Construção da proposição diagnóstica de enfermagem adaptação extrauterina ineficaz

Abstract

Methodological study aiming to construct the nursing diagnostic proposition Ineffective extrauterine adaptation. The study was operationalized by two steps: concept analysis and construction of said proposition. The first step was developed along eight steps, namely: choice of concept; determination of analysis objectives; determination of essential attributes; construction of a model case; elaboration of additional cases; determination of antecedents; identification of consequences; and definition of empirical references. The analysis of the Ineffective Extrauterine Adaptation concept was operationalized through an integrative literature review in the Medline, Scopus and CINAHL databases. Crossings of the following descriptors were used: “Adaptation”, “Physiological adaptation”, “Newborn”, “Complications” , Respiratory system, Respiratory physiological phenomena, Body temperature regulation, Term birth, Premature infant, Postmature infant, Endocrine system, Nervous system physiological phenomena, Nervous system, "Digestive system physiological phenomena", "Digestive system" and "Skin physiological phenomena", using Boolean operators AND and OR. The search resulted in a sample of 70 studies, which were thoroughly read to identify the attributes, antecedents and consequences of the concept Ineffective extrauterine adaptation. The results show the identification of three attributes: physiological changes; difficulties; and environment outside the maternal uterus. The antecedents were: lack of breastfeeding, poorly controlled maternal diabetes, prenatal exposure to harmful drugs, small gestational age newborn, prematurity, neonatal asphyxia, cardiopulmonary injuries, pre-existing congenital or genetic conditions, immediate clamping of the umbilical cord, cesarean section, birth without labor (via elective cesarean section), lack of obstetric care during labor and vaginal delivery, time-consuming, stressful or painful procedures, severe trauma and no warm-up measures of the neonate. The consequences were: persistent bradycardia, persistent hypotension, decreased oxygen saturation, tissue reperfusion greater than three seconds, need for ventilatory support, neonatal hypoglycemia, low Apgar score, persistent hypothermia, late oliguria, jaundice and disorganized behavior. It was also identified how each antecedent and consequent of the concept are measured. From these findings, it was possible to develop the second stage of the study: the nursing diagnostic proposition entitled Ineffective extrauterine adaptation. The following definition was established for this proposition: Difficulty of the newborn to reach optimal physiological standards in relation to the vital parameters necessary for its survival, to the detriment of sudden changes occurring immediately outside the maternal uterus after birth. The consequences were translated into defining characteristics and the antecedents into related factors, associated conditions or population at risk. Thus, it is concluded that the concept analysis was essential both for understanding the ineffective extrauterine adaptation event, as well as for the construction of the nursing diagnostic proposition and its components. Moreover, this study provides important contributions to the advancement and strengthening of nursing science.