The prevalence of perioperative nurse clinical judgments.

A clinical judgement about a patient situation precedes the selection of appropriate nursing actions and the identification of patient outcomes. The North American Nursing Diagnosis Association nomenclature (i.e., nursing diagnoses) is the accepted language for naming nurse's clinical judgements. Two hundred thirty-nine members of the Association of Operating Room Nurses, Inc, rated the frequency and treatment priority of 60 nursing diagnoses. They rated two diagnostic labels (i.e., risk for perioperative positioning injury, risk for infections occurring in more than 50% of the clinical judgments they make about perioperative patient situations that require immediate nursing action. These data reinforce perioperative nurses' primary role in protecting surgical patients from harm.

L-tryptophan use and the eosinophilia-myalgia syndrome.

We present a case of the eosinophilia-myalgia syndrome in a patient taking large doses of L-tryptophan for sedation. He developed the now-classic findings of myalgias, skin changes, and marked eosinophilia. This syndrome was first recognized in late 1989, and epidemiologic studies have demonstrated an association of the clinical syndrome with ingestion of L-tryptophan. The mechanism of toxicity remains unknown. Casual use of L-tryptophan has been diminished by its rapid removal from the nutrition counter of health food stores.

Methadone maintenance in pregnancy: consequences to care and outcome.

A retrospective analysis was conducted on the outcomes of the pregnancies of 26 narcotic-addicted women who were enrolled in a methadone maintenance program. Of these women, 88% continued to use other drugs during their pregnancy, with opiates the most frequently used, and 56% of these women had urine toxicology screens positive for either heroin, cocaine, or benzodiazepines when they presented in labor. When these women were compared with a similar group of 37 pregnant polydrug users who were not in the methadone maintenance program and who delivered during the same 12-month period, there was no difference in the birth weights or in the infants' one- and five-minute Apgar scores. However, the women in the methadone maintenance program had more prenatal visits, more adequate prenatal care, and less anemia than the non-methadone maintenance program drug users. When these two drug-using groups were compared with a control group of pregnant women who delivered within the same time period, there was a significant difference in the birth weights of these two groups. This raises the question of the effectiveness of methadone maintenance programs in promoting fetal growth and well-being and in reducing polydrug use during pregnancy.