Biomedical subjects
Publications and source records attributed to M D Foreman.
Quality of life assessment data for the elderly patient with cancer should be used to plan, implement, and evaluate treatment protocols. Yet, data are lacking about the quality of life of this patient population. Characteristics of the environment and conceptual and operational issues must be addressed in order to obtain reliable and valid assessment data about the quality of life of elderly persons with cancer.
To determine the necessity of restricting ice water for patients with acute myocardial infarction (MI) we performed studies in 89 patients who had been admitted to a coronary care unit with a diagnosis of acute MI or "rule out MI." Using a split-plot factorial repeated-measures design, we randomly assigned patients to position and sequence of volume. A Marquette Augmented Cardiograph was used to obtain 12-lead electrocardiogram (ECGs) at baseline and at 3, 10, and 25 minutes after ingestion of 200 or 400 ml ice water. Multivariate analysis of variance (MANOVA) was used to assess the significance of each factor alone and in interaction for both ST segments and T waves for 11 leads. The preliminary analysis of variance showed significant difference (p less than 0.10) in ST segments for position in several leads and in T waves for disease in several leads. Differences did not continue to be significant when they were considered across the four time periods (MANOVA); then time and volume were the significant variables for most leads. Mean change scores for ST segment (0.01 to 0.05) and T wave amplitude (0.01 to 0.88) were not clinically significant; however, a few patients had significant changes in ST segment of greater than 1 mm and T wave amplitude of greater than 10 mm. A few patients exhibited T wave inversion, suggesting a third level of significance: clinically detectable differences.(ABSTRACT TRUNCATED AT 250 WORDS)
Seventy-one non-surgical patients over age 60 years were studied to obtain information about the incidence, onset and variables associated with the onset of confusion. The incidence of confusion was 38%; 27 of the 71 subjects developed confusion during hospitalization. Nineteen of the 27 patients developed confusion by the second day of hospitalization; no new cases of confusion were detected after the sixth day of hospitalization. An examination of the psychophysiologic variables associated with the onset of confusion produced a profile of the confused elderly patient. Confused patients were: hypernatremic, hypokalemic, hyperglycemic, hypotensive, had elevated blood levels of creatinine and urea nitrogen, received more medications, were more frequently perceived by nurses as confused, had more orienting objects in their immediate environment, and fewer interactions with significant others. Recommendations for the continued investigation and care of confused patients are offered.
Cognitive impairment is a significant health problem for the critically ill aged and warrants further investigation. Despite the lack of knowledge of all aspects of cognitive impairment, much can be undertaken to improve the care of impaired patients. Nurses must routinely, systematically, and comprehensively assess the cognitive state of each elderly patient at the time of admission and daily throughout hospitalization. On the basis of these assessments, nurses must accurately differentiate among confusion, depression, and dementia in the cognitively impaired patient. To carry out such assessments, modification of existing tools, such as the MMSE, may be necessary. Only through such assessment, however, is it possible to detect, prevent, or treat changes in cognition, and thereby prevent its sequelae.
The purpose of this study was to quantify and classify errors in reference lists of randomly selected, recently published issues of nursing journals (n = 17) and to assess whether these errors prevented retrieval of the cited documents. Randomly selected references, 65 from clinical journals and 47 from non-clinical journals, were compared to the original sources for accuracy. Errors were classified as minor (not preventing retrieval) and major (preventing retrieval). Errors occurred more frequently in references in clinical journals, 38.4% of those reviewed, as compared to 21.3% in of non-clinical journals. Additionally, 4.6% of the clinical references contained major errors, but no major errors were located in references from the non-clinical journals. These findings have implications for all readers.
This article reviews the literature on cardiovascular disease in men. Factors believed to contribute to the development and progression of atherosclerosis are discussed. Recommendations for nursing practice and research are considered.
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Delirium, a syndrome that results in high morbidity and mortality rates in the elderly, continues to be underrecognized by physicians and nurses. Factors influencing the underrecognition of delirium are specific to individual institutions and their health care providers. The factors leading to the underrecognition of delirium must be identified so that changes can be made to increase early recognition. A case study conducted in a critical care unit in a midwestern hospital from interviews of nurses, chart audit, and patient observation, identified two major problems associated with the lack of recognition of delirium in that institution: (1) lack of knowledge on the part of nurses about the criteria and methods of detecting delirium, and (2) ineffective communication between all staff members in relaying symptoms of onset of the disorder. As a result of this study, staff education, assessment protocols, and improved communication and documentation techniques are indicated as targeted methods for improving recognition and treatment of delirium in this setting. Similar case studies can be performed to evaluate institutional practice, and thereby identify barriers to early recognition of delirium.
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Acute confusion, also known as delirium, is a prevalent disorder that contributes to poor outcomes of care. Because of their inability to think clearly, delirious patients are unable to care for themselves and often exhibit unsafe behaviors, resulting in an increased use of physical and pharmacologic restraints. Consequently, the goal of this article is to delineate prevention and treatment guidelines for acutely confused patients and thereby improve nursing care for this vulnerable patient population.
Medication consumption represents a significant source of adverse events, therapeutic misadventure, and toxicity to older Americans. Estimates indicate that as many as 25% to 40% of all U.S. prescriptions are written for older people. Hospital admission rates for drug-related problems and toxicity in elders approach 33% in some studies. This article addresses some of the physiological changes associated with aging and their effects on the absorption, distribution, and metabolic fate of common medications in elders. High-risk medications are identified, and strategies for combating their adverse effects are suggested.
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Older patients are at high risk for developing acute confusion while hospitalized with an associated increased risk of morbidity and mortality. Causes for acute confusion include physiologic, psychosocial, and environmental alterations. Often not recognized by nurses, acute confusion needs to be differentiated from depression and dementia. Nursing assessment of acute confusion should include baseline data on cognition, behavior, and functional status. Standard, routine, and systematic assessments of cognition, behavior, and functional status need to be ongoing during hospitalization if nurses are to identify and manage acute confusion in hospitalized older 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.
Reliability and validity of three mental status questionnaires--the Short Portable Mental Status Questionnaire, Mini-Mental State Examination, and Cognitive Capacity Screening Examination (CCSE)--were assessed using 66 elderly (age greater than or equal to 65 years) hospitalized medical-surgical patients. Internal consistency as well as content, criterion-related, and construct validities were examined. The CCSE was found to be the most valid and reliable measure of mental status in this patient population. Implications of the findings regarding selection of mental status questionnaires for differing purposes are discussed.
This article reviews the literature on acute confusional states, including classification, incidence and prevalence, etiology, psychogenetic theories, and implications for nursing.