Gastrointestinal function during the menstrual cycle.
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Digestive System Physiological Phenomena↗
Biomedical subjects
M Heitkemper
Publications and source records attributed to M Heitkemper.
Nursing interventions in problems of tube feeding, a consortium project.
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Diarrhea↗
Interventions for irritable bowel syndrome: a nursing model.
Irritable Bowel Syndrome (IBS) is a common problem affecting a significant portion of the U.S. population. Nurses are involved directly in the planning and implementing of therapeutic interventions for this patient population. Using a Human Response Model, the authors of this article review intervention studies for IBS. This model provides a context for integration of Person (vulnerability) and Environment (risk) factors that may modify the patient's response to a given therapeutic regimen. Human responses are categorized as Physiological, Pathophysiological, and Behavioral/Experiential. Interdisciplinary therapeutic strategies include motility manipulations via pharmacological agents, dietary modifications, and self-care enhancement. Areas for nursing research are described.
Colonic Diseases, Functional↗
Irritable bowel syndrome: causes and treatment.
Irritable bowel syndrome (IBS) is a common health care problem worldwide. In the United States and Northern European countries, more women than men seek health care services for IBS. Nurses are often called on to help women with IBS manage their symptoms. This article reviews the literature related to gender differences in diagnosis, symptoms (gastrointestinal, somatic, and disturbed sleep), and physiologic and psychological factors as well as current pharmacologic therapies used in the management of IBS.
Antidepressive Agents↗
Chronic hepatitis C. Implications for health-related quality of life.
Hepatitis C viral infection with its sequelae is a significant healthcare problem. Hepatitis C infects nearly 4 million Americans with almost half of these unaware of their infection. Many of those individuals infected with hepatitis C develop chronic hepatitis C and in 15% of these patients, the infection will progress to cirrhosis within 20 years. Several cross-sectional and longitudinal studies have demonstrated the negative impact of chronic hepatitis C on health-related quality of life. This review describes what is currently known about the impact of chronic hepatitis C on health-related quality of life during pharmacologic treatment and after liver transplantation. It is important to note that few studies have prospectively followed patients over time with respect to quality of life or examined other factors including symptoms, markers of disease progression, or host immune function. Studies suggest that patients with chronic hepatitis C, even without major disease-related complications, perceive themselves to be unwell and have significant changes in their physical and mental well being. Such results have important implications for nursing care and management. Intervention studies focused on self-care management with an emphasis on symptom reduction are warranted.
Antiviral Agents↗
Diet triggers symptoms in women with irritable bowel syndrome. The patient's perspective.
The purpose of this phenomenological analysis was to describe perceptions of women with irritable bowel syndrome regarding the relationship of diet to their symptoms. Thirty-five women ages 18-45 with a medical diagnosis of irritable bowel syndrome or symptoms compatible with a diagnosis of irritable bowel syndrome were interviewed and completed questionnaires as part of a larger study. During the interview, the women were asked what they thought caused their symptoms. Overall, women tried to adjust their diet to achieve a "Range of Comfort" so their symptoms were tolerable or manageable. To do this, women used a process of "Trial and Error." If a link could be made to diet, then women developed "Self-care Strategies" to maintain a "Healthy Diet." Women who failed to find a relationship during the "Trial and Error" process either felt the frustration of "Uncertainty" or, for a few women, decided that adjusting their diet was not worth the bother. This study suggests diet and eating behaviors are an important starting point for many women as they try to manage their irritable bowel syndrome symptoms.
Adaptation, Psychological↗
Irritable bowel syndrome. A survey of nurses' knowledge.
