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Biomedical subjects

K Puntillo

Publications and source records attributed to K Puntillo.

11 recordsLinked to original sources
PubMed2001

Advancing the science of symptom management.

UNLABELLED: Since the publication of the original Symptom Management Model (Larson et al. 1994), faculty and students at the University of California, San Francisco (UCSF) School of Nursing Centre for System Management have tested this model in research studies and expanded the model through collegial discussions and seminars. AIM: In this paper, we describe the evidence-based revised conceptual model, the three dimensions of the model, and the areas where further research is needed. BACKGROUND/RATIONALE: The experience of symptoms, minor to severe, prompts millions of patients to visit their healthcare providers each year. Symptoms not only create distress, but also disrupt social functioning. The management of symptoms and their resulting outcomes often become the responsibility of the patient and his or her family members. Healthcare providers have difficulty developing symptom management strategies that can be applied across acute and home-care settings because few models of symptom management have been tested empirically. To date, the majority of research on symptoms was directed toward studying a single symptom, such as pain or fatigue, or toward evaluating associated symptoms, such as depression and sleep disturbance. While this approach has advanced our understanding of some symptoms, we offer a generic symptom management model to provide direction for selecting clinical interventions, informing research, and bridging an array of symptoms associated with a variety of diseases and conditions. Finally, a broadly-based symptom management model allows the integration of science from other fields.

Holistic Nursing↗
PubMed2001

Predictors of cardiac patients' psychophysiological responses to caregiving.

Patients who are hospitalized for treatment of cardiac problems are at risk from life-threatening cardiovascular changes related to autonomic nervous system (ANS) arousal. Physical care during hospitalization can increase ANS arousal, yet caregiving is an essential feature of patient treatment. The purpose of this study was to identify the degree to which a patient's vulnerability to sensory stimuli, perceptions of previous caregiving and stressful events during hospitalization may contribute to ANS arousal during caregiving. Fifty-nine patients, who were hospitalized for treatment of coronary artery or valvular disease, received a standardized protocol designed to simulate aspects of physical caregiving. Heart rate, incidence of arrhythmias, blood pressure and state anxiety were measured during the protocol to determine ANS arousal. Regression analyses provided evidence that sensory vulnerability was the most consistent predictor across all indices of arousal during caregiving. Previous caregiving experiences that were perceived as 'negative' by the patient also contributed to higher blood pressure and anxiety. Stressful hospital events involving the family predicted higher blood pressure during caregiving.

Adult↗
PubMed1997

Dimensions of pain and analgesic administration associated with coronary artery bypass grafting in an Australian intensive care unit.

This descriptive correlation study evaluated the pain intensity, pain distress and morphine consumption in patients recovering from coronary artery bypass grafting (CABG) surgery in an Australian intensive care unit (ICU) and compared patients' pain intensity ratings with ratings of the nursing staff. Forty-three patients and their attending nurses rated patients' pain intensity and pain distress levels at 8-hourly intervals throughout their stay in ICU. A maximum of five assessments was obtained in the first 48 post-operative hours from patients and their nurses. Pain intensity and pain distress were measured using separate 10-point numerical rating scales (NRS). Patients' worst pain intensity scores increased over time in ICU; the amount of opioids they received was small and decreased over time. Significant differences occurred between patients' and nurses' average pain intensity scores at each time point and, except for worst pain intensity measures at the first assessment, nurses consistently underestimated patients' pain. These results indicate that patients in ICU following CABG can experience considerable pain, which is not always relieved. The application of regular systematic pain assessment and improved communication, together with the administration of adequate pain relief are necessary if nurses are to manage patients' pain effectively.

Analgesics, Opioid↗
PubMed1996

Clinical judgment and management of postoperative pain in critical care patients.

BACKGROUND: Acute pain is a significant problem in critical care patients. Although many barriers to successful assessment and management of pain in critical care patients have been noted, little is known about how critical care nurses make clinical judgments when assessing and managing patients' pain. OBJECTIVE: This qualitative analysis is part of a pilot study evaluating nurses' use of a pain assessment and intervention notation algorithm in patients in critical care areas who have limited communication abilities after abdominal or thoracic surgery. METHOD: Transcribed audiotapes of nurse participants' "thinking aloud" while using the pain assessment and intervention notation algorithm were analyzed by using interpretive phenomenology. The interpretive account is based on 31 tape recordings of 14 nurses caring for 41 patients (12 patients in the ICU and 29 patients in the postanesthesia care unit). FINDINGS: The two domains of clinical judgment found were (1) assessing the patient and (2) balancing interventions. CONCLUSIONS: Many nurses' reports showed that they accurately assessed their patients' needs for analgesics. Through testing of and learning from their patients' responses, nurses were able to give amounts of analgesics that diminished patients' postoperative pain. Additionally, nurses had to balance analgesic administration against the patients' hemodynamic and respiratory conditions, medical plan and prescriptions, and the desires of the patients and the patients' families.

Adult↗
PubMedDate not supplied

Opioid and benzodiazepine tolerance and dependence: application of theory to critical care practice.

Critical care clinicians frequently manage patient pain and agitation and promote ventilator stability through use of opioids and benzodiazepines. Often, doses of these drugs must be increased considerably over time as they lose their effectiveness-an indication of drug tolerance. Furthermore, patients can experience negative physiologic responses to withdrawal of these drugs-an indication of drug dependence. Withdrawal symptoms due to abrupt discontinuation of drug therapy can be profound and dangerous. It is important that clinicians understand the mechanisms of drug therapies and their potential negative sequelae. The purpose of this article is to present physiologic theories of opioid and benzodiazepine actions, as well as drug tolerance and dependence, as a basis of knowledge for clinical practice. A clinical scenario of an intensive care unit patient is presented, and a care plan is offered, to provide guidance to practitioners who care for patients experiencing the consequences of long-term opioid and benzodiazepine use.

Analgesics↗
PubMedDate not supplied

Pain: its mediators and associated morbidity in critically ill cardiovascular surgical patients.

This study was conducted to determine the effects of age, sex, personality adjustment, and analgesic administration on the magnitude of pain experienced by 74 cardiac and abdominal vascular surgical patients during their first few postoperative days. The relationship of pain magnitude to postoperative complications was also examined. Pain intensity was moderate and did not diminish over the first few postoperative days. Physical sensations and emotional tension associated with pain caused little distress. The primary consistent mediator of pain magnitude after surgery was the amount of analgesics administered to patients, although they received small amounts. Neither age nor personality adjustment influenced the magnitude of any pain dimension. However, women and patients having abdominal vascular surgery reported more disturbing physical sensations associated with their pain. Patients with greater pain intensity had a significantly greater incidence of atelectasis as a postoperative complication.

Abdomen↗