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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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Oxygen therapy after cardiothoracic surgery from the point of view of nurses and patients
VRCHOTOVÁ, Klára
Cardiac surgeries are very serious surgical procedures with considerable specific features. This bachelor thesis focuses on oxygen therapy from the viewpoints of nurses and patients. Its theoretical part describes physiology of breathing and the oxygen therapy as such. It describes individual sources of oxygen and indications for oxygen administration. It also describes principles to be observed during oxygen administration. Specific aids are used for oxygen administration, particularly oxygen masks or oxygen goggles. Quality pulmonary rehabilitation is also necessary to make oxygen therapy more effective. Pulmonary rehabilitation is particularly important for patients after a cardiac surgery and it should be practiced even before the surgery. This approach is critical because in the post-surgery period the therapy makes it possible for the patient to breathe and to expectorate properly. Pulmonary rehabilitation is practiced with patients by general nurses at the cardio surgery ward, as well as by physiotherapists. There are various techniques available to determine efficiency of oxygen therapy and pulmonary rehabilitation. The techniques may be classified as invasive and non-invasive; the most frequently used non-invasive method is pulse oxymetry and the most frequently used invasive technique is blood collection for ABR. Two objectives were set for the thesis. The first objective was to map knowledge of nurses about how to provide care to patients treated with oxygen therapy. The second objective was to determine how the patients feel after a cardiac surgery. Two hypotheses and two research questions were formulated. The first hypotheses were: Nurses working at the resuscitation care station have more knowledge about oxygen therapy than nurses working at the intermediate care station. The second hypothesis was: Nurses working at the resuscitation care station have more knowledge about pulmonary rehabilitation than nurses working at the intermediate care station. The first research question was: How do the patients feel during oxygen therapy and pulmonary rehabilitation? The second research question was: How are the patients after a cardiac surgery informed about oxygen therapy and pulmonary rehabilitation? In the research part of the bachelor thesis I have used both quantitative and qualitative research methods. Quantitative processing of data was used for questionnaires filled out by nurses working in the hospitals Nemocnice České Budějovice a.s., Nemocnice na Homolce in Prague and in the faculty hospital Královské Vinohrady in Prague. The method was used for evaluation and assessment of knowledge of nurses working at the resuscitation and intermediate care wards. Quantitative methods were used for processing of data obtained through semi-structured interviews with patients after a cardiac surgery. The data were transcribed and coded using a pencil and paper method. The data were categorized based on the identified codes. Two categories were created: oxygen therapy and pulmonary rehabilitation. Each of the categories was further divided into three sub-categories. Two categories were created for the research oxygen therapy and pulmonary therapy. Three sub-categories were subsequently created for the oxygen therapy and the pulmonary therapy. The quantitative research has shown that the knowledge of nurses about oxygen therapy is higher among the nurses working at the resuscitation care ward. However, the situation is different in case of their knowledge about pulmonary rehabilitation. In this case the knowledge of nurses working at the intermediate care ward was higher. The processed data from the qualitative research have shown that patients do have sufficient information about post-surgery oxygen therapy, as well as about pulmonary rehabilitation. For all patients in the post-surgery period after a cardiac surgery the frequency of pulmonary rehabilitation was higher than 1 per day.
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Comparison of physiotherapy techniques after conventional and mini-invasive surgical myocardial revascularization
JÍRA, Pavel
This thesis is focused on surgical therapy of coronary artery disease and its following physiotherapy in acute state. The main task is to find the right form of physiotherapy and check its effectiveness during the early postoperative period. I compare two different surgical intervention the mini-invasive one and the conventional technique method of surgical myocardial revascularization. The thesis is divided into theoretical and practical part. In theoretical part is described the origin and the etiology of coronary artery disease, its therapy - particularly the surgical therapy and its following physiotherapy. This part is created by research of sources enumerated at the end of the thesis. In practical part are described the possibilities of physiotherapy and the progress of patients after the operations. It was created the special list of exercises. Exercises was aimed at breathing techniques and vascular gymnastics, improving of physical condition by light special exercises, practising of verticalizing and self-reliance. The exercises had to solve the muscles disbalances without interrupting the process of recovering the postoperative scar. Special exercises was the part of the healing process. For the first time patients were examined, then they were well educated about helping techniques and special precaution. Patients were examined again before leaving the cardiothoracic ward and the acquired values were compared in all observed aspects. Physical condition of all patient were improved, it has a huge influence on disbalances in shoulder girdle and muscles of thorax and scapula. The outcome of the research is the finding that the proper activity helps with process of recovering after the coronary revascularization.
