NANDA-I<sup>®</sup> nursing diagnoses in adult critical patients with COVID-19

Azevedo, Cissa; Moura, Caroline de Castro; Salgado, Patrícia Oliveira; Mata, Luciana Regina Ferreira da; Domingos, Camila Santana; Ercole, Flávia Falci; Chianca, Tânia Couto Machado; Toledo, Luana Vieira

Cissa Azevedo

Department of Medicine and Nursing, Universidade Federal de Viçosa, Viçosa, MG, Brazil.

http://orcid.org/0000-0001-5881-5710

Caroline de Castro Moura

Department of Medicine and Nursing, Universidade Federal de Viçosa, Viçosa, MG, Brazil.

http://orcid.org/0000-0003-1224-7177

Patrícia Oliveira Salgado

Department of Medicine and Nursing, Universidade Federal de Viçosa, Viçosa, MG, Brazil.

http://orcid.org/0000-0002-0743-0244

Luciana Regina Ferreira da Mata

Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

http://orcid.org/0000-0002-5080-4643

Camila Santana Domingos

Department of Medicine and Nursing, Universidade Federal de Viçosa, Viçosa, MG, Brazil.

http://orcid.org/0000-0002-5526-3129

Flávia Falci Ercole

Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

http://orcid.org/0000-0002-1356-0854

Tânia Couto Machado Chianca

Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

http://orcid.org/0000-0002-8313-2791

Luana Vieira Toledo

Department of Medicine and Nursing, Universidade Federal de Viçosa, Viçosa, MG, Brazil.

http://orcid.org/0000-0001-9527-7325

Corresponding author: Luana Vieira Toledo E-mail: luanatoledoufv@gmail.com

Associate Editor (Peer review process): Juliana de Lima Lopes (https://orcid.org/0000-0001-6915-6781) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil

Collaborations

Azevedo C, Moura CC, Salgado PO, Mata LRF, Domingos CS, Ercole FF, Chianca TCM and Toledo LV contributed to study design, data analysis and interpretation, article writing, relevant critical review of intellectual content and approval of the version final to be published.

Conflicts of interest: none to declare.

