| Abstract [eng] |
Purpose: review nursing requirements for newborns with the critical heart diseases in post-operation period. Tasks 1.Describe group of newborns with the congenital heart diseases. 2.Consider operational peculiarities for newborns with critical heart diseases. 3.Identify nursing problems for newborns with the critical heart diseases in post-operation period. Assumption: nursing requirements for newborns with the critical heart diseases depend on the fetal maturity degree, congenital infections, associated diseases and operation nature. Study methodology. In course of the study retrospective analysis of 84 newborns with the critical heart diseases undergoing post-operation (heart surgery) treatment. Data was processed by means of programmes SPSS 8.0 for Windows. Conclusions 1.Most frequent obstruction heart diseases found among newborns are: coarctation of aorta (31%), interruption of aortic arch (4,8%), pulmonary artery stenosis or atresia (13,1%). Less often the following heart diseases are met: transposition of great arteries (23,8%.), hypoplastic left hear syndrome (13,1%). Very seldom: total abnormal pulmonary venous drainage (3,6%), tricuspid atresia (8,3%). Majority of newborns are mature (89,3%), without additional pathology (84,5%), nearly half of them have intrauterine infection (45,2%). For a bigger part of newborns with the congenital heart diseases (56%) the failure of blood-vascular system was developed which was represented by disorder of heart contraction frequency, artery blood pressure and peripherical body temperature. Hypoxemy signs were identified in case of one-third of patients (31%). At the same time blood-vascular system failure and hypoxemy symptoms were found for 11% of newborns. Breathing (81%) and kidney (8,3%) functional failures were observed. 2.In course of operation the extracorporeal blood circulation was applied for major part of newborn patients (61,9%). Long-term extracorporeal blood circulation was applied for half of them (36,9%). Operation for nearly for half of them (41,6%) was accompanied by mild or deep hypothermia. Radical surgery correction of the heart disease was done for half of the newborns (52,4%). 3.Controlled ventilation was applied for all newborns after operation, one-third of them received long-term ventilation, however, breathing complications are not frequent (20,2%). Unstable artery blood pressure was observed for most of patients (70,2%) which was maintained by large drug dozes. The chest was left open for one-third newborns (26,2%). Blood-vascular system failure was were detected in case of all patients during the first 24 hours after operation, more than one-third of them (40,5%) additionally had breathing system failure and (34,5%) kidney functional failure. One-third of newborns (28,6%) had peritoneal dialysis. Bleeding of operational wound was observed in case of one-third of patients (34,6%). Resaccitation means were applied to one-third of the newborns (31%). All patients received pain-allaying drug infusion. Most of the patients (67,9%) after operation had fever. All patients belong to the bed-sore risk group. All patients received enteral and parenteral feeding. Due to the blood circulation disorder, antibacterial therapy and intestinal peristaltic disorder the newborns suffer gastrointestinal disorders, oftener – meteorism. Major part of the patients (64%) were treated in the pediatric unit for up to 2 weeks after operation. Nature of the heart operations and large number and diversity of nursing problems in post-operation period confirms necessity of individual approach to nursing in the post-operation period. 4.Nature of heart operation and fetal maturity factor do affect the nursing requirement in the post operation period. Intrauterine infection, associated diseases do not impact the post-operation period. Extracorporal blood circulation and hypothermy appeared to be the most efficient for the post operation period. |
