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Importance of Glycemic Control on Post Open Heart Patients Project Proposal Featured

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Importance of Glycemic Control on Post Open Heart Patients

Project Proposal


Abstract

Patients undergoing critical surgical procedures such as cardiac surgery often experience increased blood sugar levels due to heightened stress (Rosas & Palma, 2009). It is the responsibility of the surgical team to ensure that the blood sugar levels are monitored and regulated before, during and after the cardiac surgery. However, health care professionals have inadequate knowledge in relation to appropriate blood glucose control methods aimed at minimizing the risk associated with such delicate surgeries. The adoption of the tight glycemic control method on post open heart patients ascertains that cardiac patients undergo heart surgery procedures and recover without complications.


The aim of the proposed project is to conduct a systematic review of literature on the results of tight glycemic control on morbidity and mortality during, before, and after cardiac surgery. In line with the findings of literature review, it is vital that key stakeholders are informed about the need to adopt the tight glycemic control process before, during and after an open heart surgical procedure. The main purpose of disseminating these results to the key stakeholders will be to call for the adoption of the tight glycemic process.

In order to ensure adequate blood glucose control, the health care facility should ensure they have adequate nurse staffing so as to minimize nurse patient ratios. An adequate number of nurses will ascertain the effective adoption and implementation of tight Glycemic control measures on open heart patients. Similarly, health care facilities must ensure that their care givers and nurses are familiar with the use of tight control measures on cardiac surgery patients. With adequate knowledge, the effective use of the process will be guaranteed.


Introduction

      Numerous studies have supported the findings that Tight Glycemic Control on post open heart patients is essential to minimize morbidity and mortality rates (Rosas & Palma, 2009). Tight Glycemic Control also improves the healing process and minimizes the occurrence of wound infections. Patients depend on health care providers such as nurses to care for them, prepare them for surgery and care for them during and after surgery. It is the responsibility of health care professionals to ensure that tight glycemic control measures are adopted for post open heart patients in the medical units.


Problem Statement

      The issue of heightened blood sugar level in patients undergoing surgical procedures has always been assumed to be a norm (Haga, & Alsotn, 2011). However, the problem is a serious concern for patient facing cardiac surgery. Such patients often acquire stress induced hyperglycemia regardless of whether they are diabetic or not. Unfortunately, stress induced hyperglycemia has been associated with increased morbidity and mortality in cardiac surgery patients. The need to establish a protocol to control blood sugar levels is mandatory so as to achieve ideal outcomes of surgery. The problem of glycemic control is associated with health care provider’s lack of knowledge about blood sugar regulation (Lazar, & Shemin, 2009). Most health care providers are incompetent with regard to knowledge over glycemic control.


      Health care givers such as nurses lack adequate knowledge on the ideal glucose levels for cardiac surgery patients. They also lack adequate knowledge on the effects of poor glycemic control. The nurse-patient ratio also interferes with the ability of health care providers to provide patients with optimal care (McAlister & Tandon, 2003). Nurses are often understaffed and overworked hence the inability to render quality services. Nurses are, for instance, required to monitor the blood glucose of recovering patients, on a regular basis. The aim of constant monitoring is to ensure that the blood sugar levels do not go too high or too low (Lazar, 2012). Unfortunately, constant monitoring is not possible as healthcare facilities have inadequate number of nurses. Healthcare facilities should strive to reduce the nurse to patient ratio. The facilities should also strive to hire competent nurses who are familiar with procedures such as insulin therapy.


Glycemic Control for Post Open Heart Patients

Numerous studies have indicated that glucose control in hospitals is inadequate. Approximately 30% of all patients admitted in health care facilities have glucose levels way over 180mg/dL (Sciencedaily, 2012). Unfortunately, a rise in blood glucose among patients increases the risk of death and other related complications such as dehydration, hypotension, slow healing and impairment of the immune system (Rosas, & Palma, 2009). Patients with abnormally low blood sugar levels are also at risk of neuroglycopenia, cardiac failure and brain dysfunction. Numerous studies seem to agree that optimal blood glucose control is bound to improve the clinical outcomes of patients. Hyperglycemia and hypoglycemia result to poor patient results.

