No description available.

The purposes of this research were to: (1) describe selected fluid and electrolyte changes that occur during the first four hours after open heart surgery; (2) determine whether significant hourly changes occurred in: blood pH, fluid intake, exogenous potassum chloride replacement, fluid output, or serum and urinary sodium and potassium levels; and finally, (3) delineate which of the above variables were most strongly related to changes in serum and urinary, sodium and potassium levels. Fifty-three patients who had undergone cardiac surgery involving cardiopulmonary bypass were studied. Urine and blood samples were collected every hour for the first four hours postoperatively and were analyzed for sodium and potassium content using flame photometry. Blood pH and exogenous potassium chloride replacement were recorded from the anesthesiologist's and nurse's records. Fluid intake and fluid output were measured directly by the investigator. Analyses included both descriptive and correlational statistics. In addition, a repeated measures procedure (MANOVA) was performed to discern performance trends over time. The data showed that hypokalemia (defined as a serum potassium level less than 4.0 mEq/L) was present in approximately 52 percent of the subjects for the first two postoperative hours and that by the fourth hour only 15 percent of the subjects were hypokalemic. In addition, subjects were noted to retain 2.47 liters of fluid over the four hour period. Significant differences in fluid output were noted across time. Serum sodium levels did not change significantly across time even though serum potassium levels did. The data indicated that the best predictors of hypokalemia were fluid intake and fluid output. Both of these variables had a significance level of p = .000. Regression analysis showed that fluid intake and exogenous potassium chloride replacement explained 11.9 percent of the variance in serum potassium at a significance level of p = .008. Furthermore, fluid output explained 7.3 percent of the variance in urinary potassium (p = .030).

No description available.

[Truncated abstract] Cardiac surgery involving cardiopulmonary bypass is a complex procedure that results in significant changes to blood coagulation, fibrinolytic biochemistry, platelet number and function, and the vasculature. These are due to pharmacological agents which are administered, haemodilution and contact of the blood with artificial surfaces. Consequently there are significant risks of thrombosis and haemorrhage associated with this procedure. The research presented in this thesis utilises in vitro, in vivo, and a novel ex vivo model to investigate the nature of the haemostatic defect induced by cardiopulmonary bypass. The components studied include the drugs heparin, protamine sulphate, and aprotinin, different types of bypass circuitry (including heparin bonded circuits) and procedures such as acute normovolaemic haemodilution. Patient variables, such as Factor V Leiden, are also studied. Each of these components is assessed for the effects on a number of laboratory measures of haemostasis including activated partial thromboplastin time, prothrombin time, activated protein C ratio, antithrombin concentration, heparin concentration, thrombin-antithrombin complex formation, prothrombin fragment 1+2 formation, markers of platelet surface activation and secretion, activated clotting time, haemoglobin concentration and coagulation factor assays.

M.Cur. / In the cardiothoracic critical care unit, the respiratory management, post-extubation forms an important component of the total nursing care of the patient. To ensure optimal respiratory management the critical care nurse needs guidelines through which quality and continuity of nursing care can be ensured. Through the effective management of the respiratory system of the patient the critical care nurse contributes to maintaining, promoting and restoring health. In this way the critical care nurse facilitates the patient's strive towards reaching his/her objective of obtaining wholeness and he/she obtains his/her objective of quality nursing. The aim of this study is to formulate guidelines for the respiratory mangement of the cardiothoracic patient, post-extubation. A qualitative-descriptive contextual spesific reseach was followed in which a focus group interview, the opinions of field specialists and the deductive analysis of a literture study were used to formulate guidelines for the respiratory management of the cardiothoracic patient, post-extubation. An analysis was done through which the focus group interview was coded and categories were formulated. These main categories and subcategories were then further explored and described by the literature and by die opinions of the field specialists. The guidelines which were formulated must relieve the uncertainty that exists among different critical care nurses and it must ensure continuity of nursing care. After the guideliness have been established to promote the nursing practice recommendations were made for nursing practice, nursing education and for further research.

Introduction: Coronary artery bypass grafting surgery is an effective treatment for coronary heart disease for many patients; however, evidence suggests that there are some patients who do not report a good post-operative recovery. Although several studies have begun investigating possible reasons for these observations, little is known about the impact of CABG on quality of life and there still remains a lack of information that can help clinicians identify those people more likely to experience poorer recovery so that interventions can be targeted appropriately. Aims: The overall aim was to investigate barriers to and facilitators of recovery after CABG. Method: Phase 1 was a retrospective qualitative study involving semi-structured interviews with eleven patients who had undergone CABG and with ten health professionals experienced in caring for these patients. Data were analysed using thematic analysis. Phase 2 was a prospective study comprising two components, questionnaire and interview. The questionnaire included measures of quality of life, perceived recovery, demographic and psychosocial variables and was administered prior to surgery and at six and twelve months post-surgery. A sample of ten people who completed questionnaires were interviewed at the same time points and data analysed using framework analysis. Results: Interview data described the patient experience of undergoing CABG and identified components of a good recovery from the patient perspective. Patient and health professional participants identified numerous barriers and facilitators to recovery at three key time points - prior to surgery, during the hospital inpatient stay and post-CABG - and noted the complex inter-relationships between them, thus emphasising the need for a holistic approach to investigating recovery. Questionnaire data described the pattern of psychosocial functioning, quality of life and perceived recovery across the surgical pathway and identified depression and self-efficacy as the main predictors of post-CABG quality of life and perceived recovery. Using interview and questionnaire data a model of recovery is proposed. Conclusions: Findings from this research have identified a complex inter-related network of barriers and facilitators to recovery, suggested the possible mechanisms by which they impact on post-CABG outcome and identified recommendations for clinical practice.