Showing papers in "Progress in Cardiovascular Nursing in 1996"

Readmission of older heart failure patients.

Abstract: The purpose of this article is to provide an overview of the literature on factors associated with hospital readmission of older heart failure patients. Important factors reported to be related to rehospitalization are sociodemographic and medical factors, premature discharge, failing support system, medication-related problems and noncompliance. To prevent readmission, interventions in the area of discharge planning, patient education and follow-up are recommended.

Women's short-term recovery from cardiac surgery.

Abstract: Cardiac surgery is becoming more prevalent in women. Previous knowledge and understanding regarding the process of recovery following cardiac surgery have been based predominantly on what has been known about men. Knowledge is needed regarding factors which may be particular to women's recovery from cardiac surgery and which include both biophysical and psychosocial components. A longitudinal study was conducted to describe, from both objective and subjective perspectives, women's short-term recovery from cardiac surgery. Preoperative (baseline) data were collected from 31 women who presented for cardiac surgery at two Northern California hospitals. Following discharge from the hospital, 27 women were followed monthly by telephone for three months to obtain subjective responses regarding postoperative symptoms, perceptions of recovery, activity, and health status. The findings indicate that women's perceptions of recovery are independent of NYHA functional classification, and these perceptions improve before other more objective measures of activity or health state demonstrate improvement.

Sleep disturbances post coronary artery bypass surgery.

Abstract: The purpose of this study was to describe the nature and frequency of sleep pattern disturbances in patients post coronary artery bypass (CABG) surgery. An exploratory design using telephone interviews at one week, one month, three months and six months was used to describe the incidence and nature of sleep disturbances post CABG surgery. Forty-nine patients completed all four measurement times. More than half of the patients reported sleep disturbances at each measurement time. Sleep disturbances during the first month post CABG were reported to be the result of incisional pain, difficulty finding a comfortable position and nocturia. Although less frequent over time, these problems persisted for six months. The authors propose nursing interventions to improve sleep post CABG surgery. Implications for continuing research are discussed.

Analgesics prescribed and administered to intensive care cardiac surgery patients: does patient age make a difference?

Abstract: This study was conducted to determine the effects of patient age on the opioid prescription and administration practices of professionals in a sample of 80 cardiac surgery patients. The age categories were patients or = 65 years of age. Medical records of adult cardiac surgery patients undergoing valve replacements and coronary artery bypass surgery within a single metropolitan teaching hospital were reviewed. Data were collected for up to three days or until the patient was discharged from the intensive care unit (ICU). For each of the study days, the specific types of opioids prescribed and administered were recorded. Calculations were performed to determine the maximum amounts of opioids prescribed and administered during the study period and to analyze for differences between the two age groups. Analyses revealed that all patients received small amounts of opioid analgesics during their three ICU days: mean = 9.4 mg, day of surgery; mean = 13.3 mg, postoperative day one; mean = 12.1 mg, postoperative day 2. When the total patient sample was evaluated, a significant difference in the doses of opioids prescribed versus administered was found across all three study days. Differences in amounts of opioids administered to the two age groups progressively increased across the three days, with patients > or = 65 receiving less than patients < 65. These differences approached significance on postoperative days one and two. The findings that elderly patients received less opioids than younger patients and that these differences became greater over time is intriguing. Questions remain as to whether ICU patients in pain are under-medicated and whether postsurgical pain control is effective over time.

Women's compliance with cardiac rehabilitation programs.

Abstract: As the incidence of cardiovascular disease in women increases, the process of cardiac rehabilitation in women is becoming increasingly important to nurses. Specifically, the issue of women's compliance with cardiac rehabilitation needs to be addressed by nurses. Most past and current research on cardiac rehabilitation and compliance with rehabilitation programs has been conducted on male subjects and cannot be accurately generalized to the female population. This article reviews current literature which addresses the issues of heart disease in women, cardiac rehabilitation and compliance in the general population, gender differences in cardiac rehabilitation, and compliance of women in cardiac rehabilitation.

Clinical and cost comparison of three postoperative skin preparation protocols in CABG patients

Abstract: This descriptive pilot study includes a clinical and cost comparison of three preoperative skin preparation protocols (razor, clipper, and depilatory cream, in combination with whole body disinfection) in 82 patients undergoing coronary artery bypass graft (CABG) surgery. The clinical research protocol included an evaluation of body surface area, index of body hair growth, depilatory effect, skin integrity after depilation, and side effects of body disinfection with chlorhexidine solution, as well as protocol-specific evaluation criteria. The cost comparison was performed by keeping a record of the materials used and the workload for each separate activity associated with the three preoperative skin preparation protocols. Material and labor costs were calculated for each of the different aspects of the protocols. Clinical evaluation revealed that the clipper protocol (if necessary, in combination with cream depilation) is most convenient for depilation of patients with heavy hair growth. The depilatory cream protocol is an appropriate method to depilate patients with slight or moderate hair growth. The razor method should be eliminated from clinical practice due to previous documented evidence of an associated increased risk of postoperative wound infection. Cost calculations revealed that the median hospital cost (standardized for differences in hair growth index, working hours and nurse qualification levels) of the razor, clipper, and cream protocols is $6.13, $9.84, and $8.16 (U.S. dollars), respectively. In 1995, yearly raw (i.e. non-standardized) hospital costs for the three procedures were $14,402, $16,114, and $16,765, respectively, with 708 CABG procedures performed. Although changing to a clipper and/or cream protocol may be associated with an initial, although moderate, increase in hospital costs, compared to the razor method, substantial cost savings could be expected long-term. The superiority of these protocols is primarily due to a decreased incidence of postoperative wound infections, as compared to that associated with the razor protocol.

