Parental reactions to children with congenital heart disease

Informal discussions with 260 families of children with congenital heart disease are reported. Parents raised questions concerning etiology, timing of the diagnosis, pathophysiology and symptomatology, and need for restriction. Depending upon the stage and seriousness of the disease, common parental behavior was observed. A psychological process similar to mourning is required at the time of diagnosis and at the time of corrective surgery in order to promote the family's adaptation to the child with congenital heart disease. Management suggestions are included.This study was supported in part by Grant #3990530 from the Mary Duke Biddle Fund and Grant #MH 08045-13 Psychiatry G.P. Special Training.     

Early Pregnancy Loss in the Infertile Couple

The infertile couple invests tremendous amounts of time, money, and physical and emotional energy in attempting to conceive. When these couples experience early pregnancy loss, their grief can be profound. The emotional aspects of such pregnancy losses and specific nursing interventions are presented.     

Respiratory Distress Syndrome and the Induction of Fetal Lung Maturity by the Use of Glucocorticoids

Respiratory distress syndrome (RDS) is the major cause of death in the pediatric age group. The introduction of neonatal intensive care units has improved the chance for survival for those infants who develop RDS, while amniocentesis to determine lung maturity prior to birth can help the health care team reduce the likelihood of RDS in some circumstances. Trials are now being conducted to see if antepartum administration of steroids to women delivering prematurely can further reduce the number of infants afflicted with RDS.     

Emotional Responses to Infertility

Couples and individuals vary in their responses to the infertility experience. The specific emotional stages that couples and individuals pass through as they cope with their infertility are discussed. Appropriate nursing interventions are suggested for each specific stage.     

Part V. Self-care for Continued Breastfeeding

The resources of motivation and knowledge that make the nurse a valuable support to the new mother initiating breastfeeding are needed again, equally as much, as the nurse prepares the mother for self-care at home and remains available for counseling afterwards. There are general guidelines for promoting continued breastfeeding success and for avoiding potential problems. The nurse should be familiar with these and with how to proceed in special situations and with specific breastfeeding problems. "Self-Care for Continued Breastfeeding" and "Some Breastfeeding Problems and Solutions", presented below, end the series on breastfeeding begun in the July/August issue.
The advantages of continuing breastfeeding beyond the neonatal period are reviewed and general guidelines for selfcare at home are discussed. Developmental changes in the instant and psychological and physical changes in the mother are outlined and related to breastfeeding success. Advice for working mothers and for weaning is also presented.     

Oral Contraceptives: Women's Rights, Nurses' Responsibilities

A nurse-educator discusses her concerns about preparing nurses for the role of counselor on birth control—specifically, what the clients should know in order to make informed choices involving the possible use of an oral contraceptive.     

Using a Teaching Guide for Better Postpartum and Infant Care

The development and use of a guide for postpartum and infant care teaching is discussed, including the rationale, methods, and advantages of using this tool at two hospitals of different sizes. Also discussed are the preparation of personnel, ongoing development, and extended uses of the guide.     

Priorities in Prenatal Education

In the provision of prenatal care it is essential that information be shared with pregnant women in an appropriate and effective fashion. Nurse-practitioners and nurse-midwives providing care to women in clinics or offices are concerned with providing relevant instruction in the context of a busy practice or crowded clinic. A priority of information-sharing is proposed in order that the practitioner might capitalize on short encounters with prenatal patients. With the knowledge of what information might be appropriate for a woman at a certain point during her pregnancy, the nurse can plan to incorporate specific instructions as she assesses the woman's needs during a prenatal visit and reflect on the priority of information needed along with the realities of time available.     

The Prognosis for Patients Referred with Suspected Acute Myocardial Infarction

ABSTRACT. Engby B, Strunge P, Olsen J. (Department of Internal Medicine, Horsens Hospital, Horsens, Denmark.) The prognosis for patients referred with suspected acute myocardial infarction. A follow-up investigation of the prognosis of 381 patients admitted with suspected acute myocardial infarction (AMI) has been carried out in respect of later AMI or death. During hospitalization the patients were divided into groups with particular attention to patients with no demonstrable myocardial infarction but with ischaemic heart disease (non-AMI) and patients with confirmed AMI. All patients were subjected to follow-up for 43 months (range 37–54). The mortality from cardiovascular causes after four years was 26.2% of 130 non-AMI patients and 25.8% of AMI patients. The majority of new infarctions were found in the AMI patients, but with even increase in both groups, 50% occurring within the first 12 months. The groups were studied with regard to earlier manifestations of ischaemic heart disease and heart failure during hospitalization, without any difference being observed. Due to the poor prognosis the question is raised whether non-AMI patients as a group should be offered prophylactic therapy.