Validation of defining characteristics of four nursing diagnoses using a computerized data base.

As the use of nursing diagnoses in clinical practice increases, systematic research is necessary to appropriately validate them. Validity studies could be expedited by the use of information technology and computerized clinical data bases. The purpose of the following descriptive study was to validate the defining characteristics (risk factors for potential diagnoses) of the four nursing diagnoses related to alterations in fluid volume proposed by the North American Nursing Diagnosis Association using a nursing minimum data set (NMDS) collected from a computerized nursing data base. A sensitivity measure, the proportion of subjects with specific defining characteristics for a given diagnosis among the total number of subjects with the respective diagnosis, was used to estimate validity. The study was conducted in a 265-bed, mid-western, community hospital in which computerized nursing diagnosis care planning is used. The elements of the NMDS and defining characteristics were collected from a systematic sample (N = 191). The sample consisted of a proportion of about half of computerized discharge patient care plan summaries from each of the four diagnostic labels related to alteration in fluid volume obtained from medical records during the 1987 calendar year. Discharge patient care plan summaries contained at least one of four nursing diagnoses related to alteration in fluid volume. The results show the existence of individual defining characteristics as well as combinations of defining characteristics meeting validation criteria for each diagnostic label. Never-documented defining characteristics also were identified.

Inductive methodology and a research team.

Large teams of researchers using inductive methodologies are relatively rare and present unique challenges to team members. A team from the University of Iowa reports on what it experienced during a project to develop a taxonomy of nursing interventions.

Family involvement with communication-impaired residents in long-term care settings.

This article describes the outcomes of a study involving family members of communication-impaired long-term care residents in a collaborative nursing/speech language pathology intervention designed to increase the residents' communication ability. Family members provided memorabilia and artifacts or produced audio or video tapes, for use in conjunction with a speech therapy enhancement program (STEP). Findings revealed that, despite a minimal improvement in speech ability, there was a dramatic increase in family members' satisfaction.

Classification of nursing interventions for care of the integument.

The Classification of Nursing Interventions research team at The University of Iowa, College of Nursing is building a taxonomy of nursing interventions that will include all of the direct care treatment activities that nurses perform on behalf of patients. This report describes the study in which 12 nursing interventions and their associated activities for care of the integument were extracted from a large database and validated through a two-round Delphi survey. Using an adaptation of Fehring's model for determining diagnostic content validity of nursing diagnoses, a definition, critical activities, and supporting activities were developed for each of the following interventions: Bathing, Bedrest Care, Hair Care, Nail Care, Oral Health Maintenance, Oral Health Promotion, Oral Health Restoration, Positioning, Pressure Management, Skin Care--Topical Treatments, Skin Surveillance, and Wound Care. Further research is needed to validate supporting activities and to continue classifying interventions and activities that nurses use in treating impaired skin integrity (potential and actual) and altered oral mucous membrane integrity (potential and actual).

Right vs. left hemispheric blood-brain barrier permeability in schizophrenia: a dynamic computed tomographic study.

Dynamic computerized tomographic brain scanning was used to make determinations of mean cerebral tissue nonenhanced density and contrast-enhanced density in 10 bilateral brain regions in 10 psychotic subjects. Asymmetry of both nonenhanced and contrast-enhanced density was observed; left regional nonenhanced values were higher than right, whereas contrast-enhanced density values were higher on the right than on the left. No significant differences were observed in arterial mean transit time (AMTT) between right and left middle cerebral artery branches or in capillary or tissue mean transit time (CMTT) in the middle temporal cortex. However, corrected CMTT (CCMTT), i.e., CMTT minus AMTT, may have been prolonged in five subjects either on the left or right, or in both homologous regions. Only 2 of 10 subjects exhibited anterior-posterior (AP) gradients that resembled to some extent the hyperfrontal pattern reported in normal subjects by other investigators with different techniques.

Ethanol exposure during brain ontogeny: some long-term effects.

The timing, intensity, and duration of the period of maximal susceptibility of the developing brain to ethanol have not been clearly elucidated. This study was designed to determine whether a lower blood ethanol concentration (BEC) or a brief exposure during the brain growth spurt in the rat might cause permanent brain damage. Two doses of ethanol (4 g/kg body weight daily during days 6-16 after birth and 6 g/kg on day 6 only after birth) were used. Significant differences in whole brain weight, a disproportionately decreased cerebellar weight, altered balancing ability, and a decreased number of cerebellar cells were observed on days 17 and 70 postnatally in both ethanol-treated groups as compared with controls. Cerebellar weight a both ages were more markedly affected in animals treated only on day 6 postnatally than in animals treated throughout the major portion of the brain growth spurt. These results suggest that episodic exposure to ethanol during peak brain growth may be just as devastating to brain development as chronic exposure throughout the major portion of the brain growth spurt.

Ethanol in preweanling rats with dams: body temperature unaffected.

