Update for nurse anesthetists--Part 1--The cerebral oximeter: what is the efficacy?

Patients having surgical procedures are at risk for anoxia that may cause cognitive impairment. Continuous monitoring of cerebral oxygenation and perfusion with an instrument such as a cerebral oximeter is desirable. The data it provides give insight into the cause of the cerebral insults along with the cerebral response to specific interventions, all of which could help prevent damage to the brain. This critical review of the literature on the efficacy, mechanics, and usefulness of the cerebral oximeter will be helpful to anesthesia providers in evaluating the controversy surrounding its use. A comprehensive understanding of the factors involved in cerebral perfusion and available equipment, such as the cerebral oximeter to monitor cerebral oxygenation, allows anesthetists to provide the best protection for the brain.

Anesthetic management of an infant undergoing radical nephrectomy for Wilms tumor: a case report.

Wilms tumor (WT), also called nephroblastoma, is a solid, malignant renal mass that can sometimes grow so large it spreads outside the kidney and invades other structures. Most experts recommend complete tumor resection as a primary intervention. The clinical manifestations caused by the WT most significantly hypertension, can appear as a barrage of pathophysiological events to the nurse anesthetist. The case presented involves an 8-week-old infant who underwent a radical nephrectomy because of a WT. The occurrence, symptoms, pathophysiology, and intraoperative anesthetic management of WT are discussed.

The perianesthesia experience from the patient's perspective.

The purpose of this study was to investigate the perianesthesia experience from the patient's perspective. An existential phenomenological approach using Pollio's interpretive framework was used. Interpretations were conducted, in part, in a research group. The purpose of the interpretation was to recognize patterns or themes in an experience. Participants were asked to describe specific experiences that stood out for them because experiences which stand out are those that are meaningful. Ten participants (5 males, 5 females) ranging in age from 23 to 66 years were interviewed using phenomenological techniques. The interpretation found the perianesthesia experience to be grounded in self, others, and time, which become figural through experiences of control. Each participant relinquished control, lost control, or strove to gain or maintain control during their surgical experience. The perception of death lurking crossed into figural experiences as well. Images of death, while grouped predominantly with self, were interpreted as the ultimate loss of self, others, and time. Loss of control of self, the relinquishing of control to others, and the temporal experience of control may contribute to perianesthesia stress and anxiety. Nurses in the perianesthesia period have many opportunities to help patients with issues of control.

Postoperative hypothermia--the chilling consequences.

Unplanned hypothermia is commonly encountered in the perioperative period. Nursing has contributed to the literature on hypothermia with studies on shivering and treatment modalities; however, the direct physiological consequences of postoperative hypothermia have been reported mainly in the medical literature. Research on the physiological effects of postoperative hypothermia offers nurses further evidence to support interventions for temperature correction in patients with hypothermia. Evidence indicates that forced-air warming is the most effective method for warming hypothermic patients. The Roy Adaptation Model is explained as a framework for nursing care of patients with hypothermia. Clinical practice guidelines for unplanned perioperative hypothermia also are provided.

Physical assessment skills: a descriptive study of what is taught and what is practiced.

The purpose of this study was to investigate physical assessment skills taught in undergraduate baccalaureate nursing programs and the physical assessment skills used by practicing nurses. Twelve educators teaching physical assessment and 51 practicing nurses were surveyed on 120 physical assessment skills listed in standard nursing textbooks. Median scores were computed on all the skills. The educators taught all of the skills, 92.5% of the skills were taught and practiced in class and 7.5% were taught but not practiced. For the practicing nurses, 37% of the skill were never used, 29% were used on a daily/weekly basis, with 34% used on a monthly/occasional basis. Based on these findings, we recommend that the content of physical assessment courses be reevaluated, with courses focusing on what nurses need to know to practice nursing.

"I was actually a nurse": the meaning of professionalism for baccalaureate nursing students.

An important process in any profession is the development of professional identity. Understanding how students experience professionalism is important to provide appropriate educational experiences to foster this aspect of professional socialization. Therefore, this study investigated baccalaureate student nurses' perspectives of what it means to be professional. This qualitative study was based on Pollio, Henley, and Thompson's interpretive framework, an existential-phenomenological approach. The purpose of the interpretation was to recognize patterns or themes in an experience. Figural experiences in one's life emerge against a backdrop, or ground. Sixty-nine baccalaureate nursing students at different educational levels participated. They described specific experiences in which they felt professional. The student experience of being professional was one grounded in a world of self and others. Three interrelated themes emerged from this ground-belonging, knowing, and affirmation. The ground of self and others provides the backdrop of the experience. It is through self and others that the figural themes are experienced. The themes are inherently inter-related. For example, the experiences of belonging and knowing were affirming to students, and affirmation enhanced their sense of knowing and belonging. Implications of the findings are explored.

A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement.

Cuffed endotracheal tubes are one aspect of airway management designed to ensure safety, yet patients can be at risk for injury from underinflated and overinflated endotracheal cuffs. Tracheal pressures exceeding approximately 48 cm H2O impede capillary blood flow, potentially causing tracheal damage, and pressures below approximately 18 mm Hg may increase the risk of aspiration. There is no standard identified in the literature describing the method of cuff inflation, and nurse anesthetists use various cuff inflation techniques. The purpose of this study was to compare endotracheal cuff pressures obtained by estimation techniques with direct endotracheal cuff pressure measurements. A convenience sample of 40 anesthesia providers (nurse anesthesia students, Certified Registered Nurse Anesthetists, and anesthesiologists) inflated the endotracheal tube cuff using their usual inflation technique. The endotracheal tube cuff pressure was measured with a noninvasive manometer connected to the pilot balloon. Pressures obtained by estimation techniques ranged from 6 to 60 cm H2O (mean = 44.5; SD = 13.07). Analysis revealed that fewer than one third of the anesthesia providers inflated the cuff within an ideal range. No differences were found between level of anesthesia provider and cuff inflation pressures. We conclude that estimation techniques for cuff inflation are inadequate and suggest that direct measurements be used.

Magnet therapy: what's the attraction?

PURPOSE: To review the current state of the science of magnet therapy with respect to pain management and to view magnet therapy from a nursing perspective. DATA SOURCES: Extensive review of the world-wide scientific literature and of scientific peer-reviewed journals regarding magnet therapy. CONCLUSIONS: Magnet therapy is gaining popularity; however, the scientific evidence to support the success of this therapy is lacking. More scientifically sound studies are needed in order to fully understand the effects that magnets can have on the body and the possible benefits or dangers that could result from their use. IMPLICATIONS FOR PRACTICE: Credibility for advanced practice will be established across disciplines as nurses demonstrate their ability to critically evaluate practices. Alternative therapies are accepted and used by many patients today. While magnet therapy is popular, the scientific evidence to support its use is limited, at best. Advanced practice nurses have more effective treatment modalities in their repertoire and are advised to avoid practices for which efficacy is unsupported.