Country	Review type	Study objective	Diagnostic clues
Italy	Narration	Assess and compare the cardiac manifestations of COVID‐19, MERS‐CoV and H1N1.(¹⁸18. Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID-19. J Cardiovasc Electrophysiol. 2020;31(5):1003–8.)	Arrhythmias; palpitations; tachycardia (Heart Rate>125bpm); ventricular/atrial fibrillation; hypotension; cardiac insufficiency; elevated troponin; hypoxemia; hypovolemia; risk for cardiac arrest; sepsis; systemic inflammatory response syndrome; acute coagulopathy; dyspnea; fatigue; pulmonary edema; acute kidney failure; fever; chills; chest pain.
China	Narrative	Assess the extrarespiratory manifestations of COVID-19.(¹⁹19. Lai CC, Ko WC, Lee PI, Jean SS, Hsueh PR. Extra-respiratory manifestations of COVID-19. Int J Antimicrob Agents. 2020 ;56(2):106024.)	Ageusia; anosmia; hyposmia; anorexia; dysgeusia; nausea/vomiting; diarrhea; abdominal pain/discomfort; arrhythmias; ccardiac insufficiency; acroischemia; dizziness; raised intracranial pressure; acute kidney failure; skin injuries; convulsion; headache; chest pain; abdominal pain/discomfort; ataxia; muscle atrophy.
China	Narration	Clarify whether the SARS-CoV-2 virus can reach the central nervous system (CNS) and induce neuronal damage that leads to acute respiratory distress.(²⁰20. Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020;92(6):552–5.)	Nausea/vomiting; dyspnea; fever; headache; raised intracranial pressure.
Brazil	Systematic	Review the literature on neurological complications of SARS-CoV-2 infection.(²¹21. Munhoz RP, Pedroso JL, Nascimento FA, Almeida SM, Barsottini OG, Cardoso FE, et al. Neurological complications in patients with SARS-CoV-2 infection: a systematic review. Arq Neuropsiquiatr. 2020;78(5):290–300.)	Ageusia; anosmia; dizziness; fatigue; convulsion; muscle pain; headache; ataxia; muscle atrophy; raised intracranial pressure.
Iran	Narration	Review studies on the neurological manifestations of COVID-19.(²²22. Niazkar HR, Zibaee B, Nasimi A, Bahri N. The neurological manifestations of COVID-19: a review article. Neurol Sci. 2020;41(7):1667–71.)	Ageusia; anosmia; hyposmia; dizziness; encephalitis; convulsion; muscle pain; headache; ataxia; muscle atrophy; raised intracranial pressure.
France	Narration	Review current knowledge about neurological sequel of COVID-19 and its possible etiology.(²³23. Ogier M, Andéol G, Sagui E, Dal Bo G. How to detect and track chronic neurologic sequelae of COVID-19? Use of auditory brainstem responses and neuroimaging for long-term patient follow-up. Brain Behav Immun Health. 2020;5:100081.)	Dizziness; agitation; confusion; dyspnea; fever; headache; raised intracranial pressure.
Belgium	Narration	Update the evidence about the prognosis of critically ill diabetic patients affected by COVID-19.(²⁴24. Orioli L, Hermans MP, Thissen JP, Maiter D, Vandeleene B, Yombi JC. COVID-19 in diabetic patients: related risks and specifics of management. Ann Endocrinol (Paris). 2020;81(2-3):101–9.)	Hyperglycemia; ketoacidosis; hypoxemia; oxygenation 300 mmHg; Tachypnea (Respiratory Rate > 30rpm).
USA	Systematic	Describe neurological and psychological effects of COVID-19 based on a literature review.(²⁵25. Rahman J, Muralidharan A, Quazi SJ, Saleem H, Khan S. Neurological and Psychological Effects of Coronavirus (COVID-19): An Overview of the Current Era Pandemic. Cureus. 2020;12(6):e8460.)	Dizziness; convulsion; muscle pain; headache; raised intracranial pressure.
