Ayla Yava

Effectiveness of local cold application on skin burns and pain after transthoracic cardioversion

Background Transthoracic cardioversion (TTC) is widely used in emergency departments and daily clinical practice. TTC may cause skin lesions on the application of apical and sternal paddle areas. The lesions are characterised by redness, erythema and blister(s), and can be defined as first degree burns locally causing pain and increased sensitivity. Aim To evaluate the effectiveness of local cold application on reducing the incidence, severity and pain/sensitivity of skin burns in patients who underwent TTC. Methods The study was conducted in the intensive care unit of the cardiovascular surgery department. The patients were assigned to study (n=24) and control groups (n=24). Local cold application was performed for a 1 hour period on patients in the study group, whereas only clinical procedures were applied in the control group following TTC. Incidence and severity of burn was evaluated 2 h after TTC, and pain/sensitivity scores were evaluated at 2, 4 and 24 h after TTC. Results The incidence of burn was significantly lower in the study group (3/24) compared to the control group (21/24) (12.5% vs 83.3%, p<0.001). Pain/sensitivity scores were significantly lower in the study group compared to the control group (p<0.05). Conclusion Local cold application following TTC is an effective means of reducing the incidence and severity of burns and pain/sensitivity. It is cost-effective and can easily be applied by nurses in medical/surgical units and emergency departments.

Evaluating the effects of preoperative fasting and fluid limitation

The aim of the study was to evaluate the effects of preoperative fasting and fluid limitation in patients undergoing laparoscopic cholecystectomy. Although traditional long-term fasting is not recommended in current preoperative guidelines, this is still a common intervention. Visual analogue scale was used to assess hunger, thirst, sleepiness, exhaustion, nausea and pain; State and Trait Anxiety Inventory was used to assess the preoperative anxiety of 99 patients undergoing elective laparoscopic cholecystectomy. Mean time of preoperative fasting and fluid limitation were, respectively, 14.70 ± 3.14 and 11.25 ± 3.74 h. Preoperatively, 58.60% of the patients experienced moderate anxiety. Patients fasting 12 h or longer had higher hunger, thirst, nausea and pain scores. The mean trait anxiety score of patients fasting 12 h or longer was statistically significantly higher. Receiving nothing by mouth after midnight preoperatively is a persisted intervention and results in discomfort of patients. Clinical protocols should be revised and nurses should be trained in current fasting protocols.

Commentary on Kidd L, Hubbard G, O'Carroll R & Kearney N (2009) Perceived control and involvement in self-care in patients with colorectal cancer. Journal of Clinical Nursing 18, 2292-2300.

The paper by Kidd et al. (2009) demonstrates changes in perceived control and the relationship between levels of perceived control and self-care behaviours in patients with colorectal cancer undergoing chemotherapy. The patients with control perceived as ‘high’ were defined as those who were significantly engaged in self-care and who showed poor participation or let health staff organise their care were defined as having a ‘low’ perception of control. Chemotherapy is an important treatment in cancer care and is associated with numerous side effects – the severity and frequency of which differ between patients (Akin et al. 2008). Complications may vary from the minor to significant such as bone marrow suppression, increased susceptibility to infection, oral mycosis, nephrotoxicity, anorexia, alopecia, diarrhoea, nausea and vomiting (Bergkvist & Wengström 2006, Vincent et al. 2001). However, it is not clear how frequently and consistently the patients in Kidd et al.’s (2009) study, who participated in their self-care more easily, experienced side effects. This poses questions, such as, did the ‘high’ perceived control levels in these patients result from facing less intense and less frequent side effects compared with other patients with ‘low’ perceived control? Furthermore, did the experience of minor and inconsistent side effects of chemotherapy actually result in a perception of ‘high’ perceived control? Certainly, participation in one’s own care can contribute to raised levels of perceived control and lessen side effects (Brody et al. 1989). It can also enhance feelings of well-being (Scharloo & Kaptein 1997). The severity of the illness appears to be an important factor in patients perceived control and adaptation to their illness (Endler et al. 2001). That is why patients experiencing severe and more frequent symptoms and complications may be expected to lessen their participation in care. The definition of ‘self-care’ by Kidd et al. (2009) is clearly defined in their paper, but it is less evident what roles a cancer patient may play to be seen as participating in self-care. For instance, can participation in decisions related to treatment alternatives be considered as participation in self-care? Or does participation in self-care mean performing procedures to protect from oral infections, avoid nausea, vomiting, etc.? As stated, chemotherapy-related complications have different effects and may vary from one to another. This is another important aspect that must be taken into account within the evaluation of participation in self-care and levels of perceived control. Research has shown that an increase in the level of selfefficacy has a positive effect on health conditions, eases symptom control in chemotherapy, and helps the patient to reconcile with the challenges of cancer treatment (Cunningham et al. 1991, Lev et al. 2001). Lev and Owen (1996) found a significant negative correlation between psychological distress and symptom distress in cancer patients and selfcare/self-efficacy and a significantly positive correlation was found between quality of life and the perception of selfefficacy (Lev & Owen 1996). Self-efficacy is actually an individual’s self-judgment ability on his or her capacity to organise the necessary activities to successfully undertake a

