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Kalp Cerrahisinde Kırılgan Hastaların Hemşirelik Bakımı

Yıl 2022, Cilt 11, Sayı 2, 806 - 816, 30.06.2022
https://doi.org/10.37989/gumussagbil.946758

Öz

Kırılganlığın standartlaştırılmış bir tanımı olmamasına rağmen yaşlanmaya bağlı fizyolojik rezervlerin azalması olarak kavramsallaştırılmış bir geriatrik sendromdur. Kırılganlık kardiyovasküler hastalıklar sonucu ortaya çıkabildiği gibi kardiyovasküler hastalıkların gelişmesi ve ilerlemesi açısından da öngördürücü bir göstergedir. Epidemiyolojik çalışmalarda kırılganlık prevelansının diğer cerrahi hastalara oranla kalp cerrahisi hastalarında daha yüksek oranda olduğu saptanmıştır. Ayrıca kırılganlık kalp cerrahisi sonrası delirium, mortalite ve morbidite gibi birçok olumsuz sağlık sonuçları ile ilişkilendirilmiştir. Kalp cerrahisi adayı hastalarda ameliyat öncesi kırılganlığın değerlendirildiği ileri değerlendirmeler ile ameliyat sonrası ortaya çıkabilecek istenmeyen olaylar öngörülebilir ve gerekli önlemler alınabilir. Kırılganlığın yönetimi multidisipliner ve çok boyutludur. Kırılgan kalp cerrahisi hastalarının yönetimi için kırılganlık kavramının, ölçüm araçlarının, patofizyolojisinin anlaşılması önemlidir. Bu derlemede kırılganlık kavramı, kırılganlığın değerlendirilmesi, patofizyolojisi, kalp cerrahisinde kırılganlığın epidemiyolojisi, hasta sonuçları üzerine etkisi, kırılganlığın değerlendirilmesinin önemi ve hemşirelik bakımına yer verilmiştir.

