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.
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Can J Cardiovasc Nurs · Jan 2005
ReviewPalliative trajectory markers for end-stage heart failure. Or "oh Toto. This doesn't look like kancerous!".
Heart failure is a complex syndrome with a high morbidity and mortality rate. The Canadian mortality rate is between 25% and 40% annually. End-stage heart failure patients suffer from many debilitating symptoms. ⋯ This is difficult to determine due to the lack of tangible trajectory markers and the roller-coaster nature of the trajectory itself. These circumstances were the impetus for a review of the current literature and a clinical experience in a cardiac clinic within a major teaching hospital in Vancouver. The objective was to determine if clear palliative trajectory markers for heart failure existed and, if so, could they be used to produce a tool to assist health care professionals to accurately determine a timeline of six months or less.
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Can J Cardiovasc Nurs · Jan 2005
Maternal cardiac autonomic function and fetal heart rate in preeclamptic compared to normotensive pregnancies.
Preeclampsia during pregnancy increases a woman's risk of cardiovascular disease in two ways. Women who develop preeclampsia are at increased risk for the development of hypertension and cardiovascular disease later in life. As well, fetal adaptations (e.g., growth restriction) may lead to the development of cardiovascular risk factors (e.g., obesity, increased cholesterol) in the offspring. Although atypical maternal cardiac autonomic function has been reported in preeclampsia, to date, its effects on fetal cardiac function have not been determined. ⋯ These findings serve to further our understanding of the cardiovascular pathophysiology of preeclampsia in both the mother and the fetus. Women who develop preeclampsia during pregnancy show atypical autonomic nervous system modulation of heart rate that is associated with a decrease in spontaneous fetal heart rate accelerations in late gestation. Implications for cardiovascular nursing practice include the monitoring of maternal cardiac autonomic function during pregnancy, especially during standing, as well as a need for continued surveillance of maternal cardiovascular function following pregnancy. The negative effect on fetal heart rate accelerations has implications for the interpretation of standardized obstetrical tests of fetal well-being.
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Can J Cardiovasc Nurs · Jan 2004
Registered nurses' experiences with an evidence-based home care pathway for myocardial infarction clients.
To obtain home health nurses' comments on an evidence-based care pathway for post myocardial infarction. ⋯ This qualitative study demonstrates the benefits of investing in the implementation of best practice guidelines by home health nurses. However, nursing associations, such as the Canadian Community Health Nurses Initiatives Group, will need to continue to champion for additional funds to support the additional expenses incurred.