Italy	Systematic	Synthesize the available evidence on the main neurological signs and symptoms in patients with COVID-19.(²⁶26. Romoli M, Jelcic I, Bernard-Valnet R, García Azorín D, Mancinelli L, Akhvlediani T, et al. A systematic review of neurological manifestations of SARS-CoV-2 infection: the devil is hidden in the details. Eur J Neurol. 2020; 27:1712-26.)	Dizziness; agitation; cerebral hemorrhage; convulsion; headache; raised intracranial pressure.
China	Narration	Report the gastrointestinal manifestations and pathological findings of patients with COVID-19 and discuss the possibility of fecal transmission of the virus.(²⁷27. Tian Y, Rong L, Nian W, He Y. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther. 2020;51(9):843–51.)	Anorexia; Nausea/vomiting; diarrhea; abdominal pain/discomfort; gastrointestinal bleeding; abdominal pain/discomfort.
Germany	Narration	Present the main cutaneous symptoms described in the literature for patients with COVID-19.(²⁸28. Wollina U, Karadağ AS, Rowland-Payne C, Chiriac A, Lotti T. Cutaneous signs in COVID-19 patients: A review. Dermatol Ther. 2020;33(5):e13549.)	Acroischemia; cold ends; dry gangrene; skin injuries.
China	Systematic	Assess the prevalence of comorbidities in patients with COVID-19 and acute respiratory syndrome.(²⁹29. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91–5.)	Dyspnea; fatigue; fever.
China	Narration	Not described.(¹1. Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res. 2020;7(1):11.)	Nausea/vomiting; diarrhea; arrhythmias; elevated troponin; dyspnea; fatigue; acute kidney failure; fever; headache; sore throat.
India	Narration	Summarize types, morphology, origin, transmission, symptoms and diagnostic methods of the SARS virus-CoV-2.(³⁰30. Ramalingam K, Balasubramanian A. 2019 Novel Coronavirus: A mysterious threat from Wuhan, China–A current review. Int J Res Pharm Sci. 2020; 11(Suppl.1): 7-15.)	Diarrhea; dyspnea; fatigue; fever; chest pain.
Taiwan	Narration	Analyze the evidence on how the digestive system and liver are affected by the SARS virus-CoV-2.(³¹31. Lee IC, Huo TI, Huang YH. Gastrointestinal and liver manifestations in patients with COVID-19. J Chin Med Assoc. 2020 ;83(6):521–3.)	Anorexia; nausea/vomiting; diarrhea; abdominal pain/discomfort.
China	Narration	Understand the mechanism of viral sepsis caused by COVID-19.(³²32. Li H, Liu L, Zhang D, Xu J, Dai H, Tang N, et al. SARS-CoV-2 and viral sepsis: observations and hypotheses. Lancet. 2020;395(10235):1517–20.)	Weak peripheral pulse; cold ends; acute renal failure.
Taiwan	Narration	Not described.(³³33. Wu YC, Chen CS, Chan YJ. The outbreak of COVID-19: an overview. J Chin Med Assoc. 2020;83(3):217–20.)	Nausea/vomiting; diarrhea; confusion; dyspnea; hemoptysis; fever; muscle pain; headache; sore throat; chest pain.
Poland	Narration	Present the typical symptoms of COVID-19.(³⁴34. Sławiński G, Lewicka E. What should a cardiologist know about coronavirus disease 2019? Kardiol Pol. 2020;78(4):278–83.)	Fever; muscle pain; fatigue; chest pain; systemic inflammatory response syndrome; hypoxemia; arrhythmias; elevated troponin.
Poland	Narration	Present information on the etiology, pathogenesis, diagnosis, clinical picture, treatment and prevention of COVID-19.(³⁵35. Wujtewicz M, Dylczyk-Sommer A, Aszkiełowicz A, Zdanowski S, Piwowarczyk S, Owczuk R. COVID-19 - what should anaethesiologists and intensivists know about it? Anaesthesiol Intensive Ther. 2020;52(1):34–41.)	Fever; fatigue; muscle pain; sore throat; diarrhea; hemoptysis; chills; sepsis.
India	Narration	Not described.(³⁶36. Yashavantha Rao HC, Jayabaskaran C. The emergence of a novel coronavirus (SARS-CoV-2) disease and their neuroinvasive propensity may affect in COVID-19 patients. J Med Virol. 2020;92(7):786–90.)	Dyspnea; muscle pain; fever; fatigue; acute kidney failure; encephalitis.

