RESUMO
The increasing medical, psychological, and social complexity of hospitalized patients is a serious concern. Most staff nurses are inadequately prepared to deal with the complexity of these patient's issues. The difficult patient is described as having a medical condition requiring hospitalization and who also exhibits problems such as pain, substance abuse, and issues such as anger, manipulation, or noncompliance which are difficult and challenging behaviors. An overview of the most troublesome patients seen in the inpatient setting today and some clinical direction on how to best manage these patients are presented.
Assuntos
Adaptação Psicológica , Comportamento Agonístico , Relações Enfermeiro-Paciente , Cuidados de Enfermagem/métodos , Cuidados de Enfermagem/psicologia , Ira , Humanos , Medicina Interna , Controle Interno-Externo , Maquiavelismo , Negociação , Participação do Paciente , Enfermagem Perioperatória , Especialidades de EnfermagemRESUMO
Without revascularization, patients with non-Q-wave acute myocardial infarction (AMI) are predisposed to angina, recurrent AMI and cardiac death. Percutaneous transluminal coronary angioplasty (PTCA) was performed in 68 patients with angina an average of 2.3 months after non-Q-wave AMI (41 anterior, 27 inferior). Mean diameter stenosis was 95%, with collateralized total occlusion of the infarct-related artery in 23 patients. PTCA was successful in 87% (59 of 68), with a mean residual stenosis of 30%. One patient had emergency bypass surgery. Long-term follow-up (average 17 +/- 10 months) was available for 58 of the 59 patients in whom PTCA was successful. Recurrent angina developed in 41% (24 of 58), but was relieved by repeat PTCA in 14, by late coronary artery bypass surgery in 4 and by medical therapy in 6. There was 1 nonfatal AMI, due to progressive disease in a nondilated vessel, and 1 noncardiac death At last follow-up, 46 of 58 patients (79%) were asymptomatic and fully active or employed. Thus, patients undergoing PTCA for angina after non-Q-wave AMI appear to have a relatively high clinical restenosis rate, but with repeat PTCA have a low incidence of subsequent angina, AMI and cardiac death.