Concerns over glycemic control lies in the ability of caregivers to maintain an optimal bold glucose level prior, during and after cardiac surgery. Unregulated blood sugar level prior to an open heart surgery can result to complication during the surgery and after the surgery.  According to Jeon & Larson (2012) patient who undergo cardiac surgery when they are hyper or hypoglycemic have a high risk death during and after surgery.  Blood sugar regulation efforts must, therefore, begin prior to a surgical procedure. Health care professionals must ensure that the blood glucose levels of a patient get to a normal 80/120mg/dL level before undergoing surgery. During surgery, the regulation process must continue to ensure that the normal level is maintained.


The ability of health care providers to ensure effective glycemic control for post open heart patients means that morbidity and mortality rates will reduce. The proper management of blood glucose levels will guarantee ideal results for post open heart surgery patients. The risk of death and complications significantly reduces with the proper management of blood sugar levels. Hyper and hypoglycemia in cardiac surgery patients has adverse effects with regard to increased risk of deaths and surgery related complications. According to Gandhi & McMahon (2007) glycemic blood glucose control can be achieved through conventional glucose management efforts during cardiac surgery.


As already mentioned, all patients undergoing cardiac surgery are susceptible to heightened blood glucose levels. However, patients that are diabetic are more susceptible to morbidity and mortality risks than those that are not diabetic (Henry & Martin, 2008). It is vital, therefore, for health care providers to conduct patient assessment to determine the patient medical status and blood glucose levels prior to the surgery. The ability of healthcare providers to have prior knowledge of the patient’s health status ensures that the right medical strategies are adopted to ascertain a successful surgery and recovery (Martinez, & Lehmann, 2011).

      Glycemic control reduces the risk of wound infection; this is according to Brethaupt (2010). Post open heart patient with high blood glucose levels are susceptible to deep wound infections. The risks are even higher for cardiac surgery patients who are diabetic. Strategies such as tight Glycemic control ensure that a patient’s blood glucose levels are maintained close to the normal range as much as possible.


Solution Description

      Cardiac surgery patients are susceptible to increased blood glucose level due to the severity of the surgical procedure they are undertaking. It is important that health care professionals are familiar with appropriate blood glucose control methods so as to minimize the risk associated with such delicate surgeries. The adoption of the tight glycemic control method on post open heart patients ascertains that cardiac patients undergo heart surgery procedures and recover without complications. Health care facility should ensure they have adequate nurse staffing so as to minimize nurse patient ratios. An adequate number of nurses will ascertain the effective adoption and implementation of tight glycemic control measures on open heart patients. Similarly, health care facilities must ensure that they care givers and nurses are familiar with the use of tight control measures on cardiac surgery patients. With adequate knowledge, the effective use of the process will be guaranteed.


Implementation Plan

Methods of Obtaining Approval

The implantation plan will include ideas and suggestions from scholars with adequate experience in cardiac surgery procedures. The scholarly texts from the scholars and health care professionals are recent and focus mainly on patients waiting to undergo cardiac surgery. The information will be presented to the leadership at the health care facility for considerations and approval.  A comparison of the effects of controlling blood sugar levels versus ignoring it in cardiac surgery patients will be made. The support of the chief executive officer and other executive leaders on the need to control blood sugar levels will be essential in establishing ideal ways to prevent complications and infections associated with unregulated blood sugar levels in cardiac surgery patients.


Implementation Logistics

Efforts to embrace stringent glycemic control measures should be integrated within health care facilities with immediate effect. Open heart patients continue to lose their lives due to complications arising from exceedingly high or low sugar levels (Lingegowda, 2008). The irony, however, is that glycemic control efforts can easily be integrated into patient care strategies. Glycemic control efforts must be made mandatory to patients who are to undergo critical surgical procedures such as open heart surgery.

The ideal strategy that can be implemented to ascertain glycemic control is the lean Six Sigma (LSS). LSS focuses on incorporation of methods aimed at reducing defects and undesirable variations in a process. In this case, LSS will involve minimizing defects and undesirable outcomes in post open heart patients (Gower, 2012). LSS will focus on change management strategies. For instance, the executive management will take the leading role of ensuring that all surgical procedures are conducted with strict monitoring of the patient’s blood glucose. The management will also strive to train its existing personnel on effective Glycemic control strategies.  The management will also strive to increase its momentum in educating new nursing staff on the importance of glucose management.