Kardiyak Cerrahi Yoğun Bakımda Uygulanan İnvaziv ve Noninvaziv Girişimler ve Postoperatif Ağrı

Amac: Kardiyak cerrahi geciren hastalara yogun bakim unitesinde uygulanan noninvaziv-invaziv girisimlerin hastalarin agri ve bazi hemodinamik degerleri uzerine olan etkisinin belirlenmesidir.Gerec ve Yontem: Bu calisma ileriye donuk, on-son olcumlu klinik bir arastirmadir. Invaziv ve non invaziv girisimler oksuruk, solunum egzersizleri, dren sagilmasi, mobilizasyon, dren cekilmesi ve endotrakeal aspirasyon olarak belirlendi. Girisimlerden hemen once ve sonra agri algisini belirlemede Sayisal Derecelendirme Olcegi kullanildi. Ayrica kan basinci ve kalp hizi (nabiz) da girisimler oncesi ve sonrasi kaydedildi. Calismaya 62 hasta dâhil edildi. Istatistiksel analiz icin Wilcoxon Signed Rank test kullanilmis ve p<0.05 degeri istatistiksel olarak anlamli kabul edildi. Bulgular: Hastalarin yas ortalamasi 51.25±18.05 yil, cogunlugu (% 87.1) erkek olup, % 74.2’sine koroner arter-baypas greftleme cerrahisi uygulanmistir. Tum invaziv ve non invaziv girisimlerden sonra hastalarin agri puanlari istatistiksel olarak anlamli seviyede artmistir (p<0.05). En yuksek agri puani endotrakeal aspirasyon oncesi ve sonrasi kaydedilmistir (sirasiyla 7.30±1.04 ve 8.80±1.25). Dren cekilmesi ve endotrakeal aspirasyon girisimleri sonrasi hastalarin sistolik ve diyastolik kan basinclari ve nabiz degerleri istatistiksel olarak anlamli seviyede artmistir (p<0.05). Oksuruk egzersizi, dren sagilmasi ve mobilizasyon girisimleri oncesi-sonrasi nabiz, mobilizasyon oncesi-sonrasi sistolik arteriyel kan basinci degerleri arasindaki degisiklikler istatistiksel olarak anlamli bulunmustur (p<0.05). Sonuc: Tum invaziv ve noninvaziv girisimler hastalarin agri ve hemodinamik degerlerini artirmistir. Bu girisimlere yonelik hastalarin bireysel agri degerlendirmelerinin yapilarak uygun agri tedavisinin yapilmasina gereksinim oldugu dusuncesine varilmistir.

Nursing care for renal transplantation between mates: case presentation -

Kidney transplantation is one of the best treatment methods for significantly improving the quality of life for patients suffering from kidney disease. Transplantation patients expose to many stress because of operation and hospital environment. Patients who had kidney transplantation, concern about emerging of rejection risk and health status of donor. It was determined that patients with whom had good communication, given information before the surgery and care needs fulfilled, were willing to participate in their care and care management after discharging. This case presentation includes implementations and evaluations of a nursing care plan which improved for caring for a patient who had kidney transplantation from his wife/husband and being hospitalized at a university hospital. Our case presentation aims to prepare standard care plan for donor and recipient, to increase patient care quality and, to reduce the nurse’s work load with the systematic approach.