Risk For Decreased Cardiac Tissue Perfusion And Activity .

Risk for decreased cardiac tissue perfusionRAll statistical analyses were performed in SAS, version 9.4. Descriptive analysis was presented usingmeans, standard deviation (SD), median, and rangefor continuous variables. Categorical variables wereexpressed as numbers and percentages. The Shapiro-Wilk test was used to verify the normality of thedata. Pearson's Chi-square test or Fisher's exact testwas used for associative measures of categorical data.AMultiple Poisson regression models were constructedwith robust variance, considering the two NDs studiedas dependent variables. In these models, prevalenceratios and their confidence intervals and p-valueswere presented (9). A significance level of 5% wasadopted for all tests.Ethical considerationsThis study was performed following the Helsinki Declaration. Ethical approvals were obtainedfrom the Institutional Review Boards at Universityof Campinas in 2018, under number 2.641.527. Eachparticipant signed informed consent forms beforeenrolling in this research.IMInterviews included questions about patients’ baselinesociodemographic characteristics and social background: sex, age, marital status, education, employmentstatus, family income, and number of inhabitantsper household. Data regarding the presence of riskfactors for ACS (arterial hypertension, diabetes mellitus, smoking, dyslipidemia, and obesity) and othersrisk factors were also collected, following the protocol previously defined. In this case, for example, anopen-ended question about the factors that couldlead to ACS was formulated, so the examiner couldcheck which risk factor(s) were known to patientsand thus minimize bias in the instrument. Dataregarding the associated conditions and whetherpatients fit into risk populations for the NDs understudy were investigated in medical records.Data analysisINwith experience in caring for patients with ACS. Theprotocol was adjusted according to the consensus ofthe discussion group and was used by the researchteam to reduce the evaluation and instrument bias.In addition, to decrease the evaluation bias relatedto measurement accuracy, the research team carriedout a theoretical-practical training of eight hoursto apply the instrument built for the collection ofdata and to carry out the physical examination in astandardized way. After a pre-test with five patients,who were not included in the final version, it waspossible to verify the adequacy of the data recordinginstrument to start data collection.ELTo complement data collection, we sought medicalrecords information on clinical indicators of DCTPon admission, as recommended by Santos et al. (2)and validated by Gonçalves et al. (3), namely: angina,pain score higher than seven, electrocardiographicchanges, arrhythmia, altered cardiac enzymes, dyspnea, irradiation of pain to shoulder and jaw, painduration for less than ten hours, nausea, alteredblood pressure, dizziness, vomiting, pulmonary rales,altered heart rate, and third heart sound.PRThe diagnostic inference was carried out independentlyby a nursing student, a nurse specialized in cardiology, who is also enrolled in a master's degree, and anurse doctor and researcher in the study area, all ofthem with broad knowledge of nursing taxonomies.This helped to limit the spectrum bias, referring theresearcher to determine which patient has a diagnosis through their perception of patient impairment.Each evaluator received the clinical information of allpatients in an Excel software spreadsheet. Afterwards,the agreement reached by the three evaluators wasused as the gold standard for the presence of NDs,as in the study by Oliveira et al. (8).370ResultsPatients’ sociodemographic characteristics are shownin Table 1.Table 1. Patients’ baseline demographic characteristicsVariablesNo. (%)GenderMale54 (72)Female21 (28)Marital statusMarried49 (65.3)Unmarried26 (34.7)EducationIlliterate3 (4.2)Incomplete primary school39 (54.2)Complete primary school12 (16.7)Incomplete secondary school3 (4.2)Complete secondary school9 (12.5)Incomplete higher education5 (6.9)Employment statusUnemployed41 (54.7)Employed34 (45.3)Source: authors, based on research data.

