[Post-operative mediastinitis in a heart hospital of Recife: contributions for nursing care]. / Mediastinite pós-cirúrgica em um Hospital Cardiológico de Recife: contribuições para a assistência de enfermagem.

The objective of this study was to determine the prevalence of post-operative mediastinitis with the purpose to contribute to nursing care knowledge. To do this, an analysis was performed on 896 medical records of patients who underwent heart surgery involving sternotomy at the Cardiology Emergency Room of Recife-PE, in the period between June 2007 and June 2009. The following variables were considered: gender, age, type of surgery, personal history, length of stay, use of antibiotics, and culture of the surgical wound. A high death rate from mediastinitis was observed (33.3%). Several risk factors were identified, including: systemic arterial hypertension (80.9%); smoking (61.9%); diabetes mellitus (42.8%); and obesity (33.3%), most of which (76.2%) were identified in patients who underwent surgery for myocardial revascularization. It is concluded that mediastinitis is a serious infection that needs continuous nursing supervision and preventive measures to assure an early diagnosis and, thus, reduce mortality.

Mediastinite pós-cirúrgica em um Hospital Cardiológico de Recife: contribuições para a assistência de enfermagem / Post-operative mediastinitis in a heart hospital of Recife: contributions for nursing care / Mediastinitis postoperatoria en un hospital cardiológico de Recife: contribuciones para la atención de enfermería

O objetivo deste estudo foi determinar a prevalência de mediastinite pós-cirúrgica com o intuito de contribuir para a assistência de enfermagem. Para tanto, foi realizada a análise de 896 prontuários de pacientes submetidos à operação cardíaca com esternotomia no Pronto Socorro Cardiológico de Recife-PE,no período de junho de 2007 a junho 2009. As variáveis consideradas foram: sexo, idade, tipo de operação, antecedentes pessoais, tempo de internamento hospitalar, uso de antibióticos e cultura de ferida operatória. Observou-se alta letalidade por mediastinite (33,3%). Vários fatores de risco foram identificados no estudo, tais como: hipertensão arterial sistêmica (80,9%); tabagismo (61,9%); diabetes mellitus (42,8%) e obesidade (33,3%), sendo a maioria (76,2%) em pacientes submetidos à cirurgia de revascularização do miocárdio. Conclui-se que a mediastinite é uma infecção grave que necessita de supervisão contínua da enfermagem e medidas preventivas para o diagnóstico precoce e a diminuição da mortalidade.

The objective of this study was to determine the prevalence of post-operative mediastinitis with the purpose to contribute to nursing care knowledge. To do this, an analysis was performed on 896 medical records of patients who underwent heart surgery involving sternotomy at the Cardiology Emergency Room of Recife-PE, in the period between June 2007 and June 2009. The following variables were considered: gender, age, type of surgery, personal history, length of stay, use of antibiotics, and culture of the surgical wound. A high death rate from mediastinitis was observed (33.3%). Several risk factors were identified, including: systemic arterial hypertension (80.9%); smoking (61.9%); diabetes mellitus (42.8%); and obesity (33.3%), most of which (76.2%) were identified in patients who underwent surgery for myocardial revascularization. It is concluded that mediastinitis is a serious infection that needs continuous nursing supervision and preventive measures to assure an early diagnosis and, thus, reduce mortality.

Este estudio objetivó determinar la prevalencia de mediastinitis postoperatoria con la intención de contribuir a la atención de enfermería. Fueron analizadas 896 historias clínicas de pacientes sometidos a operación cardíaca con esternotomía en Urgencia Cardiológica de Pernambuco, en el período de junio 2007 a junio 2009. Las variables consideradas fueron: sexo, edad, tipo de operación, antecedentes personales, tiempo de internación hospitalaria, uso de antibióticos y cultivo de la herida operatoria. Se observó alta mortalidad por mediastinitis (33,3%). Fueron identificados en el estudio algunos de los factores de riesgo, tales como: hipertensión arterial sistémica (80,9%), tabaquismo (61,9%), diabetes mellitus (42,8%) y obesidad (33,3%), ocurriendo la mayoría (76,2%) en pacientes sometidos a cirugía de revascularización del miocardio. La mediastinitis es una infección grave que necesita de supervisión continua de enfermería y medidas preventivas para el diagnóstico precoz y disminución de la mortalidad.

