Tài liệu Cardiothoracic Surgical Nursing: Current Trends in Adult Care ppt

Cardiothoracic Surgical Nursing Carl Margereson MSc BSc(Hons) DipN(Lond) RGN RMN Senior Lecturer Faculty of Health & Human Sciences Thames Valley University Jillian Riley MSc BA(Hons) RGN RM Senior Lecturer Faculty of Health & Human Sciences Thames Valley University Royal Brompton Hospital, London Cardiothoracic Surgical Nursing Dedicated to our parents Lilian and Roy Margereson and Mary and Ken Riley Cardiothoracic Surgical Nursing Carl Margereson MSc BSc(Hons) DipN(Lond) RGN RMN Senior Lecturer Faculty of Health & Human Sciences Thames Valley University Jillian Riley MSc BA(Hons) RGN RM Senior Lecturer Faculty of Health & Human Sciences Thames Valley University Royal Brompton Hospital, London # 2003 by Blackwell Science Ltd, a Blackwell Publishing Company Editorial offices: Blackwell Science Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Tel: +44 (0)1865 776868 Blackwell Publishing Inc., 350 Main Street, Malden, MA 02148-5020, USA Tel: +1 781 388 8250 Blackwell Science Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia Tel: +61 (0)3 8359 1011 The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. First published 2003 Library of Congress Cataloging-in-Publication Data Margereson, Carl. Cardiothoracic surgical nursing: current trends in adult care/Carl Margereson, Jillian Riley. ± 1st ed. p. ; cm. Includes bibliographical references and index. ISBN 0-632-05904-4 (pbk. : alk. paper) 1. Chest ± Surgery ± Nursing. 2. Heart ± Surgery ± Nursing. [DNLM: 1. Perioperative Nursing ± trends. 2. Thoracic Surgical Procedures ± nursing. 3. Cardiovascular Diseases ± nursing. 4. Nurse's Role. 5. Patient Education. 6. Respiratory Tract Diseases ± nursing. WY 161 M328c 2003] RD536.M275 2003 617.5'4059 ± dc21 2003010441 ISBN 0-632-05904-4 A catalogue record for this title is available from the British Library Set in 10/12pt Palatino by DP Photosetting, Aylesbury, Bucks Printed and bound in Great Britain using acid-free paper by TJ International Ltd, Padstow, Cornwall For further information on Blackwell Publishing, visit our website: www.blackwellpublishing.com Contents Foreword vii Preface ix Acknowledgements xi Chapter 1 The Development of Cardiothoracic Surgical Nursing 1 References 5 Chapter 2 Epidemiology of Cardiac and Respiratory Diseases 7 Cardiac disease 8 Respiratory disease 9 Epidemiology and risk factors 12 References 21 Further reading 23 Chapter 3 Applied Respiratory and Cardiac Physiology 25 Respiratory system 26 Cardiac physiology 45 Cardiovascular regulatory mechanisms 56 References 63 Chapter 4 Pre-operative Preparation 65 The stress response 66 The pre-admission clinic 69 Fitness for surgery 72 Physiological assessment 73 Nutritional assessment 86 Special pre-operative issues 88 Issues regarding risk and outcome 89 Psychosocial assessment 94 v References 97 Further reading 102 Chapter 5 Intra-operative Issues 103 The anaesthetic 103 Cardiac surgery 105 Thoracic surgery 116 References 125 Chapter 6 Post-operative Care following Cardiothoracic Surgery 129 Pulmonary changes following cardiothoracic surgery 131 Specific care issues following cardiac surgery 134 Specific care issues following thoracic surgery 151 Interventions to optimise pulmonary function following cardiothoracic surgery 156 Chest drainage 163 Fluid and electrolyte changes following cardiothoracic surgery 165 Pain control following cardiothoracic surgery 172 Post-operative infection 182 References 192 Further reading 201 Appendix: Post-operative assessment issues following cardiac surgery 202 Chapter 7 Returning Home 205 Earlier discharge 206 Patient education 206 Support strategies 214 Promoting patient confidence 220 References 223 Further reading 226 Index 227 Contentsvi Foreword I was both delighted and honoured when asked by Carl and Jill to write the foreword to this excellent nursing book. Having worked with them in varying capacities over the past six years, I have long appreciated their knowledge, understanding and expertise within this specialist field of patient care. When any author sets out to write, the most important tool for the task is credibility. It is upon this foundation that the book is written, with both authors having shaped nursing practice for many years through their teaching and encouragement of post registration nurses who accessed ENB 249 and 254 courses. Both authors remain firmly in touch with the contemporary issues that influence nursing within a modern NHS, and are respected for their ongoing support of the clinical team. A vital contribution of health care educators and their ability to help shape patient care in the twenty-first century. The book itself is written with this in mind. It is not a reflective dialogue of the many changes and challenges that the nursing profession have had to meet head on over the past two decades. It is more a recognition of where the profession and cardiothoracic surgical nursing are at, and how they need to continue to develop. It reflects current socio-political and professional thinking, in mapping the patient journey from early symptoms, hospitalisation through to returning home. It successfully enables the reader to appreciate the size of the challenge from an epidemiological perspective; deepens their understanding of physiological and pathophysiological principles; maps the