Instructional technology for nursing diagnosis and therapy after bariatric surgery

Chaves, Elisangela Ribeiro; Primo, Cândida Caniçali; Brandão, Marcos Antônio Gomes; Furieri, Lorena Barros; Lopes, Andressa Bolsoni; Lima, Eliane de Fátima Almeida; Bringuente, Maria Edla de Oliveira

doi:10.37689/acta-ape/2022AO03493459

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Acta Paulista de Enfermagem

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Original Article • Acta Paul Enferm 35 • 2022 • https://doi.org/10.37689/acta-ape/2022AO03493459 copy

Instructional technology for nursing diagnosis and therapy after bariatric surgery

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To assess a case study instructional technology for nurses who work in patient care in the postoperative period of bariatric surgery.

Methods

This is applied research on technological development carried out in a literature review, preparation and instructional material assessment by 20 specialist nurses.

Results

The instructional material consists of 10 case studies associated with protocols with nursing diagnoses and interventions. The material was assessed as adequate for most criteria of sufficiency of clinical indicators for nursing diagnosis elaboration; frequency with which the diagnoses presented in the instructional material were or could be used in the postoperative care of bariatric patients; clarity and representativeness of the content of the case studies.

Conclusion

The cases were assessed as an instructional technological resource relevant to the training of nurses with potential for the clinical judgment process in the postoperative period of bariatric surgery.

Bariatric surgery; Nursing diagnosis; Nursing care; Education technology

Case	Clinical indicators	Nursing diagnosis	Ratio of agreement n(%)	Confidence interval of ratio	Assessed as relevant
Case 1	Dyspnea on exertion, fatigue, dyspnea, and weakness	Activity intolerance	18(90.0)	70.0 to 97.0	Yes
	Dyspnea, fatigue and obesity	Ineffective breathing pattern	17(85.0)	64.0 to 94.0	No
	Capillary refill time > 3 seconds, decreased peripheral pulses and paresthesia (numbness in hands)	Ineffective peripheral tissue perfusion	19(95.0)	76.0 to 99.0	Yes
	Insufficient diabetes management, insufficient food intake and alteration in mental status	Risk for unstable blood glucose level	18(90.0)	70.0 to 97.0	Yes
Case 2	Surgical wound (tissue damage), acute pain and surgical procedure	Impaired tissue integrity	20(100.0)	84.0 to 100.0	Yes
Case 2	Pain on superficial abdominal palpation, expressive behavior and facial expression of pain	Acute pain	19(95.0)	76.0 to 99.0	Yes
Case 3	Abdominal pain, nausea, absence of flatus and abdominal distension	Dysfunctional gastrointestinal motility	16(80.0)	58.0 to 92.0	No
	Vomiting desire, increased salivation and bitter taste	Nausea	17(85.0)	64.0 to 94.0	No
	Sedentary lifestyle, bed rest (immobility) and history of activity intolerance (tiredness and pain)	Risk for activity intolerance	20(100.0)	84.0 to 100.0	Yes
Case 4	Dependence for self-care, pain, weakness in right inferior leg and paresis in lower limbs	Feeding self-care deficit/Bathing self-care deficit	18(90.0)	70.0 to 97.0	Yes
	Facial expression and pain report	Acute pain	19(95.0)	76.0 to 99.0	Yes
	Destroyed tissue (pressure injury)	Impaired tissue integrity	18(90.0)	70.0 to 97.0	Yes
Case 5	Impaired balance, impaired walking, impaired mobility and reduced strength in lower limbs	Risk for falls	20(100.0)	84.0 to 100.0	Yes
Case 5	Vomiting desire and increase in salivation	Nausea	19(95.0)	76.0 to 99.0	Yes
Case 6	Abnormal breathing pattern, fatigue and dyspnea	Ineffective breathing pattern	19(95.0)	76.0 to 99.0	Yes
Case 7	Surgical wound, peripheral venous access and alteration in skin integrity	Risk for infection	18(90.0)	70.0 to 97.0	Yes
	Self-report of intensity using standardized panel scale	Acute pain	18(90.0)	70.0 to 97.0	Yes
	Alteration in skin turgor, increased heart rate, decreased urine output, decreased blood pressure and thirst	Deficient fluid volume	19(95.0)	76.0 to 99.0	Yes
Case 8	Nasal flaring, use of accessory muscles to breathe and dyspnea	Ineffective breathing pattern	18(90.0)	70.0 to 97.0	Yes
Case 9	Postoperative period of major surgery, total anesthesia time > 90 minutes, impaired mobility (pain) and obesity	Risk for venous thromboembolism	18(90.0)	70.0 to 97.0	Yes
Case 10	Tachycardia, anxiety and restlessness, jugular vein distension and prolonged capillary refill time	Decreased cardiac output	20(100.0)	84.0 to 100.0	Yes

