity/rest
Bleeding risk	48	0	16	66.7
Fatigue	31	2	11	45.8
Impaired physical mobility	5	1	2	8.3
Impaired mobility in bed	3	0	1	4.2
Impaired ambulation	3	0	1	4.2
Pattern of sleep disturbance	3	0	1	4.2
Health Promotion
Self-neglect	2	1	1	4.2
Comfort
Acute pain	31	14	15	62.5
Nausea	22	2	8	33.3
Chronic pain	0	3	1	4.2
Nutrition
Imbalanced nutrition: less than daily needs	30	24	18	75
Coping/tolerance to stress
Anxiety	19	6	10	41.7
Behavior prone to health risk	2	1	1	4.2
Chronic sorrow	0	3	1	4.2
Life principles
Noncompliance	3	0	1	4.2
Total	462	114	194

Universidade Federal do Rio de Janeiro Rua Afonso Cavalcanti, 275, Cidade Nova, 20211-110 - Rio de Janeiro - RJ - Brasil, Tel: +55 21 3398-0952 e 3398-0941 - Rio de Janeiro - RJ - Brazil
E-mail: annaneryrevista@gmail.com

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[1] Corresponding author: Renata Miranda de Sousa. E-mail: natinha.sousa@yahoo.com.br