The training process will be an ongoing process that will include regular updates and bimonthly staff meetings. The management will also analyze existing barriers to effective glycemic control. For instance, the lack of proper blood glucose control protocols should be a call for the health care facility to establish a strategy that will guarantee desirable results. Barriers such as shortage of nurses should also lead to straightforward improvements such as the hiring of more nurses (Quattara, & Corait, 2005). The insulin protocol that is to be adopted in the operating room will be posted in all OR for easy access and reading. Resident students will also be provided with the insulin protocol so as to integrate in their care delivery efforts.


Resources Required For Implementation

The health care facility will use trained OR personnel to train nurses and resident students on the need for glycemic control. The trained OR personnel will provide other health care providers with the control protocol that has been adopted by the facility. Educational materials such as pamphlets, handouts and posters will be used to inform health care personnel on the importance of glycemic control and strategies to embrace to minimize morbidity and mortality rates (Smiley & Umpierrez, 2006). Posters will be hanged on strategic points such as in the OR so that the surgical health care personnel would review it prior to conducting any surgical procedure.


Assessment Tools

Prior to the implementation of the glycemic control efforts, questionnaires will be distributed to health care professionals in the surgical department. The questionnaires will aim to establish the level of understanding on glycemic control and the ability of health care personnel to engage in activities that regulate glucose sugar among patients. Questionnaires are vital in gauging the level on understanding and familiarity about glycemic control in open heart patients. It is from the findings of the questionnaire that the management will establish the level of training that its staff requires. Similarly, the provision of questionnaires after implementing ideal glycemic control measures will be essential in establishing the effect of the implementation. Such an analysis will help management determining whether the selected protocol was a success and whether the adoption of the control measures has reduced morbidity and mortality rates.


Funds

      Funds for the implementation process will be sourced from the health care facility budget. The ability of health care providers to assure patients of optimal health even when faced with delicate medical procedures such as cardiac surgery is paramount. An ideal health care facility is one that engages in strategies to minimize its morbidity and mortality rates. The channeling of funds to implementation strategies of glycemic control strategies will thus be a priority for the health care facility. The facility will also consider seeking funds from non-governmental organizations and other charitable organizations. The funds will be used to hire trained personnel that will guide the rest of the employees in adopting effective glycemic control strategies. The funds will also be used to produce and distribute pamphlets, posters and questionnaires related to the glycemic control efforts.


Evaluation Plan

      The effectiveness of tight glycemic control on post open heart patient can be done by assessing the level of training and education of the health care providers. Studies indicate that nurses lack adequate knowledge about glucose level controls for cardiac surgery patients. The methods that will be used to evaluate nurse’s level of understanding and knowledge about tight glycemic control will include conducting a survey on the level of knowledge about glycemic control in cardiac surgery patients. Another method will involve determining the number of nurses with adequate training on blood glucose management in surgical patients. The third method will involve collecting data on complication of cardiac patients as a result of unregulated blood sugar levels (Lazar, 2012).


      The variable that will be used in assessing the level of knowledge about glycemic control will include determining the nurse’s perception on the importance of glycemic control on cardiac surgery patients. The second variable will involve assessing the care givers/nurses level of confidence when handling open heart surgery patients.

      The tools that will be used to educate nurses and enhance their knowledge about glycemic control will include instructional pin ups that will be posted on ORs. Nurses unsure of the process will read through the pin-ups and follow the directions. Similarly, nurses will receive on-the job training on the importance of glycemic control. The training will be done practically during a surgical procedure and orally in a class like setting (Quattara, & Corait, 2005). Questionnaires will be provided after the training session to gauge the nurse’s level of understanding and their ability to conduct glycemic control processes successfully. Brochures will also be distributed in the OR department to familiarize all nurses assigned to the department on blood glucose control.


