Oncology nursing education.
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Curriculum↗
Biomedical subjects
M L Workman
Publications and source records attributed to M L Workman.
Comparison of blot-drying versus air-drying of povidone-iodine-cleansed skin.
Povidone-iodine is the cleansing agent most commonly used before accessing implanted venous devices. This agent has peak bacteriocidal action when allowed to air-dry for 20 min postscrub. However, the drying time increases the length of the procedure and the risk for accidental contamination of the site. In this study, the effectiveness of air drying versus blot drying povidone-iodine-prepared skin sites was compared by examining the number of bacterial colonies present on skin cultures obtained after each drying method. No significant differences in the number of bacterial colonies between the two drying methods were found.
Adult↗
Postpericardiotomy syndrome: its diagnosis and treatment after muscle flap closure of an infected sternal wound.
After nearly any form of cardiac surgery, an acute febrile illness characterized by leukocytosis, pericarditis with pericardial effusion, and pleural effusion may occur. In some instances, this postpericardiotomy syndrome may suggest the presence of mediastinal infection. Treatment of postpericardiotomy syndrome is conservative, and symptoms typically resolve with nonsteroidal antiinflammatory medication. We report a case of postpericardiotomy syndrome that mimicked recurrent mediastinal infection and developed after muscle flap closure of an infected sternal wound. Pericardial, pleural, and periflap fluid accumulated postmuscle flap closure and was sterile on culture. A diagnosis of postpericardiotomy syndrome was made, and the patient improved while receiving oral indomethacin. She has remained free of infection as of the 2-year follow-up.
Diagnostic Errors↗
Essential concepts of inflammation and immunity.
Virtually all patients in acute or critical care settings experience some degree of immune system alteration, which places them at risk for serious potential complications, including sepsis and debilitation. Nurses need a good working knowledge of specific areas of immune function to provide a safe environment, adequate patient support, and appropriate early interventions to prevent complications. This article presents information about basic immune function and current and potential uses for new immunodulating agents, such as granulocyte macrophage--colony-stimulating factor.
Antibody Formation↗
Anticoagulants and thrombolytics: what's the difference?
Drug therapy for dissolution of formed clots is a first-line approach in the treatment of myocardial infarction and thrombotic stroke. In addition, drug therapy for inhibition of the intrinsic and extrinsic pathways in the blood clotting cascade is used widely in ambulatory, acute care, and intensive care settings. Many health care providers mistakenly view these therapeutic approaches as identical. The authors review the physiology of intrinsic and extrinsic pathways in the blood clotting cascade and present the essential differences between anticoagulant and thrombolytic therapies.
Anticoagulants↗
Latex hypersensitivity: an iatrogenic and occupational risk.
BACKGROUND Immediate hypersensitivity reactions to natural rubber and latex products were first reported in 1979 by Nutter, who identified contact urticaria to latex gloves. Since that time, numerous cases of immediate and delayed reactions to latex have been reported. Because latex products are ubiquitous, especially in the critical care environment, there is increasing risk of hypersensitivity among patients and healthcare workers. METHOD Literature review. OBJECTIVES To review the types of allergic reaction to latex and to inform healthcare providers of the risks to patients and themselves of acquiring latex hypersensitivity. CONCLUSION Immediate hypersensitivity reactions to natural rubber and latex products pose a significant threat to patients, healthcare workers, and the general population. Medical history alone is inadequate to identify all persons at risk. Numerous proteins doubtless exist in latex that may be the link to allergenicity. Further research is needed to address demographic, behavioral, environmental, and biogenetic factors including gender differences, ethnicity and race.
Gloves, Surgical↗
Magnetic resonance imaging of the nose with surface coils: a new technique to evaluate functional and aesthetic problems.
