Clinical Validation of the Nursing Diagnosis “Risk for Shock” in Patients with Acute Myocardial Infarction Admitted to the ICU

Abstract

Objective To clinically validate the nursing diagnosis “Risk for shock” in patients with acute myocardial infarction (AMI) admitted to an Intensive Care Unit (ICU). Method A retrospective case-control study conducted at a high-complexity university hospital in Brazil. The sample consisted of 116 medical records of adult patients with AMI, equally distributed between the case group (with cardiogenic shock; n = 58) and the control group (without cardiogenic shock; n = 58). Diagnostic accuracy measures (sensitivity, specificity, predictive values, and likelihood ratios) were calculated, and multivariate binary logistic regression using the Stepwise Forward method was applied to identify independent predictors and control for confounders. Results In the accuracy analysis, the indicator “Unstable blood pressure” showed the best clinical balance, with a sensitivity of 85.0% (95% CI: 76.2–93.8) and a specificity of 83.6% (95% CI: 74.4–92.8). “Hyperthermia” and “Inadequate fluid volume” showed the highest individual specificities (90.1% and 80.3%, respectively). After adjusting the logistic regression model (Nagelkerke R 2 = 0.614; Hosmer-Lemeshow p = 0.782), only four factors remained significant as independent predictors of the outcome: unstable blood pressure (aOR = 7.80; 95% CI: 3.10–19.60; p < 0.001), hypoxia (aOR = 3.70; 95% CI: 1.50–9.20; p = 0.006), hypoxemia (aOR = 2.90; 95% CI: 1.40–6.10; p = 0.004), and inadequate fluid volume (aOR = 2.10; 95% CI: 1.00–4.50; p = 0.048). Thermal and hemorrhagic indicators lost significance after adjustment. Conclusion The study clinically validated the diagnosis and confirmed a robust predictive model composed of four indicators. Prioritizing the monitoring of these risk factors enables critical care nurses to anticipate hemodynamic collapse, support targeted care protocols, and optimize multiprofessional decision-making at the bedside.

The authors' abstract, as published at the source. International Journal of Nursing Knowledge, 2026 · DOI ↗