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Analysis on the management of laboratory critical values in the Department of Cardiovascular Surgery

Objective To review and analyze the statistics of laboratory critical values in the Department of Cardiovascular Surgery in order to improve the procedures of dealing with these values and provide references for the enhancement of the nursing level. Methods We retrospectively analyzed laboratory critical values of 236 inpatients in the Department of Cardiovascular Surgery from April 2013 to April 2014. General data of the patients including the type of critical values, the critical value, distribution, clinical processing time and complications related to the critical values. Results A total of 208 laboratory critical values of 185 inpatients were analyzed including abnormal blood potassium was involved in 99 (47.60%); abnormal blood glucose was involved in 13 (6.25%); abnormal blood sodium was involved in 11 (5.29%); abnormal blood troponin was involved in 13 (6.25%); and 72 cases had other kinds of critical values (34.62%). A total of 136 critical values were closely related to the Department of Cardiovascular Surgery. Among them, 60 cases had a processing time of 15 minutes or shorter. After re-examination, 16 were confirmed to be fake critical values; and 11 critical values did not need to be treated according to the condition of the patients. There were altogether 27 cases of complications related to critical values, including 23 cases of arrhythmia related to abnormal blood potassium, 2 cases of abnormal muscle strength caused by abnormal blood sodium, and 2 cases of hypoglycemia. After the critical values were handled, related complications disappeared without any recurrence. Conclusions Perfect regulatory regime and process of recording and handling laboratory critical values are important for nurses in our department to carry out more accurate measures in treating these critical values including abnormal blood potassium, blood glucose, blood sodium, and blood troponin, etc. In order to continuously improve medical and nursing quality, nurses should pay more attention to the identification and treatment of laboratory critical values.

浅谈运用PDCA管理法对地震伤员病房志愿者的管理尝试

摘要:将品质管理方法中的“管理循环法”(PDCA)运用于汶川5·12地震后病房志愿者的管理,取得了明显的效果,减少了病房志愿者工作的盲目性,统一了管理和要求,使志愿者的工作有序,真正能满足患者的需求。

The Designing and Application of Transporting Handover Form for Patients in ICU of Cardiovascular Surgery Department

目的　提高胸心血管外科患者ICU转出交接班质量，避免护理差错和纠纷。 方法　2010年1月－6月，针对患者转运出现的问题，在查阅文献及专家咨询的情况下，设计制定胸心血管外科ICU患者转出交接单，对患者转出ICU时的病情、用药、并发症等信息进行完善，同时规范交接班签字手续。采用调查问卷方式，对交接单运用效果进行评价。 结果　转出交接单的应用，提高了病房护士对ICU护士交接班质量满意度，除“医嘱单正确执行”、“签字和药物交接班清楚”与运用前满意程度无差异外，其余条目满意程度均有所增加，增加率波动在3.7%～33.4%。 结论　转出交接单使用能够提高ICU患者术后转运交接质量，预防护理差错和纠纷，确保证患者安全。

心脏开胸术后胸带固定必要性的探讨

目的讨论心脏开胸术后患者是否需要使用胸带固定。 方法将2012年1月－6月201例心脏开胸术后患者根据术后回病房的时间随机分为观察组（101例）和对照组（100例），观察组使用胸带固定胸骨及伤口，对照组未使用胸带固定，就两组患者的伤口愈合、胸骨是否浮动、患者舒适感受等指标进行对比分析。 结果一期愈合对照组98例（98.00%），观察组96例（95.05%），两组比较一期愈合率差异无统计学意义（χ2=1.301，P=0.254），且两组均未出现胸骨浮动；对照组患者舒适度达69.00%，观察组仅为34.70%，两组比较差异有统计学意义（Uc=20.862，P＜0.001）。 结论心脏开胸术后患者伤口一期愈合、胸骨浮动与是否使用胸带固定无直接关系。

血友病患儿合并先天性心脏病的围手术期护理一例

唐氏综合征合并先天性心脏病患儿心脏术后伤口护理一例

自制简易负压吸引装置在胸部正中切口术后的应用

Evaluation of the Effects of Comprehensive Discharge Education for Patients Having Undergone Mechanical Heart Valve Replacement

目的　探讨心脏机械瓣膜置换术后患者出院指导的综合方法，评价其效果。 方法　将2010年9月－2011年1月242例心脏机械瓣膜置换术患者按入院先后顺序随机分成试验组和对照组。试验组患者采用综合出院指导方案，对照组采用常规宣教方法，在6个月后对两组患者进行调查，评价综合指导方案的效果，并进行统计学分析。 结果　试验组患者均未出现不良并发症，对照组有1例出院后未遵医嘱服药及定期复查，死于血管栓塞；有2例出现血管栓塞，2例牙龈出血，经及时治疗后好转。 结论　对心脏机械瓣膜置换术患者出院时，发放健康教育资料及定期随访指导的综合出院指导方案，可以降低术后并发症，提高患者认知水平和满意度，帮助患者提高依从性，提高生存质量。

Study on Quality of Life and Self-management Behavior of Patients Following Mechanical Heart Valve Replacement

ObjectiveTo describe the status of quality of life (QOL) and self-management behavior in patients following mechanical heart valve replacement, and explore the relationship between QOL and self-management behavior. MethodsConvenient sampling was used to recruit 352 patients following mechanical heart valve replacement in a high-level hospital in Chengdu between January 2011 and June 2012. General information questionnaire, MOS SF-36 scales, and self-management behavior questionnaire were used to collect data. T-test was used to analyze the difference between patients and normal people. And correlation analysis was used to see the correlation between QOL and self-management. ResultsFor MOS SF-36 scale results in patients within one year after surgery, physical functioning (PF) score was 73.44±15.11, role-physical (RP) was 49.52±39.17, body pain (BP) was 63.13±17.93, general health (GH) was 58.85±14.88, vitality (VT) was 63.54±18.10, social functioning (SF) was 76.67±17.40, role-emotional (RE) was 64.96±41.37, and mental health (MH) was 72.76±17.40. All these scores of the patients were significantly lower than the norm of Sichuan Province (P<0.05) except the dimension of mental health. For patients one year or more after surgery, PF score was 76.53±14.41, RP 58.44±39.21, BP 68.16±18.26, GH 61.39±13.57, VT 68.47±16.37, SF 79.79±19.34, RE 72.94±37.29, and MH 75.87±14.70, among which PF, RE, BP and GH scores were lower than the norm (P<0.05). The average total score of self-management behavior was 143.21±20.63. QOL and self-management behavior were positively correlated. ConclusionThere is still a gap between patients following mechanical heart valve replacement and normal people in terms of quality of life. Patients' self-management behavior is positively correlated with the quality of life. Good self-management behavior contributes to the improvement of QOL.

二尖瓣、主动脉瓣、三尖瓣和肺动脉瓣置换术患者的围手术期护理

目的探索复杂心脏瓣膜置换术围手术期患者的护理体会。 方法针对2014年9月收治的1例病程长，病情复杂，心脏功能差行二尖瓣、主动脉瓣、三尖瓣和肺动脉瓣置换术的患者展开了个体化的、精心准备的围手术期护理。 结果通过团队合作、积极配合医生治疗，患者未出现不可逆的并发症，顺利出院。 结论通过对复杂心脏瓣膜置换术患者的护理，增加了护士对复杂瓣膜置换术围手术期危重患者护理的经验，为以后类似疑难重症患者的护理提供了更好的依据。