Canadian journal of cardiovascular nursing = Journal canadien en soins infirmiers cardio-vasculaires
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Can J Cardiovasc Nurs · Jan 2006
Controlled Clinical TrialChange in practice patterns in the management of diabetic cardiac surgery patients.
Diabetes and elevated blood glucose (BG) levels > 11.1 mmol/L in the acute post-operative period have been identified as risk factors for surgical site infections (SSI) and nosocomial infections (Furnary, Zerr, Grunkemeir, & Starr, 1999; American College of Endocrinology consensus guidelines for glycemic control, 2002). Some studies have suggested that intensive insulin therapy reduced in-hospital mortality and that a continuous insulin infusion should be a standard of care for diabetic cardiac surgery patients (Furnary et al., 2003; Brown & Dodek, 2001). Our urban tertiary care teaching hospital initiated an insulin nomogram in the intensive care unit intending to more effectively control blood glucose (BG) levels in cardiac surgical patients. ⋯ However, target glucose (6.1-10.0 mmol/L) was exceeded in 45% of patients in the intervention group, 65% in the control group as well as 42% of patients on the ward. The insulin nomogram is now initiated as soon as the BG is obtained immediately following patient transfer from the operating room (OR). There is more aggressive use of sliding scale insulin, and earlier resumption of pre-operative diabetic regimens on the ward.
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Can J Cardiovasc Nurs · Jan 2006
Influential factors for self-care in ambulatory care heart failure patients: a qualitative perspective.
Chronic heart failure is associated with debilitating symptoms, diminished quality of life and frequent hospitalizations. The literature suggests that effective everyday self-care decision-making can improve heart failure outcomes. This article focuses on the qualitative portion of a study of self-care decision-making in community-dwelling individuals attending a heart failure clinic. ⋯ Content analysis was used to examine predisposing attributes and enabling circumstances described in Connelly's Model of Self-Care in Chronic Illness. These interactive factors were either facilitators or barriers to self-care. The importance of individualizing patient teaching plans and frequent monitoring of factors likely to facilitate self-care were pivotal nursing implications that emerged from this study.