Kaynakça

  • 1. World Health Organization-WHO. (2018). “Ageing and Health”. https://www.who.int/news-room/fact-sheets/ detail/ageing-and-health. (Accessed: 17.01.2021).
  • 2. Kılıç, S, Şimşek, E, and Nalbantgil, S. (2016). “Kırılganlık Sendromu ve Kardiyovasküler Sistem [Frailty Syndrome and Cardiovascular System]”. MN Kardiyoloji, 23 (4), 200-206.
  • 3. Graham, A. and Brown, C.H. (2017). “Frailty, Aging, and Cardiovascular Surgery”. Anesthesia and Analgesia, 124 (4), 1053-1060..
  • 4. Afilalo, J, Alexander, K.P, Mack, M.J, Maurer, M.S, Green, P, Allen, L.A, Popma, J.J, Ferrucci, J. and Forman, D.E. (2014). “Frailty Assessment in The Cardiovascular Care of Older Adults.” Journal of the American College of Cardiology, 63 (8), 747-762.
  • 5. Koh, L.Y. and Hwang, N.C. (2019). “Frailty in Cardiac Surgery.” Journal of Cardiothoracic and Vascular Anesthesia, 33 (2), 521-531.
  • 6. Fried, L.P, Tangen, C.M, Walston, J, Newman, A.B, Hirsch, C, Gottdiener, J, Seeman, T, Tracy, R, Kop, W.J, Burke, G. and McBurnie, M.A. (2001). “Frailty in Older Adults: Evidence for A Phenotype.” The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56 (3), M146-M157.
  • 7. Walston, J, Hadley, E.C, Ferrucci, L, Guralnik, J.M, Newman, A.B, Studenski, S.A, Ershler, W.B, Harris, T. and Fried, L.P. (2006). “Research Agenda for Frailty In Older Adults: Toward A Better Understanding of Physiology and Etiology: Summary From The American Geriatrics Society/National Institute on Aging Research Conference On Frailty in Older Adults.” Journal of the American Geriatrics Society, 54 (6), 991-1001.
  • 8. Morley, J.E, Vellas, B, Van Kan, G.A, Anker, S.D, Bauer, J.M, Bernabei, R, Cesari, M, Chumlea, W.C, Doehner, W, Evans, J, Fried, L.P, Guralnik, J.M, Katz, P.R, Malmstrom, T.K, McCarter, R.J, Robledo, L.M.G, Rockwood, K, von Haehling, S, Vandewoude, M.F. and Waltson, J. (2013). “Frailty Consensus: A Call to Action.” Journal of the American Medical Directors Association, 14 (6), 392-397.
  • 9. Buta, B.J, Walston, J.D, Godino, J.G, Park, M, Kalyani, R.R, Xue, Q.L, Bandeen-Roche, K. and Varadhan, R. (2016). “Frailty Assessment Instruments: Systematic Characterization of The Uses and Contexts of Highly-Cited Instruments.” Ageing Research Reviews, 26, 53-61.
  • 10. De Vries, N.M, Staal, J.B, Van Ravensberg, C.D, Hobbelen, J.S.M, Rikkert, M.O, Nijhuis-Van der Sanden, M.W.G. (2011). “Outcome Instruments to Measure Frailty: A Systematic Review.” Ageing Research Reviews, 10 (1), 104-114. Song, X, Mitnitski, A, and Rockwood, K. (2010). “Prevalence and 10‐Year Outcomes of Frailty in Older Adults in Relation to Deficit Accumulation.” Journal of the American Geriatrics Society, 58 (4), 681-687.
  • 11. Song, X, Mitnitski, A, and Rockwood, K. (2010). “Prevalence and 10‐year outcomes of frailty in older adults in relation to deficit accumulation.” Journal of the American Geriatrics Society, 58 (4), 681-687.
  • 12. Afilalo, J, Lauck, S, Kim, D.H, Lefèvre, T, Piazza, N, Lachapelle, K, Martucci, G, Lamy, A, Labinaz, M, Peterson, M.D, Arora, R.C, Noiseux, N, Rassi, A, Palacios, I.F, Genereux, P, Lindman, B.R, Asgar, A.W, Kim, C.A, Trnkus, A, Morais, J.A, Langlois, Y, Rudski, L.G, Morin, J, Popma, J.J, Webb, J.G and Perrault, L.P. (2017). “Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study.” Journal of the American College of Cardiology, 70 (6), 689-700.
  • 13. Brown, C.H, Max, L, LaFlam, A, Kirk, L, Gross, A, Arora, R, Neufeld, K, Hogue, C.W, Waltson, J. and Pustavoitau, A. (2017). “The Association Between Preoperative Frailty and Postoperative Delirium After Cardiac Surgery.” Anesthesia and Analgesia, 123 (2), 430-435.
  • 14. Afilalo, J, Eisenberg, M.J, Morin, J.F, Bergman, H, Monette, J, Noiseux, N, Perrault, L.P, Alexander, K.P, Langlois, Y, Dendukuri, N, Chamoun, P, Kasparian, G, Robichaud, S, Gharacholou, S.M. and Boivin, J. (2010). “Gait Speed as An Incremental Predictor of Mortality And Major Morbidity In Elderly Patients Undergoing Cardiac Surgery.” Journal of the American College of Cardiology, 56 (20), 1668-1676.
