Intensive Care Of The Adult With Congenital Heart Disease

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Intensive Care of the Adult with Congenital Heart Disease

Author : Eduardo da Cruz
Publisher : Springer
ISBN 13 : 3319941712
Total Pages : 571 pages
Book Rating : 4.3/5 (199 download)

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Book Synopsis Intensive Care of the Adult with Congenital Heart Disease by : Eduardo da Cruz

Download or read book Intensive Care of the Adult with Congenital Heart Disease written by Eduardo da Cruz and published by Springer. This book was released on 2018-12-31 with total page 571 pages. Available in PDF, EPUB and Kindle. Book excerpt: Dedicated to the critical management of acutely ill adults with congenital heart disease, this comprehensive book discusses the many challenges faced in the management of these patients, who require intensive inter- and trans-disciplinary care. It provides the first universal review of the practical management of patients with these complex conditions, who survive into adulthood with congenital cardiac malformations and are often affected by other morbidities. For this reason, it reflects a consistent interaction and collaboration between several disciplines: pediatric and adult cardiology, cardiac surgery, pediatric and adult cardiac intensive care, anesthesia, intensive care nursing, nutrition, psychology and many other specialties. It offers concise and pragmatic recommendations, and provides basic and advanced concepts that allow caregivers to anticipate, prevent and effectively treat such pathologies. The book also includes chapters focusing on cardiac-database and risk-factor assessment, organizational and operational topics, advanced mechanical circulatory assistance and pharmacology. Whilst bringing together top international experts who are leading reference programs around the globe, this book is an indispensable teaching tool for clinicians and caregivers involved in the management of critically ill adults with congenital heart disease.

Critical Care of Children with Heart Disease

Author : Ricardo Munoz
Publisher : Springer Science & Business Media
ISBN 13 : 1848822626
Total Pages : 1185 pages
Book Rating : 4.8/5 (488 download)

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Book Synopsis Critical Care of Children with Heart Disease by : Ricardo Munoz

Download or read book Critical Care of Children with Heart Disease written by Ricardo Munoz and published by Springer Science & Business Media. This book was released on 2010-06-21 with total page 1185 pages. Available in PDF, EPUB and Kindle. Book excerpt: Critical Care of Children with Heart Disease will summarize the comprehensive medical and surgical management of the acutely-ill patient with congenital and acquired cardiac disease. The aim of the book is to teach bedside physicians, nurses and other caregivers, basic and practical concepts of anatomy, pathophysiology, surgical techniques and peri-operative management of critically ill children and adults with congenital heart disease, allowing these professionals to anticipate, prevent or else treat such pathologies. The book will cover specific cardiac lesions, review their anatomy, pathophysiology, current preoperative, intraoperative and postoperative assessment and management; medical and surgical complications will be briefly described with each lesion further discussed in specific chapters. In addition, the book will have dedicated chapters to management of cardiac patients on extracorporeal membrane oxygenation, hemofiltration, hemo or peritoneal dialysis and plasma exchange. Practical guidelines for cardiovascular nursing care will be also included.

Critical Heart Disease in Infants and Children E-Book

Author : Ross M. Ungerleider
Publisher : Elsevier Health Sciences
ISBN 13 : 1455751006
Total Pages : 960 pages
Book Rating : 4.4/5 (557 download)

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Book Synopsis Critical Heart Disease in Infants and Children E-Book by : Ross M. Ungerleider

Download or read book Critical Heart Disease in Infants and Children E-Book written by Ross M. Ungerleider and published by Elsevier Health Sciences. This book was released on 2018-09-26 with total page 960 pages. Available in PDF, EPUB and Kindle. Book excerpt: Features comprehensive updates throughout the text, including indications, techniques, potential complications in perioperative management of patients, and surgical techniques for congenital heart disease. Covers recent advances in the treatment of pulmonary hypertension, developments in mechanical assist devices, heart and lung transplantation, and interventional cardiac catheterization. Features an all-new, full-color format that speeds navigation and helps clarify complex concepts. Contains 27 new chapters with an emphasis on the team approach to patient care in the ICU including creating multidisciplinary teams, quality and performance improvement, training , and challenges and solutions to developing a cohesive team environment. Includes a detailed chapter on bedside ultrasound, walking you through the techniques you’re most likely to encounter in the ICU. Employs well-documented tables, text boxes, and algorithms to make clinical information easy to access, and to provide a more complete understanding of echocardiography, imaging modalities, pulmonary hypertension, and more. Describes the basic pharmacology and clinical applications of new pharmacologic agents. Examines issues affecting adults with congenital heart disease.

