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Biomedical subjects

K T Kirchhoff

Publications and source records attributed to K T Kirchhoff.

65 records · Page 4Linked to original sources
PubMedDate not supplied

An evaluation of two indirect methods of blood pressure measurement in ill patients.

Direct (intraarterial) and two indirect (using a mercury sphygmomanometer [MS] and an automatic [auscultatory] device) methods of blood pressure measurement were compared in intensive care patients (N = 32). One trained observer blind to both automatic and direct measurements obtained all indirect MS measurements. All direct and indirect measurements were made on the same arm. Direct measurements were obtained from 10-second strip chart recordings. In normotensive patients both indirect measurements of systolic blood pressure (SBP) underestimated the direct SBP; however, only the SBP value obtained with the automatic device (106 mm Hg) was significantly different, p less than .05, from the direct SBP value (120 mm Hg). No significant difference was noted between methods in measurement of normotensive diastolic blood pressure. In hypertensive patients direct SBP was significantly greater, p less than .05, from both values obtained by indirect measurement. In patients without hypotension the automatic device may be substituted for the MS and direct blood pressure methods. The automatic device may offer the advantage of decreasing observer bias and variability in blood pressure measurement.

Adult↗
PubMedDate not supplied

Research activities of clinical nurse researchers.

A nationwide telephone survey was carried out on 34 nurses employed as researchers in clinical settings (CNRs). CNRs reported current involvement in over 200 projects with a range from 1 to 29 projects. Projects were categorized into the following types: clinical practice, nursing administration, evaluation, education, or methodology. Almost half (47%) of the projects were in clinical practice. Type of involvement in research was used as a basis for conceptualizing the CNR's role as traditional scientist, associate, or facilitator. Results are discussed regarding the variations found in how the CNR role is enacted across settings and the focus of the research in which CNRs are engaged.

Adult↗
PubMedDate not supplied

Nurses' responses to do-not-resuscitate orders in the neonatal intensive care unit.

A statewide survey of nurses in perinatal centers was conducted to assess the prevalence of do-not-resuscitate (DNR) policies in neonatal intensive care units (NICUs) and to examine factors influencing nurses in those centers in their compliance with DNR orders. Three nurses in each of 10 perinatal centers were asked to complete a questionnaire on DNR policies and nurses' compliance and to respond to four hypothetical clinical situations. Eighteen of the 27 responding nurses reported the existence of a DNR policy. Factors affecting compliance with DNR orders were agreement that the infant should not be resuscitated (n = 24) or respect for the parents' wishes (n = 19). Nurses' intention to resuscitate despite a DNR order varied, depending on the description of the infant. Multiple regression analyses showed that subjective norms (beta = .41 to .82) rather than attitudes (beta = .17 to .39) exerted a more powerful influence on nurses' decisions not to resuscitate.

Adult↗
PubMedDate not supplied

Breast massage to obtain contraction stress test.

A standard contraction stress test (CST) is usually obtained by the intravenous infusion of exogenous oxytocin for 1 to 3 hours. To assess whether breast massage could elicit a CST, 30 high-risk pregnant women between 37 and 44 weeks gestation massaged their breasts with mineral oil for a maximum of 40 to 60 minutes. Of the 21 patients (70%) who met the CST criterion, 15 had at least one spontaneous uterine contraction in the 20 minutes preceding breast massage, p = .05. Thirty-three percent of those who met the CST criterion did so within 10 minutes of the start of breast massage, and 95% met the criterion within 40 minutes. Other factors, including weeks gestation, parity, overstimulation, and fetal heart rate deceleration that could reasonably influence the effectiveness of the procedure are discussed. Breast massage appears to be an effective method for meeting the CST criterion.

Adolescent↗
PubMedDate not supplied

Mean arterial pressure readings: variations with positions and transducer level.

The purpose of this study was to examine the relationship between mean arterial pressure (MAP) readings, measured at two reference points, the right atrium (RA) and the catheter site (CS), and in two body positions, supine and semi-Fowler's. Four MAP readings were taken on 29 CCU patients, 17 males and 12 females, with ages ranging from 33 to 93 (mean = 57.8; SD = 14.3). MAPs were obtained in the semi-Fowler's position-RA reference point (mean = 82.6), semi-Fowler's-CS reference point (mean = 90.3), supine-RA reference point (means = 82.2), and supine-CS reference point (mean = 84.03). All r values for pairs of readings were greater than .90 (p less than .001); therefore the readings are extremely comparable. However, when the comparability of readings is taken into account with MANOVA, the Hotelling's T2 is 58.06; the associated F is 17.97 (df = 3,26) with p less than .001. Therefore, in stable patients, MAP readings are comparable, but use of RA as the reference point for either position is the most preferable. A patient would not have to be lowered to the supine position for each MAP reading. However, in patients who are not stable, the significant differences among MAPs must be considered. The same position and the RA is preferable for all MAPs on these patients.

