Skin care intervention for pressure ulcer prevention among cardiac surgical patients

Patients undergoing cardiac surgery have increased risks for developing pressure ulcers. Inappropriate management of this condition can lead to serious negative outcomes. The present study aimed to evaluate the effect of skin care intervention in preventing development of pressure ulcer among cardiac surgical patients. Quasi-experimental research design was applied. This study was conducted in the Intensive Care Unit of Open Heart Surgery at Mansoura University Hospital. Forty adult patients of both sexes undergoing cardiac surgery with intensive care unit [ICU] length of stay more than 6 days. Skin care intervention was applied consisting of nursing actions after determination of risk factors and pressure ulcer staging together with the Braden scale for pressure ulcer prediction. This was done at the time of admission and then every 12 hours throughout the ICU length of stay, Data revealed that 30% of patients maintained their skin integrity all over the study period, 10% developed skin breakdown and 60% experienced only erythema. The effect of nursing intervention was statistically significant. Hypertension, BMI >/= 25, duration of operation and score of Braden scale were the most significant risk factors in developing pressure ulcers. Only [5%] of the study sample remained on ulcer stage 3 by the end of the study. They showed extreme values in some risk factors. The prevention of pressure ulcers or their aggravation depends mainly on frequent assessments and constant application of skin care intervention

Contribution of nocturnal nursing intervention to sleep disruption among intensive care units patients

Patient care nursing activities in the night shift in the intensive care units are the causes of sleep deprivation among critically ill patients, Sleep disturbance has long-term effects on health outcome. The present study aimed to determine the frequency and types of nursing interventions that lead to sleep disruption among critically ill patients in different intensive care units during night shift. The design is a retrospective descriptive research. This study was conducted in four critical care units the open heart surgery [OHS] intensive care unit at Mansoura Main University Hospital, the medical intensive care unit of the specialized medical hospital at Mansoura University the coronary care unit and general intensive care units of Mansoura International Hospital of the Ministry of Health Sample: The sample consisted of 80 adult patients of both sexes admitted to the four intensive care units, 20 patients from each unit. Patients were included if they stayed for at least 4 consecutive nights in a critical care unit. A tool consisting of two parts was used. Part I included the demographic data of the patients, while part II was an activity checklist that included nurse interventions between 8.00 PM and 7.00 AM. Data represented the nursing interventions leading to sleeping disruption during 240 nights. The mean number of sleep disturbing nursing interventions per night was 28.91 +/- 12.11. Interventions were most frequent at 8.00 PM and midnight and least frequent at 3.00 AM. Only 34 uninterrupted periods of two or more hours were available for sleep [14.66% of the studied nights]. Measuring vital signs and assessing intake/output were the most frequent type of nursing interventions. Significant differences were found between the four studied units concerning number, type and frequency of nursing interventions. Nocturnal nursing interventions leave patients few uninterrupted periods for sleep. Efforts should be made to expand these periods by clustering nursing intervention without affecting patients' health outcome

effect of early activity on patients outcome after open heart surgery

The postoperative phase is the most critical period for open heart surgery during which many serious and fatal complications can occur. Early physical activity can prevent such complications. The role of the critical care nurse is crucial in this concern. The present study aimed to examine the effect of early activity on patient's outcome after open heart surgery. Design: A comparative experimental design was applied. This study was conducted in the Intensive Care Unit [ICU] of Open Heart Surgery at Mansoura Main University Hospital. Sample: Fourty adults patients of both sexes undergoing open heart surgery using cardiopulmonary bypass and showing hemodynamic stability. An activity regime was applied to 20 patients who underwent such surgery. The results were compared to a matching control group. Early activity included positioning [supine, left and right sides], early ambulation [dangling, standing near the bed, chair sitting and walking] and chest physiotherapy procedures [coughing, breathing exercises, percussion, vibration and incentive spirometry]. Comparing the obtained data revealed a better outcome among the early activity group. This was manifested by better recovery in the respiratory features especially crackles and grade II dyspnea and lung functions [FVC, FEV1 and MVV]. In addition, lower postoperative rates of dysrhythmia and atelectasis were found among the early activity group. Moreover, early activity reduced significantly the length of stay in the ICU. However, no differences could be detected between the two groups concerning oxygenation and hemodynamic parameters and renal indicators. Combination of early activity and chest physiotherapy ameliorates the outcome of patients after open heart surgery. Performing early activity to such patients is recommended

Relationship between women cardiovascular disease risk factors and the perceived social support: implications for risk reduction

Heart disease is one of the leading causes of death among women. Women have received little attention regarding the risk reduction of cardiovascular diseases. Until recently, the incidence and potential severity of heart disease in women were underrecognized. As new knowledge becomes available, it is imperative that critical care nurses be acquainted with these developments and use this knowledge in their practice to modify those factors and manage that changing needs in the women's health. This study was designed to identify women cardiovascular disease risk factors, to determine the relationship between these factors and the perceived social support, and to provide supportive interventions information for risk reduction. A descriptive study design. This study was conducted in the coronary care unit and outpatient cardiac clinic of the Specialized Medical Hospital, Mansoura University. 40 adult females diagnosed as cardiovascular diseased and able to communicate. The researchers assessed the studied women individually for cardiovascular risk factors in the first 48 hours, then they were asked to answer the questionnaire about the data related to their perceived social support. Before the day of discharge a pre-test was done for every woman to determine her need of knowledge about the parameters of the supportive interventions for cardiovascular risk reduction. Then on the day of discharge, individual interview for information giving that included instructions, restrictions, and expectations about nutrition, smoking, exercises, stress, medications, and follow up care. Booklet as a handout about health instructions for lifestyle change and cardiovascular risk reduction was given to each woman. Post-test was done after one month from discharge in the outpatient cardiac clinic to measure the changes. It can be observed that more than half of studied females were at medium risk for coronary heart disease [52.5%] and the majority of them [62.5%] have perceived moderate social support. No relationship was found between the score of cardiovascular risk factors and the score of perceived social support. The mean total score was 14.80 +/- 1.95 before information giving and 42.80 +/- 2.23 after information giving [Z=5.548, P< 0.05]. It can be concluded that assessment of cardiovascular heart disease risk factors of women, which remained for long time neglected, should be recognized and managed to reduce morbidity and mortality rates. Moreover, the unique contribution of the hospital-based nurses to provide information, as part of a multi-disciplinary team, to the recovery phase following acute CHD events is not explicit. Hence, emphasizes should be done on assessment of the patients individual needs for information. These information may be backed up by written handout, and supported by critical care nurses home visits follow up or telephone calls