Saundra Pearson Beauchamp, RN
Educating patient and family for CV surgery Careful attention t o the needs of the family is included in preparing a patient for cardiovascular surgery at the Jackson, Miss, Veterans Administration (VA) Hospital. The spouses and children of these patients have dealt with the frustrations of long-term cardiac limitations. They are then faced with the anxiety and apprehension fostered by major surgery. The emotional drain caused by these demands can be eased by providing them with accurate and complete information concerning valve replacement or coronary artery bypass. Preoperative education of the patient and family begins with the patient’s
Saundra Pearson Beauchamp, RN, is acting director of nurses, St Dominic-JacksonMemorial Hospital, Jackson, Miss. A diploma graduate of St Luke’sHospital School of Nursing, Kansas City, Mo, she received a BSN from Northeast Missouri State University,Kirksville, Mo. The author is grateful to Jean Crawford for her contributions in formulating this program.
860
transfer to the surgical unit, usually three to five days before surgery. This immediate preoperative period is allotted to patient and family instruction. At the time of transfer, a member of the nursing staff is assigned as the primary nurse for the patient-family unit. This nurse’s initial responsibilities include routine introduction t o the surgical unit, establishment of rapport with the patient and family, and formulation of a nursing care plan. Before the patient arrives on the surgical unit, he has received an extensive cardiovascular evaluation. Findings of cardiac catheterization, blood laboratory values (complete blood count, enzymes, and electrolytes), a 24-hour urine collection for creatinine clearance, and pulmonary function tests will be evaluated before surgery is scheduled. The second day of the patient’s preoperative experience begins with a fasting coagulogram, usually scheduled at 8 am. If the family is there, the primary nurse strengthens the relationship established the day before. An attempt is made to identify their feelings about their roles in the days ahead. Frequently, family members will express their wish t o be helpful during the hospitalization and their uncertainty about how t o proceed. By familiarizing them with all aspects of the surgery, the nurse provides guidelines for them to follow-a framework for their efforts.
AORN Journal, April 1979, Vol29, N o 5
Including the family i n physical therapy classes for postoperative exercises shows them the scope of activity expected of the patient, enabling them t o be supportive in another way. The family is also encouraged to accompany the patient to the Respiratory Therapy Department, where they learn the importance of intermittent positive pressure treatments and pulmonary hygiene so they can confidently reinforce coughing and deep breathing exercises. With surgery only 24 hours away, the final preoperative day is one of anticipation and apprehension. Fear of not surviving the procedure is tempered by the prospect of leading a pain-free life. A preoperative teaching film is shown to each surgical patient. The presentation includes previews of the OR suite and recovery room as well as an overview of the immediate preoperative hours. The patient, nurse, and family go for a prearranged visit to the Surgical Intensive Care Unit (SICU). Equipment such as cardiac monitors, chest tube apparatus, central venous pressure lines, nasogastric tubes, and Foley catheters are seen and their functions discussed. The nursing staffof the SICU greets the patient and family, explains visiting hours, and introduces the nurse who will care for the patient immediately postoperatively. This will be the nurse’s sole assignment until the patient is extubated and otherwise stable. A cordial and informative exchange in this area provides continuity of care for the patient and comfort for the family. The feeling of awe usually felt toward intensive care is dispelled. Before returning to the patient’s hospital room, the family is introduced to the head nurse of the operating room. The OR nurse plays an important role in care of the patient and comfort of the family. Assuming responsibility for periodic reports to the family during the
