Vaka Hemşiresi Örneği: Açık Kalp Cerrahisi Geçiren Hastaların Kardiyak Outputu Düşük Dönemdeki Fizyolojik İzlem Sonuçları

Abstract

Açık kalp cerrahisi geçirmiş hastaların kardiyak out putlarındaki değişikliğin, hastalardaki fizyolojik bulgulara etkisini belirlemek ve vaka hemşiresinin hasta izlem sonuçlarını göstermek amacıyla bu araştırma yapıldı. Hastaların 24 saatte 5 izlemi değerlendirildi. Hastalar ameliyat öncesi, ameliyattan hemen sonra yoğun bakıma ilk geldiğinde, ameliyattan 4.,8.,24. saat sonra yoğun bakımda izlendi ve fizyolojik ve laboratuvar değerlendirildi. Örneklemi beliremek için güç analizi yapıldı ve tek grupta 36 hasta örnekleme alındı. Araştırma verileri; hastaları tanılama formu, hastaların hemodinamik, mekanik ventilatör izlemleri, laboratuvar değerleri ile toplandı. İzlemler için repeated measures test kullanıldı. İlk ve beşinci izlemler arasındaki farklılığın belirlenmesinde Wilxocon rank testine başvuruldu. Araştırmada %66,6 koroner arter bypass grefti ile açık kalp cerrahisi geçiren hasta yer aldı. Hastaların ortalama 3,62±0,9 saat ameliyat süresi belirlendi. Ameliyat sırasında hastalara ortalama 2590,3±1481 mlt sıvı verilmişti. Hastaların entübe edilme süresi 19,3±4,3 saatti. Hastalar ameliyattan 16,4±5,2 saat sonra uyandırıldı. Hastaların hemodinamik izlemlerine göre; hastaların ameliyat öncesi, ameliyat sonrası yoğun bakımda ilk izlemde, ameliyattan 4 saat sonra, ameliyattan 8 saat sonra, ameliyattan 24 saat sonra ortalama arter basınçları sırasıyla 86,8±5,2; 77,9±12,9; 84,3±9,1; 83,4±8,3; 82,7±6,7 mm Hg bulundu. Bu izlem sonuçları normal ortalama arter basıncı değerindeydi ve aralarında istatiksel fark anlamlı değildi (p>0.05). Hastaların ameliyat sonrası tüm izlemlerde sıvı volümleri (AÇT ve CVP değerleri), satürasyonları, eritrositleri, hemoglobin değerleri, kan gazları ile blood üre nitrojen, kreatin, bilirubin gibi atık maddeleri normal sınırdaydı. Hastaların kan glikoz değerleri, 24 saat sonraki izlemde ilk izleme göre daha yüksekti. Araştırmadaki izlemler doğrultusunda öneriler şu şekilde sıralanabilir: Vaka hemşirelerinin açık kalp cerrahisi geçiren hastaları yoğun bakımda 24 saat fizyolojik ve laboratuvar değeleri izleyerek hekimlerle birlikte kardiak out putu düşük hastalara müdahalesi hayatidir. Vaka hemşireleri hastalarda oluşabilecek tüm anormal bulguları erken tanıyabilir komplikasyonları önleyebilir. Bu nedenle vaka hemşireleri yoğun bakımda kardiyak out putu düşük hastaları ilk 24 saat yoğun bakım izlemeli ve ekip ile iş birliğini sürdürmelidir.

Keywords

• Vaka Hemşireliği
• Kardiyak Out Put
• Açık Kalp Cerrahisi

Case Nurse’s Example: Physiological Monitoring Results of Patients Undergoing Open Heart Surgery During the Low Cardiac Output Period

Abstract

This study was conducted to determine the impact of changes in cardiac output on physiological findings in patients who underwent open-heart surgery and to demonstrate the patient monitoring results of the case nurse. Five patient follow-ups were evaluated within 24 hours. Patients were monitored preoperatively, immediately postoperatively upon arrival in the intensive care unit, and 4, 8, and 24 hours after surgery, and physiological and laboratory evaluations were performed. A power analysis was performed to determine the sample size, and 36 patients were included in the sample group. Data were collected using the patient identification form, hemodynamic monitoring, mechanical ventilation monitoring, and laboratory values. Repeated measures testing was used for the follow-ups. The Wilxocon rank test was used to determine the difference between the first and fifth follow-ups. The study included 66.6% of patients who underwent open-heart surgery with coronary artery bypass grafting. The mean operating time was 3.62±0.9 hours. An average of 2590.3±1481 ml of fluid was administered during the surgery. The duration of intubation was 19.3±4.3 hours. The patients were awakened 16.4±5.2 hours after surgery. According to the hemodynamic monitoring of the patients, the mean arterial pressures of the patients before surgery, at the first postoperative follow-up in the intensive care unit, 4 hours after surgery, 8 hours after surgery, and 24 hours after surgery were found to be 86.8±5.2; 77.9±12.9; 84.3±9.1; 83.4±8.3; and 82.7±6.7 mm Hg, respectively. These monitoring results were within the normal mean arterial pressure values, and the difference between them was not statistically significant (p>0.05). In all postoperative follow-ups, the patients' fluid volumes (CVP values..ets), saturations, erythrocytes, hemoglobin values, blood gases, and waste products such as blood urea nitrogen, creatinine, and bilirubin were within the normal range. The patients' blood glucose levels were higher at the 24-hour follow-up compared to the initial follow-up. Based on the study's findings, the following recommendations can be listed: It is vital that case nurses monitor patients undergoing open heart surgery in the intensive care unit (ICU) for 24-hour physiological and laboratory values and intervene in patients with low cardiac output, in collaboration with physicians. Case nurses can identify any abnormal findings that may occur in patients early and prevent complications. Therefore, case nurses should monitor patients with low cardiac output in the ICU for the first 24 hours and maintain collaboration with the ICU team.

Keywords

• Case Nursing
• Cardiac Out Put
• Open Heart Surgery

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