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Nursing Perioperative Care in the Cardiac Surgery Department
VÍTKOVÁ, Aneta
The incidence of civilisation diseases is rising not only in the Czech Republic but also worldwide. The incidence of cardiovascular diseases is widely represented in the population. To ensure proper and continuous development in the field of cardiac surgery, seamless interdisciplinary cooperation is necessary, which includes also perioperative nurses. The aim of this thesis is to identify the specifics of nursing care provided by perioperative nurses in the cardiac surgery department and to determine whether these nurses are motivated in the area of lifelong education. The empirical part consisted of both qualitative and quantitative research. Qualitative research was conducted through semi-structured interviews with perioperative nurses working in cardiac surgery operating theatres. Nurses were deliberately selected from three different healthcare facilities. The interviews were transcribed verbatim, processed using the "pen and paper" method, and categorized. For the quantitative research was used a non-standardized questionnaire which consisted of 18 questions and was distributed among perioperative nurses working in cardiac surgery operation theatres throughout the Czech Republic. Distribution was also carried out through NCO NZO (National Centre of Nursing and Non-medical Healthcare fields) and the Faculty of Health Studies in Pardubice. A total of 62 respondents participated in the questionnaire survey. The resulting data was processed using MS Excel and the Realstatistics add-on, with the help of graphs, contingency tables, and statistical calculations. The results of the qualitative research allowed us to map the activities performed by perioperative nurses in the role of a scrub or circulating nurse in cardiac surgery operating theatres. Perioperative nurses carry out a wide range of tasks which include care before, during and after the surgery. Communication and proper functioning of the entire surgical team are also essential. By carefully preparing for the procedure, complying with all duties and fulfilling good workplace relationships, they can provide the best possible care to patients. The results of the quantitative part of the research showed that there is no correlation between years of experience and the motivation of perioperative nurses in cardiac surgery departments for lifelong education, or between the highest level of education attained and their motivation for lifelong education. Despite this, the research had positive results. We found that all perioperative nurses in our research sample are sufficiently motivated for lifelong education. This thesis and its results can be valuable by newly employed perioperative nurses. They can learn basic information about the work of perioperative nurses in the cardiac surgery department and about opportunities for specialization or lifelong education. The section of lifelong education may also be supportive for all other nursing fields.
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Treatment-rehabilitation procedure in a patient after cardiac surgery
TŮMOVÁ, Jitka
The main aim of this bachelor´s thesis is to describe the treatment-rehabilitation procedure of patients after cardiac surgery complicated by stroke. In the theoretical part, I describe cardiac surgery in general, operative approaches, complications related to cardiac surgery, including stroke. I also focus on the rehabilitation of patients after heart surgery in a hospital facility. The second half of the theoretical part is dedicated ischemic and haemorrhagic strokes, symptoms, methods of treatment. At the very end, the thesis is dedicated to the rehabilitation of patients after a stroke. The practical part is processed in the form of qualitative research. In this part, I describe the medical rehabilitation procedure of two probands. The practical part is processed in the form of qualitative research. In this part, I describe the medical rehabilitation procedure of two probands.
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Oxygen consumption in awake cardiac surgical patients
Pořízka, Michal ; Stříteský, Martin (advisor) ; Szárszoi, Ondrej (referee) ; Šetina, Marek (referee)
OBJECTIVES: Standard blood flow rates for cardiopulmonary bypass have been assumed to be the same for awake cardiac surgery with thoracic epidural anesthesia as for general anesthesia. However, compared to general anesthesia, awake cardiac surgery with epidural anesthesia may be associated with higher oxygen consumption due to missing effect of general anesthetics. This may result in insufficient oxygen delivery and lactic acidosis when standard blood flow rates were used. The primary aim of our study was to investigate if standard blood flow rates are adequate in awake cardiac surgery. The secondary aim was to evaluate postoperative clinical outcomes of patients undergoing awake cardiac surgery. METHODS: Forty-seven patients undergoing elective on-pump cardiac surgery were assigned to receive either epidural (Group TEA, n=17), combined (Group TEA-GA, n=15) or general (Group GA, n=15) anesthesia. To monitor adequacy of standard blood flow rates, arterial lactate, acid base parameters, central venous and jugular bulb saturation were measured at six time points during in all groups. Blood flow rates were adjusted when needed. Subsequently, early and late postoperative outcome data including hospital and 3-year mortality was recorded and compared among the study groups RESULTS: No lactic acidosis has...
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Factors affecting glucose metabolism and inflammatory response in critically ill patients
Kotulák, Tomáš ; Haluzík, Martin (advisor) ; Maruna, Pavel (referee) ; Šenolt, Ladislav (referee)
Hyperglycemia in critically ill patients was considered for many years an adaptive response to stress conditions being present in both patients with and without previous history of diabetes. Hyperglycemia is caused mainly by peripheral insulin resistance induced by the factors acting counteracting insulin signalling at the postreceptor level. Furthermore, hyperglycemia itself can then increase serum levels of pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-α), interleukin-6 (Il-6) and interleukin-8 (Il- 8) and others. On the contrary, peripheral insulin resistance induced by pro- inflammatory cytokines may further potentiate hyperglycemia. White adipose tissue represents in addition to its energy storage function also a very active endocrine active organ. In addition to regulation of a number of metabolic processes it also significantly modulates the inflammatory response. In critically ill patients, adipose tissue changes its morphology, i.e. the adipocytes are shrinking and adipose tissue is abundantly infiltrated by macrophages. Paradoxically, overweight and obese critically ill patients have lower mortality than underweight, lean and morbidly obese subjects. In our studies, we selected population of the patients undergoing elective major cardiac surgery with extracorporeal...
