Review of nursing home regulations.

Nursing homes are complex, specialized institutions for a growing segment of the population. Health care professionals should be aware of government regulations that currently influence nursing home practice. The effects of these regulations as well as consumer implications necessary for optimal care of nursing home residents will be addressed.

The role of laparoscopic Nissen fundoplication in gastroesophageal reflux disease.

Gastroesophageal reflux is a highly prevalent condition that usually requires long-term medical therapy. Although symptom management still remains satisfactory for the majority of patients, laparoscopic Nissen fundoplication is proving to be an effective alternative in treating complications of gastroesophageal reflux disease.

Nursing care of patients undergoing thoracoscopic minimally invasive bypass grafting.

Recent efforts in cardiac surgery to decrease cost, length of hospitalization, and morbidity without compromising care or outcomes include a method of treatment of coronary heart disease called minimally invasive coronary artery bypass grafting. This article describes the use of thoracoscopy without sternotomy, cardiopulmonary bypass, or cardioplegic arrest for grafting of the left anterior descending branch of the coronary artery with the left internal mammary artery. Preliminary information supports the concept that thoracoscopic minimally invasive bypass grafting is a less costly and less invasive procedure for patients with disease of the left anterior descending branch of the coronary artery.

Nursing care of the thoracoscopic lung volume reduction patient.

BACKGROUND: Several methods to surgically enhance pulmonary function and improve the quality of life in patients with bullous emphysema are currently being evaluated. One of these methods, lung volume reduction, is performed in patients with bullous emphysema that can no longer be well managed with medical therapy. OBJECTIVES: The focus of this article is to review bullectomy via unilateral thoracoscopy with an endoscopic stapler in the management of end-stage pulmonary emphysema, and to discuss nursing care of these patients. METHODS: An experimental study was used, including review of the literature and analysis of clinical experience using chi-square and t test analyses of pre- and postoperative variables. RESULTS: At 3-month follow-up there were significant improvements in forced expiratory volume in 1 second, forced vital capacity, minute volume ventilation, partial pressure of oxygen, residual volume, and 6-minute walk when pre- and postoperative parameters were compared. Operative mortality was 4%, with the most common complication being prolonged air leak, occurring in 30% of patients studied. CONCLUSIONS: There is now consistent preliminary information to support the concept that lung volume reduction improves pulmonary function and quality of life in a significant percentage of patients.

Aortic valve replacement. Aortic root versus coronary sinus perfusion with blood cardioplegic solution.

The role of retrograde coronary sinus cardioplegia in patients undergoing aortic valve replacement for aortic stenosis alone or in combination with myocardial revascularization has not been fully defined. Sixty-three patients undergoing elective aortic valve replacement received cold potassium blood cardioplegic solution via either the aortic root (36 patients) or the coronary sinus (27 patients). The patients were similar with respect to age, degree of aortic stenosis, ventricular function, severity of coronary artery disease, crossclamp time, completeness of revascularization, and mean volume and temperature of the infusion solution. The mean septal temperature and the release of myocardium-specific isoenzyme in the first 2 hours after crossclamp removal was higher in the retrograde group (p less than 0.008). Right and left ventricular function was preserved equally in the two groups, and volume-loading studies suggested improved diastolic performance in patients having retrograde cardioplegia. There were no differences between the two groups with respect to clinical outcome. We conclude that coronary sinus cardioplegia is as safe as aortic root perfusion for myocardial preservation in patients undergoing elective aortic valve replacement.