Teoría de medio alcance para el diagnóstico de enfermería Volumen de Liquidos Excesivo en gestantes

Fróes, Nathaly Bianka Moraes; Lopes, Marcos Venícios de Oliveira; Pontes, Cleide Maria; Ferreira, Gabriele Lima; Aquino, Priscila de Souza

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 73 (suppl 4) • 2020 • https://doi.org/10.1590/0034-7167-2019-0334 copiar

Teoría de medio alcance para el diagnóstico de enfermería Volumen de Liquidos Excesivo en gestantes

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

Establecer una teoría de medio alcance para la comprensión de los mecanismos causales y consecuencias clínicas del diagnóstico de enfermería Volumen de Líquidos Excesivo (00026) en gestantes.

Métodos:

La teoría de medio alcance ha sido construida en cinco etapas: Definición del abordaje de construcción; Definición de los conceptos principales; Desarrollo de un esquema pictorial; Construcción de las proposiciones; y Establecimiento de las relaciones de causalidad y de evidencias para la práctica.

Resultados:

Han sido identificados 14 indicadores clínicos y 6 factores causales de Volumen de Líquidos Excesivo. Ha sido construido un diagrama pictorial y establecidas relaciones entre los elementos de Volumen de Líquidos Excesivo, con seis proposiciones para ellos.

Conclusión:

La teoría de medio alcance incluyó condiciones fisiológicas y patológicas para explicar el Volumen de Líquidos Excesivo; ella puede ayudar en la mejor comprensión de las interacciones entre los factores casuales e indicadores clínicos de Volumen de Líquidos Excesivo.

Descriptores:
Diagnóstico de Enfermería; Embarazo; Teoría de Enfermería; Revisión; Salud de la Mujer

Clinical Indicators of Excess fluid volume found in the Integrative Review
Edema	Conceptual definition: Edema is the fluid retention in the interstitial space that might be local or generalized⁽¹⁵15 Aguiar MIF, Freire PBG, Cruz IMP. Sistematização da assistência de enfermagem a paciente com síndrome hipertensiva específica da gestação. Rev Rene [Internet]. 2010[cited 2019 Jan 20];11(4):66-75. Available from: http://www.periodicos.ufc.br/rene/article/view/4600/3445 http://www.periodicos.ufc.br/rene/articl... ⁾.
Decreased hematocrit	Conceptual definition: Hematocrit indicates the percentage of red blood cells that is present in a certain amount of blood. During the gestational period, the increase of plasma on blood volume surpasses the increase of erythrocytes number, leading to hemodilution. Average values of hematocrit for pregnant women are between 35% and 48%. If the value is below average, it means that there is few number of erythrocytes for the blood volume⁽²2 Hall JE, Guyton AC. Tratado de Fisiologia Médica. 12. ed. Rio de Janeiro: Elsevier, 2011.⁾.
Decreased hemoglobin	Conceptual definition: Hemoglobin is a protein that is inside red blood cells and transports oxygen from the lungs to the body cells. During gestation, the phenomenon of hemodilution leads to a decrease of hemoglobin values in the pregnant women. The usual values of hemoglobin during pregnancy are above 11 g/dl⁽²2 Hall JE, Guyton AC. Tratado de Fisiologia Médica. 12. ed. Rio de Janeiro: Elsevier, 2011.⁾.
Dyspnea	Conceptual definition: Subjective feeling of respiratory difficulty or respiratory discomfort⁽⁵5 Potter PA, Perry AG. Fundamentos de Enfermagem. 8. ed. Rio de Janeiro: Elsevier, 2013.⁾.
Pulmonary congestion	Conceptual definition: Pulmonary congestion occurs when fluid infiltrates in the lungs faster than it is eliminated, this interferes with gas exchange at alveolar level⁽¹⁶16 Razeq SSA. Obstetric emergencies: respiratory distress. Contemporary Ob Gyn. 2011; 56(11):28-35.⁾.
Excessive weight gain in a short period of time	Conceptual definition: During pregnancy, there are acceptable weight gain ranges in each gestational trimester and pregnant women nutritional status. Brasil (2012) stablishes the following values to weight gain in pregnant women:
		BMI (Body Mass Index)	Total Weight Gain on 1^st trimester	Weekly Weight Gain on 2^nd and 3^rd trimester	Total Weight Gain on gestation
		Low weight	2.3	0.5 kg	12.5-18 kg
		Adequate	1.6 kg	0.4 kg	11.5-16 kg
		Overweight	0.9 kg	0.3 kg	7-11.5 kg
		Obesity	-	0.3 kg	7 kg
	Source: Brasil, 2012.