      The health care facility can also increase its nurse staffing so as to reduce work overload and ascertain patient receive optimal care before, during and after cardiac surgery The gripping nurse shortage affects the ability of care givers to provide optimal care to patients. In an effort to ridicule the nurse patient ratio to 1:4, the health facility can strive to determine the nurse’s attitude with regard to their job satisfaction and work overload. The second method can involve determining the nurse’s perception of work overload and their ability to render effective services. The third method can involve determining the turnover rates of nurses. Nurses that are exposed to overwork and intensive work environment tend to quit their jobs hence a high work turnover rate. The variables that can be used in determining the effectiveness of implementation of tight Glycemic control processes on post open heart patient include determining the rate of nurse’s turnover rates.


A health care facility with a high nurse turnover rate will suffer with regard to the provision of quality nurse care to cardiac surgery patients (Haga, & Alsotn, 2011).  The second variable will involve gathering patient attitudes and perception with regard to the quality of nurse care they receive. A health facility that is understaffed will have patient complain of minimum nurses care before, during and after open heart surgery (McAlister, & Tandon, 2003). With minimal care, the guarantee of blood sugar monitoring and regulation is minimal. The tools necessary to educate the management on the need of hiring more nurses include management training on the need for adequate nursing. Questionnaires will be used later to establish the nurse’s level of satisfaction with their jobs as well as  their ability to offer optimal health care services to cardiac surgery patients.

Cardiac surgery patients are susceptible to increased blood glucose level due to the severity of the surgical procedure they are undertaking. It is important that health care professionals are familiar with appropriate blood glucose control methods so as to minimize the risk associated with such delicate surgeries. The adoption of the tight glycemic control method on post open heart patients ascertains that cardiac patients undergo heart surgery procedures and recover without complications. Health care facility should ensure they have adequate nurse staffing so as to minimize nurse patient ratios. An adequate number of nurses will ascertain the effective adoption and implementation of tight glycemic control measures on open heart patients. Similarly, health care facilities must ensure that they care givers and nurses are familiar with the use of tight control measures on cardiac surgery patients. With adequate knowledge, the effective use of the process will be guaranteed.


Dissemination Plan

Dissemination is a vital process that involves availing the results and deliverables of a project to shareholders (European Commission, 2010). The project focusing on the use of tight glycemic control on post open heart patients reveals that tight glycemic control is effective in minimizing morbidity and mortality rates in open heart patient patients. With these findings, it is vital that key stakeholders are informed about the need to adopt the tight glycemic process before, during and after an open heart surgical procedure. The main purpose of disseminating these results to the key stakeholders will be to call for the adoption of the tight glycemic process.  It is vital that the findings of the project reach as many individuals in the nursing community as possible. It is by adopting the glycemic control measures that morbidity and mortality rates will reduce.  The risk of infections due to accelerated blood sugar levels will no longer be a concern during patient care. It is also vital for the nursing community to be informed and ensure they adopt the tight glycemic control protocol.  There are several strategies that can be used to disseminate the results of this study.


The first strategy that can be used is seminars. Seminars will be conducted so as to inform the management of the health care facility. It is through seminars that the findings of the study will be provided to the executive management. Seminars provide a platform from where the implementation of tight glycemic control protocol during surgical procedures will be discussed. The executive managers, as well as the surgical team, will be involved in discussions with researchers over the findings of the study and overall benefits of using the tight control protocol. Researchers can also conduct workshops at the healthcare facility. Top surgical leaders and nurses in the OR can be invited to workshops where they will be informed on the need to adopt the tight control protocol in their surgical procedures. Data and statistic from previous studies that demonstrate the effectiveness of adopting the tight control protocol will be highlighted and emphasized. The seminars and workshops will be supported by PowerPoint presentations that the surgical team and nurses will follow throughout the lessons.


Meetings will also be done on a regular basis so as to update the surgical team on the need to adopt the glycemic control protocol. Brochures and pin-ups may be used at the OR, but it would not be a guaranteed that all healthcare personnel’s will be motivated to read (European Commission, 2010). Holdings regular meetings will ensure that employees assigned to the OR department familiarize themselves with the tight control protocol. The meetings will emphasize on the need for all employees to adopt the blood glucose measures so as to minimize the risk of complications. Alternatively, video tapes can be provided to the health care facility. Video tapes are important as they provide the nurses and surgical team with back up from where they can review the information provided through seminars, meetings and workshops. The videos can be accompanied by audio and visual applications. In conclusion, the dissemination process is essential to ensure that the nursing community is well informed.