Cardiovascular Pediatric Critical Illness and Injury

Author : Derek S. Wheeler
Publisher : Springer Science & Business Media
ISBN 13 : 1848009232
Total Pages : 294 pages
Book Rating : 4.8/5 (48 download)

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Book Synopsis Cardiovascular Pediatric Critical Illness and Injury by : Derek S. Wheeler

Download or read book Cardiovascular Pediatric Critical Illness and Injury written by Derek S. Wheeler and published by Springer Science & Business Media. This book was released on 2009-03-01 with total page 294 pages. Available in PDF, EPUB and Kindle. Book excerpt: The development of pediatric cardiac surgical programs has had a profound effect on the s- cialty of pediatric critical care medicine, and as a result, the ? eld of pediatric cardiac intensive care is rapidly emerging as a separate subspecialty of pediatric critical care medicine. The ability to provide care for the critically ill child with congenital heart disease clearly separates pediatric intensivists from our adult colleagues. A thorough understanding and knowledge of the unique physiology of the child with congenital heart disease are therefore absolutely crucial for anyone working in the pediatric intensive care unit. Once again, we would like to dedicate this textbook to our families and to the physicians and nurses who provide steadfast care every day in pe- atric intensive care units across the globe. Derek S. Wheeler Hector R. Wong Thomas P. Shanley v Preface to Pediatric Critical Care Medicine: Basic Science and Clinical Evidence The ? eld of critical care medicine is growing at a tremendous pace, and tremendous advances in the understanding of critical illness have been realized in the last decade. My family has directly bene? ted from some of the technological and scienti? c advances made in the care of critically ill children. My son Ryan was born during my third year of medical school. By some peculiar happenstance, I was nearing completion of a 4-week rotation in the newborn intensive care unit (NICU).

Cardiovascular Critical Care

Author : Mark J.D. Griffiths
Publisher : John Wiley & Sons
ISBN 13 : 1444391356
Total Pages : 533 pages
Book Rating : 4.4/5 (443 download)

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Book Synopsis Cardiovascular Critical Care by : Mark J.D. Griffiths

Download or read book Cardiovascular Critical Care written by Mark J.D. Griffiths and published by John Wiley & Sons. This book was released on 2011-03-25 with total page 533 pages. Available in PDF, EPUB and Kindle. Book excerpt: Remarkable improvements in cardiac survival rates have made cardiovascular critical care much more common, but no less challenging for the practitioner. This important volume draws on the skills of an expert team of editors and contributors to present a timely overview of clinical practice. The book covers the full range of the field, from pre-operative assessment and the haematological complications of cardiovascular surgery and critical care to the care of patients with: · Arrhythmias · Heart Failure · Adult Congenital Heart Disease · Mitral Valve Disease · Aortic Valve Disease · Infective Endocarditis · Vasculitis The authors also address the special problems associated with the management of conditions consequent upon pregnancy, eclampsia, and the hypertensive crisis. With high-quality illustrations and a helpful index, Cardiovascular Critical Care gives you access to information that helps you provide the best possible care to your patients.

Critical Heart Disease in Infants and Children E-Book

Author : David G. Nichols
Publisher : Elsevier Health Sciences
ISBN 13 : 0323070078
Total Pages : 1041 pages
Book Rating : 4.3/5 (23 download)

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Book Synopsis Critical Heart Disease in Infants and Children E-Book by : David G. Nichols

