Acurácia de indicadores clínicos do diagnóstico de enfermagem desobstrução ineficaz de vias aéreas em pessoas idosas com pneumonia

Abstract

Introduction: Pneumonia is one of the health problems influencing the hospitalization of elderly people. Objective: To assess the accuracy of clinical indicators of the NANDA International nursing diagnosis “Ineffective airway clearance” in elderly people hospitalized with pneumonia. Method: This is a phase II diagnostic accuracy study with cross-sectional and quantitative design, which was conducted at a public hospital in João Pessoa, Paraíba. Sampling was non-probabilistic for accessibility, considering the following inclusion criteria: people aged 60 years or over, hospitalized in clinical and intensive care units of the aforementioned hospital at the time of data collection and with up to 72 hours of the medical diagnosis of pneumonia. We excluded those who were undergoing mechanical ventilation, and the sample consisted of 43 people. Data collection took place between November 2017 and August 2018, through an interview and a specific physical examination, supported by a structured instrument. The collected data were organized and processed by SPSS 22.0. Data analysis was based on the verification of the accuracy measures of the clinical indicators of Ineffective airway clearance in the surveyed population. During the development of this study, we complied with all the ethical and legal aspects contained in Resolutions 466 and 580 of the National Health Council and their complementary ones, which resulted in its approval by the Ethics Committee of the Health Sciences Center at the Federal University of Paraíba, under Protocol 1.980.829/2017 and CAAE nº 65948717.0.0000.5188. Results: Among the study participants, 25 (58.1%) were female; with predominant age group of 80 years or over, 16 (37.2%); widows, 22 (51.2%); with low educational level, 28 (65.2%); and family income from 1 to 3 minimum wages, 35 (81.4%). The prevalence of Ineffective airway clearance was verified in 28 (65.1%) elderly patients. Regarding the indicators of this nursing diagnosis, the most prevalent were: adventitious respiratory sounds, 36 (83.7%), and orthopnea, 33 (76.7%). With regard to accuracy measures, the more sensitive were: cyanosis and hyperthermia (100%); the most specific ones were: altered breathing pattern, hyperthermia and mental confusion (100%). The presence of change in respiratory rate increased 348 times the chances of occurring Ineffective airway clearance in the investigated population. When applying the Weight of Evidence binary classifier, we verified that excessive sputum and absent cough were very influential for the outcome “Ineffective airway clearance” in the investigated elderly. Final considerations: The verification of the accuracy measures, especially sensitivity and specificity of clinical indicators, was indispensable for the inference of this nursing diagnosis. The knowledge of such indicators contributes to the planning of effective nursing actions for the resolution or minimization of this health problem among the elderly population.