Women with gastrointestinal symptoms: implications for nursing research and practice.

Irritable bowel syndrome and functional bowel disorder are diagnoses used to describe chronic GI symptoms for which no overt pathological condition can be identified. Symptoms are more common in women and are frequently followed in gastroenterology clinics. The purpose of this article is to provide an overview of the research linking GI symptoms and reproductive cycling and to discuss implications for practice. GIGl symptoms such as stomach pain and nausea are highest during menses compared with other cycle phases; also, stool consistency is loosest at menses. This pattern is present in control subjects. In women with irritable bowel syndrome the same pattern is seen but with higher symptom intensity. Although animal studies have demonstrated that estrogen and progesterone modulate contractile function of some GI segments. In humans, symptoms are highest when these hormones are at the lowest levels. Thus, symptoms in women may be related to decreasing ovarian hormone levels or to other circulating hormones or factors which vary with the menstrual cycle. Additionally, other factors such as stress aggravate symptoms. Therapeutics directed toward increasing patient awareness of cyclic patterns in symptom complaints, for example, via the use of daily symptom diaries may be a useful adjunct to dietary, pharmacological, and other therapies.

Psychoneuroimmunology and innovative behavioral interventions in patients with leukemia.

PURPOSE/OBJECTIVES: To review current research examining the effects of behavioral interventions on reducing symptom distress and improving quality of life in patients with cancer and to explore the application of behavioral interventions to patients with leukemia who are immunosuppressed by the disease or its treatment. DATA SOURCES: Published books, journal articles, and personal experiences. DATA SYNTHESIS: Interventions such as relaxation training, guided imagery, attentional/cognitive distraction, and therapeutic touch have been found to reduce pain, anxiety, and chemotherapy-related side effects, to elicit the relaxation response, and to improve several aspects of immune function in patients with cancer. CONCLUSIONS: A multicomponent, long-term program of behavioral interventions may provide the greatest and most lasting benefit, but it may be very challenging to implement. However, simple relaxation techniques are not difficult to learn, are not particularly time-consuming or costly to practice, and can be used anywhere. IMPLICATIONS FOR NURSING PRACTICE: Nurses in virtually any setting easily can incorporate behavioral modalities into their practices and help patients with leukemia to reduce their physiologic arousal and symptom distress. Nursing research examining the effects of behavioral interventions on immunocompetence and cancer pain in patients with leukemia is needed.

Neuroendocrine and immunological responses of women to stress.

Natural killer (NK) cell activity, cortisol and catecholamine levels, and physiological reactivity were examined in 15 healthy women who volunteered to take a cognitive stress test (the Stroop test). Relationships were explored among the physiological and selected psychosocial variables. Urine and blood samples were taken to examine catecholamine and cortisol concentrations and NK cell activity immediately before, immediately after, and hourly for 6 hours after the Stroop test. During the Stroop test, heart rate, skin conductance, peripheral skin temperature, and blood pressure were measured. Although skin conductance, heart rate, and blood pressure increased in response to the Stroop test, neuroendocrine values did not. Cortisol secretion decreased after the Stroop test and appeared to follow the normal circadian rhythm. NK cell activity was variable among individual participants but tended to increase over time.

Psychophysiological factors associated with irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder with no known pathophysiological etiology. Many individuals with IBS, however, report higher than normal levels of stress and exhibit abnormal personality characteristics. In this article, the author reviews the psychophysiological factors associated with IBS and discusses gastrointestinal neuroendocrinology, the effects of stress on gastrointestinal motility, and the nursing implications related to this syndrome.

Women with gastrointestinal symptoms: implications for nursing research and practice.

Irritable bowel syndrome and functional bowel disorder are diagnoses used to describe chronic GI symptoms for which no overt pathological condition can be identified. Symptoms are more common in women and are frequently followed in gastroenterology clinics. The purpose of this article is to provide an overview of the research linking GI symptoms and reproductive cycling and to discuss implications for practice. GI symptoms such as stomach pain and nausea are highest during menses compared with other cycle phases; also, stool consistency is loosest at menses. This pattern is present in control subjects. In women with irritable bowel syndrome the same pattern is seen but with higher symptom intensity. Although animal studies have demonstrated that estrogen and progesterone modulate contractile function of some GI segments, in humans, symptoms are highest when these hormones are at the lowest levels. Thus, symptoms in women may be related to decreasing ovarian hormone levels or to other circulating hormones or factors which vary with the menstrual cycle. Additionally, other factors such as stress aggravate symptoms. Therapeutics directed toward increasing patient awareness of cyclic patterns in symptom complaints, for example, via the use of daily symptom diaries may be a useful adjunct to dietary, pharmacological, and other therapies.

Cyclosporine administration practices on bone marrow transplant units: a national survey.

Cyclosporine is being used with increasing frequency in the prevention and treatment of graft-versus-host disease (GVHD) in patients undergoing allogeneic bone marrow transplant (BMT). Based on the manufacturer's administration recommendations, many institutions administer cyclosporine through one lumen of a silastic catheter with the other lumen designated for hyperalimentation, antibiotics, and blood products. Administration of many antibiotics incompatible with hyperalimentation or transfusion of multiple blood products may jeopardize the patient's nutritional support. A survey was undertaken to collect information on administration practices. It was found that the majority of BMT centers used cyclosporine in their GVHD protocols and had a variety of practices for its administration. To more adequately meet the nutritional needs of this patient population, national standards for administering cyclosporine should be developed. In addition, further research is needed to determine the compatibility of cyclosporine with a variety of intravenous solutions and drugs.