- Email: [email protected]
The nurse and the heart patient
572
Am. Heart J. October, 1972
-4 nnotations
The three the heart:
divisions of the interventricular A classification of septal defects
As Chief of the Cardiovascular Branch of the Armed Forces Institute of Pathology for nearly two decades, the late William C. Manion, M.D., examined more than 6,000 hearts with congenital defects. A large number of these hearts (more than l,SOO), had interventricular septal defects. It soon became evident to Dr. Manion that the accepted classification of interventricular septal defects into “supracristal-infracristal” was not practical. Because cardiovascular surgeons are accustomed to looking at the hearts of living patients as they are placed on the operating table, it has become customary to designate the ventricular septal defects as either “supracristal” or “infracristal.” Dr. Manion, a pathologist, examined the heart in the vertical position, corresponding to its normal anatomic relation to other organs, and it became obvious to him that the most appropriate anatomic division of the septum was the arbitrary separation of the interventricular septum into three divisions, as illustrated in Fig. 1. These three divisions are anterior (A), midseptal (M), and posterior (P). The anterior division (A) includes the right ventricular outflow tract and is anterior to the “crista supraventricularis” (CS) and conal papillary muscle group (CM). The cardiovascular surgeon often refers to the anterior division as “supracristal.” The midseptal division (M) is where the most common types of septal defects are found, usually referred to as the tetralogy type, membranomuscular, membranous, or muscular septal defects (MS = membranous septum). In the posterior division (P), the defects always involve the muscle. Defects in the posterior division are not common, comprising only about 5 per cent of the 1,500 interventricular septal defects on file in the Manion Laboratory of Cardiovascular Pathology. Antal Szakacs, M.D. Cardiovascular Pathology Branch Armed Forces Institute of Pathology Washington, D. C. 20305. *The
opinions or assertions contained herein are the private of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
views
The nurse The impeccable the physician’s manner. This tient. Patients
and
the
heart
care of the sick requires more than medical knowledge and good bedside is best exemplified by the heart paseriously ill with heart disease require
septum of by Manion*
“n,_-I .(
i 1 “^li : .: : ), :
Fig. 1. Diagrammatic representation of the three divisions of the interventricular septum proposed by Manion. A V, aortic valve: PV, puImonary valve; CS, crista supraventricularis; CM, conal papillary muscle; MS, membranous septum; A, anterior division of septum; M, midseptal division; P, posterior division of septum.
patient well-integrated care by the entire team of attendants. This team is larger than usually realized, each member having important responsibilities. The physician is the captain of the team and the nurse
Volume Number
84 4
is his representative in constant attendance. However, the physician too often takes his nurse for granted, assuming her to be a person with “clairvoyance,” a person who needs no consideration in planning therapy for she has “feminine intuitive powers” and knows what the doctor is thinking. In fact, she has been “trained” snecificallv for this patient during the particular illness with all of its manifestations and potential complications. She is merely told, “The orders are written; I’11 be back shortly.” Perfect care by the nurse is then expected by the busy physician. Good results can occur only in spite of this practice. The physician should study the patient carefully. After the study is completed, the physician should meet with his nurse, review the patient’s illness and diagnosis, objectives in therapy, complications and their manifestations to be anticipated, and the therapeutic orders. The details of and reasons for objectives in management should be discussed with the nurse. The importance of rest, sleep, procedures and drugs, limitations of visitors, avoidances of needless and disturbing talking to the patient, frictions in conversation and tone of voice and the like should be stressed. The need for sympathy but not annoyance by overindulgence should be emphasized. The nurse should be made to realize that she
Annotations
573
is an indispensable member of the team and that constant dedicated effort is expected of her. This type of discussion should apply to all nurses on duty. The discussions with each nurse not only permit the physician to decide if the nurses are adequate and compatible with the personality and illness of his patient but at the same time they make the nurses realize that the physician is serious, that his patient’s welfare comes first, and that he will not tolerate carelessness. The physician must also modify hospital routine practices as indicated, including diet and family behavior, all directed to the best interest of his patient. No nurse should be taken for granted as being capable and as having interest and ability equal to that of the physician; all nurses require special instructions and detailed advice from the physician for the management of each patient, even if the patient has just been readmitted to hospital. Train the trained nurse to fit the needs of each patient!
