Abstract
Objective: To identify the NANDA International Nursing Diagnoses (ND) in older adults in intensive care for COVID-19 who required invasive mechanical ventilation support. Methods: A longitudinal observational study, based on the retrospective analysis of nursing records from 41 patient charts at three distinct moments: upon admission to the intensive care unit, 24 hours after orotracheal intubation, and at the moment before the outcome (discharge, death, or extubation). Odds ratios were calculated. The manuscript was guided by the STROBE statement. Results: With an average hospitalization time of 17 days, 127 NDs were identified at admission, 133 NDs 24 hours after intubation, and 159 NDs before the outcome. "Risk for Infection" had the highest frequency throughout hospitalization (53.7%, 75.6%, and 87.8%), while the diagnosis of "Anxiety" showed the largest negative variation (-240%). While "Anxiety" increased the odds of "Ineffective Airway Clearance" (7.5 times) and "Ineffective Breathing Pattern" (27.7 times), "Ineffective Breathing Pattern”, in turn, was associated with "Risk for Impaired Skin Integrity" (59 times). Conclusions: Different NDs were identified throughout the hospitalization of the older adults, with great variability in frequencies, depending on the clinical moment evaluated.
References
Akinosoglou K, Schinas G, Almyroudi MP, Gogos C, Dimopoulos G. The impact of age on intensive care. Ageing Res Rev. 2023;84:101832. https://doi.org/10.1016/j.arr.2022.101832
Associação de Medicina Intensiva Brasileira. Características das internações [Internet]. São Paulo: UTIs Brasileiras; c2023 [citado 2025 Ago 18]. Disponível em: https://www.utisbrasileiras.com/caracteristicas-das-internacoes/
Ferretti-Rebustini RE de L, Nogueira L de S, Silva R de CGE, Poveda V de B, Machado SP, Oliveira EM de, et al. Aging as a predictor of nursing workload in Intensive Care Unit: results from a Brazilian Sample. Rev Esc Enferm USP. 2017;51:e03216. https://doi.org/10.1590/s1980-220x2016237503216
Ribeiro JB, Lopes FJ, Barbosa AC de L, Gallasch CH, Santos ES, Ferretti-Rebustini RE de L. Nursing Workload and care required by older adults in intensive care. Rev. bras. geriatr. gerontol. 2023;26:e230134. https://doi.org/10.1590/1981-22562023026.230134.en
Abate SM, Checkol YA, Mantefardo B. Global prevalence and determinants of mortality among patients with COVID-19: A systematic review and meta-analysis. Ann Med Surg (Lond). 2021;64:102204. https://doi.org/10.1016/j.amsu.2021.102204
Macedo LR, Araújo CB de, Carvalho LF de, Lobato JCP, Paiva NS, Costa AJL. Excesso de mortalidade geral e mortalidade por COVID-19 no Brasil e regiões no ano de 2020. Cad Saude Publica. 2025;40(11):e00217323. https://doi.org/10.1590/0102-311XPT217323
Abul Y, Leeder C, Gravenstein S. Epidemiology and Clinical Presentation of COVID-19 in Older Adults. Infect Dis Clin North Am. 2023;37(1):1-26. https://doi.org/10.1016/j.idc.2022.11.001
Batista MJ, Lino CM, Tenani CF, Barbosa AP, Latorre M do RD de O, Marchi E. COVID-19 Mortality among Hospitalized Patients: Survival, Associated Factors, and Spatial Distribution in a City in São Paulo, Brazil, 2020. Int J Environ Res Public Health. 2024;21(9):1211. https://doi.org/10.3390/ijerph21091211
Fériz-Bonelo KM, Iriarte-Durán MB, Giraldo O, Parra-Lara LG, Martínez V, Urbano MA, et al. Clinical outcomes in patients with diabetes and stress hyperglycemia that developed SARS-CoV-2 infection. Biomedica. 2024;44(Sp. 1):73-88. https://doi.org/10.7705/biomedica.7095
Brito C, de Araujo Mariz C, Freitas de Oliveira França R, Lopes EP, Silva LE, Neto RL, et al. Clinical-laboratory characteristics predictive of COVID-19 severity: a prospective hospital cohort, in Pernambuco, Northeast Brazil. Braz J Microbiol. 2024;55(3):2643-2654. https://doi.org/10.1590/0037-8682-0119-2022
Cardoso JP, Calazans MIP, Carneiro ALFC, Costa CM, Monteiro ELO, Aristizábal LYG, et al. Association between multimorbidity, intensive care unit admission, and death in patients with COVID-19 in Brazil: a cross-section study, 2020. Sao Paulo Med J. 2022;141(3):e2022226. https://doi.org/10.1590/1516-3180.2022.0226.R1.21072022
Green A, Rachoin JS, Schorr C, Dellinger P, Casey JD, Park I, et al. Timing of invasive mechanical ventilation and death in critically ill adults with COVID-19: A multicenter cohort study. PLoS One. 2023;18(6):e0285748. https://doi.org/10.1371/journal.pone.0285748
Maurício AB, Cavalcante AMRZ, de Sá ES, Bruni LG, Vieira LGD, Costa A, et al. Accuracy of the defining characteristics of respiratory nursing diagnoses in patients with COVID-19. Int J Nurs Knowl. 2025;36(3):275-283. https://doi.org/10.1111/2047-3095.12481
Brasil. Conselho Federal de Enfermagem. Resolução COFEN nº 736, de 17 de janeiro de 2024. Dispõe sobre a implementação do Processo de Enfermagem em todo contexto socioambiental onde ocorre o cuidado de enfermagem. Diário Oficial da União. 2024 Jan 23;Seção 1(16):74.