procedure, the head nurse or her designee will contact them in a predetermined waiting area. The initial call will be made when the procedure is beginning, and the patient is anesthetized. A brief second call will be placed approximately a n hour later to report that surgery is progressing. When closure of the chest wall is accomplished and transfer to the SICU is imminent, final telephone contact will be made. More frequent communication may be indicated if the procedure is lengthy or if the nurse discerns the family is extremely anxious. Many family members have said they appreciate this courtesy by the operating room staff, The patient is often unaware of the contributions to his care provided by the operating room nurses. For the primary nurse, they are resources for formulating an individual postoperative care plan based on the specific operative course. Their value as liaisons is shown daily when questions or problems arise while the physician is involved i n another procedure. They are an important segment of a cohesive whole needed for good patient care. During the surgical procedure, the primary nurse visits the waiting family to reassure them and convey the staffs concern. After surgery, she visits them daily in the SICU. The length of stay in the SICU is dictated by the rapidity of the patient’s recovery. Except for the central one, all intravenous lines will have been discontinued. The chest tube, nasogastric tube, and Foley catheter will also have been removed. The cardiac monitor will indicate a minimum of irregular beats, and vital signs will reflect an acceptable level of cardiovascular function. When the patient returns to the surgical unit, discharge preparation begins. The family is encouraged to assume increasing responsibility in directing postoperative exercises, ambu-
AORN Journal, April 1979,Vol29, No 5
861
lation, and p u l m o n a r y hygiene. T h e primary nurse provides supervision and guidance when needed. The day o f discharge heralds resumpt i o n o f a n o r m a l lifestyle, but it i s frightening because t h e security o f hospital care i s lost. Information given o n t h i s day i s either a review or w r i t t e n reinforcement t o assure p a t i e n t and family understanding. A medication schedule for home i s formulated, and a printed l i s t o f t h e medicines, t h e i r uses, and side effects i s provided. Sample tablets o f t h e prescribed dosage are taped n e x t t o t h e i r instructions. A r e t u r n demonstration o n correct suture line care
i s requested o f t h e f a m i l y members. A c t i v i t y instructions, i n c l u d i n g r e sumption o f sex, are given. A f t e r confirming t h e follow-up appointment, the patient i s discharged. F r o m t h e high degree o f professional satisfaction achieved and favorable response from the patients and families, we judge this process to be successful. The family’s knowledge and support provide the patient with security when h e resumes h i s place in t h e community. This security can m e a n t h e difference between assuming a new, normal way o f life and perpetuation o f the preoperat i v e handicaps. 0
Limited use seen for nuclear pacemaker The nuclear-powered heart pacemaker has been relegated to a limited role in the treatment of heart block, according to a report delivered to the 51st Scientific Sessions of the American Heart Association in Dallas. Market competition, high costs, and concerns about safety of nuclear pacemakers were cited as reasons the device has had limited use. According to a report by Victor Parsonnet, MD, and colleagues from Newark (NJ) Beth Israel Medical Center, after some five years of clinical experience, only about 3,000 nuclear pacemakers have been implanted. About half of the Operations have been performed on patients in the United States. The number of nuclear implants compares with an estimated total of 300,000 US patients now wearing heart pacemakers and an annual increase of some 10,000 patients who require electrical stimulation devices. Dr Parsonnet said widespread acceptance of the nuclear device was held back by its cost, initial licensing restrictions, and questions about radioactivity, patient safety, and public safety. He said the device is about three times more expensive than lithium-powered pacemakers, with a cost of $6,500 to $7,000 compared with $1,800to $2,500.
862
After the nuclear pacemaker was first licensed, Dr Parsonnet said only a few physicians and hospitals were licensed to insert the devices, limiting the number of applications. Now, however, the Nuclear Regulatory Agency of the US Energy Research and Development Administration “has relaxed its safety standards because new studies show no evidence of any problem, no danger, and there’s no longer any disagreement about the safety factor. But limited licenses are still required,” Dr. Parsonnet said. He anticipates the number of nuclear pacemakers inserted will decline because of the greater economy and increased battery life of lithium devices. New lithium battery pacemakers, which are hermetically sealed to prevent electrical circuit problems, have an expected life of 5 to 15 years, according to Dr Parsonnet. When the nuclear unit was introduced in April 1973, ordinary pacemaker batteries needed replacement every 18 to 24 months. The principal application of nuclear-powered pacemakers in the future will be for younger patients, he predicted. These patients, who could anticipate wearing a pacemaker 20 years or more, would benefit most from the anticipated 20to 30-year usefulness of the nuclear unit.