Nurses in a variety of clinical settings are often involved in educating and managing patients with irritable bowel syndrome, though their knowledge and perceptions of irritable bowel syndrome are not well known. A national survey was undertaken as a part of a larger study of patients and healthcare providers to determine nurses' knowledge of irritable bowel syndrome, including diagnosis, etiology, disease impact, management, beliefs, and attitudes regarding irritable bowel syndrome. In addition, the nurses' perceptions of the effect of irritable bowel syndrome on the patient's lifestyle and the severity of symptoms were compared to those of irritable bowel syndrome patients. One hundred practicing registered nurses were randomly selected and then interviewed by telephone using a questionnaire. A random-digit dialing method was used to identify and recruit 1,014 women with irritable bowel syndrome. The majority of registered nurses interviewed (75%) felt that nurses played a moderate-to-major role in counseling patients with irritable bowel syndrome. Only 13%, however, were aware of the diagnostic criteria for irritable bowel syndrome. The majority of nurse subjects felt the current therapies for irritable bowel syndrome had limited effectiveness varying from 6-21% depending on the symptom being treated. Almost half of the nurses felt they had an important role in management of irritable bowel syndrome and that both they and their patients needed more education about irritable bowel syndrome. There was close agreement between the nurses and the patients with regard to the impact of irritable bowel syndrome. With increased public attention on irritable bowel syndrome as a common problem affecting women, there is a need for nurses working in a variety of settings to have increased knowledge regarding the syndrome. In this article, recommendations are made regarding how to increase nurses' knowledge about this common health problem.
Colonic Diseases, Functional↗
The relationship between psychological distress and gastrointestinal symptoms in women with irritable bowel syndrome.
BACKGROUND: Individuals with irritable bowel syndrome (IBS) are reported to experience more symptoms compatible with psychopathologic disorders, abnormal personality traits, and psychological distress. Conversely, individuals with psychiatric disorders report higher levels of gastrointestinal (GI) symptoms compatible with IBS. Thus, psychological distress may contribute to GI symptoms in individuals with IBS. OBJECTIVES: To examine psychological distress in women with IBS, women with similar GI symptoms but not diagnosed (IBS nonpatients, IBS-NP), and asymptomatic Control women. METHODS: The women (N=97) were interviewed, completed questionnaires, and maintained daily diaries for 2 months. Across-women and within-woman analyses were used to calculate the results. RESULTS: The IBS and IBS-NP groups had a higher percentage of lifetime psychopathology and recalled psychological distress. At least 40% of the women in the IBS and IBS-NP groups had positive relationships between daily psychological distress and daily GI symptoms. CONCLUSIONS: Psychological distress is an important component of the IBS symptom experience and should be considered when treatment strategies are designed.
Adult↗
Self-report and polysomnographic measures of sleep in women with irritable bowel syndrome.
BACKGROUND: Women who report chronic gastrointestinal symptoms compatible with a diagnosis of irritable bowel syndrome (IBS) frequently report sleep disturbances. OBJECTIVES: The purposes of this study were to (a) compare self-reported and polysomnographic indicators of sleep quality in women with IBS symptoms (IBS-SX, n= 16) and controls (n= 16); (b) examine the relationship between the indicators of sleep quality; and (c) determine the relationship between sleep indicators and psychological distress. METHOD: The women slept in a laboratory for 2 consecutive nights. Polysomnographic measurements were recorded during sleep, and a sleep questionnaire was completed upon awakening each morning. Psychological distress was measured with the Symptom Checklist-90-R during the initial interview. RESULTS: Women in the IBS-SX group reported significantly greater numbers of awakenings during sleep (p = .008) and had a longer latency to REM sleep (p = .04) than did the controls. Self-reported and polysomnographic indicators were more highly correlated in the control group than in the IBS-SX group. In the IBS-SX group, the greater the psychological distress, the less alert (rs = .419) and rested (rs = .564) the women felt in the morning and the more time the women spent in stages 3 and 4 sleep (rs = .479) and less in stage 2 (rs = -.447) and REM (rs = -.414) sleep. In the control group, psychological distress was not significantly associated with self-reported measures but was significantly associated with the number of awakenings (rs = .506) and time in stages 3 and 4 sleep (rs = -.677). CONCLUSIONS: Although the women in the IBS-SX group reported significantly more awakenings, the weak relationship between self-reported and polysomnographic indicators suggests that clinicians must keep in mind that further assessments may be necessary.
Adult↗
Effects of age, feeding regimen, and glucocorticoids on catecholamine and cortisol excretion in preterm infants.