NANDA-I diagnosis	Never	Rarely	Often	Always	p-value
NANDA-I diagnosis	n(%)	n(%)	n(%)	n(%)	p-value
Decreased cardiac output	0(0.0)	10(50.0)	10(50.0)	0(0.0)	0.999
Feeding self-care deficit	0(0.0)	9(45.0)	9(45.0)	2(10.0)	0.077
Bathing self-care deficit	0(0.0)	2(10.0)	14(70.0)	4(20.0)	0.004*
Acute pain	0(0.0)	0(0.0)	6(30.0)	14(70.0)	0.115
Impaired tissue integrity	0(0.0)	0(0.0)	3(15.0)	17(85.0)	0.003*
Activity intolerance	0(0.0)	3(15.0)	11(55.0)	6(30.0)	0.081
Impaired physical mobility	0(0.0)	2(10.0)	10(50.0)	8(40.0)	0.064
Dysfunctional gastrointestinal motility	0(0.0)	2(10.0)	14(70.0)	4(20.0)	0.004*
Nausea	0(0.0)	1(5.0)	11(55.0)	8(40.0)	0.018*
Ineffective breathing pattern	0(0.0)	2(10.0)	15(75.0)	3(15.0)	< 0.001*
Ineffective peripheral tissue perfusion	0(0.0)	5(25.0)	13(65.0)	2(10.0)	0.006*
Risk for unstable blood glucose level	0(0.0)	0(0.0)	7(35.0)	13(65.0)	0.188
Risk for infection	0(0.0)	0(0.0)	1(5.0)	19(95.0)	< 0.001*
Risk for activity intolerance	0(0.0)	3(15.0)	10(50.0)	7(35.0)	0.152
Risk for falls	0(0.0)	0(0.0)	8(40.0)	12(60.0)	0.503
Risk for venous thromboembolism	0(0.0)	3(15.0)	11(55.0)	6(30.0)	0.081
Deficient fluid volume	0(0.0)	5(25.0)	10(50.0)	5(25.0)	0.317
Total	0(0.0)	47(13.8)	163(47.9)	130(38.2)	< 0.001*

Case studies	Case study judged regarding clarity in writing		Case study reflects situations in postoperative occurrences
Case studies	n(%)	Interval %	n(%)	Interval %
1	19(95.0)	76.0 to 99.0	20(100.0)	84.0 to 100.0
2	19(95.0)	76.0 to 99.0	19(95.0)	76.0 to 99.0
3	19(95.0)	76.0 to 99.0	20(100.0)	84.0 to 100.0
4	18(90.0)	70.0 to 97.0	20(100.0)	84.0 to 100.0
5	20(100.0)	84.0 to 100.0	20(100.0)	84.0 to 100.0
6	20(100.0)	84.0 to 100.0	20(100.0)	84.0 to 100.0
7	20(100.0)	84.0 to 100.0	20(100.0)	84.0 to 100.0
8	20(100.0)	84.0 to 100.0	20(100.0)	84.0 to 100.0
9	20(100.0)	84.0 to 100.0	20(100.0)	84.0 to 100.0
10	20(100.0)	84.0 to 100.0	20(100.0)	84.0 to 100.0

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[1] Corresponding author: Cândida Caniçali Primo E-mail: candida.primo@ufes.br