AACN advanced critical care
-
The Fontan procedure is used to treat various serious congenital heart defects. Although many people who have had the procedure live productively into adulthood, as they age, they face several health issues due to the physiology of the Fontan circulation. This article reviews the 4 types of Fontan procedures and the changes caused by the surgery, including single-ventricle physiology, nonpulsatile pulmonary perfusion, systemic venous hypertension, and intracardiac scarring, as well as their sequelae. ⋯ Additional topics, including pregnancy in patients who have undergone the procedure, infective endocarditis prophylaxis, and health-related quality of life, are briefly discussed. Options for Fontan failure, including Fontan conversion or transplantation, are presented. Potential future solutions are outlined.
-
In acute diabetes conditions, management of the following 3 potential complications is required: diabetic ketoacidosis, hyperosmolar hyperglycemic state, and iatrogenic hypoglycemia. The hyperglycemic crises diabetic ketoacidosis and hyperosmolar hyperglycemic state are the 2 most serious metabolic complications of diabetes. ⋯ This article reviews the pathogenesis, precipitating or risk factors, diagnosis or identification, and treatment of these critical complications of diabetes. In addition, a case study on diabetic ketoacidosis is provided.