  • 15. Chung, C.J, Wu, C, Jones, M, Kato, T.S, Dam, T.T, Givens, R.C, Templeton, D.L, Maurer, M.S, Naka, Y, Takayama, H, Mancini, D.M. and Schulze, P.C. (2014). “Reduced Handgrip Strength as A Marker of Frailty Predicts Clinical Outcomes in Patients with Heart Failure Undergoing Ventricular Assist Device Placement.” Journal of Cardiac Failure, 20 (5), 310-315.
  • 16. Pala, F., Gürsoy, M.Y. (2020). “Türkiye’de Yaşlı Kırılganlığını Konu Alan Araştırmalar: Sistematik Bir İnceleme”. In: Akgöl, J. (Ed.). Farklı Boyutlarıyla Sağlık (67-75). Çanakkale: Rating Academy.
  • 17. Waltson JD. (2020). “Frailty”. https://www.uptodate. com/contents/frailty?search=frailty&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H598976126. (Accessed: 23.11.2020).
  • 18. Sündermann, S, Dademasch, A, Praetorius, J, Kempfert, J, Dewey, T, Falk, V, Mohr, F.W. and Thomas, W. (2011). “Comprehensive Assessment of Frailty For Elderly High-Risk Patients Undergoing Cardiac Surgery.” European Journal of Cardio-Thoracic Surgery, 39 (1), 33-37.
  • 19. Afilalo, J, Mottillo, S, Eisenberg, M.J, Alexander, K.P, Noiseux, N, Perrault, L.P, Morin, J, Langlois, Y, Ohayon, S.M, Monette, J, Boivin, J, Shahian, D.M. and Bergman, H. (2012). “Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients At High Risk of Mortality or Major Morbidity.” Circulation: Cardiovascular Quality and Outcomes, 5(2), 222-228.
  • 20. Lee, D.H, Buth, K.J, Martin, B.J, Yip, A.M. and Hirsch, G.M. (2010). “Frail Patients are at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery.” Circulation, 121 (8), 973-979.
  • 21. Sündermann, S.H, Dademasch, A, Seifert, B, Rodriguez Cetina Biefer, H, Emmert, M.Y, Walther, T, Jacobs, S, Mohr, F, Falk, V. and Starck, C.T. (2014). “Frailty is A Predictor of Short-And Mid-Term Mortality After Elective Cardiac Surgery Independently of Age.” Interactive Cardiovascular and Thoracic Surgery, 18(5), 580-585.
  • 22. Calvo, E, Teruel, L, Rosenfeld, L, Guerrero, C, Romero, M, Romaguera, R, Izquierdo, S, Asensio, S, Andreu-Periz, L, Gomez-Hospital, J.A. and Ariza-Sole, A. (2019). “Frailty in Elderly Patients Undergoing Primary Percutaneous Coronary Intervention.” European Journal of Cardiovascular Nursing, 18 (2), 132-139.
  • 23. Jung, P, Pereira, M.A, Hiebert, B, Song, X, Rockwood, K, Tangri, N. and Arora, R.C. (2015). “The Impact of Frailty on Postoperative Delirium in Cardiac Surgery Patients.” The Journal of Thoracic and Cardiovascular Surgery, 149 (3), 869-875.
  • 24. Sepehri, A, Beggs, T, Hassan, A, Rigatto, C, Shaw-Daigle, C, Tangri, N, and Arora, R.C. (2014). “The Impact of Frailty on Outcomes After Cardiac Surgery: A Systematic Review.” The Journal of Thoracic and Cardiovascular Surgery, 148 (6), 3110-3117.
  • 25. Yuguchi, S, Saitoh, M, Oura, K, Tahara, M, Kamisaka, K, Kawamura, T, Kato, M. and Morisawa, T. (2019). “Impact of Preoperative Frailty on Regaining Walking Ability in Patients After Cardiac Surgery: Multicenter Cohort Study in Japan.” Archives of Gerontology and Geriatrics, 83 (July-August 2019), 204-210.
  • 26. Goldfarb, M, Bendayan, M, Rudski, L.G, Morin, J.F, Langlois, Y, Ma, F, Lachapelle, K, Cecere, R, DeVarennes, B, Tchervenkov, C.I, Brophy, J.M. and Afilalo, J. (2017). “Cost of Cardiac Surgery in Frail Compared with Nonfrail Older Adults.” Canadian Journal of Cardiology, 33 (8), 1020-1026.
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  • 31. Veronese, N, Cereda, E, Stubbs, B, Solmi, M, Luchini, C, Manzato, E, Sergi, G, Manu, P, Harris, T, Fontana, L, Strandberg, T, Amieva, H, Dumurgier, J, Elbaz, A, Tzourio, C, Eicholzar, M, Rohrmann, S, Moretti, C, S’Ascenzo, F, Quadri, G, Polidoro, A, Lourenço, R.A, Moreira, V.G, Sanshis, J, Scotti, V, Maggi, S. and Correll, C.U. (2017). “Risk of Cardiovascular Disease Morbidity and Mortality in Frail and Pre-Frail Older Adults: Results From A Meta-Analysis and Exploratory Meta-Regression Analysis.” Ageing Research Reviews, 35, 63-73.
  • 32. Vigorito, C, Abreu, A, Ambrosetti, M, Belardinelli, R, Corrà, U, Cupples, M, Davos, C.H, Hoefer, S, Iliou, M.C, Schmid, J.P. and Patrick, D. (2017). “Frailty and Cardiac Rehabilitation: A Call to Action from The EAPC Cardiac Rehabilitation Section.” European Journal of Preventive Cardiology, 24 (6), 577-590.
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Nursing Care of Frail Patients in Cardiac Surgery