Monsen KA, Heermann Langford L, Bakken S, Dunn Lopez K. Standardized nursing terminologies come of age: advancing quality of care, population health, and health equity across the care continuum. J Am Med Inform Assoc. 2023;30(11):1757-1759. https://doi.org/10.1093/jamia/ocad173
Rabelo-Silva ER, Dantas Cavalcanti AC, Ramos Goulart Caldas MC, Lucena A de F, Almeida M de A, Linch GF da C, et al. Advanced Nursing Process quality: Comparing the International Classification for Nursing Practice (ICNP) with the NANDA-International (NANDA-I) and Nursing Interventions Classification (NIC). J Clin Nurs. 2017;26(3-4):379-387. https://doi.org/10.1111/jocn.13387
Herdman TH, Kamitsuru S, Lopes CT, editores. NANDA-I nursing diagnoses: definitions and classification 2024-2026. 13. ed. New York: Thieme; 2024.
Kim M, Kim Y, Choi M. Intensive care unit nurses’ experiences of nursing concerns, activities, and documentation on patient deterioration: A focus-group study. Aust Crit Care. 2025;38(2):101126. https://doi.org/10.1016/j.aucc.2024.09.011
De Groot K, De Veer AJE, Paans W, Francke AL. Use of electronic health records and standardized terminologies: A nationwide survey of nursing staff experiences. Int J Nurs Stud. 2020;104:103523. https://doi.org/10.1016/j.ijnurstu.2020.103523
Lima-Medeiros GM de, Menezes-Dos-Santos CR, Jesus-Santos T de, Fraga-Santos E, Centenaro-Vaez A, Soares-Pinheiro FG de M, et al. Nursing diagnoses for patients hospitalized with COVID-19 in critical care units in Brazil: A cross-sectional study. Enferm Intensiva (Engl Ed). 2025;36(2):500541. https://doi.org/10.1016/j.enfie.2025.500541
Gomes GLL, Oliveira FMRL de, Leal NP da R, Guimarães KSL, Silva DF da, Barbosa KTF. Diagnósticos/resultados e intervenções de enfermagem para pacientes com COVID-19: estudo documental retrospectivo. Online Braz. J. Nurs. 2021;20(Suppl 1):e6512. https://doi.org/10.17665/1676-4285.2021651
Ghaferi AA, Schwartz TA, Pawlik TM. STROBE Reporting Guidelines for Observational Studies. JAMA Surg. 2021;156(6):577-578. https://doi.org/10.1001/jamasurg.2021.0528
Borges F, Bernardino E, Rorato C, Bobrowec DCDR, Silva OLDS, Carvalho AGRP de, et al. Nursing care for hospitalized patients with COVID-19 in light of Fundamental Care. Rev Bras Enferm. 2025;78(2):e20240075. https://doi.org/10.1590/0034-7167-2024-0075
Paiva R de M, Ferreira L de L, Bezerril MDS, Chiavone FTB, Salvador PTC de O, Santos VEP. Infection factors related to nursing procedures in Intensive Care Units: a scoping review. Rev Bras Enferm. 2021;74(1):e20200731. https://doi.org/10.1590/0034-7167-2020-0731
Castro-Trujillo S, Castro-Meneses J, Rojas MC, Castro-Amaya M, Lastra G, Narváez CF. Regulatory cytokines modulate early isotype-specific response associated with COVID-19 survival. Front Immunol. 2025;16:1543626. https://doi.org/10.3389/fimmu.2025.1543626
Silva CLB de, Moura EL de, Dantas TN do N, Matias KC, Carvalho LM de, Vitor AF. Nursing diagnoses in patients with COVID-19 admitted to the intensive care unit: CROSS-MAPPING. Heliyon. 2024;10(5):e27088. https://doi.org/10.1016/j.heliyon.2024.e27088
Silva AMB da, Bim LL, Bim FL, Sousa AFL, Domingues PCA, Nicolussi AC, et al. Patient safety and infection control: bases for curricular integration. Rev Bras Enferm. 2018;71:1170-1177. https://doi.org/10.1590/0034-7167-2017-0314
NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants. Lancet. 2024;404(10467):2077-2093. https://doi.org/10.1016/S0140-6736(24)02317-1
Zahedi M, Kordrostami S, Kalantarhormozi M, Bagheri M. A Review of Hyperglycemia in COVID-19. Cureus. 2023;15(4):e37487. https://doi.org/10.7759/cureus.37487
Chander S, Deepak V, Kumari R, Leys L, Wang HY, Mehta P, et al. Glycemic Control in Critically Ill COVID-19 Patients: Systematic Review and Meta-Analysis. J Clin Med. 2023;12(7):2555. https://doi.org/10.3390/jcm12072555

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