BACKGROUND: The sympathoadrenal system is important in maintaining normal physiologic functioning in infants and increased output also can reflect stress. We sought to determine the effects of age, feeding regimen, and glucocorticoids on catecholamine and cortisol excretion in preterm infants and to assess whether a particular strategy of feeding enhanced sympathoadrenal development or was stressful. METHODS: Preterm infants (26-30 wk gestation; n = 171) were assigned randomly to begin trophic feedings from day 4 through 14 (trophic group) or to start feedings at day 15 (standard group) with feedings administered either by bolus every 3 hours (bolus) or continuously over 24 hours (continuous). At 10, 28, 40, 50, and 60 days of age, urine was collected continuously for 6 hours for measurement of catecholamines (norepinephrine, epinephrine, dopamine), cortisol, and creatinine. Data were available for 98 infants. RESULTS: Norepinephrine excretion increased with postnatal age. The increase with age was significantly greater in the trophic group compared with that in the standard group. Epinephrine excretion did not change with age, and there were no differences between trophic and standard groups. Dopamine excretion increased with age but was similar between trophic and standard groups (borderline significantly greater in the trophic group). Cortisol excretion increased with age and also was similar between trophic and standard groups. There was no effect on catecholamine or cortisol excretion of bolus vs continuous feedings, antenatal or postnatal corticosteroids, gestational age at birth, age at which full feedings were attained, or use of human milk compared with preterm formula. CONCLUSIONS: The greatest determinant of catecholamine and cortisol excretion is postnatal age. Feeding method, type of feeding, and glucocorticoid administration in the amounts customarily used have little significant effect on catecholamine or cortisol excretion. The apparent link between early feeding and norepinephrine (and possibly dopamine) excretion warrants further investigation.
Age Factors↗
Gastric relaxation prior to enteral feeding.
The purpose of this investigation was to determine whether the observed gastric relaxation associated with the intragastric infusion of a liquid meal could be conditioned to the temporarily associated auditory cues to enteral feeding and thus produce decreased intragastric pressures under "sham" feeding conditions. Eight normal volunteers received either enteral feedings or sham feedings followed by enteral feedings on 72 separate trial days. The feedings were administered at a constant rate via a Harvard infusion pump. Intragastric pressure changes were monitored by an open tipped pressure cannula which was attached to the feeding tube. A sham feeding consisted of carrying out all preparatory procedures including activation of the feeding pump which was visually screened from the patient. Without the subjects' knowledge the liquid diet was diverted to another reservoir instead of through the nasogastric tube. This sham type infusion produced a gastric response similar to the response to a normal diet infusion as evidenced by a decrease in intragastric pressure and a suppression of irregular high amplitude contractions that are associated with hunger. This anticipatory response to enteral feeding indicative of prospective relaxation of the stomach may enhance the subsequent accommodation to a volume of diet. Additional studies are needed to investigate the importance of visual and auditory cues on patient tolerance of enteral feedings.
Acoustic Stimulation↗
GI symptoms, function, and psychophysiological arousal in dysmenorrheic women.
In a previous study, gastrointestinal (GI) symptoms and stool characteristics were found to be influenced by menstrual cycle phase. The current study was designed to replicate initial work regarding GI symptoms and stool characteristics and to explore the relationships between GI symptoms, stool characteristics, ovarian hormone levels, and indicators of psychophysiological arousal. Fifty women (dysmenorrheic, N = 22; nondysmenorrheic, N = 28) maintained a daily dairy for recording stool characteristics, GI symptoms, and daily anxiety level. First morning void urine specimens for catecholamine assays and serum samples for ovarian hormone and cortisol determinations were obtained at menses, follicular, and luteal phases. Results showed menstrual cycle-related differences in stool characteristics and report of GI symptoms, with the greatest changes occurring at menses in the total sample. Dysmenorrheic women reported higher levels of all GI symptoms at menses as compared to nondysmenorrheic women. In addition, cycle-related differences in serum cortisol, urine catecholamines, and report of anxiety were also noted, particularly in dysmenorrheic women. However, looser stools and GI symptoms at menses were not correlated with absolute levels of ovarian hormones or indicators of psychophysiological arousal.
Adult↗