Hopelessness in the myocardial infarction patient

Abstract: Events that cause hopelessness following a myocardial infarction may include coronary heart disease, reality-based misperceptions, lack of future goals and lack of relatedness to others. The susceptibility to hopelessness will depend on how successful the patient has been in accepting previous cardiac-related problems. Once hopelessness occurs, the patient may perceive the future to be limited. Hopelessness centers around seven components: physiological, cognitive, temporal, affective, behavioral, affiliative and contextual loss of hope. This article outlines how hopeless patients may distort their immediate environment and future goals. Methods of identifying hopelessness and intervening with appropriate nursing interventions, which will assist with the management of hopelessness, are described.

Patient and family adjustment to heart transplantation.

Abstract: Heart transplantation is an effective treatment for end-stage cardiac disease and a major stressor to patients and their families. The purpose of this paper is to review the literature on patient and family adjustment to heart transplantation during the stages from pre-transplantation to post-transplantation. Most authors indicate that patients and families adjust well to heart transplantation. Support groups are a positive resource for heart transplant patients and their families.

Cardiac patients' conversations and the process of establishing meaning.

Abstract: The purpose of this study was to describe and analyze the naturally occurring conversations of hospitalized cardiac patients. According to Blumer's symbolic interactionist perspective, individual interpretation or the meaning of a stressful event is developed and shared through social interaction. The meaning of an event is the foundation for behavioral responses that can promote or impede recovery. This study analyzed the naturally occurring conversations of ten cardiac patients. Three themes were identified within these conversations. The first theme, labeled finding cause, incorporated the processes of structuring the illness event, determining a cause for the event, and sharing the story of the illness with someone. The second theme, labeled acting normally, included participants attempting to preserve their normal patterns or habits, to resume normal activities, and to maintain personal control. The third theme, labeled passing time, encompassed sequencing the experiences within the illness event and hospitalization, waiting for news about their condition and/or recovery and structuring their future following recovery from the acute illness. An analysis of naturally occurring conversation can expedite recognition of the processes cardiac patients use to structure their reality and determine the meaning of an illness event. This may provide a foundation for understanding behaviors that affect physiological and psychosocial recovery.

Stress management for the cardiovascular patient: a look at current treatment and trends.

Abstract: Recent research findings in psychoneurobiology are increasing our clinical knowledge of how emotions and mental stress impact the cardiovascular system. Clinical trial results strongly suggest that morbidity and mortality in cardiac patients can be improved when stress management is a part of a comprehensive treatment plan. This article discusses the state of stress management in current treatment and examines some of the newer interventions and techniques being used to address this risk factor. Recommendations for integration of stress reduction into cardiovascular treatment are outlined, with an emphasis on the role of the nurse.

Parental understanding of the consequences of pediatric cardiac transplantation

Abstract: Pediatric cardiac transplantation has profound medical, social, psychological and economic consequences. Parents need to understand both the medical and non-medical consequences of the transplant procedure to make a judicious decision about this treatment. The purpose of this study was to determine the parental understanding of the multiple consequences of transplantation. A prospective ethnographic method was used to study 24 parents of 15 children prior to their decision to accept or reject the transplant option for their children. Findings revealed that the medical consequences of transplantation were well addressed by the pediatric cardiac transplant team. Little attention, however, was given to the non-medical concerns of the parents. The importance of nursing interventions related to information clarification and support for parents as they make decisions about heart transplantation for their children was identified.

ST segment deviation during myocardial ischemia: are there gender differences?

Abstract: UNLABELLED Prior research indicates that women have greater ST segment shifts at the time of percutaneous transluminal coronary angioplasty (PTCA) balloon inflation than men. However, ST deviation in men and women has not been compared during balloon occlusion of the same coronary vessel. METHODS To determine whether there is a gender difference in degree of ST deviation, 12-lead electrocardiographic (ECG) recordings were made in 45 subjects undergoing PTCA (25 men, 20 women). A total ST score was obtained by summing absolute deviations across all 12 leads. All patients had single vessel coronary artery lesions in the proximal half of one of the major epicardial arteries without evidence of collateral circulation. RESULTS There were no differences between men and women in terms of age, left ventricular hypertrophy, ejection fraction, or the Norris Coronary Prognostic Index, which combines age, history of infarction, and evidence of heart failure on chest X-ray. When comparing mean ST segment deviation in men and women, vessel to vessel, no gender differences were found. CONCLUSION When matched for coronary vessel, men and women have comparable ST deviation patterns during coronary occlusion with PTCA balloon inflation. Therefore, detection of myocardial ischemia related to coronary occlusion with continuous ST segment monitoring should be equally sensitive in men and women.

Assessment and intervention for ischemic chest pain: a case study with legal implications for nursing practice.

Abstract: In order to reduce early and long-term mortality and morbidity from myocardial infarction, nurses must promptly and thoroughly assess chest pain, intervene quickly and evaluate the results of the interventions. In Kielley v. General Hospital Corp. et al, a patient suffered a massive heart attack while under observation on a cardiology unit. The court held the hospital liable for the nurses' breach of its chest pain protocol and for failing to have electrocardiograms done when the patient experienced pain. The case clearly illustrates the harm a patient may incur when nurses fail to properly assess and intervene. It reinforces the importance of adherence to hospital protocols that have been put in place to ensure patient safety.