The Journal of cardiovascular nursing
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Delirium, an etiologically nonspecific disorder of consciousness characterized by prominent deficits in attention, cognition, and perception, affects more than one-third of adult cardiac surgical patients. Despite the frequency of occurrence and the increased morbidity and mortality associated with it, the diagnosis is commonly late or missed, and management is less than optimal. This article addresses the recognition and management of delirium. Nurses who develop an index of suspicion for the diagnosis and acquire the diagnostic and interventional skills required to address this cerebral complication of cardiac surgery may well decrease its incidence and severity.
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Inadequate pain relief has been identified as a common problem after coronary artery bypass surgery, Understanding the pharmacology of analgesics commonly used after cardiovascular surgery is a fundamental part of effective pain management. The pharmacologic properties for two analgesic drug classes, opioid and nonopioid, are reviewed. Major drugs in each class are discussed in terms of their pharmacodynamic and pharmacokinetic properties.
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This paper 1) describes what is known about recovery for families of patients who survive sudden cardiac arrest (SCA) and undergo internal cardioverter defibrillator (ICD) implantation, 2) discusses empirical evidence for interventions aimed at affecting recovery following SCA and ICD implantation, 3) presents additional data that suggest interventions for cardiac arrest survivors and their families, and 4) makes recommendations for the development of future intervention programs for SCA survivors and their families. Research supporting the use of educational and support interventions designed for SCA survivors and families is reviewed. Recommendations are made for future design and testing of interventions in the population.
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Research-based guidelines regarding patient positioning and hemodynamic measurement are compared with nonscientific routines. Published research is critiqued and synthesized. ⋯ The challenge is to balance the many patient care activities that critically ill patients require with the need for positioning and hemodynamic measurement. The duration patients are left in the supine position can be minimized, and accurate and reliable measurements can still be obtained.
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Review
Considerations related to disability and exercise in elderly women with congestive heart failure.
Congestive heart failure is one of the most common diagnoses in older women. This article reviews physiologic and pathophysiologic factors that contribute to disability in older women with normal left ejection fraction congestive heart failure; the possibility that aerobic exercise training may be an effective means to reduce the disability experienced by these women is examined. Most literature has dealt with low-output ejection fraction congestive heart failure. ⋯ A physiologic model is proposed that includes peripheral and cardiac factors caused by heart disease, and factors caused by aging, that may account for increasing the disabling consequences and reducing exercise tolerance of older women with normal left ejection fraction congestive heart failure. The potential impact of exercise training on these factors is discussed. Directions for practice and further research are included.