Henoch-Schönlein purpura: a review of the literature.

Henoch-Schönlein purpura is the most common vasculitis in children and young adults. It is generally benign, self-limiting, and characterized by purpuric rash, arthralgias, and abdominal pain. It may be complicated by gastrointestinal bleeding, nephritis, lung hemorrhage, or rarely, death. This article reviews the history, etiology, clinical manifestations, complications, and treatment of the disease.

Explanatory model of chronic venous disease in the rural Midwest--a factor analysis.

Advanced practice nurses caring for patients with venous disease may not be aware of the patient's understanding of illness, including the disease process, treatment, or outcomes. The advanced practice nurse uses his or her interpretation of illness to teach patients. Greater congruence between the nurse's and patient's understanding may result in enhanced communication, learning, and adherence. Exploration of the patient's reality may provide insight into a unique view of illness that may or may not be congruent with the biomedical model of disease. The current investigation attempts to identify an explanatory model of illness for chronic venous disease, by using the researcher-developed Diseases of Veins Explanation Survey. Data from a nonprobability sample of 114 primarily white, rural Midwestern, well-educated patients with medically confirmed and patient-acknowledged venous disease was collected at 7 sites. Twelve (10.5%) patients were men and 102 (89.5%) were women. Age range was 18 to 81 years. The factor analysis is presented. Elements of illness according to Kleinman (factors) did not fit within Kleinman's explanatory model of illness categories identified a priori in the instrument.

Assessment and nursing management of hypertension in the perioperative period.

Over 50 million persons in the United States have hypertension, making it one of the most common abnormalities found in the perioperative patient. Often discovered during the preoperative assessment of the patient scheduled for surgery, hypertension raises many concerns in the perioperative period, including hemodynamic control during anesthesia, postoperative complications, and the risk of comorbidities that may not be evident until the patient is stressed. This article concentrates on the identification of hypertension preoperatively, the potential problems associated with hypertension in the entire perioperative period, and pharmacologic and nursing management.

Buerger's disease.

Buerger's disease (thromboangiitis obliterans) is rarely seen in most clinical practices. Many advanced practice nurses may only see one or two cases in their lifetime, and some hospital-based nurses may never see the disease. Information about this occlusive peripheral arterial disease must be obtained for the vascular nurse to care for patients with the disease. The subject of Buerger's disease is not common in the literature, and little is found in nursing texts or journals. The care of the disease involves nursing emphasis on lifestyle changes. This article will address definition, history, review of literature, and pathophysiology. The recommendations for diagnosis, treatment, and nursing care interventions also will be reviewed.

Chronic mesenteric ischemia: role of the nurse practitioner in diagnosis and management.

Mesenteric ischemia can be a very subtle chronic disease state that may be hard to diagnose. The early symptoms are mild and may be mistaken for other disease entities in the elderly patient with multiple medical problems. Mesenteric ischemia can be fatal secondary to complications such as malnutrition, infection, and compounded comorbid conditions. The risk factors for this problem are the same as for any vascular disease: advanced age, hypertension, smoking, hyperlipidemia, and diabetes. Because of the subtle nature of symptoms, diagnosis may be delayed. The practitioner must be vigilant in evaluating patients at risk and refer these patients to the appropriate vascular specialist.

Appendectomy in pregnancy and postpartum: analysis of data from a large private hospital.

Little research is found in the nursing literature regarding appendicitis in the pregnant patient. Appendicitis in pregnancy is associated with: perforation of the appendix, peritonitis, and increased fetal and maternal mortality and morbidity. Preterm labor and early delivery may further complicate the pregnancy. Advanced practice nurses may encounter pregnant women with abdominal pain who present in the primary care setting as well as in an obstetric office. Knowledge of signs and symptoms of appendicitis in pregnancy, potential complications, and outcomes is essential to nursing. Early recognition may decrease complications and improve outcomes. A 10-year chart review was performed at a large urban Midwestern hospital with a large obstetric department. Deliveries numbered more than 66,000 during the 10 years. A total of 42 cases of appendicitis during pregnancy and the 2 weeks following delivery was identified. The characteristics of the population as well as considerations for practice are discussed.

Incidence of thrombosis in pregnancy and postpartum: a retrospective review in a large private hospital.

This article addresses a 10-year retrospective chart review that was conducted at St John's Mercy Medical Center in St Louis, Mo, to investigate the incidence and prevalence of deep vein thrombosis in pregnancy and during the postpartum period. A total of 65,912 deliveries occurred between 1985 and 1995, and 105 (0.2%) patients were diagnosed with a deep vein thrombosis or superficial vein thrombosis during pregnancy or during the postpartum period. The study compared specific demographic data of the patients, and the differences in diagnostic testing, obstetric and medical history, methods of treatment, and sequela of patients, as well as the nursing implications.