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Application of knowledge discovery methods in the field of cardiac surgery
Čech, Bohuslav ; Berka, Petr (advisor) ; Aiglová, Květoslava (referee)
This theses demonstrate practical use of knowledge discovery in the field of cardiac surgery. The tasks of the Department of Cardiac Surgery University Hospital Olomouc are solved through the use of GUHA method and LISp-Miner system. Mitral valve surgery data comes from clinical practice between the years 2002 and 2011. Theoretical part includes chapter on KDD -- type of tasks, methods and methodology and chapter on cardiac surgery -- anatomy and functions of heart, mitral valve disease and diagnostic methods including quantification. Practical part brings solutions of the tasks and whole process is described in the spirit of CRISP-DM.
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The Role of a Nurse and Specific Nursing Care for Minimal Invasive Cardiac Surgery Procedures
BENDOVÁ, Miroslava
The overall development of scientific and technical disciplines has enabled the introduction of minimally invasive surgical techniques in cardiac surgery practice. Implementation of minimally invasive cardiac surgery brings many positive effects for patients and healthcare. At the same time, however, it requires for the nurses to have appropriate knowledge, skills and experience to effectively provide comprehensive nursing care. The thesis is divided into theoretical and empirical parts. A total of four objectives were set. The first goal determines the specifics of nursing care of the patient before and after minimally invasive cardiac surgery. The second mapping the differences in nursing care in minimally invasive cardiac surgery from heart surgery classical approach. The third objective determines the role of nurses in patient awareness of minimally-invasive cardiac surgery. The fourth objective is focused on the needs and feelings of patients undergoing minimally invasive cardiac surgery. The results of qualitative research showed that preoperative and postoperative nursing care for minimally invasive cardiac surgery is similar to nursing care before and after cardiac surgery by standard median sternotomy approach. Nurses often wipe away differences associated with nursing care of standard and minimally invasive surgery, differences arose mainly after analysis of the data obtained. The differences include shorter hospital stay, shorter duration of mechanical ventilation, lower incidence of postoperative confusion, differences in invasive inputs, rehabilitation and awareness. For the majority of respondents from the ranks of the patients minimally invasive heart surgery technique had clearly positive impact on their mental condition.
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Factors of discontent among nurses and their impact on care quality at a cardiac surgery department.
ERETOVÁ, Zuzana
Occupation of a general nurse belongs to demanding jobs in terms of professional preparation and performance. A nurse is expected to cope with professional activity, working with modern technology, administrative work, to bear the physical and mental load of her profession, to be able to influence and direct patients? feelings and behaviour and finally to be able to cope with professional as well as family problems she is faced to. All this is often dealt with in continuous operation on shift basis at various specialized workplaces. Questions how nurses working at a cardiac surgery department are satisfied or dissatisfied at their jobs, how the work experience length affects their satisfaction, whether possible discontent among nurses may affect quality of the nursing services provided by them and how the hospital management reduces the factors of discontent, became the subject of my thesis. The research was performed at the IKEM in Prague. Quantitative as well as qualitative research methods were used for data collection when mapping the problems in question. The quantitative part involved a questionnaire both, for general nurses working at the cardiac surgery department, aimed at investigation into the discontent factors involved in their occupation, and for the patients undertaking treatment at the cardiac surgery department, to examine their satisfaction with the nursing care. Analysis of the collected data was then performed. An interview with representatives of the hospital line, middle and top managements was the instrument of the qualitative research. It was focused on the question how they proceed in elimination or reduction the discontent factors. The following facts were found out by the quantitative research. Increased physical and mental load, non-cooperating patients and care about more patients at the same time, extensive administration related to patient care, insufficient remuneration, lack of communication from doctors and superiors, lack of auxiliary staff, projection of occupation to private life or the problem of sleeping after a night shift are the most frequent discontent factors. Despite the above negative factors nurses are satisfied with their jobs regardless the length of experience. The indentified factors of discontent do not affect quality of the care provided by the nurses. The qualitative research results show that personal talks, active interviews and direct communication from the staff are the most frequent methods the management uses to map staff satisfaction. The management representative is able to work herself on elimination or reduction of the discovered factors of discontent within her competences, which happens most often. She may also cooperate with the chief nurses or ward sisters. Unless she is able to solve a problem, it is passed to the authorized persons competent to deal with it (health care manager, social-legal department, HR department). The hospital director is also informed on the most serious cases. The management hardly ever cooperates with physicians on elimination or reduction of the discontent factors. The most important aspect of solving the problem of discontent factors is its subject, which affects the solution method, whether it is to be dealt with by an individual or the whole team. They inform the head physicians or the ward chief consultant on serious problems. The course of the problem solution is communicated to the employees by the ward sisters or chief nurses personally, orally.The goals of the thesis have been met, the set hypotheses have been refuted, and the research questions have been answered.
