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Biomedical subjects

S B Dunbar

Publications and source records attributed to S B Dunbar.

26 records · Page 2Linked to original sources
PubMedDate not supplied

Supraventricular tachycardia after coronary artery bypass grafting surgery and fluid and electrolyte variables.

OBJECTIVE: To explore the relationship between fluid and electrolyte variables and the development of supraventricular tachycardia (SVT) after coronary artery bypass grafting (CABG) surgery. DESIGN: Retrospective chart review. Random selection from a list obtained from the medical records department and with use of the International Classification of Diseases code to identify patients undergoing their initial CABG. SETTING: Medical records department of a southeastern 600-bed urban referral hospital with a large cardiovascular surgical program. PATIENTS: Forty patients experiencing SVT and 40 patients not experiencing SVT during their stay in an intensive care unit after CABG. OUTCOME MEASURES: Fluid and electrolyte variables and the development of SVT in the intensive care unit after CABG. VARIABLES: Data collected included preoperative demographic variables such as age and gender; previous history of SVT, congestive heart failure, cardiac arrest, previous surgery, diabetes, hypertension, valve disease, tobacco use, obesity; preoperative and postoperative medications; postoperative laboratory values of potassium, calcium, and magnesium; intravenous intake; hourly urine output; and chest tube drainage. RESULTS: Demographic variables revealed that patients with SVT were older (p = 0.001) and had a higher incidence of preoperative SVT (p = 0.04). Although groups did not differ by numbers of patients with high or low potassium, calcium, or magnesium, patients receiving additional intravenous potassium by bolus after surgery had a higher incidence of SVT (p = 0.02). Patients who lost blood via the chest tube at a rate greater than 100 ml per hour for at least 1 hour after surgery had a higher incidence of SVT (p = 0.02). Patients with a urine output greater than 300 ml per hour for longer than 9 hours had an increased incidence of SVT (p = 0.02). In the patients experiencing SVT, 62% had it occur 24 to 48 hours after surgery. CONCLUSIONS: These data suggest that shifts in fluid and electrolytes may be important characteristics of patients in whom SVT will develop, which could lead to better identification and nursing management of SVT and improve hemodynamic status, patient recovery, and cost after CABG.

Coronary Artery Bypass↗
PubMedDate not supplied

Mood disturbance in patients with recurrent ventricular dysrhythmia before insertion of implantable cardioverter defibrillator.

OBJECTIVE: To examine the relationships among personal factors (demographic variables and trait optimism); situational factors (ejection fraction, functional status, history of sudden cardiac arrest); coping and appraisal processes; and mood disturbance in patients hospitalized for recurrent ventricular dysrhythmia before the insertion of an implantable cardioverter defibrillator (ICD). DESIGN: Descriptive and correlational. SETTING: Five community and tertiary care hospitals in the southeast and midwest. PATIENTS: Eighty-four men and 17 women (aged 24 through 79) scheduled to receive an initial implant of an ICD. VARIABLES AND MEASURES: Trait optimism measured by the Life Orientation Tool; coping measured by the Jalowiec Coping Scale; threat-and-challenge appraisal measured by the Meaning in Illness Questionnaire; functional status measured by the Heart Failure Functional Status Inventory; and total mood disturbance measured by the Profile of Mood States. RESULTS: Hierarchical regression analysis revealed that factors of age, sex, optimism, functional status, and history of sudden cardiac arrest accounted for 47% of the variance in the total mood disturbance score (F = 7.44, df = 11.68, p = 0.00) with female sex, and less trait optimism, higher threat appraisal, and more use of evasive coping behavior as significant predictors. CONCLUSIONS: These findings can be used to identify patients with recurrent ventricular dysrhythmia who are potentially at risk for mood disturbance in the acute care setting before ICD insertion. Nursing interventions to address these factors can be developed and tested. Longitudinal studies on the response to ICDs should include assessment of preinsertion affective state.

Adaptation, Psychological↗
PubMedDate not supplied

Factors associated with outcomes 3 months after implantable cardioverter defibrillator insertion.

BACKGROUND: Adjustment to living with an implantable cardioverter defibrillator (ICD) is a dynamic process that varies among individuals. The purpose of this study was to describe patterns of recovery and to examine the relationships among demographic and clinical factors, illness appraisal and coping behaviors, and outcomes of physical and emotional function in the early recovery period of the first 3 months after initial ICD insertion. METHODS: Data were collected in the acute care setting and again at 1 and 3 months after ICD insertion. Subjects were 213 patients (83% men), ages 24-85 (mean 59.6) years. Demographic and clinical variables representing personal and situational factors, illness appraisal, and coping variables were examined using hierarchical multiple-regression analyses to predict outcomes of mood disturbance and functional status. RESULTS: The data revealed that symptoms, illness appraisal, and coping behaviors significantly explained additional variance in both functional status and mood disturbance above that accounted for by the less modifiable demographic and clinical variables. CONCLUSIONS: Symptoms, illness appraisal, and coping behaviors were predictors of outcomes in ICD patients. These factors are modifiable aspects of the recovery process, and interventions aimed at symptom management, appraisal reframing, and coping training should be tested to improve mood and functional outcomes for ICD patients.