Yıl 2022, Cilt 11, Sayı 2, 806 - 816, 30.06.2022
https://doi.org/10.37989/gumussagbil.946758

Öz

Although there is no standardized definition of frailty, it is a geriatric syndrome conceptualized as a decrease in physiological reserves due to aging. Frailty may occur as a result of cardiovascular diseases, and it is also a predictive indicator for the development and progression of cardiovascular diseases. In epidemiological studies, the prevalence of frailty was determined to be higher in cardiac surgery patients than in other surgical patients. In addition, frailty has been associated with many adverse health outcomes such as delirium, mortality, and morbidity following cardiac surgery. With advanced evaluations to determine preoperative frailty in patients who are candidates for cardiac surgery, adverse events that might occur following surgery could be predicted, and necessary measures could be taken. Management of frailty is multidisciplinary and multidimensional. It is significant to recognise the concept of frailty, its assesment tools, and its pathophysiology for the management of frail patients with frailty and proposed to undergo cardiac surgery. This review discusses the concept of frailty, its evaluation, pathophysiology, epidemiology in cardiac surgery, effect on patient outcomes, importance of its evaluation, and nursing care for this condition.

Kaynakça

  • 1. World Health Organization-WHO. (2018). “Ageing and Health”. https://www.who.int/news-room/fact-sheets/ detail/ageing-and-health. (Accessed: 17.01.2021).
  • 2. Kılıç, S, Şimşek, E, and Nalbantgil, S. (2016). “Kırılganlık Sendromu ve Kardiyovasküler Sistem [Frailty Syndrome and Cardiovascular System]”. MN Kardiyoloji, 23 (4), 200-206.
  • 3. Graham, A. and Brown, C.H. (2017). “Frailty, Aging, and Cardiovascular Surgery”. Anesthesia and Analgesia, 124 (4), 1053-1060..
  • 4. Afilalo, J, Alexander, K.P, Mack, M.J, Maurer, M.S, Green, P, Allen, L.A, Popma, J.J, Ferrucci, J. and Forman, D.E. (2014). “Frailty Assessment in The Cardiovascular Care of Older Adults.” Journal of the American College of Cardiology, 63 (8), 747-762.
  • 5. Koh, L.Y. and Hwang, N.C. (2019). “Frailty in Cardiac Surgery.” Journal of Cardiothoracic and Vascular Anesthesia, 33 (2), 521-531.
  • 6. Fried, L.P, Tangen, C.M, Walston, J, Newman, A.B, Hirsch, C, Gottdiener, J, Seeman, T, Tracy, R, Kop, W.J, Burke, G. and McBurnie, M.A. (2001). “Frailty in Older Adults: Evidence for A Phenotype.” The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56 (3), M146-M157.
  • 7. Walston, J, Hadley, E.C, Ferrucci, L, Guralnik, J.M, Newman, A.B, Studenski, S.A, Ershler, W.B, Harris, T. and Fried, L.P. (2006). “Research Agenda for Frailty In Older Adults: Toward A Better Understanding of Physiology and Etiology: Summary From The American Geriatrics Society/National Institute on Aging Research Conference On Frailty in Older Adults.” Journal of the American Geriatrics Society, 54 (6), 991-1001.