Adult↗
PubMedDate not supplied

An examination of the physiologic basis for "coronary precautions".

The only restriction in the list of coronary precautions that is well supported by research is the restriction of stimulant beverages. The restriction of taking rectal temperatures and the rationale usually given, vagal stimulation, are not supported by clinical studies. The restriction of iced beverages has some support only if the amount of fluid is about 600 to 800 cc and if the patients is in the supine position, allowing the heart to be cooled. Limiting the ingestion of ice water to a glass of less at a time would seem to be supported by the studies reviewed and by a recent study of healthy young adults. In contrast to the conclusions drawn in this study, a recent national survey of nurses who care for cardiac patients revealed that coronary precautions remain in practice. Mean importance and frequency ratings for the individual restrictions were comparable to ratings for other commonly practiced nursing activities; however, the standard deviations for the mean ratings were greater for coronary precaution items than for others. Hopefully this article will summarize needed information, and nurses will be able to make decisions for practice on the basis of research rather than tradition.

Animals↗
PubMedDate not supplied

A diffusion survey of coronary precautions.

A national survey of a stratified random sample (n = 240) of accredited hospitals with critical care units (CCU) was conducted in order to describe the current practice of restrictions imposed upon myocardial infarction (MI) patients. A cross-sectional correlational survey with a two-stage mailing was used. The first-stage mailing, at the institutional level, was sent to the head nurses of the CCU's. The second-stage mailing was to two randomly selected nurses plus the head nurse from each responding CCU (n = 600). Nurses were requested to give (a) importance and frequency ratings of selected coronary care nursing practices; (b) information about the use of discontinuance of two specific restrictions: ice water and rectal temperature measurement. Follow-ups by mail and/or telephone yielded response rates of about 87 percent for each stage of mailing. The conceptual framework "Diffusion of Innovations" was used to assess the diffusion of the results of studies published in clinical journals. Despite findings that cast doubt on the practices of restricting ice water and rectal temperature measurement, coronary precautions are commonly practiced. Hours spent reading and the number of journals read correlate (p less than .001) with greater levels of awareness in nurses that such restrictions are in question. Levels of awareness are not related to the importance and frequency ratings for those restrictions. Differences among nurses do not explain differences in ratings. If research is to be used, nurse researchers and managers need to actively intervene in care. Passive diffusion of research results is inadequate, unsure, and slow.

Body Temperature↗
PubMedDate not supplied

Patterns of postnatal weight changes in infants with very low and extremely low birth weights.

OBJECTIVE: To describe (1) short-term postnatal weight loss and gain patterns in infants with very low and extremely low birth weights and (2) the variables that may affect these weight change patterns. DESIGN: Descriptive, retrospective review. SETTING: University hospital in the intermountain western United States. SUBJECTS: Sixty-two charts of infants admitted to a university neonatal intensive care unit from July 1990 through November 1992 were reviewed. Infants who weighed 1000 grams or less were categorized as extremely low birth weight (ELBW) and infants weighing 1001 to 1500 grams were categorized as very low birth weight (VLBW). Each group was comprised of 31 infants. Fifty percent of the sample were male, and 50% were female. Eighty-five percent of the sample were Anglo-American, and 15% were non-Anglo-American. MEASURES: Data were collected on a three-part data collection tool and included demographic and treatment variables. RESULTS: A significant difference was found in the maximum percent weight lost between the two groups, with the ELBW group losing a mean of 14.77% of birth weight and the VLBW group losing a mean of 11.35% of birth weight (t = 2.45, p < 0.05). The day the infants reached their nadir weight was significantly different between the two groups. The ELBW group reached their nadir on day of life 7, and the VLBW group reached their nadir on day of life 6 (t = 2.00, p < 0.05). No significant difference was noted in the time to return to birth weight between the two groups, with a mean of 15 days to return to birth weight. Factors associated with postnatal weight changes were intraventricular hemorrhage, use of diuretics and steroids, day of life when nadir weight occurred, and maximum percent of weight lost. Many of the independent variables were significantly interrelated to each other (r = -0.90 to r = 0.91, p < 0.01 to p < 0.001). However, only the variables that correlated with time to return to birth weight were entered into the regression analysis. These variables included number of days diuretics were given before return to birth weight, maximum percent of weight lost, and day of life the infants reached their nadir weight. Number of days diuretics were given before return to birth weight correlated significantly with time to return to birth weight (r = 0.77, F = 26.66, p < 0.0001) although maximum percent of weight lost and day of life the infants reached their nadir weight had a minimal effect. CONCLUSIONS: Further research into the effects of diuretic therapy on weight changes in this population of infants may lead to interventions to minimize the negative effects of diuretics on return to birth weight. In addition, the older growth charts may not be applicable to this population of infants. Generation of new growth charts that provide growth curves based on these data could be useful in developing nutritional therapies that would promote growth and possibly decrease the length of hospital stay for these infants.

Birth Weight↗