Nitrogen sparing and the catabolic hormones in patients nursed at an elevated ambient temperature following major surgery.

Fasted patients managed at an elevated ambient temperature following major surgery have reduced nitrogen excretion and body protein catabolism. To investigate the mechanism behind this three 24 h urine collections were made in 16 patients nursed for 48 h following aortobifemoral surgery on a Clinitron fluidized bed at 32 degrees C and analysed for total urinary nitrogen, cortisol and catecholamine excretion. Results were compared with a similar group of patients nursed throughout on a standard ITU bed at 22 degrees C. Patients managed at the elevated ambient temperature showed a significant reduction in the cumulative total urinary nitrogen (20.73 g +/- 6.42 v 28.95 g +/- 6.44; mean +/- S.D.; p less than 0.002) and cortisol excretion (1238 microg +/- 436 v 2197 microg +/- 844; mean +/- S.D.; p less than 0.001). Catecholamine excretion was also reduced but failed to achieve significance. There were significant correlations between cumulative total nitrogen excretion and both cortisol (r = +0.414; p = 0.02; n = 32) and noradrenaline (r = +0.369; p = 0.05; n = 32). These results confirm that the beneficial effect of an elevated ambient temperature on postoperative protein metabolism is brought about through a reduction in metabolic stress.

Psychological distress across the course of care: a case study from implantable cardioverter defibrillator to cardiac transplantation evaluation.

The psychological distress of cardiac patients can complicate treatment or the recovery process. This case study presents a 47-year-old male recipient of an implantable cardioverter defibrillator who experienced multiple, consecutive shocks and subsequently developed anxiety and depressive difficulties. Psychological treatment to diminish these symptoms was employed. Despite declining cardiac function, the patient made significant progress in managing this negative affect. Subsequently, he was evaluated for cardiac transplant, and this treatment progress became critical evidence of his psychosocial suitability for transplant.

How well is your patient prepared for an MRI? An insider's perspective.

Often patients undergoing magnetic resonance imaging (MRI) for diagnostic purposes are not adequately prepared to deal with the claustrophobia commonly experienced while in the MRI machine. They may have been instructed on the procedure and some of the physical sensations they might encounter, but teaching about coping strategies to utilize when confronted with the occurrence of unanticipated claustrophobia when a sedating medication is not immediately available may often be lacking. Drawing on excerpts from a patient's journal that vividly describes her struggle to cope with claustrophobia during an MRI, this article discusses this commonly encountered experience within the context of theoretical perspectives of stress to underscore the importance of assessing for indications of rising anxiety. Suggestions for coping strategies to include in patient teaching are presented.

Modifying perfusion, nutrition, and stress to promote wound healing in patients with acute wounds.

Tissue injury is common among patients in acute care settings. The subsequent response to injury, wound healing, follows an intricate but well-defined sequence that, under normal conditions, proceeds to satisfactory repair. However, because of the complexity of the healing response, several factors can intervene to impair normal healing. As a better understanding of how diverse factors influence healing is gained, the use of interventions that modulate these factors becomes possible and potentially beneficial. This article reviews knowledge of perfusion, nutrition, and stress as they relate to healing in patients experiencing acute wounds. Therapeutic implications based on current research are discussed.

Pastoral care for perinatal and neonatal health care providers.

Health care workers in the perinatal and neonatal environments experience many emotions as they encounter stressors day after day. The chaplain, one of many on the multidisciplinary team, can serve as a valuable resource for other team members. This article provides an overview of the various supportive roles the chaplain can assume. A case presentation highlights pastoral care of staff and family across the continuum from the perinatal to the neonatal units.

The effect of nonnutritive sucking on bottle-feeding stress in preterm infants.

