The Impact of Renal Artery Stenosis on Outcomes after Open-Heart Surgery. Research Paper Example.

The research article focuses its study on open-heart surgery patients diagnosed with atherosclerotic renal artery stenosis. The primary variables were categorized into four; patient variables, procedure-related variables, support device variables, and time variables.

Problem Statement

The informative research problem of the article is the problem of an injury of the acute kidney after undergoing an open-heart surgery can result in an increased morbidity and mortality rate (Philip, Gornik, Rajeswaran, Blackstone, Shishehbor, 2014). To support the problem statement, statistical data is presented. Philip et al. (2014) point out that 3%-30% of open-heart surgery patients end up developing an acute kidney injury, and 1%-5% of the patients who develop the injury have to undergo a renal replacement therapy, which as a result gives them a mortality rate of 60%.

Considering the number of patients who develop acute kidney injuries and their mortality rates consequently affected, the study can be justified. The results as presented by the study can direct the researcher to numerous findings that conclude the study. In the case the study finds a connection between renal artery stenosis and an increased morbidity and mortality rate, then the researcher can conduct a study to find out possible solutions for decreasing the outcome. However, if the study finds no connection, another study can be carried out to evaluate other factors that cause high morbidity and mortality rates after open-heart surgery.

Nurses assess lab values, the output of urine, renal replacement therapy, and participation in perioperative and post care of open-heart surgery patients. Nurses monitor heart and lung pressures continually before and after cardiac surgery. As such, they are conversant with the numbers and ways through which kidney injuries increase or decrease after open-heart surgery.

Nurses have to have a clinical awareness of the risks of acute kidney injuries. Also, nurses know the history of patients and their diagnosis, therefore, they would be in a position to know whether patients with stenosis are more or less prone to acute kidney injuries.

The problem aforementioned is researchable considering that data can be easily collected from patients meeting the criteria. The use of biophysical markers, imaging, and lab values can be evaluated to provide statistical data for the research study.

Conceptual/ Theoretical Framework

There is no written explanation provided in this research article on the type of framework present. According to Green (2014), the framework of a research study can be found in the literature review that is absent in this research article. Green goes on to mention that there are researchers who unequivocally do not include the type of framework in their study, yet will discuss the way through which the study was set up in the literature review. However, while reviewing this research article, the data presented appeared to use a general research framework. A research question is brought forth, data collected, analyzed, and finally, a conclusion answering the question presented. Therefore, a general research framework fits this study considering that the question is answered being supported by the data presented to conclude.

Review of Literature

In Philips et al. research article, The Impact of Renal Artery Stenosis on Outcomes After Open-Heart Surgery a review of literature is not present. However, all through this article, the numbers of references that have been listed are 30 in total and dated between 1972-2012, with the majority dated from the year 1972-2012. In the reference list, three primary resources are evident and are all retrieved from a single source, Blackwell. The remaining references are sourced from secondary sources. Going through the entire research article and the references used to support the researchers data, it is evident that the primary source of both definitions and the statistics used was sourced from the listed references, yet none of these have neither been discussed nor reviewed.

Research Problem/Purpose of the Study

The purpose of the study as presented by the researcher is explained as, However, the impact of ARAS on postoperative glomerular filtration rate (GFR) and clinical outcomes is unknown. We sought to study the impact of ARAS on a postoperative change in GFR, AKI with a need for RRT, length of stay, and overall short-term and long-term mortality. (Philip et al., 2015).

According to the research article, the provided purpose statement can be described as a declarative one. The purpose statement provides the reason as to why they conduct the study, which the researcher explains as finding out the unknown reasons for the outcomes that follow patients diagnosed with renal artery stenosis after undergoing cardiac surgery. Also, the researchers provide the aspects that they will use for the study before a patient undergoes open-heart surgery.

Research Questions/Hypotheses

The research question presented in this research article is, What is the outcome after open heart surgery in patients with renal artery stenosis? In support of this research question, the researchers also point out the precise values they will use to investigate to find an answer to the question posed. However, the absence of a hypothesis by the researchers fails to show the results they expect in regards to the study.

Operational Definitions

Operational definitions ought to state in a precise manner the ways through which variables are measured (Fain, 2015). As such, this research article fails to fully meet this criterion considering that the researchers define only a number of the variable measurements. Using a table, the study presents the number of patients in whom the variables occurred on. However, no particular order has been followed to list them within the categories selected. Additionally, the researchers do not specify how each variable was measured as per the lab values, although they provide the glomerular filtration rate and the equation they used.

Research Design

In the entire research article, Philip et al. fail to identify the type of study that they perform. Fain (2015) defines the term quantitative as, Quantitatively refers to measurement and analysis of relationships between and among variables at a particular point in time. Considering this after reviewing the research article, it can be concluded that the study is quantitative given that the researchers focus on patients diagnosed with renal artery stenosis prior and have undergone open-heart surgery. From their findings, the researchers analyzed and measured the data they gathered categorically and periodically; before patients went for cardiac surgery, 30 days after surgery, 60 days after surgery, and 90 days after surgery. The data analysis tools used was Random Forest Analysis and Power Calculation. Through these analysis tools, data were presented in tables. One of the studys findings was that there was no association between ARAS and post-operative changes.

Summary

The study was only observational meaning that investigation could not allow the assumption of the causes. As a result, the researchers cannot generalize their findings to the other populations. The study came to conclude that there was no association between patients diagnosed with atherosclerotic renal artery stenosis undergoing open-heart surgery and their morbidity and mortality rates.

References

Fain, J. A. (2015). Reading, understanding, and applying nursing research (4th ed). Philadelphia, PA: F.A. Davis Company.

Femi Philip, Heather L. Gornik, Jeevanantham Rajeswaran, Eugene H. Blackstone, Mehdi H.

Shishehbor, The Impact of Renal Artery Stenosis on Outcomes After Open-Heart

Surgery, Journal of the American College of Cardiology, Volume 63, Issue 4, 4 February 2014, Pages 310-316, ISSN 0735-1097, http://dx.doi.org/10.1016/j.jacc.2013.09.046.

(http://www.sciencedirect.com/science/article/pii/S0735109713056064)Green H (2014) Use of theoretical and conceptual frameworks in qualitative research.

Nurse Researcher. 21, 6, 34-38