Download or read book Critical Heart Disease in Infants and Children E-Book written by David G. Nichols and published by Elsevier Health Sciences. This book was released on 2006-08-29 with total page 1041 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pediatric intensivists, cardiologists, cardiac surgeons, and anesthesiologists from the leading centers around the world present the collaborative perspectives, concepts, and state-of-the-art knowledge required to care for children with congenital and acquired heart disease in the ICU. Their multidisciplinary approach encompasses every aspect of the relevant basic scientific principles, medical and pharmacologic treatments, and surgical techniques and equipment. From the extracardiac Fontan procedure, and the Ross procedure through new pharmacologic agents and the treatment of pulmonary hypertension to mechanical assist devices, heart and lung transplantation, and interventional cardiac catheterization—all of the developments that are affecting this rapidly advancing field are covered in depth. Employs well-documented tables, text boxes, and algorithms to make clinical information easy to access. Features chapters each written and reviewed by intensivists, surgeons, and cardiologists. Integrates the authors' extensive experiences with state-of-the-art knowledge from the literature. Offers four completely new chapters: Cardiac Trauma, Congenital Heart Disease in the Adult, Congenitally Corrected Transposition of the Great Arteries, and Outcome Evaluation. Describes the basic pharmacology and clinical applications of all of the new pharmacologic agents. Details important refinements and developments in surgical techniques, including the Ross pulmonary autograft replacement of the aortic valve, video-assisted fluoroscopy, and the extracardiac Fontan connection, and discusses their indications and potential complications. Explores the latest advances in the treatment of pulmonary hypertension, new developments in mechanical assist devices, heart and lung transplantation, and interventional cardiac catheterization. Examines issues affecting adults with congenital heart disease.

Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care

Author : Eduardo da Cruz
Publisher : Springer
ISBN 13 : 9781447146186
Total Pages : 3572 pages
Book Rating : 4.1/5 (461 download)

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Book Synopsis Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care by : Eduardo da Cruz

Download or read book Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care written by Eduardo da Cruz and published by Springer. This book was released on 2013-10-28 with total page 3572 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care provides a consistent and comprehensive approach to multiple congenital and acquired cardiac pathologies pre, peri and postoperatively, with the use of algorhythms, guidelines and current research issues. Included with the e-reference are interactive videos with the most common interventions, online access to practical learning activities, and to the comprehensive Aristotle score and database. This reference work satisfies the need for a universal and practical review of management of critically ill children and adults with congenital heart disease, based upon taskforce decisions and the cumulative experience of the world leaders in the field.

Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care

Author : Eduardo M, da Cruz
Publisher : Springer
ISBN 13 : 9783030622923
Total Pages : 3500 pages
Book Rating : 4.6/5 (229 download)

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Book Synopsis Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care by : Eduardo M, da Cruz

Download or read book Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care written by Eduardo M, da Cruz and published by Springer. This book was released on 2022-03-29 with total page 3500 pages. Available in PDF, EPUB and Kindle. Book excerpt: This thoroughly updated key reference is an innovative project that provides a continuous editorial effort to update scholarly information related to the comprehensive prevention, management and follow-up of congenital and acquired cardiac pathologies. It illustrates the need for interdisciplinary collaboration and evidence-based practices as well as perspectives of future modalities of patient care. Included are interactive videos with the most common interventions, online access to practical learning activities and to the comprehensive scores and database information. This second edition of Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care is a universal and practical review of management of critically ill children and adults with congenital heart disease, based upon taskforce decisions and the cumulative experience of the world leaders in the field.

Pediatric Cardiac Intensive Care

Author : Anthony C. Chang
Publisher : Lippincott Williams & Wilkins
ISBN 13 : 9780683015089
Total Pages : 608 pages
Book Rating : 4.0/5 (15 download)

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Book Synopsis Pediatric Cardiac Intensive Care by : Anthony C. Chang

Download or read book Pediatric Cardiac Intensive Care written by Anthony C. Chang and published by Lippincott Williams & Wilkins. This book was released on 1998 with total page 608 pages. Available in PDF, EPUB and Kindle. Book excerpt: A distinguished list of contributors from some of the major international centers covers this specialty like never before. With recent advances in ultrasound technology and pharmacology the expertise required to care for a critically ill child with heart disease takes an integrated approach with a multidisciplinary team and central focus. This resource provides comprehensive discussions of pertinent cardiac issues in the ICU setting with emphasis on perioperative care.

