نشریه پرستاری مراقبت ویژه
پیاپی 1 (زمستان 1387)

AIMS. Various and controversial reports are present about correlation of different diseases and their complications with type of blood group. This study was done for assessing correlation between type of blood group and post operative bleeding in coronary artery bypass graft surgery. METHODS. In this retrospective study, amount of bleeding was measured in 228 non-emergency patients in first 24 hours after coronary artery bypass graft surgery, and its correlation with type of blood group and other parameters was evaluated. RESULTS. Maximum bleeding rate was observed in AB blood group with mean of 1672 milliliter and minimum bleeding rate was observed in O blood group with mean of 1365 milliliter. Statistical test of analysis variance didn’t confirm meaningful correlation between type of blood group and amount of post operative bleeding. Also there was no meaningful correlation between variables of number of grafts, reoperation due to massive bleeding, time pump and time of operation with type of blood group. CONCLUSION. Although results were not significant, due to clinical importance, it is concluded that patients with AB blood group, especially Rh negative, had more bleeding after CABG surgery than other blood groups.

AIMS. Nursing is one of important divisions of health and medical service acting during critical circumstances; because nurses are from first personnel present in the situation of disaster and offer care service. The goal of this study is evaluation of clinical proficiency of nurses in critical situations. METHODS. Essential data were collected with questionnaires from three hospitals; Baqiyatallah, Najmieh and Jamaran. Collected data were entered to computer and assessed and evaluated with SPSS 11.2 software using descriptive statistics. RESULTS. In this study nurses were classified into three groups according to total acquired points for clinical proficiency: week (point less than 79), medium (point 80 to 125) and good (higher than 125). According to this, 14% of persons were grade week, 64.5% were grade medium and 21.5% were grade good. CONCLUSION. One of the most important needs of nurses is education of clinical proficiencies. By evaluating results, it was shown that majority of nurses in the study don’t have many of needful proficiencies for critical situations which require high science and practical experience, and need to learn essential proficiencies for critical and emergency situations is completely evident.

AIMS. Presence and effective enterprises of therapeutic cadre and paramedics is one of the important factors that if done timely and with specified program and science can prevent many damages, preserve soldiers’ morale and prevent complications. Undoubtedly making correct clinical decisions, design in stressful situations, order of data and information and appropriate use of theoretic and practical educations are of paramedics’ liabilities, which have been studied in this research. METHODS. This investigation is a descriptive cross-sectional study. For study subject, questionnaires were prepared and disposed to 50 paramedics who were present at war. Obtained data were analyses and assessed according to study goals with SPSS statistical software. RESULTS. In recognition field, paramedics diagnosed 70% of abdominal lacerations to need emergency interventions. In transmission field, 50% of answers of paramedics about therapeutic cares of sharp abdominal traumas were incorrect. In mental and emotional fields, 42% paramedics mentioned practical and theoretic education and domination on work as the best mental and emotional supports. CONCLUSION. According to results of this study, paramedics need education in three recognition, transmission and behavior fields.

AIMS. Expensiveness of medical cares, being far from family, high rate of nosocomial infections cause self-care and in-home care to be considered more than previous. So present study have been done to assess effect of self-care education on quality of life in patients suffering from myocardial infarction METHODS. This research is a clinical trial study. 64 patients (32 people in case group and 32 people in control group) who were admitted in coronary care unit of hospital with diagnosis of myocardial infarction were assessed. Self-care education was done in intervention group. “Nottingham quality of life” questionnaires were used for assessing quality of life before and after education program. RESULTS. Statistical independent T- test (P>0.17) showed that total number and quality of life number have not significant difference between two groups before intervention, while after intervention, total number and quality of life number have significant difference between two groups (P<0.005). Paired T- test also showed significant difference in total number and quality of life number before and after intervention (P<0.001). CONCLUSION. Quality of life can improve with self-care education in patients suffering from myocardial infarction.