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Life after a heart transplant
Kováčová, Anna ; Kordulová, Pavla (advisor) ; Dynáková, Šárka (referee)
Patients with terminal heart failure that cannot be treated with conventional therapies are indicated for heart transplantation. In acute deterioration, patients can be brought to transplant using a mechanical cardiac support that is able to partially or completely take over the role of the heart and allow the restoration of sufficient cardiac output (Fila et al., 2014). The period before and after transplantation represents a very challenging period for patients, when they feel not only physical, but especially mental and social needs, which change during their phases of life and at the same time affect their entire subsequent experience. The main goal of this diploma thesis was to monitor how the previous implantation of long-term mechanical cardiac support and the subsequent heart transplantation affect the needs and feelings of patients. Respondents were selected from patients who had been implanted with mechanical cardiac support prior to heart transplantation. The diploma thesis contained another five sub- objectives, which dealt with mapping the needs of patients before and after implantation of long- term mechanical cardiac support and after heart transplantation, as well as during compliance with regimen measures, information retrieval and education. For qualitative research, the method of...
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Assessment of information knowledge for patients after cardiac surgery
Lomozová, Lenka ; Burišková, Klára (advisor) ; Pucholtová, Romana (referee)
Creating conditions for the effective healthcare provision in cooperation with the patient is one of the main missions of today's healthcare. A cardiac surgery is a difficult life situation for patients. Being informed, as the basic premise for the patient to become an active part of the entire healing process. The main aim of my thesis was to evaluate the awareness of patients who underwent a cardiac surgery, to map the problematic areas and to propose solutions. A combination of qualitative and quantitative method was used for the research. The qualitative part was carried out by means of semi-structured interviews with three interviewees. The quantitative part had the form of the questionnaire presented to 52 respondents. The results of both researches have been analyzed. The results show that the patients seem to have been provided with adequate information at the clinic. Impact of patients' awareness on their cooperation with healthcare professionals was proven, in particular in rehabilitation. A medical doctor remains the main source of information for patients, but they often seek to obtain additional information from other sources. The use of multiple sources and different forms of information seems to be advisable. I identified the groups of patients requiring a specific approach when...
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Factors affecting glucose metabolism and inflammatory response in critically ill patients
Kotulák, Tomáš ; Haluzík, Martin (advisor) ; Maruna, Pavel (referee) ; Šenolt, Ladislav (referee)
Hyperglycemia in critically ill patients was considered for many years an adaptive response to stress conditions being present in both patients with and without previous history of diabetes. Hyperglycemia is caused mainly by peripheral insulin resistance induced by the factors acting counteracting insulin signalling at the postreceptor level. Furthermore, hyperglycemia itself can then increase serum levels of pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-α), interleukin-6 (Il-6) and interleukin-8 (Il- 8) and others. On the contrary, peripheral insulin resistance induced by pro- inflammatory cytokines may further potentiate hyperglycemia. White adipose tissue represents in addition to its energy storage function also a very active endocrine active organ. In addition to regulation of a number of metabolic processes it also significantly modulates the inflammatory response. In critically ill patients, adipose tissue changes its morphology, i.e. the adipocytes are shrinking and adipose tissue is abundantly infiltrated by macrophages. Paradoxically, overweight and obese critically ill patients have lower mortality than underweight, lean and morbidly obese subjects. In our studies, we selected population of the patients undergoing elective major cardiac surgery with extracorporeal...
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Nursing Care for Patient after Surgery of Valvular Defects
Beranová, Veronika ; Burišková, Klára (advisor) ; Hocková, Jana (referee)
This thesis is focused on the nursing care for patient after valvular defects surgery. The aim of this final paper is to ascertain the principles of specialized nursing care for patient after valvular defects surgery, analyse the condition of written standards for providing aftercare to patients who underwent valvular defects surgery, or the state of the nursing protocols in specialized nursing care. The purpose of qualitative - observational research in providing specialized nursing care is to find an answer to the question of whether the specifics of nursing care in Prague cardiac centres are significantly different. The theoretical section contains chapters describing cardiac centres, the history of surgical treatment of heart valves, and the most common valvular heart defects in adulthood. In the theoretical section of this study, I focus in detail on the nursing care for patients following cardiac procedure, ensuring not to forget the monitoring of physiological functions, artificial pulmonary ventilation, and immediate position after elective cardiac surgery. The empirical section is divided into quantitative and qualitative research. The quantitative empirical investigation is focused on an anonymous questionary survey that has been applied in three Prague cardiac centres. Approximately 150...
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