A Practical Handbook on Pediatric Cardiac Intensive Care Therapy

Author : Dietrich Klauwer
Publisher : Springer
ISBN 13 : 3319924419
Total Pages : 581 pages
Book Rating : 4.3/5 (199 download)

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Book Synopsis A Practical Handbook on Pediatric Cardiac Intensive Care Therapy by : Dietrich Klauwer

Download or read book A Practical Handbook on Pediatric Cardiac Intensive Care Therapy written by Dietrich Klauwer and published by Springer. This book was released on 2018-11-11 with total page 581 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book combines valid physiology and treatment strategies with the institutional experience of one of the leading German pediatric heart centers. It is intended as a pragmatic guide, focusing on daily practice and bedside medicine: straightforward, easy to implement, and results-oriented. It offers readers a profound understanding of intensive care, with a specific focus on organ systems, their interactions, and the effect of life support technologies, pursuing a comprehensive approach to congenital heart defects and therapies, including pitfalls and solutions. The target group is extended towards pediatric cardiologists and anesthesiologists by integrating chapters on the systematic analysis of hemodynamics and anatomy, diagnostics and treatment of congenital heart defects, plus a chapter on modern anesthesiology during heart operations with a focus on early extubation that minimizes on-pump and medication trauma. As such, the book offers a pragmatic and clinically oriented guide for physicians with advanced experience and expertise in (cardiac) intensive and intermediate care, as well as beginners and junior physicians.

Hospital Resource Utilization and Presence of Advance Directives at the End of Life for Adults with Congenital Heart Disease

Author : Jill M. Steiner
Publisher :
ISBN 13 :
Total Pages : 17 pages
Book Rating : 4.:/5 (18 download)

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Book Synopsis Hospital Resource Utilization and Presence of Advance Directives at the End of Life for Adults with Congenital Heart Disease by : Jill M. Steiner

Download or read book Hospital Resource Utilization and Presence of Advance Directives at the End of Life for Adults with Congenital Heart Disease written by Jill M. Steiner and published by . This book was released on 2018 with total page 17 pages. Available in PDF, EPUB and Kindle. Book excerpt: Objective: Overall healthcare resource utilization by adults with congenital heart disease has increased dramatically in the last two decades. No prior studies have examined utilization at the end of life. The objective of this study is to better understand the patterns and influences on the intensity of care at the end of life for adults with congenital heart disease. Methods: We identified a sample of adults with congenital heart disease, cancer, or heart failure who died between January 2010 and December 2015. We used multivariate analysis to evaluate markers of resource utilization, location of death, and documentation of advance care planning among patients with congenital heart disease versus those with cancer and those with heart failure. Results: Close to 40% of adults with congenital heart disease experienced inpatient and intensive care unit hospitalizations in the last 30 days of life; 64% died in the hospital. Compared to patients with cancer, patients with ACHD were more likely to have inpatient (adjusted risk ratio 1.57; 95% CI 1.12-2.18) and intensive care unit admissions in the last 30 days of life (adjusted risk ratio 2.56; 95% CI 1.83, 3.61), more likely to die in the hospital (adjusted risk ratio 1.75; 95% CI 1.43, 2.13), and more likely to have documentation of advance care planning (adjusted risk ratio 1.46; 95% CI 1.09, 1.96). Compared to patients with HF, they were less likely to have an intensive care unit admission in the last 30 days of life (adjusted risk ratio 0.73; 95% CI 0.54, 0.99). Conclusions: Adults with congenital heart disease have significant hospital resource utilization near the end of life, notable for more hospitalizations and a higher likelihood of death in the hospital compared to patients with cancer. This population represents an important opportunity for the application of palliative and supportive care.

Adult Congenital Heart Disease

Author : Sara Thorne
Publisher : Oxford University Press
ISBN 13 : 0198759959
Total Pages : 277 pages
Book Rating : 4.1/5 (987 download)

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Book Synopsis Adult Congenital Heart Disease by : Sara Thorne

Download or read book Adult Congenital Heart Disease written by Sara Thorne and published by Oxford University Press. This book was released on 2017 with total page 277 pages. Available in PDF, EPUB and Kindle. Book excerpt: A practical approach to the investigation and treatment of adult congenital heart disease (ACHD), this fully updated Oxford Specialist Handbook is a concise and accessible overview of a complex condition. Packed with straightforward advice, management strategies and key clinical points, it equips clinicians with a sound understanding of the principles and physiology of ACHD. An ideal reference tool for cardiology trainees, general cardiologists and acute medicine physicians, this second edition of Adult Congenital Heart Disease has been fully reviewed to include new guidelines and increased illustations to aid understanding. Brand new chapters on epidemiology, heart failure, device therapy and transition and transfer of care ensure that Adult Congenital Heart Disease remains the definitive guide to supporting clinicians throughout all aspects of the patient's care.