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Cardiac Surgical Patient in the RES Room and the Approach of a Nurse to Nursing Care
KAFKOVÁ, Zuzana
In the past years, the cardiac surgery performance was very demanding. The limited range of medical performances, imperfect procedures and techniques resulted in frequent postoperative complications and high postoperative mortality. Over time, surgical techniques, heart replacements, extracorporeal circulation and postoperative care have improved. This makes it possible today to operate on much older patients, where surgeries previously were nor feasible. The diploma thesis on the topic Cardiac surgical patient in the RES room and the approach of a nurse to nursing care is dedicated to the patient after heart surgery. It deals with meeting the patient's needs in the RES room and what the patient perceives while staying in the resuscitation unit and what he /she needs from a nurse. In the empirical part of this thesis two objectives were stated. To determine what a cardiac surgical patient perceives and what he /she needs in the RES room, and to find out whether it is possible to improve the quality of patient-oriented care. Based on these objectives, hypotheses and research questions were established. The objectives were successfully achieved, the hypothesis was confirmed and the questions answered. The research was conducted using qualitative quantitative research methods in the RES units of the cardiac surgery department, where the patients with heart disease are operated on. For the quantitative research the questionnaire interview method was selected. The qualitative research method was used to carry out semi-conducted interviews with the patients.
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Cardiac surgery patient with surgical wound dehiscence
BENDULOVÁ, Adriana
Dehiscence or wound spacing is characterized by failure of wound healing and it is a very serious postoperative complication that occurs most frequently in patients who suffer from an associated disease. It usually develops between the fifth and ninth postoperative day. The cause of dehiscence is an infection in the wound, which is caused by proliferation of bacterial strains. The thesis on "Cardiac surgery patient with surgical wound dehiscence{\crqq} is focused on theoretical and practical parts. The theoretical part deals with the development of cardiac surgery and important personalities, medical indications for a cardiac surgery, cardiac surgery, surgical wound healing, surgical wound complications and nursing care of patients with dehiscence. The practical part was carried out by a quality - quantitative survey. The research sample for the qualitative research, which was conducted by the semi-structured interview technique with open questions, consisted of four cardiac surgery patients with wound dehiscence. The research sample for the quantitative research, which was carried out through anonymous questionnaires, consisted of 100 nurses working in cardiac surgery centers, Czech Republic, and 30 cardiac surgery patients with wound dehiscence. The results were processed into tables, graphs and diagrams. This work may serve as a resource for the interpretation of the subject matter or as a source of information for Cardiac Surgery Centers to improve the needs satisfaction in patients with wound dehiscence.
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Anticipating versus reality of work of nurses in cardiosurgery department
BÁRTOVÁ, Marie
In my bachelor paper I dealt with expectation of nurses before their entry in practice and confrontation with the reality of work at hospital units. Expectation plays an important part in coping with the nursing occupation. There are many factors that can influence it both in a positive and negative way. The fast pace in current medical establishments requires that a nurse should assess, predict and evaluate the state of patients and that she should react to it within several minutes so that the care for the ill is most efficient and coordinated. Such a task is difficult for every-one but for a nurse disappointed by the health system it is an impossible task. Therefore it is important that there is a correspondence between expectations and the final reality of work.
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