Appendicitis during pregnancy.

Appendicitis during pregnancy is a serious medical condition that requires diagnostic accuracy. If diagnosis is delayed, there is an increased incidence of perforation and peritonitis, which can lead to fetal and maternal mortality and morbidity. Since appendicitis is the leading reason for surgery during pregnancy, healthcare providers must be aware of the signs and symptoms of this disease (Allen, Helling, & Langenfeld, 1989; Weingold, 1983). Pregnancy often blunts the symptoms, making diagnosis difficult (Sharp, 1994; Weingold, 1983). This article discusses the incidence of appendicitis in pregnancy, the signs and symptoms, as well as laboratory and radiologic tests used in diagnosis. The risks to the mother and fetus, along with surgical and medical interventions, are also discussed.

Low-molecular-weight heparin.

Traditionally unfractionated heparin is given in the hospital and then followed with 3 to 6 months of oral anticoagulant therapy. Hospitalization is expensive, intravenous administration of heparin limits mobility, and the patient is exposed to iatrogenic infections. Depolymerization of heparin results in low-molecular-weight heparin (LMWH), which has advantages over unfractionated heparin. The advantages are better bioavailability, a longer half life, and more predictable anticoagulant activity. Because of these characteristics it can be given subcutaneously, without laboratory monitoring, in a dose that is calculated by the patient's body weight alone. Studies have shown that LMWH is as effective as unfractionated heparin at preventing clot extension and pulmonary emboli. and is possibly safer. There are a number of LMWH preparations available worldwide, and clinical trials have been conducted in a number of countries. This article will review the clinical properties, uses, complications, and nursing implications associated with LMWH.

An investigation of the explanatory model of venous disease: a pilot study.

Communication between provider and client is essential. When there are differences in the understanding of illness, communication suffers and adherence to treatment decreases. A method of extracting the client's understanding of illness is Kleinman's Explanatory Model of illness (EM). This is a qualitative interview technique that is not conducive to the practice setting. This study explores the understanding of venous disease in clients using a semi-structured survey instrument. Thirty one male clients in an upper middle class practice are reported in this pilot study. The disparity in understanding of venous disease has implications for practice and research.

Decision making in prevention and treatment of arterial leg ulcers: use of patho-flow diagramming.

Ulceration is a serious outcome of arterial occlusive disease. The nurse must learn when interventions are appropriate and under what conditions. One method that is useful for decision making by the advanced nurse or for teaching of decision making to the novice nurse is the use of patho-flow modeling. Patho-flow modeling was devised at the University of Texas-El Paso, for use in teaching students critical thinking and decision making. It adapts well to specific disease entities. This article elaborates on the model and provides an annotated model for use in the practice setting.

Internal carotid artery aneurysm. A case report.

This case report documents the diagnosis and treatment of a large carotid artery aneurysm (4 cm) associated with fibromuscular hyperplasia of the internal carotid artery. This patient underwent replacement of the section of internal carotid artery using a segment of the proximal greater saphenous (from the groin to upper thigh). She did well postoperatively with the exception of some difficulty with swallowing, which rapidly cleared. At one year she was neurologically intact with no complaints.

Defining vascular nursing: a survey of vascular nurses.

For the purpose of defining the specialty of vascular nursing, a survey was sent to the nursing membership of the Society for Vascular Nursing. Nurses in all geographic locations were included, and the survey was accompanied by a self-addressed, stamped return envelope. A total of 873 nurses were surveyed. Respondents were encouraged to give the survey to other vascular nurses who were not members of the Society for Vascular Nursing. The initial mailing resulted in 276 responses. A second mailing provided an additional 224 responses for a total response of 500. Fifty-six of the 500 respondents (11.2%) were nonmembers. Response rate of members was 50.9% (444 of 873). Demographic information was obtained regarding age, years in nursing and vascular nursing, sex, employment type, and location. In addition to demographic information, the survey asked the respondent to identify a definition or definitions of vascular nursing. There was no restriction on space or content. In a small pilot study, "defining the specialty" was the only question asked. However, on the basis of responses to the pilot, the form was refined to request a description of the skills necessary to be a vascular nurse. A total of 73 definitions were identified on the basis of coded responses. The range in number of definitions given on any survey was 0 to 13. Essential skills listed by any one respondent ranged in number from 0 to 14. A total of 90 skills were identified. The purpose of this study is to identify the definitions of vascular nursing given by vascular nurses. In addition, the skills identified as necessary will be elaborated on.(ABSTRACT TRUNCATED AT 250 WORDS)