Determining the preoperative functional and aesthetic anatomy has been of critical importance to surgeons planning nasal procedures. Beyond skilled clinical examination, few objective studies exist to aid the surgeon. Magnetic resonance imaging (MRI) represents a potentially excellent method for precise anatomic imaging of the nose. Unlike computed tomography (CT) and conventional x-rays, MRI involves no radiation. Similar to CT, however, MRI can provide computer-enhanced three-dimensional and quantitative airway data. Full-head MRI has proven sensitivity in evaluation of tumors of the brain and sinuses and is the imaging modality of choice for many soft-tissue tumors. Due to the relatively high cost of conventional full-head MRI scanning ($600 to $1200 per scan), MRI of the nose utilizing full head scanning technique has been limited. The recent development of small field of view surface coils has enabled higher-resolution nasal scans at a fraction of the scanner time and cost ($200 to $500) of conventional MRI scans. We have developed a protocol utilizing a small field of view coil which results in reproducible high-resolution nasal scans requiring less than 6 minutes of scanner time. This protocol has been used in both the diagnosis and follow-up of patients with traumatic and congenital nasal and septal deformities. Image resolution obtained using the protocol is significantly better than with conventional coils. This technique is excellent for both diagnosing and documenting nasal anatomy and pathology.
Humans↗
The immune system: your defensive partner and offensive foe.
Immune function and inflammation are normal physiologic processes essential to health and well-being. However, overactivity of any inflammatory or immune responses can result in tissue-damaging reactions that threaten the functional integrity of tissues and organs. This article reviews the normal defense responses of inflammation and immune function as well as selected conditions resulting from offensive or hyperactive inflammatory and immune responses. The selected conditions include those seen more often in the acute and critical-care setting, such as tissue-damaging inflammation, drug allergy, autoimmunity, and transplant rejection.
Anaphylaxis↗
Malignant melanoma with evidence of maturation arising from a giant congenital nevocellular nevus.
The association between melanoma and giant congenital nevocellular nevus has been well documented, although controversy still exists regarding the precise incidence. The following patient report illustrates the excision of malignant melanoma arising from a giant congenital nevocellular nevus in a 4-month-old infant. The child had malignant melanoma with deep dermal involvement diagnosed by incisional biopsy with positive margins. She underwent subsequent en bloc resection of the original biopsy site and nevus. The reexcision specimen showed no evidence of malignancy. No adjuvant chemotherapy was used. The child is disease free at 5 years. It is possible that very young children (infants) with melanoma arising in a giant congenital nevocellular nevus may have a good prognosis.
Cell Transformation, Neoplastic↗
Popliteal-based filleted lower leg musculocutaneous free-flap coverage of a hemipelvectomy defect.
A 33-year-old man suffered from locally recurrent malignant fibrous histiocytoma of his left thigh unresponsive to previous excision, radiation therapy, chemotherapy, and hyperthermic treatment. He underwent radical hemipelvectomy for cure. Because of extensive tumor involvement, a free flap consisting of his distal left leg based on the popliteal artery was utilized to close the defect. Both the tibia and fibula were removed from their periosteal sheaths, and the foot was excised from the flap. The popliteal artery and vein were anastomosed to the iliac vessels. The flap survived, and the patient was discharged home after physical rehabilitation. We suggest that uninvolved portions of the distal leg may be utilized as a free flap to successfully close hemipelvectomy defects in selected patients when conventional pedicle flaps are unavailable.
Adult↗
Magnesium and phosphorus: the neglected electrolytes.
Magnesium and phosphorus normally are present in very low serum concentrations and usually are not included in common serum electrolyte laboratory studies. Though their normal serum concentrations are relatively low, both of these ionized minerals are necessary for many critical physiologic functions, and decreases in normal serum levels can have serious deleterious effects. Some of these effects, especially in myocardial tissues, may lead to permanent tissue damage. Hospitalized patients at greatest risk for developing hypomagnesemia or hypophosphatemia are trauma victims; individuals with poorly controlled diabetes mellitus, renal impairment, parathyroid dysfunction, or chronic alcoholism; and individuals who have been treated with antineoplastic agents.
Critical Illness↗
Common electrolyte imbalances associated with malignancy.
More than one million Americans will be diagnosed with cancer during 1992, and 50% will be cured of their disease. Of those individuals not cured of the malignancy, survival time after diagnosis has increased tremendously compared to 1980. Because of advances in therapy and the increase in long-term survival, the presence of cancer patients in critical care units should no longer represent either a medical contradiction or an ethical dilemma when the condition requiring critical care is potentially reversible. Many of these individuals may become patients in critical care settings as a result of specific electrolyte imbalances caused by the malignant disease or treatment of malignancy. Although the imbalances often are temporary, they can be life-threatening without intervention. The most common temporary electrolyte imbalances associated with malignant conditions are hypercalcemia, hyperkalemia, and tumor lysis syndrome. Critical care nurses can contribute skill and knowledge in ameliorating these conditions so that the person with cancer can have better quality and longer survival time.