patient journey in the peri-operative period, through the experience of surgery to post-operative recovery and reha- bilitation. This book is not a snapshot of cardiothoracic surgical patient care, but more a considered and reflective account that is based on understanding and intuition of how nurses can meet the challenges of patients and their families' needs. It is written with the post-registration student in mind, supporting many of the vii excellent undergraduate specialist cardiothoracic pathways that shape both thinking and practice. To this end it will be an invaluable test, giving wide coverage of the essential areas of knowledge and expertise that the cardiothoracic surgical nurse needs to develop. It reflects the authors' passion for the subject, their compassion for the patient and their commitment to the profession. Enjoy the journey. Dr Ian Bullock Head of Education and Training Royal Brompton and Harefield NHS Trust Forewordviii [...]... than moderate drinkers, regardless of their previous drinking status The protective effect of moderate alcohol consumption is related to (Criqui & Ringel 1994): & & & & Increase in HDL Reduction in plasma fibrinogen Decreased platelet aggregation Reduced triglycerides The protective effect against CHD in moderate drinkers is lost rapidly if they stop drinking Excessive alcohol intake will increase blood... accounting for 1 in 4 deaths in men (Fig 2.1(a)) and 1 in 6 in women (Fig 2.1(b)) CHD is responsible for 24% of premature deaths in men and 14% in women There are 149 000 heart attacks each year in men of all ages and about 125 000 each year in women, an approximate fatality rate of 50%, with 25±30% dying before reaching Other cancer 17% Colo-rectal cancer 3% Respiratory disease 16% Injuries and poisoning... lipoprotein) cholesterol Sterols are similar to cholesterol but are not absorbed in the human gastrointestinal tract and also have the ability to inhibit the absorption of cholesterol Various margarines have been marketed containing plant sterols but it is important to remember that these are still high in calories Polyunsaturated fatty acids and antioxidants Increased intake of oily fish containing large... cardiothoracic surgery are therefore clear: assisting the provision of seamless care from the pre-admission preparation to returning home, providing an expert outreach service, managing ventilator or inotropic weaning are a few examples Yet the care of the cardiothoracic surgical patient requires teamwork from both within and without the hospital setting Understanding the contribution that each profession... markers of inflammation have also been evaluated as potential tools for prediction of the risk of CHD These markers include C reactive protein, serum amyloid A and interleukin-6, and some of these inflammatory markers have shown significance in postmenopausal women (Ridker et al 2000) Predisposing risk factors Predisposing factors may intensify the causal risk factors in some way and in CHD include:... likely to be best addressed by primary and secondary prevention Infant origins of disease There is ongoing debate regarding the significance of adverse factors, including under-nutrition possibly affecting early development in utero It is argued that factors acting in early life may have consequences for the later risk of certain diseases, including CHD (Barker 1992) and some respiratory diseases, e.g COPD... excellent forum for learning, enabling the nurse to develop skills in both the interpretation of physiological data, psychological assessment, communication and patient education Evidence-based health care is also gaining popularity It is increasingly important that nursing interventions are derived from a research base and able to withstand strict scrutiny Purchasers of health care, patients and their families... deserve the best care, and nursing actions should be evaluated and developed So nurses must incorporate nursing research into their practice, appraising research, implementing findings and developing new studies Although the current climate suggests that randomised controlled trials are the gold standard for research, such trials may not be the most appropriate method to study the individual response... being underfunded in terms of research and training where `cutting edge' initiatives receive the lion's share of resources, leaving other areas struggling If funding is poor for medical research and education in some of the less glamorous areas of cardiothoracic work, then funding for nursing is likely to be even worse Given the scale of respiratory disease in the UK today it is unfortunate that the government... to an increase in the number of people developing mitral valve disease Interestingly, although this has led to a reduction in the number of people with mitral valve disease, the increased longevity of life enjoyed by many has led to a corresponding increase in the number of people presenting with stenosis of the aortic valve Although the process of aortic valve stenosis is now thought to be inflammatory . 2003 Library of Congress Cataloging -in- Publication Data Margereson, Carl. Cardiothoracic surgical nursing: current trends in adult care/ Carl Margereson, Jillian. education in nursing: perceptions of practice in acute settings. Journal of Advanced Nursing 17(2): 164±72. The Development of Cardiothoracic Surgical Nursing