ABSTRACT
The advancement of myocardial protection techniques is considered to be the most instrumental in achieving successful cardiac surgical outcomes. Although many issues complicate the efficacy of myocardial protection, warm cardioplegia is instituted more often as a better myocardial protection method for patients undergoing cardiac surgery. Understanding differences in patient response between warm and cold cardioplegia is essential for development of appropriate nursing intervention strategies and prevention of postoperative complications. Advanced practice nurses in cardiac surgical settings must continue to evaluate metabolic, functional, and hemodynamic variations of patients with different cardioplegia for positive patient outcomes.
Subject(s)
Cardiac Surgical Procedures/nursing , Heart Arrest, Induced/nursing , Critical Care , HumansABSTRACT
The indications for GEA grafting may expand due to increased coronary bypass demand and superior patency. The utilization of the right GEA as an alternative conduit may become a future trend for complex CABG patient populations. Nurses must document more cases and conduct more research to guide future nursing actions.
Subject(s)
Coronary Artery Bypass/methods , Coronary Artery Bypass/nursing , Omentum/blood supply , Patient Care Planning , Stomach/blood supply , Adult , Arteries/transplantation , Humans , MaleABSTRACT
BACKGROUND: Temperature gradients that normally exist between body areas may be altered as a result of heat generated by shivering. METHODS AND POPULATION: Two core thermal gradients between pulmonary artery and urinary bladder were compared with shivering in 37 coronary artery bypass graft patients. Pulmonary artery and urinary temperature were measured every 15 minutes, and shivering was evaluated electromyographically. RESULTS: Shivering developed in 28 patients (76%). With shivering the pulmonary artery/urinary bladder temperature ratio was less than 1 but in the nonshivering group was greater than 1. Correlation (r value) between pulmonary artery and urinary temperature ranged from 0.93 to 0.99. Rate pressure product was higher in the shivering group than in the nonshivering group. A pulmonary artery/urinary bladder temperature ratio of less than 1 was seen with shivering in this subset of patients. CONCLUSION: Pulmonary artery and urinary bladder temperatures are readily available clinically. The combination of a ratio of less than 1 and an increase in rate pressure product should be considered suggestive of shivering in coronary artery bypass graft patients.
Subject(s)
Body Temperature , Coronary Artery Bypass , Pulmonary Artery/physiology , Shivering/physiology , Urinary Bladder/physiology , Adult , Aged , Body Surface Area , Catheterization, Swan-Ganz , Electromyography , Female , Hemodynamics , Humans , Hypothermia, Induced/adverse effects , Male , Middle Aged , Monitoring, Physiologic , Oxygen Consumption , Postoperative Period , Predictive Value of Tests , Thermometers , Time Factors , Urinary CatheterizationABSTRACT
The demand for expanded knowledge and accountability in critical care nursing has increased the need for qualified critical care nurses and is tempered by requirements that their preparation be cost-effective. The Emory University School of Nursing (EUSN) has pioneered in meeting this challenge. Since June 1988, a Critical Care Consortium consisting of the EUSN and Emory-affiliated hospitals has been operational, providing uniform critical care education to multiple hospital nursing staffs. Instructional resources are being economically utilized, eliminating duplication of efforts. This collaboration between academic and service settings enhances productivity, quality patient care, professional growth, and promotes significantly greater interinstitutional cohesiveness.
Subject(s)
Critical Care , Education, Nursing, Continuing , Curriculum , Evaluation Studies as Topic , Faculty, Nursing , GeorgiaABSTRACT
"Core" temperature and the proper methods for its assessment and management in cardiac surgical patients with hypothermia continues to be a concern for physicians and nurses. In this study we investigated the relationship between pulmonary artery and urinary bladder temperatures over a 6-hour period during rewarming in 14 (adult) patients in the intensive care unit after cardiopulmonary bypass. Bladder temperatures were 0.1 degree C to 0.2 degree C higher than pulmonary artery temperature with correlation coefficients of 0.94 to 0.99. This relationship continued for most of this period with significant mean differences clustering in the early and late period after admission. The significance of these small differences of temperatures and why the two temperatures reversed at certain time periods needs further investigation because the normal thermal gradients may be altered by the hypermetabolic activities consequent to shivering or iatrogenic overheating.
Subject(s)
Body Temperature , Pulmonary Artery/physiology , Urinary Bladder/physiology , Adult , Aged , Cardiopulmonary Bypass , Female , Humans , Male , Middle Aged , Postoperative PeriodABSTRACT
Critical care nurses caring for postoperative cardiac surgery patients are confronted, on a regular basis, with care issues related to thermal gradients and shivering. Thermal gradients are defined as temperature differences between two body parts. Monitoring the central and peripheral temperatures, evaluating the thermal gradients, and measuring shivering with reliable means are the prerequisites for the prediction of shivering. The detrimental physiologic effect of shivering necessitates additional clinical research to further define causative factors of shivering.