	For example, a weekly gestational weight gain of 400g during the second trimester on a pregnant woman with adequate BMI before pregnancy is something that needs to be assessed.
Alteration in blood pressure	Conceptual definition: Observation of absolute tensional levels equal or higher than 140mmHg of Systolic Pressure and equal or higher than 90mmHg of Diastolic Pressure, sustained in repeated measurements, under ideal conditions, in at least three occasions⁽¹⁷17 Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica Atenção ao pré-natal de baixo risco. Brasília (DF); 2012.⁾.
Alteration in arterial pulmonary pressure	Conceptual definition: Arterial pulmonary pressure above usual values. Average value of systolic arterial pulmonary pressure is 25mmHg and average diastolic pulmonary pressure is 8mmHg, medium arterial pulmonary pressure is 15mmHg⁽²2 Hall JE, Guyton AC. Tratado de Fisiologia Médica. 12. ed. Rio de Janeiro: Elsevier, 2011.⁾.
Increase in central venous pressure	Conceptual definition: Central venous pressure is regulated by the balance between heart capacity of pumping the blood outside the right atrium and ventricle to the lungs and the tendency of the blood to flow from peripheral veins to the right atrium. Its normal values are 2-8mmHg (using pressure transducer) or 3-11 cmH2O (using saline solution scale)⁽²2 Hall JE, Guyton AC. Tratado de Fisiologia Médica. 12. ed. Rio de Janeiro: Elsevier, 2011.⁾.
Oligury	Conceptual definition: Decreased urinary output, despite regular fluid ingestion⁽⁵5 Potter PA, Perry AG. Fundamentos de Enfermagem. 8. ed. Rio de Janeiro: Elsevier, 2013.⁾.
Orthopnea	Conceptual definition: Respiratory difficulty that appears when patient is in supine position⁽⁵5 Potter PA, Perry AG. Fundamentos de Enfermagem. 8. ed. Rio de Janeiro: Elsevier, 2013.⁾.
Paroxysmal nocturnal dyspnea	Conceptual definition: Situation in which the patient has her sleep interrupted due to the breathing difficulty, needing to sit or stand up in order to obtain relief of the respiratory discomfort⁽¹⁸18 Jarvis C. Exame físico e avaliação de saúde para enfermagem. 6ª Ed. Rio de Janeiro: Guanabara Koogan, 2012.^-¹⁹19 Rezende Filho J, Montenegro CAB. Obstetrícia fundamental. 11ª edição. Rio de Janeiro: Editora Guanabara Koogan, 2007.⁾.
Anasarca	Conceptual definition: Generalized edema (face, upper and lower limbs), resulting from fluid retention in the tissues⁽¹⁷17 Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica Atenção ao pré-natal de baixo risco. Brasília (DF); 2012.⁾.

Etiological factor	n	%
Chronic diseases	10	30
Vascular alterations related to pregnancy diseases	8	25
Excessive sodium intake	7	21
Hormonal changes	5	17
Mechanical factor	4	12
First pregnancy	3	9
Extremes of reproductive age	3	9
Clinical indicator	n	%
Edema	10	30
Decrease in hematocrit	4	12
Decrease in hemoglobin	4	12
Dyspnea	4	12
Pulmonary congestion	4	12
Weight gain over short period of time	4	12
Alteration in blood pressure	3	9
Alteration in pulmonary artery pressure	2	6
Increase in central venous pressure (CVP)	2	6
Oligury	2	6
Orthopnea	2	6
Paroxysmal nocturnal dyspnea	2	6
Anasarca	1	6

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Nathaly Bianka Moraes Fróes. E-mail: nathaly.bmf@hotmail.com

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