AORN Journal, April 1979, Val 29,No 5
Educating patient and family for CV surgery Careful attention t o the needs of the family is included in preparing a patient for cardiovascular surgery at the Jackson, Miss, Veterans Administration (VA) Hospital. The spouses and children of these patients have dealt with the frustrations of long-term cardiac limitations. They are then faced with the anxiety and apprehension fostered by major surgery. The emotional drain caused by these demands can be eased by providing them with accurate and complete information concerning valve replacement or coronary artery bypass. Preoperative education of the patient and family begins with the patient’s
Saundra Pearson Beauchamp, RN, is acting director of nurses, St Dominic-JacksonMemorial Hospital, Jackson, Miss. A diploma graduate of St Luke’sHospital School of Nursing, Kansas City, Mo, she received a BSN from Northeast Missouri State University,Kirksville, Mo. The author is grateful to Jean Crawford for her contributions in formulating this program.
860
transfer to the surgical unit, usually three to five days before surgery. This immediate preoperative period is allotted to patient and family instruction. At the time of transfer, a member of the nursing staff is assigned as the primary nurse for the patient-family unit. This nurse’s initial responsibilities include routine introduction t o the surgical unit, establishment of rapport with the patient and family, and formulation of a nursing care plan. Before the patient arrives on the surgical unit, he has received an extensive cardiovascular evaluation. Findings of cardiac catheterization, blood laboratory values (complete blood count, enzymes, and electrolytes), a 24-hour urine collection for creatinine clearance, and pulmonary function tests will be evaluated before surgery is scheduled. The second day of the patient’s preoperative experience begins with a fasting coagulogram, usually scheduled at 8 am. If the family is there, the primary nurse strengthens the relationship established the day before. An attempt is made to identify their feelings about their roles in the days ahead. Frequently, family members will express their wish t o be helpful during the hospitalization and their uncertainty about how t o proceed. By familiarizing them with all aspects of the surgery, the nurse provides guidelines for them to follow-a framework for their efforts.
AORN Journal, April 1979, Vol29, N o 5
Including the family i n physical therapy classes for postoperative exercises shows them the scope of activity expected of the patient, enabling them t o be supportive in another way. The family is also encouraged to accompany the patient to the Respiratory Therapy Department, where they learn the importance of intermittent positive pressure treatments and pulmonary hygiene so they can confidently reinforce coughing and deep breathing exercises. With surgery only 24 hours away, the final preoperative day is one of anticipation and apprehension. Fear of not surviving the procedure is tempered by the prospect of leading a pain-free life. A preoperative teaching film is shown to each surgical patient. The presentation includes previews of the OR suite and recovery room as well as an overview of the immediate preoperative hours. The patient, nurse, and family go for a prearranged visit to the Surgical Intensive Care Unit (SICU). Equipment such as cardiac monitors, chest tube apparatus, central venous pressure lines, nasogastric tubes, and Foley catheters are seen and their functions discussed. The nursing staffof the SICU greets the patient and family, explains visiting hours, and introduces the nurse who will care for the patient immediately postoperatively. This will be the nurse’s sole assignment until the patient is extubated and otherwise stable. A cordial and informative exchange in this area provides continuity of care for the patient and comfort for the family. The feeling of awe usually felt toward intensive care is dispelled. Before returning to the patient’s hospital room, the family is introduced to the head nurse of the operating room. The OR nurse plays an important role in care of the patient and comfort of the family. Assuming responsibility for periodic reports to the family during the
