Common infections in heart transplant patients.

Infection is the primary cause of morbidity and mortality following cardiac transplantation because of the strict immunosuppressive regimens patients follow. In the immediate postoperative phase, patients are more susceptible to infection because of interruption of their external barriers to infection. Cardiac transplant recipients are most likely to succumb to infections caused by cytomegalovirus, Epstein-Barr virus and bacterial organisms, especially staphylococcus. Fungal, protozoal and herpes simplex infections are also frequently troublesome to the transplant recipient. Critical care clinicians can control the incidence of infection in the cardiac transplant population by initiating measures to maintain external barriers, monitoring the patient for early signs of infection, and instituting appropriate isolation techniques.

Biventricular assist devices.

Ventricular assistance and its effect on the human body are described in this article. Nursing care based on the physiology of device influence and prevention of complications is also discussed.

OKT3 monoclonal antibody in cardiac transplant patients.

The nurse's role in caring for cardiac transplant patients involves attention to many details, including assessment of organ function, provision of care, and administration of immunosuppressive medications. OKT3 monoclonal antibody, an immunosuppressive agent under investigational use in the cardiac transplant population, requires special nursing considerations.

Sternal wound infections.

Sternal wound infections are a major cause of morbidity and mortality in patients undergoing cardiac surgery. They occur in 1% to 3% of patients who undergo open-heart surgery and carry a 20% to 40% mortality rate. Sternal infections can range from minor, superficial infections to open mediastinitis with invasion of the sternum, heart, and great vessels. Staphylococcus species are responsible for the majority of sternal infections, but environmental sources can cause infections by other organisms. The common signs and symptoms of mediastinitis are fever, leukocytosis, sternal instability, drainage, and pain. Several risk factors exist for sternal wound infection, with bilateral internal mammary artery bypass grafting in diabetic patients being the most common. Treatment entails surgical debridement with either closed irrigation, open-wound packing, or muscle or omental flap procedures, as well as antibiotic therapy. Some simple procedures help limit the development of sternal infections in certain patients.

The clinical nurse specialist in cardiovascular surgery: a new twist.

Advanced practice nurses execute many different functions in many different roles. Perhaps the most ambiguous of these roles is that of the clinical nurse specialist. This article describes how one hospital developed the clinical nurse specialist into an acute care nurse practitioner position in the cardiac surgery arena. How the role started and was implemented is discussed from a personal perspective. Evaluation of the position was performed quantitatively, by cost data, and qualitatively, by patient, family, nurse, and physician satisfaction.

Fluid and electrolyte imbalances after cardiac surgery.

Patients having cardiac surgery experience a myriad of fluid and electrolyte disorders. Cardiopulmonary bypass (CPB) can cause multiple physiologic alterations, including electrolyte disturbances, acid-base imbalances, atelectasis, diminished pulmonary compliance, hemolysis, and thromboembolism. Cardioplegic solutions and induced hypothermia impose alterations in potassium metabolism and pH. The stress of surgery increases catecholamine circulation and augments antidiuretic hormone release, both of which affect fluid and electrolyte equilibrium. Dilution of the circulating blood volume from pump perfusate and volume resuscitation with crystalloid and colloid solutions produce fluid, electrolyte, and hemostatic disorders. Nonpulsatile flow produced by CPB can alter renal function. This article describes the metabolic alterations that are iatrogenically produced by cardiac surgery and the nursing and medical therapies aimed at correcting such alterations.

Sudden cardiac death in young athletes: a review for nurses.

Sudden death in young athletes is a rare and devastating event. The most frequent causes of sudden death in this group are hypertrophic cardiomyopathy, anomalous coronary artery, and Marfan syndrome. This article describes the physiology of exercise and the pathophysiology associated with the most frequent causes as well as some of the less common causes of sudden death in young athletes. Identification of youth who may be at risk should be a priority for health care practitioners, and suggestions for recognizing and counseling affected athletes are therefore included.

Cardiac surgery in special populations, Part 1: Octogenarians, patients with neuropsychiatric disorders, and blacks.

This is the first of a series of articles that discusses the pertinent issues involved in caring for patients undergoing surgery who belong to special populations. Octogenarians have higher mortality, more comorbidities, and special needs regarding convalescence. Patients with neuropsychiatric disorders may have exacerbations of their mental illness after surgery and require special care and patience by the nurse. Survival after cardiac surgery is similar in black and white patients, but the number of blacks having cardiac surgery is significantly and proportionately lower than whites, suggesting either a referral bias or a problem with access to care. Subsequent articles discuss cardiac surgery in women, during pregnancy, in Jehovah's Witnesses, and in patients with Down's Syndrome.

Cardiac surgery in special populations, Part 2: Women, pregnant patients, and Jehovah's Witnesses.

This is the second in a series of articles that discusses cardiac surgery in patients who belong to special populations. Women are often the victims of sex bias regarding their referral to cardiac testing, and are consequently sicker when they present for heart surgery. Pregnant women undergoing cardiac surgery require vigilant care while undergoing surgery, with anticoagulant administration and valve selection to achieve positive maternal and fetal outcomes. Progressive improvements in technology, perioperative care, and pharmaceutical development has made cardiac surgery in Jehovah's Witnesses safer than in the past.

Cardiac surgery in special populations, Part 3: Patients with cognitive dysfunction.

Patients with cognitive dysfunction, usually Down's syndrome, frequently require corrective cardiac surgery for congenital cardiac anomalies. The most common cardiac anomalies in Down's syndrome are patent ductus arteriosus, atrial septal defect, ventricular septal defect, atrioventricular canal defects, and Tetralogy of Fallot. This article, the third and last in a series, discusses the physiology of the defects and the nursing care required for comprehensive care of the patient with delayed development.

Intrarenal abscess in a transplant organ.

We report the first case of an intrarenal abscess in a transplant organ. Diagnosis was made by ultrasonography and excretory urography, and was confirmed by percutaneous aspiration under ultrasonographic guidance. Surgical drainage and systemic antibiotic therapy resulted in complete resolution of the lesion and no change in renal function.

Terminal infections in renal transplant patients in a tropical environment.

Infections were a major cause of death in 84% of 38 autopsied renal allograft recipients in a south Indian hospital. Pyogenic bacteria and fungi were the most common etiological agents encountered, being present in 50 and 47% of cases, respectively. Tuberculosis and hepatitis B virus infection were more prevalent and Pneumocystis carinii and cytomegalovirus disease rarer than in comparable series from non-tropical countries. 1 case each of amoebiasis, strongyloidiasis and filariasis were the parasitic infections encountered.

Abnormalities of the immune system in patients with chyluria.

A study of the immune system in 11 patients with chyluria showed lymphocytopenia, decrease in T cells, a low serum IgA concentration and suppression of delayed hypersensitivity responses to intradermally injected antigens. The similarity of chyluria to intestinal lymphangiectasia and thoracic duct fistula suggests that the immune deficiency may be due to loss of lymph in the urine.