AIMS. Coronary artery disease is one of most common diseases of human society. Atrial fibrillation is one of most common cardiac dysrhythmias that cause prolonged admission (2-3 days more than other patients), high mortality and increased treatment costs. METHODS. This study is a cross-sectional and descriptive trial. Studied group had consisted of patients referred to two Baqiyatallah and cardiac Jamaran hospitals for surgical graft of coronary vessels in year 1384. In this study 600 patients were evaluated and studied. Obtained data were analyzed and assessed with descriptive statistics via tables, graphs and distribution of status of objective variables. RESULTS. Mean age of patients was 58.6 years with standard deviation of 10.2 years, that youngest age of cases was 34 and oldest age was 81 years. The most common complication was atrial fibrillation (31.3%) and least common complication was myocardial infarction (1.3%). CONCLUSION. It is suggested to do necessity preoperative care, including precise assessment of patient status, correction and management of electrolyte disturbances and predisposing factors. Also this complication could be minimized with correction of surgical procedures, less and gentle manipulation of heart and management of electrolyte disturbances.

AIMS . While the physiological effects of stress are advantageous when the response occurs to prepare the body for “fight or flight,” they can be detrimental if long lasting or repeated without outlet. One of the mechanisms that may link stress to illness is arousal of the sympathetic nervous system (SNS) that occurs during the stress response. Through the SNS, the stress response prepares the individual to deal with the stressor physiologically. Problems arise when the individual is unable to, or perceives she is unable to, escape the stressor. Stress reactivity was assessed in aerobically fit (n = 20) and unfit (n = 18) females during the follicular phase of the menstrual cycle. METHODS . Participants completed the survey sheet and provided a urine sample for catecholamine analysis before and after mental stress testing, Strop Color-Word Test. Blood pressure and heart rate were measured during mental stress testing. RESULTS. Fit and unfit participants differed significantly in baseline heart rate but not in stress reactivity or in state or trait anxiety. CONCLUSION. These data suggest that aerobic fitness does not attenuate the stress response in women prior to menopause.

AIMS. Change in position during general anesthesia may accompany hemodynamic and mechanical complications. In this study effect of change in position on intra-thoracic pressure during general anesthesia has been studied. METHODS. In this cross-sectional descriptive study, 115 adult patients were evaluated. Peak and plateau intra-thoracic pressures were measured with spirometer in supine position and then peak and plateau intra-thoracic pressure during one to 60 minutes of anesthesia were measured and registered in Trendelenburg, left hemi lateral, right hemi lateral or prone positions in 10 minute intervals. RESULTS. The highest peak and plateau intra-thoracic pressures were registered in supine position and before changing position (33.7±5.5 and 20.5±5.1) that had not significant change during general anesthesia (p > 0.05). Highest intra-thoracic pressure after changing position was registered in right hemi lateral group, and least change of pressure was seen in group who were changed to prone position. CONCLUSION. Change in position of patients during general anesthesia and complete muscle relaxation from supine position to prone, right hemi lateral, left hemi lateral or Trendelenburg positions don’t cause significant clinical change in intra-thoracic pressure.

AIMS. Proper respond to unexpected disasters needs readiness of equipments and appropriate planning. In each hospital, abilities and limitations should be recognized, so by augmentation of weak points, have more readiness to resist unexpected disasters. This study was done for detecting abilities and limitations in social security educational hospitals of Khorramabad city in crisis management. METHODS. This study was a cross-sectional, observation study. Research statistical population includes managers, nursing directors and also masters of crises committee of hospitals. These were totally 21 persons. Data collection was performed with questionnaire, direct observation of vouchers and documents and completion of check lists. Descriptive analysis was offered with frequency, percentile of frequency, mean, and standard deviation with SPSS 11.5 software. RESULTS. A codified planning program did not exist or performed correctly in subject of crisis; and there are major problems in non-structural subject. In structural subject most persons in statistical society (55.6%) believed that hospitals didn’t have necessary stability during outbreak of an earthquake. CONCLUSION. Necessity of reevaluation of available hospital buildings is suggested with purpose to decrease structural and non-structural vulnerability and to plan codified executive program to ensure continuous care giving in instances of crises.