Diagnosis and Management of Adult Congenital Heart Disease E-Book

Author : Michael A. Gatzoulis
Publisher : Elsevier Health Sciences
ISBN 13 : 0702069310
Total Pages : 576 pages
Book Rating : 4.7/5 (2 download)

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Book Synopsis Diagnosis and Management of Adult Congenital Heart Disease E-Book by : Michael A. Gatzoulis

Download or read book Diagnosis and Management of Adult Congenital Heart Disease E-Book written by Michael A. Gatzoulis and published by Elsevier Health Sciences. This book was released on 2017-02-02 with total page 576 pages. Available in PDF, EPUB and Kindle. Book excerpt: Designed to meet the needs of clinicians working with adults with congenital heart disease, Diagnosis and Management of Adult Congenital Heart Disease , by Drs. Michael A. Gatzoulis, Gary D. Webb, and Piers E. F. Daubeney, offers essential guidance on the anatomical issues, clinical presentation, diagnosis, and treatment options available to practitioners today. This latest edition features completely updated content, including new information for nurses and nurse practitioners who, now more than ever, are playing an important role in the care of adults with CHD. You'll also access four new chapters, illustrated congenital defects, coverage of long-term outcomes, and much more. Drs. Gatzoulis, Webb, and Daubeney lead a team of experts ideally positioned to provide state-of-the-art global coverage of this increasingly important topic. Each disease-oriented chapter is written to a highly structured template and provides key information on incidence, genetics, morphology, presentation, investigation and imaging, and treatment and intervention. Congenital defects are illustrated with full-color line drawings and by the appropriate imaging modality (for example, EKG, x-ray, echocardiogram, MRI, CT, ). Provides coverage of long-term outcomes, including the management of pregnant patients and patients undergoing non-cardiac surgery. Features the addition of four new chapters: A Historic Perspective; Quality of Life in Patients with Pulmonary Hypertension; Psychosocial Issues in ACHD; Supportive and Palliative Care for End-Stage ACHD.

Diagnosis and Management of Adult Congenital Heart Disease E-Book

Author : Michael A. Gatzoulis
Publisher : Elsevier Health Sciences
ISBN 13 : 1455710016
Total Pages : 527 pages
Book Rating : 4.4/5 (557 download)

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Book Synopsis Diagnosis and Management of Adult Congenital Heart Disease E-Book by : Michael A. Gatzoulis

Download or read book Diagnosis and Management of Adult Congenital Heart Disease E-Book written by Michael A. Gatzoulis and published by Elsevier Health Sciences. This book was released on 2010-10-13 with total page 527 pages. Available in PDF, EPUB and Kindle. Book excerpt: Diagnosis and Management of Adult Congenital Heart Disease, by Drs. Gatzoulis, Webb, and Daubeney, is a practical, one-stop resource designed to help you manage the unique challenges of treating long-term adult survivors of congenital heart disease. Authored by internationally known leaders in the field, this edition is the first that truly integrates anatomy and imaging technology into clinical practice, and includes new chapters on cardiac CT for ACHD assessment, critical and perioperative care, anesthesia for ACHD surgery, cardiac resynchronization therapy, and transition of care. Congenital defects are presented with high-quality illustrations and appropriate imaging modalities. Find all the information you need in one user-friendly resource that integrates anatomy, clinical signs, and therapeutic options. Confidently make decisions aided by specific recommendations about the benefits and risks of surgeries, catheter interventions, and drug therapy for difficult clinical problems. Recognize and diagnose morphologic disorders with the help of detailed, full-color diagrams. Quickly find what you need thanks to easily accessible, consistently organized chapters and key annotated references. Keep pace with the latest advancements including five new chapters on cardiac CT for ACHD assessment, critical and perioperative care, anaesthesia for ACHD surgery, cardiac resynchronisation therapy, and transition of care Comply with the latest European Society of Cardiology (ESC) and American College of Cardiology (ACC) practice guidelines - integrated throughout the book - for cardiac pacing and cardiac resynchronisation therapy See imaging findings as they appear in practice and discern subtle nuances thanks to new, high-quality images and illustrations Integrates anatomy, clinical signs and therapeutic options of congenital heart disease both in print and online!