Av Enferm. 2021;39(2):367-376.Pendiente et al.No.%6384Inexperience with activity7093.3Sedentary lifestyle6789.3Physical deconditioning6586.74864.55675.7Imbalance between oxygen supply/demandAt risk populationHistory of previous activity intoleranceAssociated conditionCirculatory problemRRisk factors51681621.36080Insufficient knowledge of modifiable factors7296Substance misuse1013.54053Coronary artery spasm7194.7Pharmaceutical agents6384Diabetes mellitus3445.3Hyperlipidemia2938.7Cardiovascular emia79.3Cardiac tamponade11.3Respiratory problemRisk for decreased cardiac tissue perfusionRisk factorsAt risk populationFamily history of cardiovascular diseaseAssociated conditionIMRelated to RAI diagnosis, all the risk factors of thiscondition were present in more than 50% of theindividuals in the sample, except for the immobility risk factor, which was not identified in any ofthe participants. As for the risk of DCTP, 96% of theparticipants had insufficient knowledge about modifiable risk factors (e.g., smoking, sedentary lifestyle,obesity) and 94.7% had artery spasms associatedwith this coronary ND.VariablesRisk for activity intoleranceAAs for ACS risk factors, we highlight that 72% of participants reported living with arterial hypertension,54.7% were active or passive smokers, 45.3% haddiabetes mellitus, 40% dyslipidemia, and 12% wereobese. This way, all the indicators of DCTP were evidenced in this sample. The NDs and their elementsare shown in Table 2.Table 2. Frequency of nursing diagnosis of risk foractivity intolerance and risk for decreased cardiactissue perfusionINThe study included 75 patients with ACS, with an average age of 60.2 years (standard deviation - SD 10.4),in age ranges from 36 to 86 years, and who in mostcases were married (65.3%). There was a prevalence ofmen among the sample (72%). About 54.2% of patientsdid not complete elementary school, the averagemonthly family income was 2.7 minimum wages(SD 1.5), and the number of inhabitants/householdwas in mean 1.9 (SD 1.7), with a range from 1 to 9.Besides, 30.7% of the sample was aged 65 years orover, and 84% had a history of cardiovascular disease.LTable 3 shows the significant diagnostic inferencesbetween risk factors, associated conditions, population at risk, and the presence or absence of thecorresponding nursing diagnosis. Table 4, in turn,presents the multiple Poisson regression models.Source: authors, based on research data.PREIt was observed that patients admitted at risk ofactivity intolerance and dyspnea were 1.32 times morelikely to develop a diagnosis of activity intolerance.For the risk of decreased cardiac perfusion, thosewho did not have dyspnea and pain duration forless than ten hours were more likely to develop suchdiagnosis. Finally, in those who did not report painirradiation the probability of having this diagnosisdecreased by 47%, compared to those who had thissymptom.371

Risk for decreased cardiac tissue perfusionTable 3. Analysis of associations of nursing diagnoses of risk for activity intolerance and risk for decreasedcardiac tissue perfusion with risk factors, associated conditions, and at-risk populationRisk for activity intoleranceVariablesPresentnInexperience with activity (RF)History of previous activity intolerance (RP)Circulatory problem 074*.0001*.0.0001*RPhysical deconditioning (RF)p-valueAbsent%61.1.0.0001*50.0Risk for decreased cardiac tissue perfusionPharmaceutical agent (AC)%Yes3690.0No2468.6Yes5485.7NoYesDiabetes mellitus (AC)No*Fisher test. **Chi-square test.RF Risk factor; AC Associated conditions; RP At-risk population.Source: authors, based on research data.Independent 6PR*.0206**.0111*.0186*CI 429Radiation to the shoulder and jaw (No)1.14.901.43.2786Nausea (No).83.581.20.32861.24.811.88.3238Dizziness (No).76.571.02.0679Altered blood pressure (No).95.771.18.6354Pulmonary rales (No).97.761.25.8279Pain score greater than 7 (No)1.07.811.41.6318Pain time less than 10 hours (No).98.801.19.8114Altered cardiac enzymes (No)1.06.801.41.6840EVomiting (No).6713LDyspnea (No)Age ( 60).92.711.18.4968Sex (Male)**1.08.831.42.5600Dyspnea (No)1.541.152.06.0042Radiation to the shoulder and jaw (No).53.36.77.0009RP411p-valueULSex (Male)**Risk for decreased cardiac tissueperfusion%LLAge ( 60)Risk for activity intolerancen34IMTable 4. Multiple Poisson regression modelsDependent variableAFamily history of cardiovascular disease (RP)AbsentnINPresentNausea (No).84.661.07.1575Vomiting (No).86.611.20.3628Dizziness (No)1.12.751.65.5836Altered blood pressure (No)1.17.851.62.3287Pulmonary rales (No).88.671.16.3787Pain score greater than 7 (No).84.611.17.3034Pain time less than 10 hours (No)2.281.423.64.0006Altered cardiac enzymes (No).65.421.03.0673* PR Prevalence ratio, the probability of presenting the result "Yes" was estimated. ** In relation to the set of variables, the evaluation ofthe multiple Poisson regression models only considered the male sex as the reference for the variable, since there is a higher prevalenceof ACS among the participating male population.CI Confidence interval; LL Lower limit; UL Upper limit.Bold indicates the significance at p 0.05.Source: authors, based on research data.372

