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Biomedical subjects

B J Holtzclaw

Publications and source records attributed to B J Holtzclaw.

9 recordsLinked to original sources
PubMed1990

Temperature problems in the postoperative period.

Postoperative patients have difficulty maintaining thermal balance for several reasons. Normal thermoregulation is suppressed by anesthesia, neuromuscular blocking agents, and other drugs, and cool environmental conditions and exposure contribute to heat loss. Specific patient groups at high risk for hypothermia include infants, the elderly, and the neurologically impaired. Temperature drift, afterfall, shivering, malignant hyperthermia, and fever are among the temperature-related conditions requiring vigilant assessment and nursing action during the postoperative period.

Body Temperature Regulation↗
PubMed1990

Shivering. A clinical nursing problem.

Shivering is a common but complex phenomenon that occurs in many patient care situations. Its metabolic costs and cardiorespiratory consequences should not be underestimated, particularly for the seriously ill, debilitated, or elderly patient. Using a conceptual frame of reference for assessment and action, independent and collaborative actions can be planned to reduce the energy expenditure, distress, and loss of control imposed by severe shivering.

Humans↗
PubMed1988

Amphotericin B-induced shivering in patients with cancer: a nursing approach.

Shivering is a common and distressful reaction associated with administration of amphotericin B, a systemic antifungal agent. Shivering occurs as a result of the drug's intrinsic pyrogenicity, and thus resembles febrile shivering. This heat loss phenomenon has metabolic as well as psychologic costs. The intervention approach to amphotericin B-induced shivering includes reporting the phenomenon, restoring lost heat, modifying the rate of heat loss, altering the physiologic determination of heat loss, and giving drugs to suppress shivering. Specific suggestions for interventions are discussed. Supportive care of the patient with cancer who is receiving this drug is briefly mentioned as it relates to thermoregulatory principles. Possible areas of future inquiry into shivering suppression are mentioned.

Amphotericin B↗
PubMedDate not supplied

The febrile response in critical care: state of the science.

Fever is a dynamic alteration in thermal balance caused by effects of pyrogens on the hypothalamic thermostatic set point. Thermoregulatory function remains intact during fever, but temperatures are maintained at higher levels. Shivering and vasoconstriction drive temperatures higher while causing physical exertion and distress to the patient. Biomedical research reveals potential benefits of fever, because fever-producing cytokines stimulate host defense responses. Nursing care is aimed at making rational decisions for comfort and energy conservation while maximizing the immune response. In this article the pathophysiologic process and benefits of fever are reviewed and a conceptual approach to nursing care based on knowledge of thermoregulatory responses is proposed. Nursing care measures include assessment of alterations in thermal balance, selection of appropriate measures to modify or support physiologic responses, and evaluation of outcomes of therapy. Research-based direction for care is presented, as well as gaps in scientific knowledge.

Clinical Protocols↗
PubMedDate not supplied

Use of amphotericin B in immunosuppressed patients with cancer. Part One: Pharmacology and toxicities.

Potentially fatal fungal infections account for most of the prolonged fevers found in immunosuppressed patients with cancer. Amphotericin B (AmB) is the most effective drug available to treat these infections. This article, Part One of two parts, reviews the biochemical properties of AmB and its dosage and administration. Major toxicities and common side effects are discussed. Part Two uses the pharmacodynamics addressed in Part One as a basis for planning nursing interventions to prevent or suppress adverse reactions.

Amphotericin B↗
PubMedDate not supplied

Use of amphotericin B in immunosuppressed patients with cancer. Part Two: Pharmacodynamics and nursing implications.

Nursing care of patients receiving amphotericin B (AmB) must address the underlying condition of the immunosuppressed patient with cancer and the iatrogenic responses induced by the drug. This review, the companion to "Part One: Pharmacology and Toxicities," focuses on nursing actions that consider both the drug's specific pharmacodynamics and the altered human responses caused by disease and therapy. Maximization of drug effectiveness and minimization of drug toxicity are key care goals.

Amphotericin B↗
PubMedDate not supplied

Effects of extremity wraps to control drug-induced shivering: a pilot study.

Efficacy of a nursing intervention to control amphotericin B-induced, febrile shivering was tested in 40 hospitalized adult patients with cancer. Extremity wraps were used to modify the rate of heat loss from skin to prevent shivering stimulus. Duration of shivering and amount of meperidine required for shivering suppression were compared between treatment and control groups. Total shivering duration was shorter in the treatment group than in the control, p less than .005. Less meperidine was administered to the treatment group than to controls but differences were not statistically significant. The fact that nurses differ in their propensity to use a narcotic to treat shivering may make use of meperidine a poor measure of the intervention's efficacy. Shivering was found to significantly affect myocardial oxygen consumption (MVO2) among subjects who shivered. MVO2, as reflected in the rate pressure product, was found to be significantly higher during shivering (p less than .0001) than at pre- or postshivering periods.

Adult↗
PubMedDate not supplied

Control of febrile shivering during amphotericin B therapy.

"Rigors" of febrile shivering often complicate therapy with amphotericin B (AmB) in immunosuppressed patients with cancer. Violent muscle contractions cause physical and emotional distress as well as dread of future therapy. This experimental study tested the effectiveness of a nursing measure in 20 hospitalized adult patients with cancer. In addition, the effects of shivering on myocardial oxygen consumption were studied. Based on Abbey's Model of Nursing Action, wraps of terry cloth toweling were applied to extremities to protect dominant skin sensors against heat loss. Patients with wrapped extremities had shorter, less severe shivering episodes than controls (p = 0.04) and required less meperidine for shivering suppression (p = 0.04). Shivering significantly elevated myocardial oxygen consumption, reflected in the rate pressure product (RPP), above pre- or post-shivering levels (p less than 0.0001). The study reflects first-year findings of a federally funded project.

Adult↗