OBJECTIVE: To examine the effects of nonnutritive sucking on the physiologic and behavioral stress reactions of preterm infants at early bottle feedings and to examine the effect of nonnutritive sucking on the feeding performance of preterm infants at early bottle feedings. DESIGN: Quasi-experimental with a matched sample. SETTING: A level III neonatal intensive-care unit in a large medical center. PARTICIPANTS: Twenty preterm infants whose gestational ages at birth ranged from 26 to 34 weeks. INTERVENTIONS: Ten infants were provided nonnutritive sucking for 5 minutes before and 5 minutes after an early bottle feeding. Ten infants served as controls. MAIN OUTCOME MEASURES: Physiologic stress was measured by heart rate and oxygen saturation rate. Behavioral stress was measured by observation of behavioral state. Feeding performance was measured by duration, percentage of formula taken by bottle, and behavioral state after feeding. RESULTS/CONCLUSIONS: Infants who received nonnutritive sucking before and after bottle feedings were more likely to be in a quiescent behavior state 5 minutes after the feeding (p = .01) and had higher feeding performance scores (p = .01) than infants who did not receive nonnutritive sucking.

The relationship between physiological and behavioral measures of stress in preterm infants.

OBJECTIVE AND DESIGN: The purpose of this exploratory descriptive analysis was to explore relationships among physiological stress, behavioral stress, and motor activity cues in preterm infants when they were not being handled or disturbed, and to determine whether there were differences between younger and older preterm infants in these variables or relationships. SETTING AND PARTICIPANTS: The convenience sample included 42 preterm infants who had been 27 to 33 weeks gestational age at birth and were from 6 to 19 days old at the time of data collection in the neonatal intensive-care unit. MEASURES: In each 10-minute observation, heart rate (HR) and oxygen saturation (O2 sat) levels were recorded every 5 seconds, and observational measures of behavioral distress and motor activity were recorded twice a minute. The physiological data were coded to reflect the percentage of each 10-minute period during which HR levels were less than 100 bpm or more than 200 bpm or O2 sat levels were abnormally low (less than 90 mg%). Data were analyzed with correlational and general linear mixed models procedures. RESULTS: Stress cues and motor activity were more often related to low levels of O2 sat than to low or high HR. Physiological status was more often related to motor activity than to stress cues. Few differences in the relationships were observed between younger and older preterm infants. CONCLUSION: Although these results are preliminary, they suggest that neonatal nurses should monitor preterm infants' behavioral stress and motor activity cues in response to caregiving and minimize stimuli that evoke stress responses linked to physiological instability.

Music modulates behaviour of premature infants following heel lance.

The physiological and behavioural effects of music during recovery from heel lance were examined in 14 preterm infants at 29 to 36 weeks post-conceptual age (PCA). Infants were tested on 2 occasions: during a music condition and during a no-music control condition. Each condition was videotaped during 3 periods: baseline, heel lance, and recovery. Infants were divided into 2 age groups for data analyses: less than and greater than 31 weeks PCA. Mixed model ANOVAs showed that heel lance elicited a stress response (i.e., increased heart rate, decreased oxygen saturation, increased state-of-arousal, and increased facial actions indicative of pain) in both age groups. The stress response was greater in the older group. During recovery, the older group had a more rapid return of heart rate, behavioural state, and facial expressions of pain to baseline levels in the presence of compared to the absence of music. It was concluded that music is an effective NICU intervention following a stress-provoking stimulus in infants older than 31 weeks PCA.

Aerospace nursing: the new frontier.

Since the days of Florence Nightingale and the Crimean War, nursing has been involved in shaping the environment to make it more conducive to human existence. With the emergence of the Space Age the environment has broadened to encompass not only Earth and its ionosphere, but its moon and sister planets as well. To date, nursing has been successful in developing theories that address human-environmental interactions. However, the environment of the 21st century will be vastly different from the environment of the 1980s. In the 21st century, macroutilization of space will become a reality. Such broad-based use of space will include space industrialization and manufacturing, satellite solar power generation, and space habitation. In order to achieve long-duration space flights and habitation, human needs and responses to microgravity must be addressed. This article discusses the physiological and psychological stresses that have an impact on the ability of humans to achieve space habitation and nursing's role in that endeavor. The nursing knowledge base needed to establish the discipline as a major contributor to space health science is discussed. An educational strategy for the development of this knowledge at both the master's and doctoral levels is proposed.