Review of Literature

The problem of uncontrolled blood sugar level on post open heart patients cannot be ignored (Haga, & Alsotn, 2011). It is estimated that nearly half of all patients that undergo heart surgery experience high sugar levels to the extent that insulin intervention efforts are mandatory. The rise in blood glucose levels is considered a normal occurrence for patients facing stressful situations. This is regardless of their diabetic or non-diabetic status.  It is the responsibility of health care providers to ensure that post cardiac surgery patients recover and complications associated with blood glucose are contained.

According toRosas and Palma (2009) blood sugar control problem such as hyperglycemia is common among patients facing cardiac surgery.  Patients facing cardiac surgery often acquired stress-induced hyperglycemia regardless of whether they were diabetic or not. The occurrence of stress-induced hyperglycemia was assumed by health care providers to be an unavoidable beneficial response to the operative status of the patient. However, recent studies on animals and human being indicated that stress-induced hyperglycemia increases the risk of morbidity and mortality in cardiac surgery patients. Stress-induced hyperglycemia occurs when the body is put through a situation that calls for a high metabolic demand. Such situations include hemorrhage, burns or major surgeries such as cardiac surgeries. Unfortunately, hyperglycemia increases morbidity and mortality rates in diabetic and non-diabetic patients facing cardiac surgery.


With this in mind, there is a need to establish protocols that ascertain that a patient’s blood-glucose levels are under control during the Perioperative period. It is through the proper management of blood glucose levels that patients will present ideal outcomes after surgery. Lazar (2012) also points out patients with acute coronary syndrome and CABG surgery are at risk of death or acquiring surgical complications if they end up hypoglycemic. The emphasis lies in the ability of caregivers to maintain an optimal bold glucose level prior, during and after the cardiac surgery. Similar findings were also made by McAlister & Tandon (2003) who discovered that hyperglycemia in the first operative day of a cardiac surgery patients was associated with subsequent adverse consequences with regard to the patients health and welfare.

According to Gandhi and McMahon (2007) strategies such as the use of intensive insulin therapy during cardiac surgery does not reduce the risk of death and morbidity. Emphasis should be on the implementation of an effective but conventional glucose management efforts using cardiac surgery. A similar study conducted by Lingegowda (2008) also reveals that diabetic patients are most susceptible to risks after cardiac surgery. This is because diabetics use insulin for the optimal functioning of their body. Under surgery, however, there glucose levels rise in reaction to the surgery. In the end, the diabetic patient is prone to high mortality rates, heart failure and other dire complications. Diabetic patients have high chances of complications because their bodies are not able to maintain a balance between insulin and its regulatory hormone. A non-diabetic patient may experience high blood glucose levels, but will eventually recover as his body will increase insulin secretion, which will increase glucose uptake in the body. Diabetic patients, however, are unable to compensate due to their dysfunctional system thus faces the risk of hyperglycemia.


According to Quattara and Corait (2005) poor intraoperative blood glucose control is associated with worsening outcomes for patient recovering from cardiac surgery. With this in mind, there is a need for health care professionals to conduct Perioperative blood glucose control to ensure the optimal health of the patient. A patient with low glucose cause level has a high chance of recovering without complications. Health care providers should ensure that they regularly measure the blood glucose levels of patients to ensure that it is at a normal level. Factors such as diet can contribute to glucose imbalance hence the need for regulation prior to cardiac surgery. These sentiments are supported by Lazar & Shemin (2009) who also argue that the management of blood glucose during adult cardiac surgery is vital.

Patients that are diabetic and require cardiac surgeries are most susceptible to risk and complications if their blood glucose levels are not regulated. The diabetic status of a patient makes blood glucose regulation the top priority as a patient may be at risk associated to the surgery as well as his diabetic status. Health care facilities should adopt assessment strategies such as the 3-blood glucose, 3-BG, to determine glucose levels during surgery and after surgery.


