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      Excess fluid volume: clinical validation in patients with decompensated heart failure Translated title: Volumen de líquidos excesivo: validación clínica del diagnóstico en pacientes con insuficiencia cardíaca descompensada Translated title: Volume de líquidos excessivo: validação clínica em pacientes com insuficiência cardíaca descompensada

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          Abstract

          This cross-sectional study aimed to clinically validate the defining characteristics of the Nursing Diagnosis Excess Fluid Volume in patients with decompensated heart failure. The validation model used follows the model of Fehring. The subjects were 32 patients at a university hospital in Rio Grande do Sul. The average age was 60.5 ± 14.3 years old. The defining characteristics with higher reliability index (R): R ≥ 0.80 were: dyspnea, orthopnea, edema, positive hepatojugular reflex, paroxysmal nocturnal dyspnea, pulmonary congestion and elevated central venous pressure, and minor or secondary, R> 0.50 to 0.79: weight gain, hepatomegaly, jugular vein distention, crackles, oliguria, decreased hematocrit and hemoglobin. This study indicates that the defining characteristics with R> 0.50 and 1 were validated for the diagnosis Excess Fluid Volume.

          Translated abstract

          Estudio transversal que tuvo como objetivo validar clínicamente las características definidoras del Diagnóstico de Enfermería Volumen de Líquidos Excesivo en pacientes con insuficiencia cardíaca descompensada. Para la validación se utilizó el modelo de Fehring. Participaron 32 pacientes de un hospital universitario en Rio Grande del Sur. El promedio de edad fue de 60,5±14,3 años. Las características definidoras mayores que tuvieron tasa de fiabilidad (R): R ≥ 0,80 fueron: disnea, orto-disnea, edema, reflujo hepatoyugular positivo, disnea paroxística nocturna, congestión pulmonar y presión venosa central elevada; y las menores o secundarias con R > 0,50 a 0,79, fueron: aumento de peso, hepatomegalia, distención de la vena yugular, crepitaciones, oliguria, hematocrito y hemoglobina disminuidos. Se demostró en este estudio que las características definidoras con R > 0,50 y 1 fueron validadas para el diagnóstico Volumen de Líquidos Excesivo en la muestra en estudio.

          Translated abstract

          Estudo transversal que teve como objetivo validar clinicamente as características definidoras do diagnóstico de enfermagem volume de líquidos excessivo, em pacientes com insuficiência cardíaca descompensada. Para a validação, utilizou-se o modelo de Fehring. Participaram 32 pacientes de um hospital universitário do Rio Grande do Sul. A média de idade foi de 60,5±14,3 anos. As características definidoras maiores com taxa de fidedignidade(R): R ≥0,80 foram: dispneia, ortopneia, edema, refluxo hepatojugular positivo, dispneia paroxística noturna, congestão pulmonar e pressão venosa central elevada; e menores, ou secundárias, R >0,50 a 0,79: ganho de peso, hepatomegalia, distenção da veia jugular, crepitações, oligúria, hematócrito e hemoglobina diminuídos. Demonstrou-se, neste estudo, que as características definidoras com R >0,50 e 1 foram validadas para o diagnóstico volume de líquidos excessivo na amostra em estudo.

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          Most cited references25

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          Methods to validate nursing diagnoses.

          R Fehring (1987)
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            Usefulness of the external jugular vein examination in detecting abnormal central venous pressure in critically ill patients.

            Central venous pressure (CVP) provides important information for the management of critically ill patients. The external jugular vein (EJV) is easier to visualize than the internal jugular vein and may give a reliable estimate of CVP. To determine the usefulness of the EJV examination in detecting abnormal CVP values, we performed a prospective blinded evaluation comparing it with CVP measured using an indwelling catheter in critically ill patients with central venous catheters. Blinded EJV examinations were performed by clinicians with 3 experience levels (attending physicians, residents and fellows, and interns and fourth-year medical students) to estimate CVP (categorized as low [ /=10 cm of water]). The usefulness of the EJV examination in discriminating low vs high CVP was measured using receiver operating characteristic curve analysis. One hundred eighteen observations were recorded among 35 patients. The range of CVP values was 2 to 20 cm of water. The EJV was easier to visualize than the internal jugular vein (mean visual analog scale score, 8 vs 5; P<.001). The reliability for determining low and high CVP was excellent, with areas under the curve of 0.95 (95% confidence interval [CI], 0.88-1.00) and 0.97 (95% CI, 0.92-1.00), respectively, for attending physicians and 0.86 (95% CI, 0.78-0.95) and 0.90 (95% CI, 0.84-0.96), respectively, for all examiners. The EJV examination correlates well with catheter-measured CVP and is a reliable means of identifying low and high CVP values.
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              Critical thinking and accuracy of nurses' diagnoses.

              Interpretations of patient data are complex and diverse, contributing to a risk of low accuracy nursing diagnoses. This risk is confirmed in research findings that accuracy of nurses' diagnoses varied widely from high to low. Highly accurate diagnoses are essential, however, to guide nursing interventions for the achievement of positive health outcomes. Development of critical thinking abilities is likely to improve accuracy of nurses' diagnoses. New views of critical thinking serve as a basis for critical thinking in nursing. Seven cognitive skills and ten habits of mind are identified as dimensions of critical thinking for use in the diagnostic process. Application of the cognitive skills of critical thinking illustrates the importance of using critical thinking for accuracy of nurses' diagnoses. Ten strategies are proposed for self-development of critical thinking abilities.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rlae
                Revista Latino-Americana de Enfermagem
                Rev. Latino-Am. Enfermagem
                Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo (Ribeirão Preto )
                1518-8345
                June 2011
                : 19
                : 3
                : 540-547
                Affiliations
                [1 ] Universidade Federal do Rio Grande do Sul Brazil
                [2 ] Universidade Federal do Rio Grande do Sul Brazil
                [3 ] Universidade Federal do Rio Grande do Sul Brazil
                Article
                S0104-11692011000300013
                10.1590/S0104-11692011000300013
                3385d805-17ba-4570-b890-0525196a9e46

                http://creativecommons.org/licenses/by/4.0/

                History
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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0104-1169&lng=en
                Categories
                NURSING

                Nursing
                Heart Failure,Nursing Diagnoses,Medical History Taking,Insuficiencia Cardiaca,Diagnóstico de Enfermería,Anamnesis,Examen Físico,Physical Examination,Insuficiência Cardíaca,Diagnóstico de Enfermagem,Anamnese,Exame Físico

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