Influences of a relaxation intervention on perceived stress and power spectral analysis of heart rate variability.

This study was designed to determine whether power spectral analysis (PSA) of heart rate variability (HRV) can detect change in autonomic tone following a relaxation intervention called therapeutic touch (TT). Thirty healthy subjects underwent TT by one of three TT practitioners using the steps developed by Krieger and Kunz (The Therapeutic Touch, Prentice-Hall, 1979). Both subjects and TT practitioners were monitored by continuous electrocardiographic monitoring (Holter) before (15 minutes), during, and after (15 minutes) TT was administered. Subjects and TT practitioners completed a visual analogue scale (VAS) of perceived stress before and after TT. Change scores for VAS and PSA of high-frequency/low-frequency (HF/LF) ratios were compared for the 2-minute interval before TT began and the end of TT and the end of the recovery period, using t tests. VAS scores decreased (less stress) from before to after TT for both subjects (p < 0.0005) and TT practitioners (p < 0.0005). Mean HF/LF ratios increased significantly to reflect greater parasympathetic dominance from before TT to the end of treatment for subjects (p = 0.006), but not for TT practitioners. However, further analysis revealed that this change was due to an exaggerated HF/LF response from four outliers (p < 0.0005). Data collected in this study did not reveal differences between these four subjects and the rest of the sample. There were no significant changes in HF/LF ratios from the end of TT to end of recovery for either group. Further research is needed to determine why some subjects may have greater change in autonomic tone in response to relaxation in order to be able to predict who will demonstrate physiologic response to relaxation interventions.

Hopelessness in the myocardial infarction patient.

Events that cause hopelessness following a myocardial infarction may include coronary heart disease, reality-based misperceptions, lack of future goals and lack of relatedness to others. The susceptibility to hopelessness will depend on how successful the patient has been in accepting previous cardiac-related problems. Once hopelessness occurs, the patient may perceive the future to be limited. Hopelessness centers around seven components: physiological, cognitive, temporal, affective, behavioral, affiliative and contextual loss of hope. This article outlines how hopeless patients may distort their immediate environment and future goals. Methods of identifying hopelessness and intervening with appropriate nursing interventions, which will assist with the management of hopelessness, are described.

Physical stresses related to the transport of the critically ill: optimal nursing management.

The critically ill patient's physical well being is constantly at risk. This fragile physical state means the patient is vulnerable to a host of hazards within the critical care setting, none of which are more relevant to patient outcome than the hazards awaiting them should the patient require transportation. The stresses exerted on the human body and the vulnerability of the critically ill to various means of movement, transport and subsequent environmental changes are explored through this review. The review includes a brief history of the evolution of patient transportation, which has provided a basis for the inception of formal strategies in patient management related to transportation. Within this framework current optimal nursing management minimising the detrimental effects of transport on the critically ill is reasoned to its scientific base. The basic laws of physics are an important consideration in all modes of patient movement or transport and play an integral role in the critical care nurses' practice. A clear understanding of pathophysiological and technological processes involved in caring for the critically ill and applying the principles of physics to effective contextual practice enhances the capability of the critical care nurse.

Video display terminal operators: technology's biopsychosocial stressors.

1. Professional nurses can contribute significantly to the implementation of a multidisciplinary team to solve biopsychosocial stress issues in the "high tech" workplace. 2. Educating workers about risk factors, ergonomics, and self management measures is one of the most important aspects of preventing video display terminal related disorders. 3. The evaluation of biopsychosocial stress involves examination of workers' physical health, psychological demands, decision latitude, social support, workstation design, and other special considerations such as electronic performance monitoring.