According to Smiley and Umpierrez (2006) effective Perioperative glucose control has a significant effect on the occurrence of post operative infection in patients undergoing cardiac surgery. A high blood glucose levels on the first post operative day of the patient heightens the risk of post operative infection. It is mandatory, therefore, for health care providers not to issue blood glucose to patients who have just emerged from surgery. The risk for serious post operative infections such as sepsis, pneumonia, and wound infections increased with an increased of glucose sugar levels. If the issue of blood glucose control is mandatory, care givers should ensure that they monitor the overall blood glucose levels in a patient. It is the responsibility of health care facilities to establish reliable Glycemic control protocols that they can use during cardiac surgeries.

According to Martinez and Lehmann (2011) the lean sigma methods of Glycemic control can be ideal for patients undergoing heart surgery. The lean six sigma method emphasizes on improving the quality of care that patients undergoing surgical procedures receive. With emphasis on minimizing the risk of infections and complications, the six sigma methodology guides health care providers to achieve success with cardiac surgery patients. It is an undeniable fact that poor Glycemic control in cardiac surgery patients results to poor outcomes. Adopting the right protocol means that the health care facility will be able to ensure that the cardiac surgery patient is under optimal Glycemic control of 80-120mcg/dL


The exact relation between the control of glucose and the occurrence of surgical infections remains unclear. However, there appears to be a strong relation between the two medical situations. According to Jeonand Larson (2012)most patients who undergo cardiac surgery risk death due to pre-operative hypoglycemia and glucose levels variability. According to the findings from a retrospective cohort study, in-hospital deaths are more common among patients found to have pre-operative hypoglycemia and high glucose variability. The findings thus mean that the stabilization of glucose and the management of hypoglycemia could play a significant role in the reduction of post-operative deaths. It is undeniable that there is a need for health care providers to conduct patient assessment to determine their blood glucose levels prior to conducting any major surgeries.

Glycemic control in post-operative patients should be a mandatory for health care providers. This is according to Breithaupt (2010) who establish that the effective control of glucose levels minimizes morbidity and mortality risks.  The management of blood glucose levels and reduces the risk of wound infection. Numerous studies on the impact of elevated glucose levels on the occurrence of wound infection reveal a close link. Post-operative patients with high blood glucose levels are susceptible deep wound infections. Patients who undergo cardiac surgery also have a high risk of infection if their glucose levels are high. The situation is worse for patients that are diabetics as their risk of infection is higher that the non diabetic patients who undergo cardiac surgery and have high sugar levels.


The management of optimal blood-glucose control levels has remained a cause of concern for health care professional due to the high risks of morbidity and mortality associated with it. The issue of blood-sugar control in patients waiting, undergoing or post cardiac surgery is particularly important. According to Haga and Alston (2011)patients undergoing cardiac surgery have the alternative of having a tight glycemic control or a normal glycemic control during surgery.  The tight glycemic control aims to keep a patient’s glucose levels as close to normal as possible to as to reduce risks. Tight Glycemic control minimizes the occurrences of hyperglycemia that is common, in patients undergoing critical medical procedures. A patient undergoing cardiac surgery is bound to have stress induced hyperglycemia. 

Hyperglycemia has many adverse effects as it can impair the healing process of wounds and heighten the risk of infections due to leukocyte chemotaxis and phagocytosis impairment. Since the risk of hyperglycemia is apparent, a tight glycemic control will ensure that the patient undergoes the cardiac surgery and recovers under optimal glucose levels.


The effectiveness of implementation of the tight glycemic control lies in the ability of health care providers such as nurses to ensure that patients receive the tight glycemic control. Training of nurses over the optimal execution of the tight glycemic control is paramount. A similar study conducted by Gower (2012) indicates that a high peak intraoperative blood glucose level increase the risk of surgical site infections hence the need to adopt effective blood sugar control strategies. The study, which focused on the use of the tight conventional and standard Glycemic control conditions, revealed that the tight glycemic control was most ideal in minimizing infection rates in patients undergoing open heart surgery.


In any health care facility, nurses take up the vital role of management and care of patients. It is the nurse’s responsibility to monitor a patient prior and after a surgical procedure. Nurses handling post cardiac surgery patients need to have adequate skills and competencies with regard to glycemic control. According to Henry and Martin (2008) the ability of a patient achieving excellent clinical outcomes after undergoing cardiac surgery depends on the nurse’s ability to acquire ideal glucose levels. However, nurses and care givers face numerous challenges that impede their efforts to assist patients recover. Most nurses and care givers lack time due to work overload. The nurse to patient ratio is sometimes so high that it is difficult for the nurses to render quality services to patients. Most nurses and care givers also lack adequate knowledge relating to the importance of glucose control and the overall effects associated to glycemic control. The management of health care facilities thus needs to work with care givers and nurses and ensure that nurses are able to provide optimal care to post cardiac surgery patients.


