Adecuación de las características definitorias en los diagnósticos de deterioro del intercambio de gases y de la ventilación espontánea en niños asmáticos / The adequacy of the defining characteristics of the diagnostics "impaired gas exange" and spontaneous ventilation" in asmathic children

OBJETIVO: Determinar la validez de las medidas de las características definitorias de los diagnósticos enfermeros «deterioro del intercambio de gases» y «deterioro de la ventilación espontánea» en niños con asma seguidos en el área de urgencias. MÉTODO: Estudio observacional, descriptivo transversal desarrollado entre abril y septiembre de 2013 en un hospital ubicado en el nordeste de Brasil con una muestra de 205 niños. Los diagnósticos fueron establecidos por enfermeros expertos formados en esta materia. Se calcularon las medidas de sensibilidad, especificidad, valor de predicción positivo y negativo, razón de verosimilitud positiva y negativa y odds ratio diagnóstica para las características definitorias identificadas. RESULTADOS: Un 28,8% de los niños evaluados presentaron «deterioro del intercambio de gases». La disnea, la respiración anormal, la taquicardia y la hipoxemia presentaron las frecuencias más altas. La hipoxemia como característica clínica ha presentado valores altos de sensibilidad y especificidad. Un 5,9% de los niños evaluados presentaron «deterioro de la ventilación espontánea» y sus características definitorias más frecuentes fueron la disnea, el aumento de la frecuencia cardíaca y la disminución de la SaO2. El uso creciente de los músculos accesorios para respirar presentó las mejores medidas de validez para este diagnóstico. CONCLUSIÓN: La hipoxemia y el uso creciente de los músculos accesorios presentaron las mejores medidas de la validez respectivamente para «deterioro del intercambio de gases» y «deterioro de la ventilación espontánea». Es necesario contemplar estas características para una adecuada definición y uso de los diagnósticos en la práctica clínica

OBJECTIVE: To determine the diagnostic accuracy measures of defining characteristics of respiratory nursing diagnoses "impaired gas exchange" and "impaired spontaneous ventilation" in asmathics children in emergency department. METHODS: Observational, descriptive transversal study developed between April and September 2013 in a hospital in northeastern Brazil with a sample of 205 children. Diagnoses were established by nurses trained experts in this field. Measures of sensitivity, specificity, positive and negative value prediction right positive and negative likelihood ratio and diagnostic odds for the defining characteristics identified were calculated. RESULTS: 28.8% of the evaluated children had "impaired gas exchange". Dyspnea, abnormal breathing, tachycardia and hypoxemia had higher frequencies. Hypoxemia presented as clinical feature high sensitivity and specificity.5.9% of the evaluated children had "impaired spontaneous ventilation" and their most frequent defining characteristics were dyspnea, increased heart rate and decreased SaO2. The increasing use of accessory muscles to breathe presented the best measures of validity for this diagnosis. CONCLUSIONS: The hypoxemia and increased use of accessory muscles presented the best measures of the validity respectively to "deterioration in gas exchange" and "impairment of spontaneous ventilation". These characteristics is necessary to provide for adequate definition and use of diagnostics in clinical practice

The effects of leg/body position on transcutaneous oxygen measurements after lower-extremity arterial revascularization.

A postoperative nursing goal in a patient with peripheral artery disease requiring lower-extremity arterial reconstruction surgery is to maintain blood flow and tissue oxygenation to the revascularized extremity. This may be achieved through extremity positioning. Transcutaneous oxygen (TcPO(2)) measurements provide a noninvasive objective determination of oxygen at the skin surface and assessment of underlying circulation and tissue oxygenation. The purpose of this study was to determine which lower-extremity position afforded the highest TcPO(2) in 10 subjects with a lower-extremity arterial revascularization procedure preoperatively and 24 and 48 hours postoperatively. Hypotheses included comparing preoperative and postoperative TcPO(2) measurements, leg skin temperatures, and limb volumes. The subjects were studied in three different leg/body positions: supine with legs extended, sitting with legs extended, and supine with legs-elevated 20 degrees using the Radiometer TCM30 (Radiometer; Copenhagen) and PhysitempTH-5 Thermalert (Physitemp; Clifton, NJ) monitors. There was no change in the postoperative leg TcPO(2) measurements or limb volumes compared with preoperative measurements (P = .12-.92). A small sample size and lack of peripheral artery disease stratification were among study limitations. Significant to the nursing care of patients with vascular dsease is the finding that any of the leg/body positions in this study could be used postoperatively on the revascularized extremity without decreasing TcPO(2) measurements.

Transcutaneous carbon dioxide monitoring.

Technologies now exist that measure carbon dioxide levels transcutaneously. Rapid assessment of patients who have depressed ventilation or suspected sepsis can improve treatment decisions including the need for admission to the ICU and pulmonary artery catheterization.

Cardiovascular aspects of septic shock: pathophysiology, monitoring, and treatment.

The care of patients with septic shock is exceedingly complex. New therapies and monitoring technologies are being rapidly developed. To create an effective plan of care that integrates these new therapies and technologies, critical care nurses must understand the underlying pathophysiology of septic shock, techniques to accurately monitor patients' status, and the rationale for care.

Utilizing the ankle brachial index in clinical practice.

The ankle brachial index is one of many tests that can be used to indirectly assess lower extremity peripheral blood flow. This article reviews ankle brachial index technique and presents some of its applications for clinicians and researchers based on a literature review. The ankle brachial index is relatively simple and inexpensive and can be performed in both clinical and home care settings. Reliability level is reported to be high, with an intraclass correlation coefficient range of 0.80 to 0.99. When used with other noninvasive vascular tests such as pulse volume recordings, lower extremity segmental systolic limb pressures, and transcutaneous oximetry mapping, the ankle brachial index is a valuable screening tool to detect individuals at risk for wounds and other problems associated with poor peripheral arterial circulation.

Transcutaneous oxygen measurements: implications for nursing.

Transcutaneous oxygen measurement is a noninvasive diagnostic technique that records the partial pressure of oxygen at the skin surface. This measurement provides information regarding the supply and delivery of oxygen to the underlying microvascular circulation. It can be used for adults in wound evaluation, hyperbaric therapy, plastic surgery, amputation level determination, and peripheral vascular disease assessment, including the status of limb revascularization procedures. This article presents an overview of transcutaneous oxygen measurement and situations that influence measurement levels, including environmental, dermal, physiologic, and mechanical factors. Nursing considerations and indications for further research are also discussed.

Transcutaneous oxygen monitoring in congenital diaphragmatic abnormalities.

The article considers the use of transcutaneous (Tc) partial pressure of oxygen (PO2) monitoring as an alternative form of continuous monitoring of respiratory function in paediatric critical care. The principles of TcPO2 monitoring are discussed. The relationship between TcPO2, arterial blood gases and oxygen saturation is highlighted by examining trends in TcPO2 derived in three neonates with congenital diaphragmatic abnormality. The effect of critical incidents upon TcPO2 is also explored. TcPO2 is unlikely to enhance the assessment of ventilation provided by pulse oximetry and blood gas analysis.