Adaptation, Psychological↗
PubMedDate not supplied

Cardiac instrument development in a low-literacy population: the revised Chest Discomfort Diary.

OBJECTIVE: The purpose of this study was to pilot test a self-administered chest pain questionnaire, a revised version of the Chest Discomfort Diary (CDD-R), in a sample of patients with chronic angina selected from a population known to have low literacy. DESIGN: The study design was descriptive and correlational. SAMPLE: The study used a convenience sample of 27 subjects with documented history of coronary artery disease and angina. Characteristics of the sample included a mean age of 56.3 years (SD, 12.4 years), 88.9% African-American, and 56.3% male, and 59.3% had a history of acute myocardial infarction. Approximately 28% had achieved a 9th-grade education or less, and reading levels ranged from 4th grade to 12th grade. Subjects completed the CDD-R, a 36-item instrument reflecting multiple dimensions of anginal chest pain. RESULTS: Descriptions of the location (left chest, 66.6%), character (pressure, 59.2%), and precipitants of chest pain (walking, 51.8%) were consistent with clinical descriptions of "typical angina." Other physical symptoms such as shortness of breath (88.8%) and fatigue (85.1%) were reported. Walking (55.5%) was the activity most frequently described as difficult to perform because of chest pain, with sublingual nitroglycerin (77.7%) the most frequently used and most effective chest pain relief strategy. CONCLUSION: The CDD-R adequately measured multiple characteristics of anginal chest pain. Further research is needed to establish construct validity of the CDD-R and to determine the feasibility of using the instrument to monitor changes over time in patients' chronic angina.

Adult↗
PubMedDate not supplied

Temporal patterns of heart rate and blood pressure in elders.

Circadian patterns of heart rate, systolic and diastolic blood pressure, and rate-pressure product were compared in elders with heart disease (N = 22, mean age 86 years) and a comparison group (N = 18, mean age 80 years) who did not have a cardiac diagnosis. For 4 consecutive days, automated measures of heart rate, diastolic and systolic blood pressure, and rate-pressure product were taken every 2 hours while subjects were awake. Activity-rest patterns were recorded by an observer, and demographic and medication profiles were obtained. Data were subjected to cosinor analysis, and the groups were compared on rhythmic parameters. Although the cardiac subjects were older, in poorer health, less active, and more prone to daytime napping, they exhibited more rhythms in rate-pressure product than did the comparison subjects. The cardiac group also had more synchronized oscillation of overt heart rate and systolic blood pressure rhythms. These results can be attributed to standardized times of cardiac medication administration. Attention to patterns of heart rate and systolic blood pressure in elders may suggest more appropriate times of day for conducting individual cardiac assessments.

Aged↗
PubMedDate not supplied

A child's occupational performance: considerations of sensory processing and family context.

Sensory processing problems can be serious enough to affect a child's performance in school and home environments but often go undetected or are misunderstood. Poor sensory processing can affect a child's ability to successfully perform daily activities because of its effect on cognitive, sensory, and motor development. The relationship of sensory processing to children's occupational performance in their daily lives is an important consideration.

Child Behavior Disorders↗
PubMedDate not supplied

Internal cardioverter defibrillator device discharge: experiences of patients and family members.

PURPOSE: The purpose of the study was to describe sensations, symptoms, and experiences of internal cardioverter defibrillator (ICD) activations from the perspective of patients and a member of their family. METHODS: A prospective, descriptive study with qualitative and quantitative measures was used. Patients with an ICD returned a device activation form within 24 hours after receiving a shock and both patient and family members participated in interviews at 1, 3, and 6 months after ICD implantation. SAMPLE: Twenty-two patients with ICD (two women, 20 men) between the ages of 24 to 72 years (mean 56.5 years) and one family member per patient participated. Family members ranged in age from 43 to 67 years (mean 52.6 years) and were primarily spouses. RESULTS: The most distressing aspects of receiving a shock were lack of warning, multiple shocks, and progressively increased sensations with multiple shocks. Mean shock intensity was ranked 5.44 on visual analog scale with a range of 0 to 10. The most frequently reported symptoms and sensations were generalized nervousness and terror/fear. Dizziness, general weakness, nausea and vomiting, palpitations, and chest soreness were also noted. IMPLICATIONS: Nursing interventions related to education of patients with an ICD and their families can incorporate knowledge of these experiences to facilitate anticipatory guidance and strengthen preparation of both the patient and family member for ICD device discharge. Further research as device technology evolves is warranted.

Adaptation, Psychological↗