Method: this is a descriptive, quantitative, cross-sectional study. Conclusion: in general, nurses often perform nursing interventions suggested in the NIC for the seven highly accurate nursing diagnoses identified in this study to care patients with liver cirrhosis.
Accurate and valid nursing diagnoses guide the selection of appropriate interventions that nurses can perform to enhance patient safety and thus improve patient health outcomes.
The disease is responsible for high rates of morbidity, mortality, consecutive hospitalizations, work absenteeism, and increases in societal costs. Liver cirrhosis is a public health concern and is the second cause of death amongst gastrointestinal diseases.
Liver disease affects more people than other types of organ failure. With the progression of the disease, patients can experience associated complications, such as jaundice, portal hypertension, esophageal, gastric and hemorrhoid varices, edema, nutritional deficiency and variceal hemorrhage 3.
Moreover, patients with end-stage liver cirrhosis present calorie and protein malnutrition due to poor intake, absorption, processing and storage of nutrients, resulting in an unfavorable prognosis 4. There is no specific cure for cirrhosis. Therefore, the goal of treatment is to minimize the progression of the disease and to prevent complications. In this context, nurses play an important role in the multidisciplinary team because they perform comprehensive and continuous patient care.
To meet comprehensive and complex patient needs in an efficient and safe way, nurses need to have critical thinking skills to accurately diagnose, identify nursing-sensitive patient outcomes and select specific nursing interventions to achieve the desired goals.
The use of standardized nursing terminologies in clinical practice contributes to clinical reasoning and decision making to improve healthcare and patient outcomes 6. The nursing assessment identifies clinical indicators for nursing diagnosis, which represent evidence leading to the identification and implementation of interventions.
Accurate and valid nursing diagnoses guide the selection of interventions capable of producing the desired outcomes 7. The Nursing Interventions Classification NIC figures among the nursing classification systems widely used by nurses around the world 8. The interventions provided in the NIC facilitate communication among nurses and other healthcare professionals, provide information to administration to balance the cost of components and quality of care, and facilitate the identification of care for specific populations 9.
Although the use of a standardized nursing language system, including NANDA-I and NIC taxonomies, is well described in the nursing literature, there is a need for further testing in clinical practice to demonstrate their applicability to patient care and to add to a body of evidence in specific patient populations 8.
This study addressed patients with liver cirrhosis as a population because the burden of the disease in Brazil has risen steadily, with ever-increasing associated costs and its effect on hospital admissions and mortality rates To date, previous studies have shown the effectiveness of nursing interventions in the treatment of nursing diagnoses in diverse populations and in different clinical settings 8. There has been no specific research though that captures the contribution of nursing interventions to improve care to patients with liver cirrhosis.
Purpose The purpose of this study was to identify the nursing interventions associated with the most accurate and frequently used NANDA-I nursing diagnoses for hospitalized patients with liver cirrhosis. Methods In this paper, we present results from a major investigation on nursing diagnosis and interventions in patients with liver cirrhosis This is a descriptive, quantitative, cross-sectional study, conducted from January to December Settings and Participants All nurses working at the gastroenterology ward of a Brazilian university hospital were eligible to participate.
The exclusion criteria were nurses on vacation during data collection; participants were all Portuguese speakers; they were between 28 and 62 years of age mean of Researchers provided the participants with oral and written information about the aim and procedure of the research. Participants were assured that their identity would remain confidential and the written consent form stipulated that they could decline or withdraw from the research at any time with no repercussions in their work.
Procedure This study was conducted in three phases: i evaluating the accuracy of the most frequent used NANDA-I nursing diagnosis for hospitalized patients with liver cirrhosis identified in previous study 11 ; ii designing of the data collection tool based on the 5th edition of NIC 9 ; and iii identifying the nursing interventions associated with the most frequent and accurately used NANDA-I nursing diagnosis for these patients. The three phases are explained in the following sections.
First phase: evaluating the accuracy of the most frequently used NANDA-I nursing diagnosis for patients with liver cirrhosis An expert panel composed of five nurses reviewed the most frequently used NANDA-I nursing diagnoses identified in a previous study To evaluate the accuracy of nursing diagnoses, the principal investigator sent the following to the experts: case studies of 20 patients, the Nursing Diagnosis Accuracy Scale EADE-version 2 , adapted to Brazilian culture by Matos and Cruz 12 from Lunney 13 ; a guide for completing the EADE-version 2; and a copy of the 12 most frequently identified nursing diagnoses as stated in a previous study.