At an ambient temperature of 24 degrees C, the neonatal rat was found to exhibit poikilothermic characteristics if separated from the dam. On day one after birth, at one hour after separation from dams, the body temperature in rat pups was found to be identical with ambient temperature. Preweanling pups, under these circumstances, were unable to maintain a constant body temperature prior to day 19 postnatally. No differences were observed in body temperatures of rat pups treated chronically (days 6-16 postnatally) with ethanol 4 g/kg body weight (in two 2 g/kg doses three hours apart), as compared with isocaloric isovolumetric milk-, or sham-treated control groups. A significantly lower temperature was observed only at 105 minutes after the first treatment in a group of rats acutely treated (one day only) with ethanol on day 22 postnatally as compared with an isovolumetric water control group. In adult rats, also treated acutely with ethanol, a significant hypothermic response occurred at 105 minutes after the first 2 g/kg dose and persisted during the remainder of the observation period. This study shows that body temperature was unaffected in neonatal Sprague-Dawley rats left with their dams after intubation with ethanol 4 g/kg body weight. Therefore any brain biochemical and/or structural alterations resulting from ethanol exposure, using this animal model, are not due to an ethanol induced hypothermic response.

The effects of ethanol exposure during the brain growth spurt in rats.

The purpose of this study was to determine whether micromorphological changes occur at a low level of ethanol exposure previously shown by us to induce alterations in synaptosomal biochemistry. The results suggest that 4 g ethanol per kg body weight daily throughout the brain growth spurt causes no significant structural changes in the cerebellum, lobule IX, at the light and electron microscopic levels. Although ethanol- and isocaloric sucrose-treated groups did not differ from each other in cumulative percent body weight gain throughout the treatment period, both groups differed significantly in this parameter from isocaloric milk-treated and "handled" control groups. On the day following completion of the treatment period, brain weight in the ethanol-treated group was significantly less than that of all other groups. Further, the results indicate that isocaloric sucrose "pair feeding" is contraindicated in postnatal studies and that nutritional status is better controlled by daily gavage of neonates than by other methods currently used in ethanol studies in postnatal animals.

Effect of ethanol on synaptosomal sialic acid metabolism in the developing rat brain.

The total, glycoprotein-bound and glycolipid-bound sialic acid concentration, ad the activities of ecto-sialyltransferase and neuraminidase were determined in synaptosomes from preweanling ethanol-treated and control rats. The period of treatment corresponded to that of maximal synaptogenesis and peak synthesis of sialoglycocompounds (days 27-37 postconception). The average of the peak blood ethanol concentration was 271 mg/100 ml. In the ethanol-treated animals the sialic acid concentration was significantly reduced (approximately 20%) with an equally distributed decrease of glycoprotein- and glycolipid-bound sialic acid. The activity of ecto-sialyltransferase with asialofetuin as exogeneous acceptor was significantly diminished (about 30%) in the ethanol-treated pups. Neuraminidase showed an unchanged activity after correction for the reduction of endogeneous sialic acid substrate concentration. The total protein and lipid concentrations of the synaptosomal preparations did not differ between the groups. These results suggest that ethanol treatment during on of the vulnerable periods of brain development causes an inhibition of the incorporation of sialic acid into synaptosomal membrane-bound sialoglycocompounds. Such an effect of ethanol exposure might disturb intercellular interactions and the functional performance of the membrane during development, and could be of importance in the pathogenesis of the central nervous system manifestations of the fetal alcohol syndrome.

Blood-brain barrier, aging, brain blood flow, and sleep.

We have shown that significant ultrastructural changes occur with increasing age in the BBB in the nonhuman primate. It is probable that similar changes occur in aging humans. Clearly, morphophysiological changes, i.e., structural changes in cerebral capillaries, may alter the BBB mechanism as well as capillary perfusion which, in turn, may affect cerebral energy metabolism and neuronal function. Thus neurological function may be affected and sensitive indices of function such as sleep patterns altered.

Changes with age in cerebral capillary morphology.

Age related alterations in cerebral capillary morphology were investigated in 4-, 10-, and 20-year-old Macaque monkeys and in 1-, 14-, 35-, 180-, and 800-day-old Sprague-Dawley rats. This study revealed the following changes with increasing age: a significant decrease in cerebral capillary wall thickness in frontal cortex in monkeys but not in rats; a significant increase in the thickness of basal lamina (BL) of cerebral capillaries in rats but not in monkeys, however there was a marked increase in this parameter in the monkey between 4 and 10 years of age; a significant decline in cerebral capillary endothelial mitochondrial content in monkeys whereas a significant decline in this parameter in rats was found only when the peak content at 35 days was contrasted with that at 800 days of age; and, aberrant tight junctions and thickened BL in one of five 20-year-old monkeys. These findings suggest impairment of barrier characteristics of cerebral capillaries with increasing age in both the rat and the monkey.

Thinning of capillary walls and declining numbers of endothelial mitochondria in the cerebral cortex of the aging primate, Macaca nemestrina.

Samples were obtained from the frontal and occipital cortex of Macaque monkeys at 4, 10 and 20 years of age. Electron microscopic studies revealed attenuation of capillary walls and declining numbers of endothelial mitochondria per capillary profile with increasing age. The basal lamina surrounding the capillary increased in thickness between 4 and 10 years of age; however, it did not undergo further change between 10 and 20 years. These results corroborate morphological and biochemical studies indicative of declining numbers of mitochondria, and decreasing mitochondrial ATP synthesis and ATPase activity in other tissues during aging.