A Practical Manual of Pediatric Cardiac Intensive Care

Author : Rakhi Balachandran
Publisher : JP Medical Ltd
ISBN 13 : 9390595630
Total Pages : 449 pages
Book Rating : 4.3/5 (95 download)

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Book Synopsis A Practical Manual of Pediatric Cardiac Intensive Care by : Rakhi Balachandran

Download or read book A Practical Manual of Pediatric Cardiac Intensive Care written by Rakhi Balachandran and published by JP Medical Ltd. This book was released on 2021-08-31 with total page 449 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Cardiac Intensive Care

Author : Allen Jeremias
Publisher : Elsevier Health Sciences
ISBN 13 : 141603773X
Total Pages : 738 pages
Book Rating : 4.4/5 (16 download)

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Book Synopsis Cardiac Intensive Care by : Allen Jeremias

Download or read book Cardiac Intensive Care written by Allen Jeremias and published by Elsevier Health Sciences. This book was released on 2010 with total page 738 pages. Available in PDF, EPUB and Kindle. Book excerpt: Ventilator Management for the Cardiac Patient; Management of Post-Operative Complications in the Cardiac Surgery Patient; Guidelines Relevant to Care in the Cardiac Intensive Care Unit--to keep the book and you up to date. yPresents the text in a new, full-color design and layout for a more visually-appealing and accessible format that makes finding the information you need quick and easy.

Guide for Advanced Nursing Care of the Adult with Congenital Heart Disease

Author : Serena Francesca Flocco
Publisher : Springer Nature
ISBN 13 : 3031075986
Total Pages : 325 pages
Book Rating : 4.0/5 (31 download)

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Book Synopsis Guide for Advanced Nursing Care of the Adult with Congenital Heart Disease by : Serena Francesca Flocco

Download or read book Guide for Advanced Nursing Care of the Adult with Congenital Heart Disease written by Serena Francesca Flocco and published by Springer Nature. This book was released on 2022-12-01 with total page 325 pages. Available in PDF, EPUB and Kindle. Book excerpt: The aim of this book is to provide one central resource for nurses within the adult spectrum of life-long congenital heart disease care who are seeking expert guidance for their practice, regardless of clinical setting. Over the past 50 years, advances in surgical techniques and medical therapies have drastically improved the number of congenital heart disease patients surviving into adulthood, with the result being that there are now more adults then children living with congenital heart disease. In the past three decades, recognition of this new cardiology subspecialty has given way to formalized programs, standards of care, and multidisciplinary expertise. Indeed Nursing care of adult patients with congenital heart disease (ACHD) is a relatively new medical subspecialty with limited knowledge and guidance available and also an important component of the multidisciplinary care team. Nursing care of the ACHD encompasses a holistic approach to the physical, psychological, social, and spiritual wellbeing of these unique individuals across their lifespan. Understanding the intricacies for the various heterogeneous defect types, the transition from pediatric to adult care, the unique educational and self-care needs, life-events such as pregnancy/reproduction, advanced heart failure, and end-of-life care helps prepare the nurse caring for the ACHD patient. Nurses as a first point of care for the ACHD patients play a pivotal role in the education and empowerment of the ACHD patient population and provide an invaluable role in the multidisciplinary team and with this guide nurses can feel confident in the quality of the care they provide. This book aims to introduce nursing focused care to wider audiences, nurses, medical technicians, and physicians who are involved in the management and treatment of ACHD patients. Improving care and the quality of life for adult congenital heart disease patients with a multidisciplinary team-based approach, including nursing care, should be a central goal for all ACHD programs.