  • 8. Morley, J.E, Vellas, B, Van Kan, G.A, Anker, S.D, Bauer, J.M, Bernabei, R, Cesari, M, Chumlea, W.C, Doehner, W, Evans, J, Fried, L.P, Guralnik, J.M, Katz, P.R, Malmstrom, T.K, McCarter, R.J, Robledo, L.M.G, Rockwood, K, von Haehling, S, Vandewoude, M.F. and Waltson, J. (2013). “Frailty Consensus: A Call to Action.” Journal of the American Medical Directors Association, 14 (6), 392-397.
  • 9. Buta, B.J, Walston, J.D, Godino, J.G, Park, M, Kalyani, R.R, Xue, Q.L, Bandeen-Roche, K. and Varadhan, R. (2016). “Frailty Assessment Instruments: Systematic Characterization of The Uses and Contexts of Highly-Cited Instruments.” Ageing Research Reviews, 26, 53-61.
  • 10. De Vries, N.M, Staal, J.B, Van Ravensberg, C.D, Hobbelen, J.S.M, Rikkert, M.O, Nijhuis-Van der Sanden, M.W.G. (2011). “Outcome Instruments to Measure Frailty: A Systematic Review.” Ageing Research Reviews, 10 (1), 104-114. Song, X, Mitnitski, A, and Rockwood, K. (2010). “Prevalence and 10‐Year Outcomes of Frailty in Older Adults in Relation to Deficit Accumulation.” Journal of the American Geriatrics Society, 58 (4), 681-687.
  • 11. Song, X, Mitnitski, A, and Rockwood, K. (2010). “Prevalence and 10‐year outcomes of frailty in older adults in relation to deficit accumulation.” Journal of the American Geriatrics Society, 58 (4), 681-687.
  • 12. Afilalo, J, Lauck, S, Kim, D.H, Lefèvre, T, Piazza, N, Lachapelle, K, Martucci, G, Lamy, A, Labinaz, M, Peterson, M.D, Arora, R.C, Noiseux, N, Rassi, A, Palacios, I.F, Genereux, P, Lindman, B.R, Asgar, A.W, Kim, C.A, Trnkus, A, Morais, J.A, Langlois, Y, Rudski, L.G, Morin, J, Popma, J.J, Webb, J.G and Perrault, L.P. (2017). “Frailty in Older Adults Undergoing Aortic Valve Replacement: The FRAILTY-AVR Study.” Journal of the American College of Cardiology, 70 (6), 689-700.
  • 13. Brown, C.H, Max, L, LaFlam, A, Kirk, L, Gross, A, Arora, R, Neufeld, K, Hogue, C.W, Waltson, J. and Pustavoitau, A. (2017). “The Association Between Preoperative Frailty and Postoperative Delirium After Cardiac Surgery.” Anesthesia and Analgesia, 123 (2), 430-435.
  • 14. Afilalo, J, Eisenberg, M.J, Morin, J.F, Bergman, H, Monette, J, Noiseux, N, Perrault, L.P, Alexander, K.P, Langlois, Y, Dendukuri, N, Chamoun, P, Kasparian, G, Robichaud, S, Gharacholou, S.M. and Boivin, J. (2010). “Gait Speed as An Incremental Predictor of Mortality And Major Morbidity In Elderly Patients Undergoing Cardiac Surgery.” Journal of the American College of Cardiology, 56 (20), 1668-1676.
  • 15. Chung, C.J, Wu, C, Jones, M, Kato, T.S, Dam, T.T, Givens, R.C, Templeton, D.L, Maurer, M.S, Naka, Y, Takayama, H, Mancini, D.M. and Schulze, P.C. (2014). “Reduced Handgrip Strength as A Marker of Frailty Predicts Clinical Outcomes in Patients with Heart Failure Undergoing Ventricular Assist Device Placement.” Journal of Cardiac Failure, 20 (5), 310-315.
  • 16. Pala, F., Gürsoy, M.Y. (2020). “Türkiye’de Yaşlı Kırılganlığını Konu Alan Araştırmalar: Sistematik Bir İnceleme”. In: Akgöl, J. (Ed.). Farklı Boyutlarıyla Sağlık (67-75). Çanakkale: Rating Academy.
