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Biomedical subjects

M J Kocan

Publications and source records attributed to M J Kocan.

9 recordsLinked to original sources
PubMed1999

Cardiovascular effects of acute stroke.

A wide variety of dysrhythmias, conduction defects, and repolarization abnormalities have been observed following all types of stroke, most likely related to disruptions in the autonomic nervous system. Patients at highest risk for developing ECG changes include those with hemorrhagic stroke, those with strokes involving the right cerebral hemisphere, and elderly patients with stroke. Nursing interventions for these patients revolve around vigilant monitoring of both neurologic and cardiovascular status, to identify any negative consequences from the interaction of these systems. Strict blood pressure monitoring is required, with different management goals depending upon the type of stroke. Also important is the prevention of further exacerbation of ECG abnormalities by maintaining normal electrolyte levels.

Acute Disease↗
PubMed1998

The brain-heart connection: cardiac effects of acute ischemic stroke.

Cerebrovascular events are known to produce changes in the electrocardiogram (ECG). Whether or not these changes are actually reflective of myocardial damage has been the topic of much research. There are indications that these ECG changes result from an imbalance in the autonomic nervous system, resulting in a relative excess of sympathetic activity. This article provides an overview of the ECG and physiologic changes noted in patients with acute ischemic stroke and identifies subgroups that may be at high risk for developing these changes. Implications for nursing care are discussed.

Acute Disease↗
PubMed1995

Intrahospital transport of neuro ICU patients.

Neuroscience intensive care unit (NICU) patients are frequently transported out of the critical care environment for diagnostic and interventional procedures. Four hundred and seventy-one such transports from seventeen clinical centers were studied to identify the characteristics of intrahospital transport. Data collected included the destination and duration of transport, number and type of personnel involved, changes in monitoring and treatment during transport, adverse patient responses and the impact on patients left in the unit. Differences between transports characterized as elective or emergent in nature were noted. Results validate that intrahospital transport of NICU patients is both time and labor intensive. The study also suggests that the optimal process for safe and efficient transport is yet to be designed.

Central Nervous System Diseases↗
PubMed1993

Applying critical pathways to neurosurgery patients at the University of Michigan Medical Center.

UNLABELLED: Project Overview: In April 1990, The University of Michigan Hospitals began a major, multidisciplinary project to standardize care processes in order to increase efficiency and reduce costs while maintaining the quality of clinical care. A team of nurses began the project by developing critical pathways for two neurosurgery procedures--lumbar laminectomy and transphenoidal pituitary tumor resection. The pathways were reviewed by physicians and other staff from other disciplines and were implemented in January of 1991. KEY FINDINGS: Data from the first 14 months show a decrease in patients' average lengths of stay in both the intensive care unit (ICU) and routine care unit. Costs and variance data are being analyzed and further improvements to the pathways are being made. Eleven critical paths are now being used for neurosurgery patients. In retrospect, participants learned that physicians should be involved at the earliest stages of critical pathway development and in the process of implementation.

Academic Medical Centers↗
PubMed1990

Pulmonary considerations in the critical care phase.

Spinal cord injuries create alterations in ventilatory mechanics that range from complete ventilator dependence in high cervical injuries to the need for an assisted cough to clear secretions in low thoracic injuries. The initial nursing assessment should include the degree of respiratory muscle impairment, the effectiveness of the patient's inspiratory efforts, and the ability to cough. Once the mechanisms responsible for respiratory difficulty have been determined, nursing interventions can be planned to compensate for impaired function. This may involve assisted coughing, frequent chest physiotherapy and suctioning, monitoring vital capacity and ABGs, and use of kinetic beds. Perhaps the greatest challenge for both the nurse and the patient is weaning from mechanical ventilation. Weaning requires a coordinated plan, based on trust between patient and nurse, in order to achieve maximum independence from ventilatory support.

Critical Care↗
PubMed1988

Electrocardiographic changes following subarachnoid hemorrhage.

Electrocardiographic abnormalities are frequently seen in patients who have experienced a subarachnoid hemorrhage (SAH). These changes often mimic those seen in acute myocardial infarction although often patients have no history or other symptoms of cardiac disease. This paper reviews the types of rhythm disturbances seen following SAH and discusses the pathophysiologic basis for these changes. It also presents possible nursing interventions for these patients and explores areas needing further research.

Arrhythmias, Cardiac↗
PubMed1986

A comparison of continuous and intermittent enteral nutrition in NICU patients.

Tube feedings are frequently used for the nutritional support of neurologically impaired patients. Feedings may be delivered either continuously or intermittently. There is little evidence for advantages of one method over the other in patients with neurologic problems. In this study, a convenience sample of 34 adult neurological intensive care unit (NICU) patients were randomly assigned to either continuous or intermittent administration. No significant differences were found in number or consistency of stools per day, presence of blue dye in pulmonary secretions as evidence of aspiration, or in caloric intake as a percent of the patient's nutritional goal. Also, there was no correlation between patient's level of consciousness, based on Glasgow Coma Scale (GCS), and the incidence of aspiration. Implications for nursing practice are discussed.

Adult↗
PubMed1981

Flow-regulated continuous spinal drainage: technical note with case report.

A new method for continuous external drainage of cerebrospinal fluid (CSF) for the treatment of CSF fistulas is described. In this system, CSF is withdrawn continuously from the lumbar subarachnoid space at a controlled flow rate calculated to be slightly less than the natural absorption rate of CSF. Controlled spinal drainage can be achieved using equipment readily available in most intensive care units. This system was developed to prevent pneumocephalus during CSF drainage, as illustrated in the case presentation.

Adult↗