The EADE-version 2 allows the nurse to take into consideration the presence, relevance, specificity and coherence of cues to reach a nursing diagnosis. The patient may develop nausea and vomiting, confusion, agitation, and aggression. Check his oxygenation status and fluid and electrolyte balance.
Electrolyte imbalances—specifically sodium and potassium imbalances—may result from water retention and impaired function of the sodium-potassium pump. Check, too, for signs and symptoms of coagulopathy, which develops from platelet dysfunction, thrombocytopenia, decreased hepatic synthesis of fibrin, deficiencies in coagulation factors, and vitamin K deficiency.
Renal failure may develop from liver failure or cardiovascular changes. Changes in circulation may lead to a compromised cardiovascular status, and some patients may experience renal insufficiency. Hypoglycemia may result from depleted glycogen stores and hyperinsulinemia.
And impaired host defense mechanisms increase the risk of infection. Managing the complications Some causes of acute liver failure require specific treatments. If the cause is acetaminophen toxicity, for example, the patient should receive N-acetylcysteine within 8 hours of ingestion.
If the cause is Amanita poisoning, the patient needs a penicillin and silymarin infusion. Most nursing interventions, however, focus not on the underlying cause but on the complications of acute liver disease.
Neurologic complications A leading cause of death in patients with acute liver failure is cerebral edema. Some patients may require an ICP monitoring device. High ammonia levels may cause cellular swelling, increased cerebral vasodilation, or increased levels of gamma aminobutyric acid, all of which decrease neurologic function.
If the patient is going from stage 2 to stage 3 encephalopathy, notify the physician and gather equipment for elective intubation and ventilation. If the patient needs sedation, a short-acting drug such as propofol Diprivan should be prescribed. Infection Patients with acute liver failure have an increased risk of infection and sepsis.
Gram-positive, gram-negative, or fungal organisms may cause the infection. Common infection sites are the lungs and the urinary tract. Respiratory complications from sepsis, hemorrhage, pleural effusions, atelectasis, and intrapulmonary shunts may contribute to respiratory problems. Some patients develop acute respiratory distress syndrome. To prevent infection, limit I. If the patient will receive a liver transplant, empiric antibiotics may be prescribed. Fluid imbalances and renal failure A patient with acute liver failure may develop fluid overload because of renal dysfunction or fluid shifts caused by fluctuating oncotic pressures.
Or the patient may become dehydrated from osmotic diuretic therapy, diabetes insipidus, or high-output renal failure.
Evaluate hydration status, using hemodynamic monitoring to assess central venous pressure and maintaining accurate intake and output records. Initially, administer I. A patient with renal failure may need dialysis or continuous venous-venous hemodialysis. Abnormal glucose levels and malnutrition Closely monitor serum glucose levels to prevent hyperglycemia and hypoglycemia.Time may not heal all livers in acute failure, but it heals most. The experts had days to evaluate and return the tool and evaluation form to the researchers. If the patient is a good candidate, he or she will receive priority status for transplantation. First phase: evaluating the accuracy of the most frequently used NANDA-I nursing diagnosis for patients with liver cirrhosis An expert panel composed of five nurses reviewed the most frequently used NANDA-I nursing diagnoses identified in a previous study From those, seven
Interventions focusing on breastfeeding, plastering or pneumatic tourniquets, surgical patients and latex precautions were excluded, resulting in 17 interventions. The disease is responsible for high rates of morbidity, mortality, consecutive hospitalizations, work absenteeism, and increases in societal costs. For the diagnosis Infection, Risk for , a total of 24 interventions and 30 additional optional interventions is suggested in NIC, but researchers elected only 16 of these interventions.
A data collection tool was developed based on the 5th edition of NIC 9 , as no other instrument was found suitable for this study. The Nursing Interventions Classification NIC figures among the nursing classification systems widely used by nurses around the world 8.
Gram-positive, gram-negative, or fungal organisms may cause the infection. Normally, ammonia is synthesized by microorganisms in the GI tract and detoxified in the astrocytes in the central nervous system. High ammonia levels may cause cellular swelling, increased cerebral vasodilation, or increased levels of gamma aminobutyric acid, all of which decrease neurologic function. Respiratory complications from sepsis, hemorrhage, pleural effusions, atelectasis, and intrapulmonary shunts may contribute to respiratory problems. The EADE-version 2 allows the nurse to take into consideration the presence, relevance, specificity and coherence of cues to reach a nursing diagnosis.
Martin RH, Hassanein T. Method: this is a descriptive, quantitative, cross-sectional study. Changes in circulation may lead to a compromised cardiovascular status, and some patients may experience renal insufficiency.