Validação conceitual e clínica do diagnóstico de enfermagem "risco de perfusão renal ineficaz" em transplantados de células tronco hematopoéticas

Abstract

The hematopoietic stem cell transplantation is a therapeutic modality for the treatment of malignancies, and hematologic defects. It is full of complexity and may offer complications such as renal toxicity. For these patients, the nursing diagnosis of riskfor ineffective renal perfusion is established, but little studied specially related to risk factors listed in NANDA International and its identification and validity for patients undergoing to this type of transplantation. This study aimed to validated the nursing diagnosis of "Risk of Renal Perfusion Ineffective" with patients undergoing to hematopoietic stem cell transplantation. The specific goals established that define the concept of renal perfusion ineffective; for seek gold standard measures for determining ineffective renal perfusion; established to identify risk factors for the problem development in patients undergoing to transplantation and risk factors study and to propose a model for predicting the risk of ineffective renal perfusion. The study was conducted in two stages: an integrative literature review and clinical validation using a historical cohort. The databases MEDLINE, LILACS, CINAHL and the Cochrane Library were consulted for the integrative review. The sample consisted of 30 studies evaluated by the type, country, language and level of evidence using a structured instrument. A historical cohort study was conducted in 216transplant patients records. The data were submitted to descriptive, univariate and multivariate analysis. The concept of ineffective renal perfusion and the identification of the risk factors were established by the conceptual validation from publications level of evidence grade III and VI. Clinical validation was conducted in patients records in order to identify thefactors contributing to the risk of renal perfusion ineffective. The risk of ineffective renal perfusion was present in 54/216 patients (25%) and the normal renal function occurred in 107/216 (49.5%). The final model obtained in the logistic regression independent variables total serum bilirubin more than 2mg/dl, the presence of elevated levels of serum creatinine after transplantation, use of teicoplanin and activation of cytomegalovirus. The following risk factors described in NANDA International were validated: side effects to treatment, exposure to nephrotoxic agents, hypoxia, infection and malignancy. Some risk factors of the nursing diagnosis have not been validated because they are not statistically significant or were not present in this specific population. It was suggested a change in NANDAs nursing diagnoses including definition to risk reduction in blood circulation to the kidneys increase 1.5 times in of serum creatinine or reduction of in 25% glomerular filtration or urine output rate value isless than 0 5 ml/kg/h for 6 hours, in order to be capable of affect of human beings health. Other risk factors should be included as total bilirubin greater than 2mg/dl, the presence of high levels of serum creatinine and activation of cytomegalovirus.