Sample characterization	n(%)
Female	4(80.0)
Professional experience
5 to 10 years	1(20.0)
10 to 20 years	3(60.0)
20 to 40 years	1(20.0)
Scientific production on the theme of nursing care in the ICU and nursing classification systems
Publication in Qualis CAPES A1/A2/A3/B1 magazines or journals	4(80.0)
Presentation of work at a national or international scientific event	3(60.0)
Subject in master’s thesis or doctoral thesis	2(40.0)

BNH	Diagnostic clues	Diagnostic title*	Domain/Class*	Corresponding diagnostic indicators**	%
Food	Ageusia; Anorexia; Anosmia; Dysgeusia; Hyposmia	Imbalanced nutrition: less than body requirements	Nutrition/Intake	Defining characteristics: Alteration in taste sensation; Food intake less than recommended daily allowance. Related factor: Insufficient dietary intake.	100
Elimination	Diarrhea; Abdominal pain/Discomfort	Diarrhea	Elimination and exchange/Gastrointestinal function	Defining characteristics: Colic; Abdominal pain; Associated conditions: Infection.	80
Elimination	Nausea/Vomiting	Nausea	Comfort/Physical comfort	Defining characteristics: Feeling sick. Associated conditions: Biochemical dysfunction; Gastrointestinal irritation.	100
Hormone regulation	Hyperglycemia; Ketoacidosis	Risk for metabolic imbalance syndrome	Nutrition/Metabolism	Defining characteristic: Risk for unstable blood glucose.	100
Hormone regulation	Hyperglycemia; Ketoacidosis	Risk for unstable blood glucose	Nutrition/Metabolism	Defining characteristic: Insufficient diabetes management	100
Vascular regulation	Arrhythmias; palpitations; tachycardia (HR >125 beats per minute - bpm); ventricular/atrial fibrillation; hypotension; cardiac insufficiency; elevated troponin; weak peripheral pulse	Risk for decreased cardiac output	Activity and rest/Cardiovascular and pulmonary responses	Associated conditions: altered contractility, alteration in heart rate, alteration in rhythm.	80
	Acroischemia; weak peripheral pulse; cold ends; dry gangrene	Ineffective peripheral tissue perfusion	Activity and rest/Cardiovascular and pulmonary responses	Defining characteristics: alteration in skin characteristics; capillary refill time > 3 seconds; decrease in peripheral pulses; decrease in blood pressure in extremities.	100
	Hypotension; hypoxemia; risk for cardiac arrest; sepsis; systemic inflammatory response syndrome	Risk for shock	Safety and protection/Physical injury	Associated conditions: hypotension; hypoxemia; infection; sepsis; systemic inflammatory response syndrome.	80
	Acute coagulopathy; hemoptysis; cerebral hemorrhage; gastrointestinal bleeding	Risk for venous thromboembolism	Safety and protection/Physical injury	Populations at risk: admission to Intensive Care Unit.	80
		Risk for bleeding	Safety and protection/Physical injury	Associated conditions: inherent coagulopathy; gastrointestinal condition.	80
	Dizziness; acute coagulopathy; ventricular/atrial fibrillation; encephalitis	Risk for ineffective cerebral tissue perfusion	Activity and rest/Cardiovascular and pulmonary responses	Associated conditions: coagulopathy; atrial fibrillation.	80
	Hypovolemia; hypoxemia	Risk for decreased cardiac tissue perfusion	Activity and rest/Cardiovascular and pulmonary responses	Associated conditions: hypovolemia; hypoxemia	100
	Arrhythmias; increase in intracranial pressure	Risk for unstable blood pressure	Activity and rest/Cardiovascular and pulmonary responses	Associated conditions: cardiac arrhythmia; increase in intracranial pressure.	100
Neurological regulation	Agitation; confusion	Acute confusion	Perception and cognition/Cognition	Defining characteristics: agitation; alteration in level of consciousness.	100
Neurological regulation	Brain hemorrhage; hypotension; encephalitis; increase in intracranial pressure	Decreased adaptive capacity, intracranial	Coping and stress tolerance/neurobehavioral stress	Associated conditions: systemic hypotension with intracranial hypertension; brain injury.	100
Oxygenation	Oxygenation (≤ 300 mm mercury - mmHg); dyspnea; tachycardia (HR>125bpm); agitation; hypoxemia	Impaired spontaneous ventilation	Activity and rest/Cardiovascular and pulmonary responses	Defining characteristics: increase in heart rate; decrease in arterial oxygen saturation; decrease in partial pressure of oxygen; dyspnea; restlessness.	100
	Dyspnea; tachypnea (FR>30 irpm); fatigue	Ineffective breathing pattern	Activity and rest/Cardiovascular and pulmonary responses	Defining characteristics: Abnormal breathing pattern dyspnea; tachypnea. Related factor: fatigue; hyperventilation.	100
	Oxygenation (≤ 300 millimeters of mercury - mmHg); confusion; dyspnea; hypoxemia; agitation; tachycardia (HR>125bpm)	Impaired gas exchange	Elimination and exchange/Respiratory function	Defining characteristics: confusion; dyspnea; hypoxemia; hypoxia; restlessness; tachycardia. Associated conditions: Alveolar-capillary membrane changes; ventilation-perfusion imbalance.	100
	Tachypnea (FR>30irpm); fatigue; agitation; confusion; tachycardia (HR>125bpm); hypoxemia; dyspnea;	Dysfunctional ventilatory weaning response	Activity and rest/Cardiovascular and pulmonary responses	Defining characteristics: respiratory distress; moderate increase in respiratory rate over baseline; fatigue; restlessness; increase in heart rate from baseline (> 20 mmHg); decrease in level of consciousness.	100
Hydrosaline regulation	Pulmonary edema; acute renal failure	Excessive fluid volume	Nutrition/Hydration	Defining characteristics: pulmonary congestion; electrolyte imbalance; edema; oliguria.	100
Skin integrity	Skin injuries; acroischemia; dry gangrene	Impaired skin integrity	Safety and protection/ Physical injury	Defining characteristics: altered skin integrity. Associated conditions: impaired circulation.	100
		Impaired tissue integrity	Safety and protection/ Physical injury	Defining characteristics: tissue damage; destroyed tissue. Associated conditions: impaired circulation.	100
		Risk for pressure injury	Safety and protection/ Physical injury	Associated conditions: impaired circulation; decrease in tissue oxygenation; decrease in tissue perfusion.	100
Thermal control	Fever; convulsion; chills; tachycardia (HR >125 bpm); tachypnea (FR>30 irpm); hypotension	Hyperthermia	Safety and protection/ Thermoregulation	Defining characteristics: Tachycardia; tachypnea; convulsion; skin warm to touch; hypotension.	100
Pain perception	Self-report of: muscle pain; headache; sore throat; chest pain; abdominal pain/discomfort	Acute pain	Comfort/ physical comfort	Defining characteristics: change in physiological parameter; self-report of intensity using standardized pain scale; self-report of pain characteristics using standardized pain instrument; expressive behavior.	100
Locomotion	Ataxia; muscle atrophy	Impaired physical mobility	Activity and rest/ Activity and exercise	Defining characteristics: uncoordinated movement; decrease of fine and gross motor skills. Related factors control, strength and decreased muscle mass. Associated conditions: musculoskeletal impairment; neuromuscular impairment.	100

[1] Corresponding author: Luana Vieira Toledo E-mail: luanatoledoufv@gmail.com

Brasil

Brasil

NANDA-I^® nursing diagnoses in adult critical patients with COVID-19

Abstract

Objective

Method

Results

Conclusion

Brasil

Brasil

NANDA-I® nursing diagnoses in adult critical patients with COVID-19

Abstract

Objective

Method

Results

Conclusion

NANDA-I^® nursing diagnoses in adult critical patients with COVID-19