Av Enferm. 2021;39(2):367-376.Pendiente et al.RAnother point to be explored is the relationshipbetween the presence of ACS and increased risk offunctional decline, which leads to an increased chanceof hospital readmissions and death in elderly patients,as well as impacts on their quality of life (19, 20).Thus, it is evident the gap that needs to be addressedduring early stages, through intervention studies aimedat promotion, disease prevention, and rehabilitationof patients at risk, thus favoring the non-developmentof problem-focused NDs (15).IMResearch with stable heart disease patients identified13 NDs, where lifestyle (00168) and activity intolerance(00092) stand out. However, RDCTP (00200) and RAI(00094) presented less agreement between specialistnurses (15), which shows the difference betweenNDs of the acute, subacute and chronic faces. Theevidence of activity intolerance (00092) shows thatthe presence of dyspnea on exertion, fatigue, theimbalance between oxygen supply and demand,stress discomfort, and the presence of angina is acommon feature (15).As previously stated (3), patients with ACS showedangina (100%), pain score higher than seven (81.3%),electrocardiographic changes (82.4%), arrhythmia(78%), altered cardiac enzymes (76.4%), dyspnea (61.6 %),radiation to shoulder and jaw (55.4%), pain for lessthan ten hours (53.3%), nausea (45.3%), altered bloodpressure (30.7%), dizziness (29.3%), vomiting (26.7%),pulmonary rales (18.9%), altered heart rate (14.7%),and third heart sound (4%).APopulation aging and the increase in chronic diseasesare important factors in the growing prevalence ofACS, as reflected in the sociodemographic characteristics collected by this study (10-12). Corroboratingthe findings of other studies, participating patientsshowed hypertension, diabetes mellitus, dyslipidemia,and other cardiovascular diseases. We also found thatsmoking and obesity are associated risk factors (13-16).Due to the absence of studies that analyzed theelements of the two NDs studied in the populationchosen for this study, we made comparisons withstudies that performed an analysis in patients witha phenomenon often installed, which demands theimportance of early assessment.In this study, the defining characteristics of DCTP wereobserved in patients at the time of admission to theemergency department, showing a relationship withthe determination of risk diagnoses. In other words,the accurate and precise identification of clinicalparameters is essential for making diagnostic andtherapeutic decisions with potential impacts on theevolution of the patient.INDiscussionLThe insufficient knowledge of modifiable factorswas identified in a more significant percentage ofthe patients in this sample who were diagnosed withRDCTP. The correct adherence to treatment and therapid conduction in emergency cases are affected bythe lack of knowledge about ACS risk factors, as wellas by failure in identifying the signs of the ischemicevent in heart diseases (17, 18).REIn this context, knowledge about risk factors needs tobe addressed in primary and secondary care services.The prioritization of the approach to drug therapyin consultations results in a lack of knowledge aboutheart disease as a whole by the population, a factobserved in a study with patients with ACS (18).PIn nursing appointments, RDTP increases when thereis a family history of cardiovascular disease or diabetes mellitus, accompanied by the use of drugs thatact on the heart pump. Concomitant with thesefactors, early non-adherence to treatment and lackof therapeutic continuity increases the chances ofthe patient developing again DCTP.In the context of hospital discharge of patients withRDCTP and RAI diagnoses, it is necessary to continuewith rehabilitation mediated by a multidisciplinaryteam in patients’ home environment. Therefore,the complete evaluation, with the introduction ofelements of the measure of functionality, should beprioritized, especially when considering individualswith multiple morbidities and the elderly (20). Basedon the data collected, the importance of investigatingthe patient’s previous and current functional statusduring hospitalization is a remarkable finding that willcontribute to reducing the impacts on rehabilitation.Linked to the elements of physical deconditioningand inexperience with activity, the ability to walk isa crucial point to be evaluated.A possible explanation for this fact would be therelationship between the loss of microvascular perfusion after ACS, which is responsible for the supplyof oxygen and nutrients to the tissues, and the continuity of ischemia and the development of adverseclinical results (21).373

