Antiphospholipid antibody syndrome: implications for nursing practice.

Lupus anticoagulant and anticardiolipin are antiphospholipid antibodies. The presence of either or both antiphospholipid antibodies may result in antiphospholipid antibody syndrome, which is typified by recurrent venous or arterial thrombosis, recurrent fetal loss, and thrombocytopenia. Many features of this syndrome are not well understood, including its prevalence, how and why antiphospholipid autoantibodies develop, and their definitive role in disease states. In clinical practice, nurses care for patients and families with antiphospholipid antibody syndrome who require treatment, education, and support.

Preventing postoperative complications.

Learn nursing interventions for preventing or dealing with some common postoperative complications--including how the latest research may affect standard techniques.

Allergy to protamine sulfate.

Adverse responses to protamine sulfate have been identified for many years. The antigen-antibody response to protamine sulfate results in a type I anaphylactic reaction. Manifestations of allergic reactions include hypotension, bronchospasm, and skin and mucous membrane reactions. The severity of the adverse responses may vary from mild to causing death. Several potential risk factors for adverse reactions to protamine have been identified, including insulin-dependent diabetes mellitus, vasectomy, allergy to fish, prior exposure to protamine sulfate, and the rate of infusion. A case study is presented, and strategies for improving patient outcomes are discussed.

Peripheral vascular anatomy, physiology, and pathophysiology.

The primary function of the circulatory system is to transport oxygen, nutrients, and waste products. Hemodynamics of the vessels are governed by a variety of physical properties and laws that explain blood flow through the vascular system. Blood flow is affected by pressure differences, radius of the vessel, length, and viscosity (Poiseuille's Law). Flow is directly proportional to the difference in pressure and inversely proportional to resistance. Any disturbance in blood flow in the arterial and venous system disrupts the delivery of oxygen and nutrients and the elimination of waste products. Disturbances of blood flow can be due to compression of the blood vessel (edema, hematoma, compartment syndrome), structural changes within the vessel (atherosclerosis), vasospasm (Raynaud's syndrome), vasodilatation (sepsis, distributive problems), or blood clot (thrombus or embolus). Decrease in perfusion will promote compensatory mechanisms such as vasodilatation, development of collateral vessels, and anaerobic metabolism. If compensatory mechanisms are unable to meet the oxygen demand by the tissues, ischemia develops, and eventually, tissue death occurs.

Caring for the pneumonectomy patient: challenges and changes.

Caring for pneumonectomy patients presents the nurse with challenges such as early detection of potentially fatal complications, promoting postoperative recovery, and preparing the patient for a life with one lung. Changes in healthcare practice and treatment modalities contribute to the challenge of providing quality nursing care for all patients.

A comparison of learner outcomes to traditional and videotaped classes.

A course was taught to registered nurse students using videotaped classes shown on a bus while students commuted to and from a distant clinical site. Course outcomes for this group were compared with course outcomes for a traditional classroom-taught group of registered nurse students. Outcomes were quite similar, thus making this method of technology use and time management an appropriate teaching outreach/recruitment technique for the college to use with the registered nurse student population.

Patients' learning priorities for reoperative coronary artery bypass surgery.

This study describes the perceived learning priorities of patients undergoing reoperative coronary artery bypass surgery (CABS). The study also examines whether reoperative CABS patients' learning priorities are different from those of patients undergoing initial CABS. Data were collected by means of a 40-item questionnaire from 16 reoperative and 20 initial CABS patients during the postintensive care hospital period and again 3 months after discharge. Reoperative patients most frequently rated most items as "very important" to learn about. Few of the 40 items were rated differently by reoperative and initial CABS patients. Inhospital, reoperative patients more frequently rated "knowing who all the doctors and nurses are" as very important. After discharge, reoperative patients more frequently rated "waiting before surgery" and "sharing a room with others" as very important while less frequently rating "coping with stress" as very important. The results suggest that reoperative CABS patients rate learning as very important and that reoperative CABS patients have learning priorities similar to those of initial CABS patients.

Critical care leadership course: a recruitment and retention strategy.

This article describes how to implement a baccalaureate level course in critical care leadership and management and emphasizes the value of this course in recruiting and developing critical care nurses with leadership abilities.

Effects of alternative techniques of low-dose heparin administration on hematoma formation.

A small clinical trial was conducted to compare a modified subcutaneous injection technique with the standard subcutaneous method. The data in this study do not strongly support the use of either technique. However, the modified subcutaneous method may be preferable in that fewer injection-site hematomas formed. Further research with a larger population is indicated before either method can be recommended over the other.

Critical care unit transfer: reducing patient stress through nursing interventions.

Thirty patients hospitalized with acute myocardial infarction were studied by means of comparison of randomized groups to determine the effectiveness of two different nursing interventions on reducing the stress associated with CCU transfer. In order to promote continuity of patient care, one intervention implemented a family centered nursing approach while the other established a staff nurse-patient relationship prior to transfer to the general medical unit. Inferences as to the relationship between each of the nursing interventions and reduction of patient stress during the CCU transfer period were based on a comparison of the mean scores of psychosocial and physiological measures for the experimental and control groups. Six variables were measured. Overall, experimental patients in each group scored lower than control patients for (1-3) patient stress as reported by patient, family, and nurse, (4) cardiovascular complications within 24 hours of transfer, and (5) cardiovascular complications 24 to 72 hours after transfer; no difference was found in (6) physical complaints reported by the patient the evening of transfer.