ISSN:1046-7467    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Substantial changes in the practice of cardiology ultimately produce a change in the types of patients who become candidates for surgery. This has been especially true for patients with coronary artery disease. The primary goals of coronary artery bypass graft (CABG) surgery are to relieve symptoms, prolong survival, and improve the quality of life. Because of recent improvements in pharmacologic therapy and medical interventions, the criteria used to select patients for CABG surgery has changed secondary to the clinical characteristics of the patient population.

ISSN:1046-7467    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The quest for the ideal cardiac valve substitute represents a highly categorized goal for the cardiac surgical community. Ongoing research has resulted in the development and creation of multiple newer heart valves and techniques for valve repair. Each of the many valves commercially available possesses a wide array of features. With the expansion of research investigations, improvement in long-term management can be translated and incorporated directly into patient care. As valvular replacement and repair/reconstruction surgery become more commonplace, it is paramount for nurses to be knowledgeable regarding the critical components of care.

ISSN:1046-7467    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Chronic heart failure is a progressive syndrome characterized by diffuse coronary artery disease (CAD) or left ventricular failure not amenable to acute interventions of myocardial revascularization. A spectrum of treatment options is available to such patients. Medical therapies consist largely of pharmacologic alternatives and are used in the early stages of heart failure to slow the processes of ventricular remodeling. Surgical interventions are used as adjunctive therapies in the later stages of heart failure. These procedures include coronary endarterectomy, high-risk surgical revascularization, automatic internal cardioverter-defibrillator insertion (Coronary Artery Bypass Grafting in Conjunction with Implantable Cardioverter Defibrillator Trial), cardiac transplantation, and dynamic cardiomyoplasty. This article provides an overview of each of these surgical therapies. Indications for each procedure and patient selection criteria are outlined. A description of each surgical procedure is included. Guidelines for postoperative nursing care are provided, and postoperative complications are discussed.

ISSN:1046-7467    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Competent chest tube management represents the mainstay of postoperative care for the cardiothoracic patient. Patency and integrity of mediastinal and pleural catheters is crucial to preservation of cardiopulmonary performance. Despite the relatively brief period of time these catheters dwell, knowledge of their placement, function, and current research findings relevant to their care is essential for appropriate nursing interventions. This article addresses application and management of chest tubes, autotransfusion techniques, and areas for future nursing research.

ISSN:1046-7467    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Ensuring adequate oxygen delivery to the tissues with respect to oxygen demand is an important operative challenge during cardiac surgery. The state of the art in myocardial preservation in the 1990s has evolved to include pretreatment of the myocardium; intraoperative use of systemic hypothermia with cardiopulmonary bypass (CPB), topical cooling of the myocardium, cold cardioplegia, and myocardial reperfusion; and postoperative oxygen transport support. These techniques optimize myocardial preservation while providing adequate cardiac surgery operative times by decreasing the myocardial ischemic period, decreasing cellular metabolic requirements, and preserving energy stores. Awareness of the physiologic consequences of hypothermia in the postoperative cardiac patient improves nursing assessment of the hypotherrmic patient. Appropriate temperature monitoring and reporting support timely medical and nursing interventions for hypothermia, such as internal and external rewarming techniques or drug administration to facilitate the rewarming process and suppress or treat shivering. This article addresses the physiologic condition of hypothermia, the elective hypothermia techniques used during cardiac surgery, and the medical or nursing rewarming and management techniques for the postoperative cardiac surgery patient.

ISSN:1046-7467    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Cardiovascular surgery patients may experience a low cardiac output state as a result of anesthesia, cardiopulmonary bypass, and myocardial stunning. Prompt assessment and early intervention are critical to patient survival. A variety of pharmacologic agents are available to support the failing circulation, including several promising new experimental inotropic agents. Intraaortic balloon pumps (IABP) and ventricular assist devices (VAD) are additional therapies reserved for advanced cardiac decompensation that is unresponsive to pharmacologic treatment. A review of etiologic factors precipitating postcardiotomy failure is presented, and traditional and experimental inotropic agents are discussed. An overview of mechanical cardiac support with the IABP, centrifugal and pneumatic VAD, and the Hemopump (Johnson & Johnson Interventional Systems, New Brunswick, NJ) device is presented, all of which addresses information critical to optimal patient outcomes.

ISSN:1046-7467    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Low cardiac output after cardiac surgery may be caused by hypovolemia, myocardial depression, vasoconstriction, and dysrhythmias. Postoperative hypovalemia occurs because of blood volume loss and decreased diastolic filling. Diuresis, intravascular fluid shift into the interstitium, hormonal influences, and bleeding deplete blood volume. Diastolic filling may be compromised by positive end-expiratory pressure, vasodilation, dysrhythmias, and venous return obstruction. The primary indicator of intravascular volume is ventricular preload, which may be measured indirectly with central venous pressure, left atrial pressure, or pulmonary capillary wedge pressure. Recognition of hypovolemia is aided through the use of cardiac pressure trend monitoring and evaluation of noninvasive indicators of hypovolemia. Nursing goals, in response to hypovolemia, are to increase the circulating volume, optimize oxygen delivery, stabilize hemodynamics, improve tissue perfusion, and prevent shock.

ISSN:1046-7467    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Tremendous strides have been made in the surgical treatment of cardiac disease. Research has documented many physical and psychologic benefits for the patient, but many questions remain unanswered. The change in quality of life may be the single most important outcome of cardiac surgery. This issue has received considerable attention in professional literature in recent years, particularly in the midst of rapidly expanding technology and soaring health care costs. This article reviews the literature related to the quality of life of cardiac surgical patients. Specific topics, such as physiologic and psychologic outcomes, return to work, family responses, and issues related to transplant patients, are discussed. The article includes a discussion of nursing implications.

ISSN:1046-7467    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Hypoplastic left heart syndrome (HLHS) is a common congenital heart defect that is universally fatal without surgical intervention. Two distinctly different surgical options, heart transplantation and reconstructive surgery, have been successful in treating infants with HLHS. This article reviews the anatomy and pathophysiology of HLHS. Preoperative care of infants with HLHS is discussed. The care required by infants with HLHS after heart transplantation is the same as that required by other infants who need heart transplant and has been reported. The primary focus of this report is postoperative care after staged reconstructive surgery for infants with HLHS.

ISSN:1046-7467    

出版商:OVID    

年代:1993

数据来源: OVID