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Specifics of nursing care in children before and after cardiac surgery.
NOVOTNÁ, Stanislava
Heart defects are classified into two types: critical and non-critical, with the vast majority of heart defects requiring immediate initiation of treatment or initiation of surgery. This bachelor thesis deals with the specifics of nursing care for children before and after such a cardiac surgery invasion. The first goal of this work was to find out what are the specifics of nursing care for children before heart surgery, the second goal was to find out what are the specifics of nursing care for children after heart surgery, and the third goal of the bachelor thesis was to map the issue of nursing care for children before and after cardiac surgery from the parents' point of view. In the bachelor thesis, two research questions and two hypotheses were set. The first research question concerned the specifics of nursing care for children before heart surgery. The second research question aimed to define the specifics of nursing care for children after heart surgery based on findings. In the first hypothesis, we were interested in whether the parents of children undergoing cardiac surgery are educated in the field of nursing care. The second hypothesis was to determine whether the parents of children undergoing heart surgery are satisfied with nursing care. The first part of the research was carried out using the method of qualitative research, in the form of a semi-structured interview with nurses who care for children before or after heart surgery. The second part of the research was carried out by the method of quantitative research, in the form of anonymous questionnaires with parents of children before and after cardiac surgery. Interviews in the qualitative survey showed that nurses have sufficient knowledge in the field of preoperative and postoperative care. They can independently determine what preoperative preparation is needed, which samples are important before surgery, what premedication is appropriate and how long before the procedure the child should be fasted, which is very important for new-borns. In postoperative care, their knowledge is above standard. They can evaluate complications after operations and, if necessary, are able to intervene independently. They are familiar with the area of sampling and examinations, which must be done immediately upon arrival from the hospital ward, and can evaluate how to load the digestive tract after surgery. A lot of knowledge also comes from communication with parents, where the sisters see great pitfalls that could be addressed in the form of seminars on communication. From the evaluation of the results of the quantitative survey, it was found that the parents of the children are sufficiently educated in the field of nursing care and are satisfied with the nursing care. Based on the results, it can be stated that in comparison with the theoretical knowledge, the nurses have essentially the same knowledge. Preoperative and postoperative care for children with heart defects is very demanding and burdensome not only for the child but also for nurses, and therefore it is very welcome that the parents of the children were satisfied with the education and nursing care.
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Pathophysiological and clinical aspects of cardiac dyssynchrony in children and adolescents
Kovanda, Jan ; Janoušek, Jan (advisor) ; Bulava, Alan (referee) ; Klásková, Eva (referee)
Pathophysiological and clinical aspects of cardiac dyssynchrony in children and adolescents Electromechanical dyssynchrony is an important factor in the development of heart failure. It is caused by abnormal activation of the working myocardium in case of bundle branch block or ventricular pacing. Asymmetric hypertrophy of the affected ventricle develops together with its dilatation and reduced function and fulfils the picture of dyssynchronous cardiomyopathy. The development of dyssynchronopathy can be prevented by careful selection of the permanent pacing site and treated by cardiac resynchronization therapy. One of the aims of this work was to compare clinical and echocardiographic findings in patients paced from the left-ventricular apex with the healthy population. Using a retrospective cross-sectional study, we have proved that left ventricular function is not adversely affected in long-term follow-up. Another aim of the study was to evaluate the long-term results of resynchronization therapy of the systemic ventricle in patients with congenital heart defects. Using a retrospective study, we have described an acceptable long-term survival at the price of relatively frequent complications. We were extensively working on a new method of resynchronization of the right subpulmonary ventricle in...
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Contribution of BNP to prognostic stratification of patients with advanced heart failure.
Hegarová, Markéta ; Málek, Ivan (advisor) ; Bedáňová, Helena (referee) ; Pudil, Radek (referee)
Plasma levels of B-type natriuretic peptide (BNP) are a strong and independent predictor of prognosis in patients with advanced heart failure (CHF). However, the importance of this biomarker has been documented only in CHF of common causes such as dilated or ischemic cardiomyopathy. We hypothesized that BNP can serve as a strong predictor of end-stage CHF in group of patients with advanced CHF due to congenital heart disease (CHD) with the right ventricle in systemic position (SRV). The second hypothesis was that BNP monitoring in patients with implanted left ventricular assist device (LVAD) Heart Mate II could detect serious complications which negatively affect prognosis. We performed a retrospective analysis in 28 consecutive patients with severe systolic dysfunction of the SRV (ejection fraction 23 ± 6%) evaluated as heart transplant (HTx) candidates between May 2007 and October 2014. During a median follow-up of 29 months (interquartile range, 9-50), 14 pts reached primary endpoints of the study (death, urgent HTx, and LVAD implantation). We have considered these events equivalent to end-stage CHF. Using ROC analysis, we identified the first measured value of BNP as the strongest predictor of prognosis with the area under the curve (AUC) of 1.00, followed by the New York Heart Association...
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Nursing care for a child with Fallot's tetralogy
NEJDLOVÁ, Tereza
Tetralogy of Fallot (TOF) is a congenital heart defect which is classically understood to involve four anatomical abnormalities of the heart; pulmonary stenosis, right ventricular hypertrophy, overriding aorta and ventricular septal defect. This not common but life-threatening disease is found in about 3.4% newborns with congenital heart disease. TOF is a multifactorial disease both hereditary and influenced by surrounding environment. This bachelor thesis deals with anatomy and physiology of the heart, causes, symptoms, diagnostics and treatments of the disease as well as the role of the nurse during pre- and post-operative care, postoperative complications and life situation of children with TOF after surgery. The aim of this work is to map pre- and post-operational specifics of nursing care for children with TOF. These research questions were used: - Which are the specifics of pre-operational care for children with TOF? - Which are the specifics of post-operational care for children with TOF? Qualitative method of questioning and the in-depth interview technique with paediatric nurses from Child cardio centre at FN Motol hospital in Prague were used for the analysis of the research part of the thesis. Transcribed interviews were analysed by open coding, giving rise to following categories: Preoperational examination, monitoring, premedication, fasting, post-operational care, information on the heath condition, post-operational life. Subcategories with important encoded data were assigned to each category. Important within the preoperational examination are biology material testing, RTG of heart and lungs, EKG, ECHO and anaesthesiology examination. In Monitoring category belong according to the respondents the monitoring of physiological functions and the risk of hypoxia seizures. Information about the patients being administered Midazolam and Diazepam before surgery was categorised under Premedication. Fasting was shown to differ for nursing and older children. Post-operational care was shown to be a very wide category where monitoring of vital functions and the surgical wound is most important. EKG, blood testing, throat, nose and rectum samples are also performed. The child is given analgosedation, catecholamines, Korotrop and Dobutamine. Nutrition on surgery day consists of 5% glucoses. The category Information on health condition shows that all such information the responsibility of the doctor in charge. Parents are allowed to visit the child for a short while after performed surgery, when his/her state is stable they can spend all day at the ward. The last category dealing with Life after surgery summarises all medication administered to the child after release to home care. The conducted research shows that the respondents answered the individual question identically to the compared theoretical findings. Preoperational care demands several tests and post-operational care is rather demanding both for the nursing staff and the paediatric patient.
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