What you need to know about IgA deficiency: a case study.

PURPOSE: To provide nurse practitioners (NPs) with an overview of the physiology, pathophysiology, associated diseases clinical implications for blood transfusions for patients with immunoglobulin A deficiency (IgAD). DATA SOURCES: A review of the scientific literature was performed on IgAD using PubMed, Medline, and CINAHL. The case study of a patient with IgAD going for cardiac surgery is used to integrate this knowledge into clinical practice. CONCLUSIONS: IgAD is being identified in asymptomatic people through screening for numerous conditions. NPs receiving results on their patients may not fully comprehend the significance of IgAD. IMPLICATIONS FOR PRACTICE: Knowledge of the underlying physiology and pathophysiology of IgAD enables the NP to obtain an accurate and comprehensive patient assessment, establish differential diagnoses, and manage issues related to potential associated conditions as well as potential blood transfusion risks.

Getting to the heart of pleural effusions: a case study.

PURPOSE: To provide nurse practitioners (NPs) with an overview of the physiology, pathophysiology, clinical presentation, and comprehensive assessment, as well as the differential diagnosis process and initial management of patients with unilateral pleural effusions. DATA SOURCES: A review of the scientific literature was performed on pleural effusions, using Pub Med, Medline, and CINAHL. The case study of a patient with a pleural effusion related to heart failure is used to integrate this knowledge into clinical practice. CONCLUSIONS: Pleural effusions are common sequelae of numerous pathophysiological processes. IMPLICATIONS FOR PRACTICE: Knowledge of the underlying physiological and pathophysiological mechanisms enables the NP to obtain an accurate and comprehensive assessment, establishes a differential diagnosis, and provides the timely initial management necessary to optimize patient care outcomes.

Total spinal anesthesia for cardiac surgery: does it make a difference in patient outcomes?

BACKGROUND: Heart disease is a major cause of morbidity and mortality. While cardiac surgery is a viable treatment option, it is a potent physiological stressor. The surgical stress response may result in patient decompensation and negative patient outcomes. The goal of a novel anesthetic approach, which combines high spinal anesthesia with intrathecal morphine and general anesthesia (TSA), is to attenuate this stress response. PURPOSE: The primary purpose of this pilot study (n = 70) was to describe and compare the outcomes of TSA cardiac surgery with a matched control sample of patients who received the "standard general anesthetic" (GA). METHOD: A retrospective, descriptive, correlational design was used for a matched pair total sample of (n = 70). Following ethics approval, patient consents were obtained and chart review data collection was completed. FINDINGS: TSA patients were more likely to be extubated in the operating room (p < 0.0001) and also had significantly shorter overall duration of endotracheal intubation (p < 0.0008). During the initial 24 hours after surgery, the TSA group received significantly less morphine (p < 0.0001). The mean difference in postoperative hospital length of stay did not reach statistical significance. However, on average, the TSA group was discharged three days earlier than the GA group. CONCLUSION: This evidence highlights the clinical nursing relevance of the type of anesthesia on postoperative care and outcomes. The knowledge gained from these findings will help to enable the multidisciplinary critical care team to anticipate TSA patient outcomes and to facilitate the development of appropriate and effective evidence-based, patient-focused plans of care. This pilot study establishes sound rationale for subsequent larger prospective cohort research of the TSA patient population.

Roadblock to recovery: the surgical stress response.

Inadequately managed post-operative pain and the resulting surgical stress response (SSR) negatively affect patient outcomes. Critical care nurses need to understand that adequate pain management is critical to enabling patient recovery. A review of the physiology and pathophysiology of the SSR provides concrete evidence to substantiate the need for critical care nurses to prioritize nursing care that focuses on the prevention, early detection, and management of pain and the surgical stress response. Critical care nurses equipped with this evidence are capable of improving patient outcomes.