Transplante hepático: diagnósticos de Enfermagem segundoa NANDA em pacientes no pós-operatório na unidade de internação

Abstract

Since the 1983s Consensus Development Conference held in the USA, organ and tissue transplantation has been considered as a healing treatment and, therefore, this procedure has been increasingly performed around the world. Nurses incorporated this specialty demands with distinction, now working into assistance systematization. Studies aiming to develop nursing care methods for transplanted patients are appropriate, especially during the essential nursing diagnosis phase,which is a base for intervention planning and outcome evaluation. This research was accomplished aiming to analyze nursing diagnosis, according to NANDAs taxonomy II, among pos surgical patients who had liver transplantation. This is a quantitative, descriptive, retrospective and exploratory study, carried out in a in a university hospital in Belo Horizonte, Minas Gerais, Brazil. Sixty four patients who had liver transplantation from September 1st, 2005 to September 30th, 2006 were considered for inclusion in the study. Exclusion criteria were patients under 18 years old (9), patients who had retransplant (5) and those who died in the ICU (7). The sample was composed of 43 patients, whose charts were used for data collection, in conformity to ethical legal aspects of human subjects research. The sample was composed mainly by male patients, with an average of 52 years of age, white, and who lived in the interior towns of Minas Gerais. Hepatic cirrhosis caused by C virus was the prevailingdisease. Nursing diagnosis studies were performed in 35 (81.4%) of the studied population who remained in the transplant unit up to 22 days. Fifty five nursing diagnosis were identified, structured according to the reference taxonomy, and classified in 11 dominions and 22 groups. The adopted Nursing History in this hospitals Transplantation Unit is based on the Wanda de Aguiar Hortas Human Basic Needs theory. This model allowed identifying 25 needs, which were distributed and classified as psychobiologic (83.6%), psychosocial (12.7%), and psycho spiritual(3.7%). The discussed nursing diagnosis prevailed on at least 40.0% of the sample: impaired cardiopulmonary, renal, and peripheral tissular perfusion, damaged tissue integrity, impaired self-care, diarrhea, acute pain, impaired sleep pattern, anxiety, impaired physical mobility, risk for fall, unbalanced body temperature, and infection. Despite limitations of the present study, a diagnostic profile was verified, which will allow a review on the nursing protocol used in the Unit. Results suggest a need for clinical studies to validate nursing diagnosis among transplanted patients, not yet described in NANDA taxonomy II, and infer that the importance of the diagnosis will be evident not only theoretically, but on the nursing daily care.