Tulane
G. E. Burch, M.D. Department of Medicine University School of Medicine 1430 Tulane Ave. New Orleans, La. 70112
Am. Heart J. October, 1972
-4 nnotations
The three the heart:
divisions of the interventricular A classification of septal defects
As Chief of the Cardiovascular Branch of the Armed Forces Institute of Pathology for nearly two decades, the late William C. Manion, M.D., examined more than 6,000 hearts with congenital defects. A large number of these hearts (more than l,SOO), had interventricular septal defects. It soon became evident to Dr. Manion that the accepted classification of interventricular septal defects into “supracristal-infracristal” was not practical. Because cardiovascular surgeons are accustomed to looking at the hearts of living patients as they are placed on the operating table, it has become customary to designate the ventricular septal defects as either “supracristal” or “infracristal.” Dr. Manion, a pathologist, examined the heart in the vertical position, corresponding to its normal anatomic relation to other organs, and it became obvious to him that the most appropriate anatomic division of the septum was the arbitrary separation of the interventricular septum into three divisions, as illustrated in Fig. 1. These three divisions are anterior (A), midseptal (M), and posterior (P). The anterior division (A) includes the right ventricular outflow tract and is anterior to the “crista supraventricularis” (CS) and conal papillary muscle group (CM). The cardiovascular surgeon often refers to the anterior division as “supracristal.” The midseptal division (M) is where the most common types of septal defects are found, usually referred to as the tetralogy type, membranomuscular, membranous, or muscular septal defects (MS = membranous septum). In the posterior division (P), the defects always involve the muscle. Defects in the posterior division are not common, comprising only about 5 per cent of the 1,500 interventricular septal defects on file in the Manion Laboratory of Cardiovascular Pathology. Antal Szakacs, M.D. Cardiovascular Pathology Branch Armed Forces Institute of Pathology Washington, D. C. 20305. *The
opinions or assertions contained herein are the private of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
views
The nurse The impeccable the physician’s manner. This tient. Patients
and
the
heart
care of the sick requires more than medical knowledge and good bedside is best exemplified by the heart paseriously ill with heart disease require
septum of by Manion*
“n,_-I .(
i 1 “^li : .: : ), :
Fig. 1. Diagrammatic representation of the three divisions of the interventricular septum proposed by Manion. A V, aortic valve: PV, puImonary valve; CS, crista supraventricularis; CM, conal papillary muscle; MS, membranous septum; A, anterior division of septum; M, midseptal division; P, posterior division of septum.
patient well-integrated care by the entire team of attendants. This team is larger than usually realized, each member having important responsibilities. The physician is the captain of the team and the nurse
Volume Number
84 4
is his representative in constant attendance. However, the physician too often takes his nurse for granted, assuming her to be a person with “clairvoyance,” a person who needs no consideration in planning therapy for she has “feminine intuitive powers” and knows what the doctor is thinking. In fact, she has been “trained” snecificallv for this patient during the particular illness with all of its manifestations and potential complications. She is merely told, “The orders are written; I’11 be back shortly.” Perfect care by the nurse is then expected by the busy physician. Good results can occur only in spite of this practice. The physician should study the patient carefully. After the study is completed, the physician should meet with his nurse, review the patient’s illness and diagnosis, objectives in therapy, complications and their manifestations to be anticipated, and the therapeutic orders. The details of and reasons for objectives in management should be discussed with the nurse. The importance of rest, sleep, procedures and drugs, limitations of visitors, avoidances of needless and disturbing talking to the patient, frictions in conversation and tone of voice and the like should be stressed. The need for sympathy but not annoyance by overindulgence should be emphasized. The nurse should be made to realize that she
Annotations
573
is an indispensable member of the team and that constant dedicated effort is expected of her. This type of discussion should apply to all nurses on duty. The discussions with each nurse not only permit the physician to decide if the nurses are adequate and compatible with the personality and illness of his patient but at the same time they make the nurses realize that the physician is serious, that his patient’s welfare comes first, and that he will not tolerate carelessness. The physician must also modify hospital routine practices as indicated, including diet and family behavior, all directed to the best interest of his patient. No nurse should be taken for granted as being capable and as having interest and ability equal to that of the physician; all nurses require special instructions and detailed advice from the physician for the management of each patient, even if the patient has just been readmitted to hospital. Train the trained nurse to fit the needs of each patient!
Tulane
G. E. Burch, M.D. Department of Medicine University School of Medicine 1430 Tulane Ave. New Orleans, La. 70112