  • 17. Waltson JD. (2020). “Frailty”. https://www.uptodate. com/contents/frailty?search=frailty&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H598976126. (Accessed: 23.11.2020).
  • 18. Sündermann, S, Dademasch, A, Praetorius, J, Kempfert, J, Dewey, T, Falk, V, Mohr, F.W. and Thomas, W. (2011). “Comprehensive Assessment of Frailty For Elderly High-Risk Patients Undergoing Cardiac Surgery.” European Journal of Cardio-Thoracic Surgery, 39 (1), 33-37.
  • 19. Afilalo, J, Mottillo, S, Eisenberg, M.J, Alexander, K.P, Noiseux, N, Perrault, L.P, Morin, J, Langlois, Y, Ohayon, S.M, Monette, J, Boivin, J, Shahian, D.M. and Bergman, H. (2012). “Addition of Frailty and Disability to Cardiac Surgery Risk Scores Identifies Elderly Patients At High Risk of Mortality or Major Morbidity.” Circulation: Cardiovascular Quality and Outcomes, 5(2), 222-228.
  • 20. Lee, D.H, Buth, K.J, Martin, B.J, Yip, A.M. and Hirsch, G.M. (2010). “Frail Patients are at Increased Risk for Mortality and Prolonged Institutional Care After Cardiac Surgery.” Circulation, 121 (8), 973-979.
  • 21. Sündermann, S.H, Dademasch, A, Seifert, B, Rodriguez Cetina Biefer, H, Emmert, M.Y, Walther, T, Jacobs, S, Mohr, F, Falk, V. and Starck, C.T. (2014). “Frailty is A Predictor of Short-And Mid-Term Mortality After Elective Cardiac Surgery Independently of Age.” Interactive Cardiovascular and Thoracic Surgery, 18(5), 580-585.
  • 22. Calvo, E, Teruel, L, Rosenfeld, L, Guerrero, C, Romero, M, Romaguera, R, Izquierdo, S, Asensio, S, Andreu-Periz, L, Gomez-Hospital, J.A. and Ariza-Sole, A. (2019). “Frailty in Elderly Patients Undergoing Primary Percutaneous Coronary Intervention.” European Journal of Cardiovascular Nursing, 18 (2), 132-139.
  • 23. Jung, P, Pereira, M.A, Hiebert, B, Song, X, Rockwood, K, Tangri, N. and Arora, R.C. (2015). “The Impact of Frailty on Postoperative Delirium in Cardiac Surgery Patients.” The Journal of Thoracic and Cardiovascular Surgery, 149 (3), 869-875.
  • 24. Sepehri, A, Beggs, T, Hassan, A, Rigatto, C, Shaw-Daigle, C, Tangri, N, and Arora, R.C. (2014). “The Impact of Frailty on Outcomes After Cardiac Surgery: A Systematic Review.” The Journal of Thoracic and Cardiovascular Surgery, 148 (6), 3110-3117.
  • 25. Yuguchi, S, Saitoh, M, Oura, K, Tahara, M, Kamisaka, K, Kawamura, T, Kato, M. and Morisawa, T. (2019). “Impact of Preoperative Frailty on Regaining Walking Ability in Patients After Cardiac Surgery: Multicenter Cohort Study in Japan.” Archives of Gerontology and Geriatrics, 83 (July-August 2019), 204-210.
  • 26. Goldfarb, M, Bendayan, M, Rudski, L.G, Morin, J.F, Langlois, Y, Ma, F, Lachapelle, K, Cecere, R, DeVarennes, B, Tchervenkov, C.I, Brophy, J.M. and Afilalo, J. (2017). “Cost of Cardiac Surgery in Frail Compared with Nonfrail Older Adults.” Canadian Journal of Cardiology, 33 (8), 1020-1026.
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Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Derlemeler
Yazarlar