Adult↗
Effects of steroids on postoperative nausea and vomiting.
The purpose of this study was to determine if the use of intraoperative steroids was effective in decreasing the incidence of postanesthetic nausea and vomiting and whether or not those complications were gender related. This retrospective study involved a chart review of 208 patients undergoing lumbar laminectomy at a large metropolitan hospital during a 10-month period in 1989-1990. Sixty-one patients met inclusion criteria and were accepted into the study. Of these, 34 patients had received an intraoperative steroid; 21 were male and 13 female. Twenty-seven patients did not receive intraoperative steroids; 17 were male and 13 female. Data collected included the number of pain medications and antiemetics used in the postoperative period, as well as the number of episodes of nausea and vomiting in the 24 hours following surgery. Results demonstrated that those patients who received intraoperative steroids were less likely to experience problems of nausea and vomiting than those who did not receive the drug. Requirements for postoperative pain medication were also reduced in the steroid group. Female patients in both groups were shown to have a greater incidence of nausea and vomiting than male patients.
Anesthesia↗
Immunologic late effects in children and adults.
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Adult↗
Biologic characteristics of four Ewing's sarcomas.
Four Ewing's sarcomas were examined for chromosomal characteristics, growth in cell culture, tumorigenicity in nude mice, and presence of beta-adrenergic receptors. Three tumors were from untreated patients (one obtained directly from the patient and two after growth in nude mice) and one was a metastatic lesion obtained after treatment. All four tumors were diploid or near-diploid, with one or more structural rearrangements. In the metastatic lesion, 21 abnormalities were seen. No specific chromosome aberration was found to be common to all four tumors, although a t(1,16) was observed in two and a t(11;22) in two. Abnormalities involving chromosomes #1, #3, #11, #13, #16, and #22 were each found in two of four tumors. All four tumors were tumorigenic in nude mice; two grew well in cell culture, one of which became an established line, and all four expressed high concentrations of beta-adrenergic receptors.
Adolescent↗
Cardiovascular and endocrine effects of potassium in spontaneously hypertensive rats.
Although potassium is known to lower blood pressure in a number of forms of experimental and human hypertension, the mechanism for this effect remains unclear. We studied several possible mechanisms for this effect in the spontaneously hypertensive rat (SHR). Fourteen-week-old SHR were given 0.5% KCl in the drinking water. This potassium supplement resulted in a 16-mmHg fall in mean arterial pressure and a 22% decrease in peripheral vascular resistance. Plasma potassium increased 0.4 meq/l, while muscle potassium was unchanged. Potassium supplementation resulted in no change in plasma renin activity, plasma aldosterone, or plasma norepinephrine. Urinary excretion of prostaglandin (PG) E2 and 6-keto-PGF1 alpha was also not altered by potassium supplementation. Potassium-supplemented SHR were found to have no difference in sodium excretion compared with control SHR, and plasma volume was similar in both groups. The pressor response to angiotensin II and norepinephrine was not substantially affected by potassium supplementation. Furthermore, baroreflex control of heart rate was not altered by potassium supplementation. Finally, potassium supplementation resulted in no change in mesenteric artery angiotensin II receptor number or receptor affinity. Therefore, although potassium lowers blood pressure in the SHR by decreasing peripheral vascular resistance, the mechanism of this effect on vascular resistance remains unknown.
Angiotensin II↗
Chromosome features of two retinoblastomas.
Giemsa-banded chromosomal analysis of two unilateral retinoblastoma tumors from unrelated patients with normal constitutional chromosomes revealed near-diploid karyotypes with multiple structural rearrangements. The two tumors shared aberrations of trisomy 1q, monosomy 16 and 17, and 21p+. Other aberrations were unique to each tumor. One tumor expressed a del(13) and trisomy 6p.
Adult↗