Critical care nurse
-
Critical care nurse · Oct 2018
Hyperlactatemia and Patient Outcomes After Pediatric Cardiac Surgery.
Elevated serum lactate level, or hyperlactatemia, is often associated with alterations in tissue perfusion, increased risk for complications in the postoperative period, and patient mortality. Measuring lactate levels is a relatively simple and noninvasive method of obtaining useful data about an impending clinical deterioration in a seemingly hemodynamically stable patient. This article evaluates the current practice of measuring lactate levels in pediatric patients after cardiac surgery and the association between these levels and patient outcomes. The article addresses periods of increased risk for decreased perfusion, the critical postoperative period, use of lactate measurements in conjunction with a risk scoring system for pre-and postoperative congenital heart disease patients, and the implications of elevated lactate levels in nursing practice.
-
Critical care nurse · Oct 2018
Caring for Pediatric Heart Failure Patients With Long-Term Mechanical Circulatory Support.
Pediatric cardiac failure is a significant problem that may be caused by cardiomyopathy, myocarditis, or congenital defects that cannot be surgically repaired. Long-term mechanical circulatory support (LTMCS) devices provide hemodynamic support for patients in heart failure as a bridge to heart transplant and, sometimes, cardiac recovery or destination therapy. ⋯ Patient care should be family centered and nurses must strive to maximize patients' quality of life throughout device implantation. This article provides a basic guide to caring for pediatric patients receiving LTMCS, including specific information regarding 4 devices that are often used for pediatric heart failure: Berlin Heart EXCOR, SynCardia Total Artificial Heart, HeartWare HVAD, and HeartMate II.
-
Critical care nurse · Oct 2018
In-Hospital Initiation of Guideline-Directed Heart Failure Pharmacotherapy to Improve Long-Term Patient Adherence and Outcomes.
Heart failure is a burdensome cardiovascular condition associated with high rates of morbidity and mortality. The 3-month period after hospitalization is a vulnerable phase in which patients are at high risk for mortality and rehospitalization. To reduce risk during this period, patients with heart failure and reduced ejection fraction should receive guideline-directed pharmacological therapies-the right drugs at the right doses-before hospital discharge. ⋯ Because optimal prescription and adherence are both necessary to ensure the best clinical outcomes, nurses need to participate in interventions that optimize prescription and drug use over time. Collaboration with pharmacists and advanced practice acute care nurses may help ensure that medication selection and dosing are consistent with national guidelines. Use of a predischarge order set and electronic medical records checklist can enhance collaborative care.
-
Critical care nurse · Oct 2018
Congenital Cardiac Defects That Are Borderline Candidates for Biventricular Repair.
This article discusses congenital heart defects that are marginal candidates for biventricular repair and highlights the anatomic considerations upon which the surgical decision is based. Specifically, the article reviews the importance of capacitance and compliance of the ventricles and their associated atrioventricular valves. For each of the defects discussed, the imaging modalities used to diagnose a marginal ventricle are reviewed and the surgical decision-making process is outlined. The article also reviews immediate postoperative treatment of these patients and when to consider biventricular repair of a marginal lesion to be a failure.