Estudio de caso en un paciente postoperado de cirugía cardiovascular con mediastinitis / Study of a case in a patient postoperated of cardiovascular surgery with mediastinitis", "_i": "

Los modelos y teorías de enfermería, así como el proceso deatención de enfermería (PAE) le han proporcionado a estaprofesión una identidad propia y un carácter científico, estableciendocomo único objeto de estudio: el cuidado de la saludde la persona, familia o comunidad. El número creciente de cirugíascardiovasculares que requieren esternotomía se ha vistosólo parcialmente limitado por sus complicaciones. De ellasla mediastinitis post-quirúrgica (MPQ) es una de las másgraves por su alta tasa de morbimortalidad y por que su tratamientodemanda habitualmente de procedimientos quirúrgicosadicionales, además de costosas terapias antimicrobianasy tiempos prolongados de hospitalización, lo que causa un impactosevero en la esfera biopsicosocial de los pacientes y susfamiliares.

Models and Theories of Nursing and the Nursing Care Process(PCN) have provided the identity and profession ascientific character, setting as the sole object of study healthcare of the person, family or community. he increasing numberof cardiovascular surgery requiring sternotomy has beenonly partially limited by its complications. Of these post-surgicalmediastinitis (MPQ) is one of the most serious becauseof its high rate of morbidity and mortality. Its treatmentusually demands additional surgical procedures in additionto costly and prolonged antimicrobial therapy in hospitalwhich causes a severe impact on the biopsychosocial field ofpatients and their families.

[Nature, classification and nursing interventions for patients with mediastinitis]. / Natureza, classificação e intervenções de enfermagem para pacientes com mediastinite.

This is a descriptive and retrospective study that aimed at analyzing the nature and classification of nursing interventions for patients with mediastinitis following cardiac surgery. The results obtained from the surgical wards show an incidence of mediastinitis of 3%. The subjects studies were primarily male, all of whom suffer from diabetes. The nursing problems were categorized according to Horta and the interventions according to the NIC. Among the problems found, 76.5% were of psychobiological needs and 23.5% were psychosocial. Fifty-three (53) nursing interventions were implemented: 84.9% were physiological in nature, 11.3% behavioral and 3.8% family related. The relationship between the problems identified and the interventions developed were adjusted principally to address the psychobiological needs. Educational interventions were used frequently to attend to the psychosocial needs of the patients.

Natureza, classificação e intervenções de enfermagem para pacientes com mediastinite / Naturlaleza, clasificación y intervenciones de enfermería para pacientes con mediastinitis / Nature, classification and nursing interventios for patients with mediastinitis

Trata-se de estudo quantitativo, descritivo e retrospectivo que objetivou analisar a natureza e classificação das intervenções de enfermagem para pacientes acometidos por mediastinite no pós-operatório de cirurgia cardíaca. Os resultados obtidos através de prontuários mostraram uma incidência de 3 por cento de mediastinite. A população do estudo era na maioria do sexo masculino, sendo todos diabéticos. Os problemas de enfermagem foram categorizados segundo Horta e as intervenções classificadas conforme a NIC. Dentre os problemas levantados, 76,5 por cento foram de necessidade psicobiológica e 23,5 por cento psicossocial. Implementou-se 53 intervenções de enfermagem: 84,9 por cento de natureza fisiológica, 11,3 por cento comportamental e 3,8 por cento familiar. A relação entre problemas identificados e intervenções desenvolvidas, foi adequada principalmente nas necessidades psicobiológicas, sendo freqüente as intervenções educativas, principalmente nas necessidades psicossociais.

