Preparing nursing students for contemporary practice: restructuring the psychomotor skills laboratory.

The restructured laboratory experience offered a safe environment that supported student experimentation with psychomotor skills and self-initiated approaches to problem solving. Restructuring psychomotor laboratory experiences with emphasis on communication and conceptualization of principles supported students to begin addressing clinical problems with flexibility, creativity, and the premise for lifelong skill acquisition. Students who have skills that extend beyond technique will inevitably be better prepared to meet the demands of health care systems and patients now and in the future.

Collaboration and partnership: nursing education and self-help groups.

Development of a collaborative partnership between a mental health psychiatric nursing course and Recovery Incorporated, a self-help group, is described. Baccalaureate nursing students' reactions to their clinical experience as participant observers are examined. Through collaboration, a partnership developed that afforded students an appreciation of the role of self-help groups in supporting mental health, awareness of consumer responsibility for decision making. This partnership also fostered increased openness to diversity.

Clinical ladders: do they reflect levels of competence?

Staff nurses positioned within two discrete clinical ladder levels were surveyed for their responses to two components of clinical competence: job performance and problem-solving tactics. Although findings suggest that clinical ladders do not seem to provide clear delineation of competence levels, several interventions with staff nurses may increase clinical ladder viability: 1) opportunity to practice and utilize mixed and integrative problem-solving styles, 2) challenging work experiences, and 3) opportunity to mentor and be mentored.

Pulmonary edema associated with the use of betamimetic agents in preterm labor.

A case report of pulmonary edema associated with the use of a betamimetic agent in preterm labor is reported. A 31-year-old, black multigravida woman, 28 weeks pregnant, was admitted to the hospital with dysuria, vaginal bleeding, and uterine contractions. She had experienced premature labor in her previous pregnancies, and she had a history of kidney stones, confirmed by pyelography, and repeated urinary tract infections. Eighteen hours after admission, the contractions were occurring every five minutes. Terbutaline sulfate constant infusion (10-20 micrograms/min) was started. By hospital day 2, the uterine contractions were occurring every 1-2 minutes and lasting 50 seconds. The terbutaline therapy was discontinued, and isoxsuprine hydrochloride infusion was started at 240 micrograms/min and gradually increased to 800 micrograms/min. The patient complained of smothering and became tachypneic after one hour and 40 minutes of therapy. The shortness of breath and tachypnea continued in spite of the administration of oxygen and positional changes. The isoxsuprine was discontinued. The diagnosis of pulmonary edema was confirmed by abnormal findings in the chest roentgenogram, bilateral rales, and a decrease in arterial blood oxygen pressure. A literature review of pulmonary edema associated with the administration of beta sympathomimetic drugs is presented, which suggests this adverse effect is multifactorial in origin. Precipitating factors may include corticosteroids, fluid overload, low levels of serum potassium, twin gestations, a sustained tachycardia greater than 140 beats per minute, undiagnosed cardiopulmonary disease, or catecholamine-induced cardiac injury. Patients requiring betamimetics for the delay of premature labor should be monitored closely to obviate this complication.

Incidence and origin of heteroploidy, especially haploidy, in chick embryos from intraline and interline matings.

Preparations for chromosomal analysis were made from 2107 chick embryos at 16 hours of incubation. The embryos resulted from intraline and reciprocal interline matings of two genetically different stocks (AG and D6). The two stocks had been previously characterized as producers of high (AG) and low (D6) frequencies of chromosomally aberrant embryos. The overall frequency of aberrant embryos was 4.0 plus or minus 0.42%. The types and frequencies of abnormalities were: haploidy and haploid-euploid mosaics, 57%; polyploidy and polyploid-diploid mosaics, 19%; aneuploidy, 17%; aneuploid-diploid mosaics, 5%; and structural aberrations, 2%. Although there were no significant differences among the four types of matings in the overall frequency of heteroploid embryos (P greater than 0.1), a significant difference (P smaller than 0.01) in the frequency of haploid and haploid-euploid mosaic embryos was found. The difference was entirely attributable to the line of dam; D6 dams had 1.2% and AG dams had 2.7% haploid and haploid-euploid mosaic embryos. The difference between lines of sires was not significant. In addition, there was evidence of nonrandom distribution, among dams of both lines, of haploid and haploid-euploid mosaic embryos. It was concluded that the genotype of dam is an important influencing factor in the production of haploid cell lines in embryos. The superfluous genome in triploid embryos is usually maternal in origin, resulting from retention of the second polar body in the ovum. Sex-chromosome aneuploidy in chick embryos apparently derives from nondisjunction at meiosis I of oogenesis. The sex proportion of 2023 chromosomally sexed, diploid embryos was 50.2 plus or minus 1.1% male. No significant heterogeneity was observed among the types of matings. Sex proportion was not significantly influenced by any of a number of nongenetic variables.