Fatma DEMİR KORKMAZ>
EGE UNIVERSITY, FACULTY OF NURSING
0000-0003-3810-297X
Türkiye


Bilgen ARIKAN> (Sorumlu Yazar)
UŞAK ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, HEMŞİRELİK BÖLÜMÜ
0000-0001-7194-6010
Türkiye

Yayımlanma Tarihi 30 Haziran 2022
Yayınlandığı Sayı Yıl 2022, Cilt 11, Sayı 2

Kaynak Göster

Bibtex @derleme { gumussagbil946758, journal = {Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi}, eissn = {2146-9954}, address = {}, publisher = {Gümüşhane Üniversitesi}, year = {2022}, volume = {11}, number = {2}, pages = {806 - 816}, doi = {10.37989/gumussagbil.946758}, title = {Nursing Care of Frail Patients in Cardiac Surgery}, key = {cite}, author = {Demir Korkmaz, Fatma and Arıkan, Bilgen} }
APA Demir Korkmaz, F. & Arıkan, B. (2022). Nursing Care of Frail Patients in Cardiac Surgery . Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi , 11 (2) , 806-816 . DOI: 10.37989/gumussagbil.946758
MLA Demir Korkmaz, F. , Arıkan, B. "Nursing Care of Frail Patients in Cardiac Surgery" . Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 11 (2022 ): 806-816 <https://dergipark.org.tr/tr/pub/gumussagbil/issue/70821/946758>
Chicago Demir Korkmaz, F. , Arıkan, B. "Nursing Care of Frail Patients in Cardiac Surgery". Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 11 (2022 ): 806-816
RIS TY - JOUR T1 - Nursing Care of Frail Patients in Cardiac Surgery AU - Fatma Demir Korkmaz , Bilgen Arıkan Y1 - 2022 PY - 2022 N1 - doi: 10.37989/gumussagbil.946758 DO - 10.37989/gumussagbil.946758 T2 - Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi JF - Journal JO - JOR SP - 806 EP - 816 VL - 11 IS - 2 SN - -2146-9954 M3 - doi: 10.37989/gumussagbil.946758 UR - https://doi.org/10.37989/gumussagbil.946758 Y2 - 2022 ER -
EndNote %0 Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi Nursing Care of Frail Patients in Cardiac Surgery %A Fatma Demir Korkmaz , Bilgen Arıkan %T Nursing Care of Frail Patients in Cardiac Surgery %D 2022 %J Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi %P -2146-9954 %V 11 %N 2 %R doi: 10.37989/gumussagbil.946758 %U 10.37989/gumussagbil.946758
ISNAD Demir Korkmaz, Fatma , Arıkan, Bilgen . "Nursing Care of Frail Patients in Cardiac Surgery". Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 11 / 2 (Haziran 2022): 806-816 . https://doi.org/10.37989/gumussagbil.946758
AMA Demir Korkmaz F. , Arıkan B. Nursing Care of Frail Patients in Cardiac Surgery. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2022; 11(2): 806-816.
Vancouver Demir Korkmaz F. , Arıkan B. Nursing Care of Frail Patients in Cardiac Surgery. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2022; 11(2): 806-816.
IEEE F. Demir Korkmaz ve B. Arıkan , "Nursing Care of Frail Patients in Cardiac Surgery", Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, c. 11, sayı. 2, ss. 806-816, Haz. 2022, doi:10.37989/gumussagbil.946758