ABSTRACT
Invasive hemodynamic monitoring has become a valuable assessment parameters in critical care nursing in patients undergoing open heart surgery patients. During cardiac surgery, the Swan Ganz catheter is placed in the pulmonary artery. Critical care nurses routinely obtain cardiac output, cardiac index, and pulmonary arterial pressure in these patients. Traditionally, patients are positioned flat and supine for cardiac output measurement. Numerous studies have dealt with the effects of changing position on the hemodynamic variables. However, there are a few studies dealing with patients who undergo cardiac surgery in Korea. Thus, the purpose of this study was to determine the effects of changing position on cardiac output, PAP, CVP, BP, HR and discomfort in patients after cardiac surgery. A sample of 21 adults who had CABG and/or valve replacement with Swan Ganz catheters in place was studied. The data were collected in the cardiac ICU of a university hospital in Seoul during the period from July 28, 1999 to August 30. 1999. In this study, the independent variable is patient position in the supine, 30 degree, and 45 degree angles. Dependent variables are C.O., C.I., CVP, PAP, MAP, HR and patients' perceived discomforts. Subject discomfort was measured subjectively by visual analogue scale. Other hemodynamic data where collected by the thermodilution method and by direct measurement. The data were analyzed by percentile, t-test, ANOVA, Linear regression analysis using SPSS-/WIN program. The results are as follows: 1) Changes in cardiac output were absent in different angle positions, 0, 30, 45 degrees(F=0.070,P=0.932). Changes in cardiac index were absent in different angle positions, 0. 30, 45 degrees(p>0.05). 2) Changes in central venous pressure were absent in differentangle positions, 0, 30, 45 degree(p>0.05). 3) PAP had no change in different angle 0, 30, 45 degree positions; systolic PAP(p>0.05), diastolic PAP(p>0.05). 4) Changes in systolic blood pressure were absent in different angle positions, 0, 30, 45 degree(p>0.05). 5) Changes in heart rates were absent in different angle positions, 0, 30, 45 degree(p>0.05). 6) Patients' perceived discomfort was absent in different angle positions, 0, 30, 45 degree(p<0.05). In conclusion, critical care nurses can measure C.O., C.I., PAP, BP, & CVP in cardiac surgery patients at 30 degree or 45 degree positions. This can improve the patients' comfort.
Subject(s)
Adult , Humans , Arterial Pressure , Blood Pressure , Cardiac Output , Catheters , Central Venous Pressure , Critical Care , Critical Care Nursing , Heart Rate , Hemodynamics , Korea , Linear Models , Pulmonary Artery , Seoul , Thermodilution , Thoracic SurgeryABSTRACT
Chronic eosinophilic pneumonia is a very rare disorder of unknown etiology characterized by striking systemic and pulmonary manifestations such as fever, weight loss, dyspnea, blood eosinophilia, and fluffy peripheral opacities on chest radiograph. A number of these patients developed asthma before or with the onset of illness. The roentgenographic lesion rapidly resoluted with corticosteroid and recurrence was occasionally occured in the same location. Histopathologic features of chronic eosinophilic pneumonia include dense aggregates of eosinophils, histiocytes, and multinucleated giant cells within alveolar spaces, interstitium, and bronchioles associated with scattered lymphocytes and plasma cells. We report a case of chronic eosinophilic pneumonia diagnosed by clinical, radiographic, and histologic findings with review of the literature.