This is a descriptive and retrospective study that aimed at analyzing the nature and classification of nursing interventions for patients with mediastinitis following cardiac surgery. The results obtained from the surgical wards show an incidence of mediastinitis of 3 percent. The subjects studies were primarily male, all of whom suffer from diabetes. The nursing problems were categorized according to Horta and the interventions according to the NIC. Among the problems found, 76.5 percent were of psychobiological needs and 23.5 percent were psychosocial. Fifty-three (53) nursing interventions were implemented: 84.9 percent were physiological in nature, 11.3 percent behavioral and 3.8 percent family related. The relationship between the problems identified and the interventions developed were adjusted principally to address the psychobiological needs. Educational interventions were used frequently to attend to the psychosocial needs of the patients.

Se trata de estudio cuantitativo, descriptivo y retrospectivo que objetiva analizar la naturaleza y clasificación de las intervenciones de enfermería para pacientes acometidos por mediastinite en el post-operatorio de cirugía cardiaca. Los resultados logrados a través de prontuarios mostraron una incidencia del 3 por ciento de mediastinite. La población del estudio era en la mayoría del sexo masculino, siendo todos diabéticos. Los problemas de enfermería fueron categorizados según Horta y las intervenciones clasificadas conforme a NIC. Dentro de los problemas estudiados, 76,5 por ciento fueron psicobiológicas y 23,5 por ciento psicosocial, Se implementó 53 intervenciones de enfermería: 84,9 por ciento de naturaleza fisiológica, 11,3 por ciento comportamental y 3,8 por ciento familiar. La relación entre problemas identificados e intervenciones realizadas, fue adecuada principalmente en las necesidades psicobiológicas, siendo frecuente las intervenciones educativas, principalmente en las necesidades psicosociales.

Patients' experiences of mediastinitis after coronary artery bypass graft procedure.

Few studies have focussed on patients' experiences of and suffering due to mediastinitis following Coronary Artery by-pass Graft (CABG). Mediastinitis creates a complex and invasive experience for the patient with prolonged hospitalisation, and would be expected to be a significant stressor. The aim of the present study was to capture patients' experiences of the medical and nursing care they received for mediastinitis following CABG. Content analysis revealed three themes with regard to how the patients coped with the stress and threats of mediastinitis and its treatment and how they thought it would influence their future life. A first theme centred on physical and psychological discomfort and impact on autonomy. The staff's medical knowledge and the quality of nursing care as well as the patients' understanding of the situation influenced their experience. A second theme was how patients dealt with perceived danger and stress. Coping strategies such as problem solving, information seeking, dissociation, distraction, minimisation and expression of emotion were used to handle the situations. The third theme comprised the patients' belief that the mediastinitis would not affect the outcome of the CABG procedure, even though their confidence in this was influenced by uncertainty about the rehabilitation process.

Understanding mediastinitis: nursing's role in prevention and treatment.

Mediastinitis is a clinical problem seen in patients after a mediasternotomy usually following cardiac surgery. Although relatively rare, this complication slows recovery, lengthens hospital stay and increases health care costs. An overview of the problem of sternal wound infection after cardiac surgery is provided. Predisposing, intraoperative and post-operative factors related to this problem will be discussed. Attention to the factors related to the problem may contribute to the prevention of mediastinitis. Clinical recognition of the problem will be described and treatment options, nursing therapeutics and research questions will be addressed.

Managing postoperative mediastinitis.

Mediastinitis is a serious complication following cardiac surgery that requires early diagnosis and expert care. This article describes normal and impaired wound healing. Risk factors in the development of sternal wound infections are also discussed. Diagnosis, surgical management, and nursing management of mediastinitis are described, with emphasis on the nursing diagnoses Potential for Infection, Ineffective Coping, and Potential Alteration in Home Health Management.