Risk for decreased cardiac tissue perfusionRThe nursing diagnoses of risk of activity intoleranceand risk of decreased cardiac tissue perfusion werepresent in 84 and 80% of patients with DCTP, respectively.When verifying the relationship between the riskfactors and the NDs studied, we found an associationof the use of pharmacological agents, the presence ofdiabetes mellitus, and family history of coronary diseasewith RPCD. In the case of RAI, this reports an associationwith lack of physical conditioning, previous historyof activity intolerance, inexperience with activity, andcirculatory problems. Finally, RPCP is associated withpharmacological agents and dyslipidemia.The absence of evidence of DCTP such as dyspnea,radiation to shoulder and jaw, and arterial pressure, andpain for less than ten hours acted as protective factorsfor the development of the studied risk diagnoses.IMIt should be noted that in the current study sampleall risk factors for RAI were identified, although onlyin association with inexperience with activity, andimbalance between oxygen supply/demand. Onthis regard, a study whose objective was to verifythe prevalence of ND sedentary lifestyle (SL) and thedefining characteristic of physical deconditioning inpatients with ACS reported a frequency of 56.1 and46.8%, respectively (24).ConclusionAHowever, faced with the evidence of low adherence tohealth promotion and disease prevention activities,the possibility of a decline that may affect the areaof cardiac rehabilitation (CR) becomes a concern.At home and in the primary care setting, CR couldcontribute to improving and maintaining physicalactivity habits and increasing cardiorespiratory fitnessand survival, thus reducing the risk of mortality (23).We should mention as a limitation of this research thatit is a cross-sectional study, leading to the observationof some characteristics only in a single moment, whichcould compromise the reading of the phenomenon.Besides, due to the use of a sample for convenience ina single hospital, our findings may not be generalized.INIn another study, it was observed that the limitations in performing basic activities of daily livingstarted eight years before the acute event (22). Thatis the period in which interventions for RDCTP andRAI could have started, considering the presence ofrisk factors, thus corroborating the findings of ourstudy regarding the association of NDs and the riskof activity intolerance and the history of previousactivity intolerance element.RELIn the case of appearance of these two elements, thereis a higher chance of systemic, muscular, respiratory,cardiovascular, and articular changes, and, consequently, activity intolerance, which might cause a newepisode of DCTP (15). As for RDCTP, all the constituentelements of NDs were identified in the sample studied.According to the research study by Moreira et al. (25),in which 1,542 adult patients were monitored forseven years after percutaneous coronary intervention (PCI), 12.1% of the sample developed DCTP, listingadvanced age, multivessel disease, and complicationsof the intra-procedure injury as predictor of such acondition. These outcomes reinforce the need forcontinuous monitoring of the population at risk.PThe care of patients with DCTP should be focusedon health promotion and risk prevention in light oftheir basic psychosocial and psychobiological humanneeds. The results found in this study reinforce thisclaim. The importance of early identification of riskdiagnosis and risk factors was also observed thoughthis research. Therefore, diagnosing these risk factorssignificantly contributes to the care and preventionof ACS complications.374To conclude, considering the high cardiovascular vulnerability of patients with ACS to nursing diagnosesthrough the NANDA-I domain Class 4, we recommendfurther studies to determine the predictive power ofthe risk diagnoses evaluated by ND from a problemcentered approach.Financial supportThis study did not receive any funding.References(1) Herdman T; Kamitsuru S. NANDA InternationalNursing Diagnoses: Definitions & Classification 20182020. 11th ed. New York: Thieme; 2017.(2) Santos VB; Atallah AN; Lopes CT; Lopes JL; BotturaABL. Defining characteristics and related factors ofdecreased cardiac tissue perfusion: Proposal of a newnursing diagnosis. Int J Nurs Knowl. 5.12095

Av Enferm. 2021;39(2):367-376.Pendiente et al.(6) Melguizo-Herrera E; Acosta-López A; Gómez-PalenciaIP; Manrique-Anaya Y; Hueso-Montoro C. The design andvalidation of a nursing plan for elderly patients withpostoperative delirium. Int J Environ Res Public Health.2019;16(22):4504. http://doi.org/10.3390/ije

decreased cardiac tissue perfusion ( dcTP), we identify the Nd Risk for Decreased Cardiac Tissue Perfusion (00200) in the taxonomy. To assist in the develop-ment of NANdA-i Taxonomy ii, two recent surveys have proposed and validated (2, 3) the Nd of dcTP, presenting acute coronary syndromes (AcS) as the most common associated condition. These worksAuthor: Suellen Cristina Dias Emidio, Laís Pereira Giovanini, Paula Rocco Gomes Lima, Julia Leme Gonçalves, .Publish Year: 2021