procedure, the head nurse or her designee will contact them in a predetermined waiting area. The initial call will be made when the procedure is beginning, and the patient is anesthetized. A brief second call will be placed approximately a n hour later to report that surgery is progressing. When closure of the chest wall is accomplished and transfer to the SICU is imminent, final telephone contact will be made. More frequent communication may be indicated if the procedure is lengthy or if the nurse discerns the family is extremely anxious. Many family members have said they appreciate this courtesy by the operating room staff, The patient is often unaware of the contributions to his care provided by the operating room nurses. For the primary nurse, they are resources for formulating an individual postoperative care plan based on the specific operative course. Their value as liaisons is shown daily when questions or problems arise while the physician is involved i n another procedure. They are an important segment of a cohesive whole needed for good patient care. During the surgical procedure, the primary nurse visits the waiting family to reassure them and convey the staffs concern. After surgery, she visits them daily in the SICU. The length of stay in the SICU is dictated by the rapidity of the patient’s recovery. Except for the central one, all intravenous lines will have been discontinued. The chest tube, nasogastric tube, and Foley catheter will also have been removed. The cardiac monitor will indicate a minimum of irregular beats, and vital signs will reflect an acceptable level of cardiovascular function. When the patient returns to the surgical unit, discharge preparation begins. The family is encouraged to assume increasing responsibility in directing postoperative exercises, ambu-
AORN Journal, April 1979,Vol29, No 5
861
lation, and p u l m o n a r y hygiene. T h e primary nurse provides supervision and guidance when needed. The day o f discharge heralds resumpt i o n o f a n o r m a l lifestyle, but it i s frightening because t h e security o f hospital care i s lost. Information given o n t h i s day i s either a review or w r i t t e n reinforcement t o assure p a t i e n t and family understanding. A medication schedule for home i s formulated, and a printed l i s t o f t h e medicines, t h e i r uses, and side effects i s provided. Sample tablets o f t h e prescribed dosage are taped n e x t t o t h e i r instructions. A r e t u r n demonstration o n correct suture line care
i s requested o f t h e f a m i l y members. A c t i v i t y instructions, i n c l u d i n g r e sumption o f sex, are given. A f t e r confirming t h e follow-up appointment, the patient i s discharged. F r o m t h e high degree o f professional satisfaction achieved and favorable response from the patients and families, we judge this process to be successful. The family’s knowledge and support provide the patient with security when h e resumes h i s place in t h e community. This security can m e a n t h e difference between assuming a new, normal way o f life and perpetuation o f the preoperat i v e handicaps. 0
Limited use seen for nuclear pacemaker The nuclear-powered heart pacemaker has been relegated to a limited role in the treatment of heart block, according to a report delivered to the 51st Scientific Sessions of the American Heart Association in Dallas. Market competition, high costs, and concerns about safety of nuclear pacemakers were cited as reasons the device has had limited use. According to a report by Victor Parsonnet, MD, and colleagues from Newark (NJ) Beth Israel Medical Center, after some five years of clinical experience, only about 3,000 nuclear pacemakers have been implanted. About half of the Operations have been performed on patients in the United States. The number of nuclear implants compares with an estimated total of 300,000 US patients now wearing heart pacemakers and an annual increase of some 10,000 patients who require electrical stimulation devices. Dr Parsonnet said widespread acceptance of the nuclear device was held back by its cost, initial licensing restrictions, and questions about radioactivity, patient safety, and public safety. He said the device is about three times more expensive than lithium-powered pacemakers, with a cost of $6,500 to $7,000 compared with $1,800to $2,500.
862
After the nuclear pacemaker was first licensed, Dr Parsonnet said only a few physicians and hospitals were licensed to insert the devices, limiting the number of applications. Now, however, the Nuclear Regulatory Agency of the US Energy Research and Development Administration “has relaxed its safety standards because new studies show no evidence of any problem, no danger, and there’s no longer any disagreement about the safety factor. But limited licenses are still required,” Dr. Parsonnet said. He anticipates the number of nuclear pacemakers inserted will decline because of the greater economy and increased battery life of lithium devices. New lithium battery pacemakers, which are hermetically sealed to prevent electrical circuit problems, have an expected life of 5 to 15 years, according to Dr Parsonnet. When the nuclear unit was introduced in April 1973, ordinary pacemaker batteries needed replacement every 18 to 24 months. The principal application of nuclear-powered pacemakers in the future will be for younger patients, he predicted. These patients, who could anticipate wearing a pacemaker 20 years or more, would benefit most from the anticipated 20to 30-year usefulness of the nuclear unit.
AORN Journal, April 1979, Val 29,No 5