The control of blood glucose has been given utmost importance due to its association with the occurrence of infections and deaths in post cardiac surgery patients. However, the positive effects associated with the management of blood glucose have been noted in adults only. According to Sciencedaily (2012) blood sugar control strategies are ineffective in assisting infants and children undergoing heart surgery. According to findings provided by the National Institute of Health, risk of post-operative infection in children remains high regardless of blood glucose management efforts. Children are susceptible to infections after undergoing heart surgery regardless of efforts to regulate their blood glucose. It is believed that other factors such as their weak immune systems play a significant role in the health recovery process.

The need for pre-surgical evaluation is paramount so as to minimize problems encountered during and after surgery. Most important, care givers should gather a patient’s medical history and conduct test to verify whether they are diabetic or not. For any patients preparing for cardiac surgery, the main determinant of the ideal preparation process is to determine whether the patient is diabetic.  Examination of the patient’s blood will be essential in determining the patient’s medication and the appropriate time of withdrawal or use of specified medications prior to the surgery.


References

Breithaupt, T. (2010), “Post-operative Glycemic control in cardiac surgery patients”, Journal Of Baylor University Medical Center Proceedings. 23(1): 79-82

Gandhi, G. & McMahon, M. et al. (2007), “Intensive Intraoperative insulin therapy versus conventional glucose management during cardiac surgery”, Annual Journal of Internal Medicine, 146(2007): 233-243

Gower, S. (2012). The effect of tight Glycemic control on surgical site infection rates in patients undergoing open heart surgery. Scholar common: graduate school theses and dissertations

Haga, K. & Alsotn, P. (2011), “The effect of tight Glycemic control, during and subsequent to cardiac surgery, on patient mortality and morbidity: A systematic review and meta-analysis”, Journal of Cardiothoracic Surgery, 6(2011): 3

Henry, L. & Martin, L. (2008), “Nurses perception of Glycemic control in patients who have undergone cardiac surgery”, Clinical Nurse Specialist, 22(6): 271-277

Jeon, C. & Larson, E. (2012), “The role of pre-operative and post-operative glucose control in surgical infection and mortality”, PLoS One, 7(9): e45616

Lazar, H. & Shemin, R. et al. (2009), “Blood glucose management during adult cardiac surgery”, Annual Journal of Thoracic Surgery, 87: 663-9

Lazar, H. (2012), “Glycemic control during coronary artery bypass graft surgery”, ISRN Cardiology, Volume 2012, Article ID 292490, 14 pages

Lingegowda, V. (2008), “Review: evidence for major benefits and harms of anti-diabetic agents for diabetes with heart failure is limited”. ACP Journal Club, 148(1): 4

Martinez, E. & Lehmann, C. (2011), “Successful implementation of a Perioperative Glycemic control protocol in cardiac surgery, Anesthesiology Research and Practice, Article ID 565069, 10 pages, Doi:10.1155/2011/565069

McAlister, F. & Tandon, P. (2003), “Diabetes and coronary artery bypass surgery’, Journal of Diabetes Care, 26(5): 1518-1524

Quattara, A. & Corait, P. (2005), “Poor intraoperative blood glucose control is assisted with a worsened hospital outcome after cardiac surgery”, American Society of Anesthesiologists, 103(1): 687-94

Rosas, M. & Palma, B. (2009), “Glycemic control in cardiac surgery”. In Narin, C. “Perioperative Considerations in Cardiac Surgery”, InTech

Sciencedaily (2012), “Blood sugar control does not help infants and children undergoing heart surgery, study finds”

Smiley, D. & Umpierrez, G. (2006), “Perioperative glucose control in the diabetic or non-diabetic patients”, Southern medical association

European Commission, (2010), “Disseminating project results”, Retrieved from http://ec.europa.eu/eahc/management/Fact_sheet_2010_10.html


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