Biomedical subjects
Publications and source records attributed to M J Grap.
Monitoring pulmonary function with an effective nursing assessment can identify patient problems early. An understanding of ventilation, alveolar perfusion, oxygenation, and patient signs and symptoms, guides medical-surgical nurses in assessment and in intervention choices.
OBJECTIVE: To determine the actual oxygen delivery of the manual resuscitation bags (MRBs) hanging at the bedsides of patients receiving mechanical ventilation. DESIGN: Descriptive study of 24 MRBs in use at the patient's bedside from six adult ICUs at a 1100-bed Mid-Atlantic medical center. METHODS: MRBs were Puritan Manual Resuscitators with reservoir. Oxygen concentration delivered was measured with a Ventronic Oxygen Analyzer Model 5575. Oxygen flow to the MRB was recorded before collecting data and then set at 15 L/min. The MRBs were compressed three times, with a 5-second interval between compressions. RESULTS: Oxygen flow before data collection varied from 6 L/min to 15 L/min. Measurements taken at the exit port before MRB compression ranged from 23% to 97%. Oxygen concentration ranged from 26% to 95%, with a mean of 59%. The oxygen values for each compression time were significantly lower than 100% (p < 0.001). The first compression values differed significantly from the second compression (p < 0.001) and the second differed from the third compression (p < 0.01). CONCLUSION: MRBs are not delivering the level of oxygen nurses have assumed. In addition, variation in oxygen delivery occurs from compression to compression.
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Hardiness, ways of coping, social support and burnout in 103 critical care nurses were addressed in this study. Work-related and nonwork-related social support and hardiness were negatively related to burnout. Use of emotion-focused coping was positively correlated with burnout while hardiness was negatively related to the use of emotion-focused coping and positively related to both types of social support. After controlling for working nights, social support, hardiness, emotion-focused coping and problem-focused coping accounted for 44% of the variance in burnout scores.
OBJECTIVE: To determine the incidence and the effect of intraoperative and discharge variables on gastrointestinal (GI) symptoms after cardiac surgery during hospitalization and 2 and 6 weeks after discharge. DESIGN: Prospective and descriptive. SETTING: Two university-affiliated medical centers. PATIENTS: One hundred twenty-two adult patients undergoing cardiac surgery. OUTCOME MEASURES: Frequency of GI symptoms and level of distress caused by GI symptoms during hospitalization and 2 and 6 weeks after hospital discharge. INSTRUMENTS: GI symptoms were measured by The Gastrointestinal Symptom Frequency and Symptom Distress Scale. Depression was measured by The Center for Epidemiologic Studies Depression Scale. INTERVENTION: Demographic and physiologic variables were collected by chart review. Patients completed the Gastrointestinal Symptom Frequency and Symptom Distress Scale and The Center for Epidemiologic Studies Depression Scale in the hospital. Telephone interviews were used to collect 2- and 6-week data. RESULTS: Fifty-seven percent of patients after surgery reported poor appetite, 37% lack of taste, and 34% nausea during hospitalization. The frequency of all GI symptoms decreased with time; 19% of subjects reported poor appetite, 19% lack of taste, and 10% nausea at 6 weeks after discharge. Although poor appetite occurred with the greatest frequency, patients reported the greatest distress with lack of taste. When analyzed with a logistic regression model, use of antihypertensive agents was associated with lack of taste; use of diuretic and antiarrhythmic agents was associated with nausea; and level of depression was associated with all three GI symptoms. Length of cardiopulmonary bypass time mean arterial blood pressure during surgery, mixed venous oxygen saturation during surgery, and subject age did not significantly affect the frequency of GI symptoms at any data collection point. CONCLUSIONS: The incidence of GI symptoms after cardiac surgery is significant, but their etiology has yet to be determined.
Pneumonia is the second most common nosocomial infection in the United States and the leading cause of death from nosocomial infections. Intubation and mechanical ventilation greatly increase the risk of bacterial pneumonia. Ventilator-associated pneumonia (VAP) occurs in a patient treated with mechanical ventilation, and it is neither present nor developing at the time of intubation; it is a serious problem--with significant morbidity and mortality rates. Aspiration of bacteria from the oropharynx, leakage of contaminated secretions around the endotracheal tube, patient position, and cross-contamination from respiratory equipment and health care providers are important factors in the development of VAP. Nurses caring for patients treated with mechanical ventilation must recognize risk factors and include strategies for reducing these factors as part of their nursing care. This article summarizes the literature related to VAP: its incidence, associated factors, diagnosis, and current therapies, with an emphasis on nursing implications in the care of these patients.
This study of NCLEX performance was designed to identify the best risk indices for students who do not pass the test, to pinpoint the earliest time in their academic careers that their risk can substantially be known, and to estimate the effectiveness of a formal review course. Results show that 62% of the variance in NCLEX scores can be predicted with a combination of variables that includes four nursing school course grades, the test scores of the Scholastic Aptitude Test, and National League for Nursing test scores. Whether a student took an NCLEX review course was not a significant predictor of performance. A method of deriving risk estimate from these values is also shown.
OBJECTIVE: To examine nurses' ability to deliver 1.5 times the ventilated tidal volume at 100% FIO2 with a manual resuscitation bag during endotracheal suctioning. DESIGN: Prospective, descriptive. SETTING: Six adult critical care units in a large university-affiliated medical center. SUBJECTS: One hundred nurses randomly selected from the six adult intensive care units. OUTCOME MEASURES: Nurses' manual resuscitation bag delivery of tidal volume and oxygen, as well as bagging rate, number of breaths delivered, and number of suction catheter passes performed. Patients' heart rate, mean arterial pressure, and arterial oxygen saturation. RESULTS: The mean FIO2 delivered was 0.71 (range 0.24 to 0.97). Oxygen liter flow and nurses' delivered minute ventilation predicted 24% of the variance in FIO2 delivered. Mean bagging rate was 31 compressions per minute. The mean volume per breath delivered was 626 cc, which resulted in achievement of 57% of the standard (1128 cc). Volume achieved was related to patient lung compliance, but not related to nurses' experience, unit of employment, hand strength, or size. CONCLUSIONS: Nurses observed were unable to meet the standard for volume or oxygen delivery. However this did not affect the patient's heart rate, mean arterial pressure, or SaO2.