Asian Journal of Nursing Education and Research

A. Dhanya ¹, Praveen Agarwal ², Manju Dhandapani ³, Jaideep Mahendra ⁴, Lakshmanan Gopichandran ⁵

Affiliations
1 College of Nursing, AIIMS, New Delhi, IN
2 Dept. of Emergency Medicine, AIIMS, New Delhi, IN
3 PGIMER, Chandigarh, IN
4 Meenakshi Ammal Dental College, Chennai, IN
5 College of Nursing, AIIMS, NewDelhi, IN

Abstract

Background: Diabetes mellitus (DM) is one of the major risk factors of acute coronary syndrome (ACS). There are certain differences reported in clinical presentation of patients with ACS between diabetic and non-diabetic patients. Objective: To compare the clinical profile and symptoms experienced by diabetic and non-diabetic patients of ACS. Methodology: A descriptive cross-sectional survey was conducted among 60 diabetic and 60 non-diabetic patients hospitalized with ACS in atertiary care centre, Delhi. The sample size of 120 i.e. 60 in each diabetic and non- diabetic group, was statistically calculated. Patients were enrolled only if they were hemodynamically stable and did not have any cognitive dysfunction or communication disability. Consent was obtained from patients after explaining the objectives of the study. Data on patient as well as clinical profile and initial symptoms of ACS were collected using structured interview. Results: The mean age of the patients with DM was 64.23+14.7years and without DM was 64+13.1years. Majority of the patients in both groups were males, married, belonged to nuclear family and were from urban setting. When 56.67% of diabetic patients were employed, 63% of non-diabetic patients were retired (p=0.001). Two third of the patients were diagnosed to be diabetic for more than one year. Majority of the patients who were on treatment were receiving oral hypoglycemic agents. As compared to non-diabetic patients of ACS, more number of diabetic patients with ACS were found to have high cholesterol level, alcoholism, family history of CAD, previous history of ACS, history of CABG and endovascular coronary interventions. Significantly higher number of diabetic patients i.e,83.3% were found to have STEMI as compared to 38.3% in non-diabetic patients. Cardiac enzymes were elevated in 90% of the diabetic patients as compared to 55% of non-diabetic patients (p=0.001). When 86.7% of nondiabetic patients experienced chest pain as one of the initial symptom of ACS, only 20% diabetic patients experienced the same in non-diabetic patients(p=0.001). Among prevalent symptom of ACS, chest pain, cold sweat, nausea/vomiting and palpitation were reported by significantly higher number of non-diabetic patients. significantly higher number of diabetic patients reported shortness of breath/ dyspnea, gastric discomfort, unusual fatigue, anxiety, syncope/giddiness and headache. While, significantly more number of non-diabetic patients reported pain in shoulders and arms. Significantly more number of diabetic patients reported jaw pain and neck pain. Conclusion: As per the present study findings, chest pain is less prevalent as an initial symptom of ACS in patients of diabetes and the diabetic patients may experience various atypical symptoms other than chest pain during ACS. Dyspnea, syncope/ giddiness were the major symptoms experienced by diabetic patients during ACS as compared to non-diabetic patients. Appropriate measures must be taken for diabetic patients by the health care providers to facilitate early and adequate management of ACS.

Keywords

Symptoms, Diabetic Patients, Non-Diabetic Patients, Acute Coronary Syndrome.

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Parisha Rai ¹, Manju Dhandapani ², Shiv Bagga ³, L. Gopichandran ⁴, Yash Paul Sharma ³

Affiliations
1 B & B Medical Institute, Gwarko, Lalitpur, NP
2 NINE, PGIMER, Chandigarh, IN
3 Department of Cardiology, PGIMER, IN
4 All India Institute of Medical Sciences (AIIMS), New Delhi, IN

Abstract

Background and Aim : Femoral route is a common approach for doing coronary angiography, but bed rest is recommended due to risk of vascular complications. The aim of present study was to assess effect of position change followed by early ambulation after coronary angiography via femoral approach on comfort, fatigue and vascular complications of the patients. Subjects and Methods: A randomized controlled trial was conducted on 80 patients (40 each in control and experimental group) undergoing coronary angiography in a tertiary care institute in India. Patients in control group were placed in supine position and ambulated after 6 hours. Experimental group were kept in supine position for 2 hours after angiography, followed by right lateral position (1 hour), supine position (1 hour) and ambulated after 4 hours. Kolcaba’s Outcome was assessed using General Comfort Questionnaire, Numerical pain rating scale and Fatigue Visual Numeric Scale at 2, 4, 6 and 24 hours after angiography. Incidence of vascular complications was documented at 24^th hours. Results: At 4^th and 6^th hours after angiography, fatigue experienced by experimental group was significantly lower than control group. At 6^th and 24^th hour, experimental group had significantly lesser back pain and better comfort. There was no significant difference in the incidence of vascular complications between the control and experimental groups. Conclusion: Position change followed by early ambulation after coronary angiography via femoral approach is safe and effective as it decreases back pain, fatigue and improve comfort without increasing vascular complications.

Keywords

Bed Rest, Cardiac Catheterization, Coronary Angiography, Early Ambulation, Position Change, Cardiac Nursing.

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Manju Dhandapani ¹, V. R. Vijay ², Nadiya Krishnan ², Lakshmanan Gopichandran ³, Alwin Issac ², Shine Stephen ², Jaison Jacob ², Thilaka ⁴, Lakshmi Narayana Yaddanapudi ⁵, Sivashanmugam Dhandapani ⁶

Affiliations
1 National Institute of Nursing Education, IN
2 College of Nursing, AIIMS, Bhubaneswar, IN
3 College of Nursing, IN
4 Dept. of Anesthesia, AIIMS, New Delhi, IN
5 Dept. of Anesthesia and Intensive Care, IN
6 Dept. of Neurosurgery, PGIMER, Chandigarh, IN

Abstract

Background: Nursing care plays a vital role in critically ill patients’ recovery process and outcome with COVID-19. Though there is a tremendous surge in COVID-19 literature, there is no comprehensive documentation of nursing aspects.Objective: To develop nursing care standards for critically ill patients with COVID-19. Methodology: To prepare this scoping review, a detailed literature review was done by the experts and trainers involved in the critical care of patients with COVID-19 from India’s premier institutes. Results: Rapidly progressing hypoxemia with respiratory failure induced by COVID-19 in critically ill patients poses a management challenge. Patients of COVID-19 progressing to critical stage must be identified early, and appropriate management initiated while taking all the specific measures to prevent infection to the healthcare providers. The essential components of critically ill patients’ nursing care include constant monitoring and maintenance of ventilation, oxygenation, fluid volume/hemodynamic status, and shock prevention. The other adjunctive measures include meeting the nutritional demands, prevention, early identification of complications, timely initiation of rehabilitation, and personal and environmental hygiene. Ensuring the safety of the healthcare providers with adequate PPE and infection control measures is of utmost importance while caring for the patients of COVID-19. Conclusion: The nursing interventions must be tailored vigilantly for the individual patient. The evidence is evolving, and the nursing care strategies discussed in this article based on existing evidence may guide the nurses and healthcare providers in managing critically ill patients of COVID-19.

Keywords

Pandemic, COVID-19, Coronavirus Infection, Sars-Cov-2, Nursing, Critical Care, Epidemiology, Acute Complications, Diagnosis, Prevention and Control, Physiotherapy.

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