Physiological responses of myocardial infarction patients to transfer from the coronary care unit.
Creators: name: Wood, Connie
Publisher: name: University of Utah
Year: 2012
Subjects: Arrhythmias
Oxygen Consuption

description: This study investigated the immediate post-transfer phase of the recovery period of the myocardial infraction patient to determine if transfer from the coronary care unit to the general medial unit was associated with a physiological stress response.  If such a response did occur, it could be a serious threat to the already decompensted cardiovascular system of the myocardial infarction patients.  The general problem considered in the study was the effects of transferring myocardial infraction patients from the coronary care unit on pulse rate, systolic blood pressure, diastolic blood pressure, pulse pressure, and number and type of arrhythmia.  A Biographical Data Sheet, Pre- and Post-transfer Questionnaires, and Physiological data Sheets were developed and utilized for data collection during the study.  The final study group was 40 myocardial infarction patients transferred from the coronary unit to the general medical unit during a two-month study period.  Statistically significant increases, as assessed by t-tests for dependent measures, occurred between the 15-minute mean pre-transfer pulse rates, systolic blood pressure, diastolic blood pressure and pulse pressure when compared with 30-minute mean post-transfer reading for each of these variables.  Graphic analysis of pulse rate, systolic blood pressure, diastolic blood pressure, and pulse for specified intervals four hours pre-transfer and four post-transfer indicated that the change in these variables is a diffuse phenomena rather an acute phenomena.  In other words, there was only a moderate increase in the post-transfer means for pulse rate, systolic blood pressure, diastolic blood pressure, pulse pressure, but the changes were present throughout most of the four hour study period.  Although the mean changes between the 15-minute pre-transfer readings and the 30-minute post-transfer reading for pulse rate, systolic blood pressure, diastolic blood pressure, pulse pressure were statistically significant they did not achieve clinical significant.  This is to say that the mean increases noted for each of these variables did not reach the 10-beat per minute or the 10 mm Hg pressure changes established by Braumelle in 1976 as clinically significant changes in pulse rates and pressure readings in the early post-myocardial infarction patient.   Arrhythmia data was limited and did not allow for statistical analysis.  Several biographical as well as psychological variables were correlated with the increase in the mean the mean 30-minute pot-transfer pulse was found that females did have a statistically significant increase in their 30-minute post-transfer pulse when compared to their male counterparts, utilizing a t-test for independent measures.  No statistically significant difference was found in patients classified according to age, previous myocardial infarction history, number of days spent in the coronary care unit or the nurse's or patient's rating of preparation for transfer.  Therefore, this study indicates that a physiological stress response does occur when the myocardial infarction patient is transferred from the coronary care unit to the general medical unit.  The sex of the patients is the only factor which is significantly correlated with the occurrence of this response identified in this study.  Further research is necessary to determine the exact nature of this response and other factors related to its occurrence.  It is suggested that further research should be conducting using a larger and more randomly selected patient population.  Other recommendations include: Elimination of arrhythmia number and type of physiological stress indicator or the utilization of five-minute rhythm strips rather than one-minute rhythm strips; utilization of standardized anxiety tests rather than patient questionnaires to determine patient's psychological response to transfer; and more control over external variables, i.e., time of transfer, length of time between when the patient is informed about transfer and actual transfer, and patient preparation for transfer.