Risk factors for decreased cardiac output after coronary artery bypass grafting: a prospective cohort study.

BACKGROUND: No previous study has investigated the predictive risk factors of the nursing diagnosis of risk for decreased cardiac output after coronary artery bypass grafting (CABG). AIMS: This study aimed to identify the predictive risk factors of the nursing diagnosis of risk for decreased cardiac output after CABG. METHODS: This was a prospective cohort study performed at a cardiac university hospital in São Paulo, Brazil and 257 adult patients undergoing CABG were included. Potential risk factors for low cardiac output in the immediate post-operative period were investigated using the patients' medical records. Univariate analysis and logistic regression were used to identify the predictive risk factors of decreased cardiac output. The area under the receiver operating characteristic curve was calculated as a measure of accuracy. The variables that could not be analysed through logistic regression were analysed through Fisher's exact test. RESULTS: One hundred and ninety-five patients had low cardiac output in the immediate post-operative period. The predictive risk factors included age ⩾60 years, decreased left ventricle ejection fraction, not using the radial artery graft, positive fluid balance and post-operative arrhythmia that differed from the pre-operative arrhythmia. This model predicted the outcome with a sensitivity of 62.9%, a specificity of 87.2% and an accuracy of 81.5%. The variables analysed through Fisher's exact test included heart failure, re-exploration and bleeding-related re-exploration. CONCLUSIONS: The predictive risk factors for the nursing diagnosis of risk for decreased cardiac output after CABG were found. These results can be used to direct nurses in patient monitoring, staff training and nursing team staffing.

Adequacy of the Activities in the Nursing Intervention Exercise Therapy: Ambulation for Medical-Surgical Patients With Impaired Physical Mobility.

OBJECTIVE: To evaluate the adequacy of the activities in the nursing intervention Exercise Therapy: Ambulation for medical-surgical patients with impaired physical mobility. METHODS: A methodological study with 60 medical-surgical nurses in a large hospital in São Paulo, SP, Brazil. Nurses judged the appropriateness of the 20 activities that comprise the intervention, classified as major or minor. RESULTS: Eight activities were classified as major and 12 as minor for the care of medical-surgical patients with impaired physical mobility. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The activities of the intervention Exercise Therapy: Ambulation were considered adequate for medical-surgical patients with impaired physical mobility. These results contribute to future content validation studies and teaching of undergraduate students.

Validation of the concept risk for decreased cardiac output.

OBJECTIVES: to validate the concept "risk for decreased cardiac output". METHOD: Six of the eight steps suggested in the technique developed by Walker & Avant were adopted to analyze the concept of the phenomenon under study and the proposal made by Hoskins was used for content validation, taking into account agreement achieved among five experts. RESULTS: the concept "decreased cardiac output" was found in the nursing and medical fields and refers to the heart's pumping capacity while the concept "risk" is found in a large number of disciplines. In regard to the defining attributes, "impaired pumping capacity" was the main attribute of decreased cardiac output and "probability" was the main attribute of risk. The uses and defining attributes of the concepts "decreased cardiac output" and "risk" were analyzed as well as their antecedent and consequent events in order to establish the definition of "risk for decreased cardiac output", which was validated by 100% of the experts. CONCLUSION: The obtained data indicate that the risk for decreased cardiac output phenomenon can be a nursing diagnosis and refining it can contribute to the advancement of nursing classifications in this context.