The effect of preprocedure teaching, relaxation instruction, and music on anxiety as measured by blood pressures in an outpatient gastrointestinal endoscopy laboratory.

A gastrointestinal examination can be frightening to patients. Abnormally elevated blood pressure and pulse caused by anxiety often are present on admission to the hospital. These elevated vital signs are then used as the baseline vital signs for the patient's hospital stay. The first purpose of this study was to determine whether vital signs are elevated because of anxiety on admission to the hospital and how much they decrease after sedation. The second purpose of this study was to explore the effect of instruction about relaxation and the use of music relaxation audio tapes in decreasing patient anxiety. Patients undergoing endoscopic examinations for the first time were randomly assigned into two groups. Patients in the treatment group were given brief instructions in relaxation and provided with an audio tape player and relaxation music. Statistical analysis using multivariate analysis of variance (MANOVA) comparing differences between control and treatment groups over time showed that there was a significant main effect for diastolic blood pressure. Subjects in the treatment group had significantly lower blood pressures throughout the entire GI procedure. There was no significant difference between groups regarding the amount of medication used. Music combined with relaxation is an inexpensive nursing intervention for patients in relaxing during a GI examination.

The blood cell transplant program.

OBJECTIVES: To discuss the critical components of a blood cell transplantation (BCT) program as they relate to the standards developed by The Foundation for Accreditation of Hematopoietic Cell Therapy (FAHCT). DATA SOURCES: FAHCT Standards, book chapters, and articles pertaining to developing a BCT program. CONCLUSIONS: BCT is a burgeoning therapy for oncologic and hematologic diseases. New regulations have emerged to promote quality medical and laboratory practice in blood and marrow transplantation. IMPLICATIONS FOR NURSING PRACTICE: As BCT increases for oncologic and hematologic diseases, a growing number of oncology nurses will be caring for BCT recipients and their families. Nurses in administration, research, advance practice, and education are increasingly involved in implementing BCT as a standard therapy for a growing number of diseases.

Struggling to gain meaning: living with the uncertainty of breast cancer.

Uncertainty is a common experience for women living with breast cancer, particularly when treatment cannot assure disease cure. The study described in this article sought to provide insight into uncertainty experiences for women living with breast cancer. Hermeneutic phenomenology and photographic hermeneutics were used to describe and interpret uncertainty for nine women between 2 and 6 years posttreatment for breast cancer. Data were collected using interviews and interpretations of photographs. Five themes of uncertainty among women were uncovered. Major study findings included support for a reconceptualization of Mishel's Uncertainty in Illness Theory and the explication of growth-producing aspects of uncertainty.

Intrapelvic extraction of a total hip prosthesis. A case report.

A 69-year-old man with a total hip prosthesis, recurrent infection, and intrapelvic incarceration of the acetabular components required extraction of a long-stem total hip prosthesis through three incisions. Retroperitoneal intrapelvic extraction of the incarcerated prosthesis was necessary. This approach allowed removal of intrapelvically migrated components and the eradication of the infection. The patient had no signs of infection five years postoperatively.

The vascular history and physical examination.

The value of the vascular examination cannot be over-estimated. Symptoms of vascular disease present in the foot and lower extremity may actually be manifestations of severe life-threatening disease. Symptoms, their location, and the frequency and quality of the patient's pain often provide valuable clues for the clinician's diagnosis. Central nervous system symptoms, ocular disturbances, cardiac symptoms, impotence, or constitutional disturbances may all indicate systemic arterial disease. Risk factors for this disease include smoking, hypertension, hyperlipidemia, genetic predisposition, diabetes, emotional stress, and physical inactivity. Those factors attributable to hypercoagulability and venous disease are birth control pill use, estrogen chemotherapy, obesity, prolonged immobilization, paralysis, previous thrombotic episodes, venous stasis disease, and varicose veins. An accurate bilateral assessment of blood pressure, pulses, and capillary perfusion is of critical importance. Careful inspection of the extremity for trophic changes, skin color, texture, temperature, edema, ulceration, atrophy, or paresis, will provide clues of vasculopathy. A relatively accurate assessment of circulatory status may be obtained without the use of exotic instruments. Simple tests such as the elevation and dependency tests, capillary bed return test, venous filling time test, along with blood pressure, pulse, and possibly oscillometry data are valuable in arterial evaluation. Such venous tests as inspection, percussion, Homan's sign, Trendelenburg, and Perthes' tourniquet are useful in the determination of the presence of venous disease. Fortunately, over the past few years tremendous advances have been made in the technology of the vascular laboratory. If symptoms are discovered during the vascular history and physical examination, the complete noninvasive study will provide impressive data to quantitate and specifically establish the diagnosis.

Perceived health, self-esteem, health habits, and perceived benefits and barriers to exercise in women who have and who have not experienced stage I breast cancer.

As more women survive the experience of breast cancer, it is essential to discover the impact it has on a woman's life. The purpose of this study was to determine differences in perceived health, self-esteem, health habits, and perceived benefits and barriers to exercise in women who have and who have not experienced stage I breast cancer and its treatment. A random sample of 55 women who have experienced stage I breast cancer and have not received adjuvant therapy was selected and matched to a cohort of women in the community who had not experienced cancer. No significant differences were found in perceived health, self-esteem, and health habits between women who had experienced breast cancer and the matched cohorts. There was a significant difference in both perceived benefits and barriers to exercise between groups (t = 2.4, df = 106, p = 0.18), with the matched cohorts scoring higher on perceived benefits and barriers to exercise.

Malignant fibrous histiocytoma associated with total hip replacement. A case report.

This report documents another case of malignancy associated with total hip replacement. A malignant fibrous histiocytoma of the femur was diagnosed approximately 10 years after insertion of a cemented Müller cobalt-chromium prosthesis.

The effect of previous surgery, operating room environment, and preventive antibiotics on postoperative infection following total hip arthroplasty.

In 711 consecutive total hip arthroplasty operations, approximately 80% of patients were followed one to 7 years. Per priman operations outnumbered hips having had previous operations 511 to 200. The incidence of infection was higher in the hips having had previous operations (1.6 vs 3.5%). The overall incidence of deep infection was 16/711, or 23%. Analysis of the influences of operating room environment and preventative antibiotics revealed that there was a marked decrease in the attack rate of deep infection (7.6 vs 0.6%) when the Clean Room, personnel-isolator system, and preventative antibiotics were used. Reduced intraoperative wound bacterial contamination is accompanied by a reduced incidence of sepsis.

Reduction of deep sepsis after total hip arthroplasty.

The role of the operating room environment in the development of deep sepsis after total hip arthroplasty was studied at four centers. The incidence of deep sepsis after 5,865 total hip arthroplasties performed in the four centers varied from 0.5% to 2.3%. Procedures performed in a conventional operating room were associated with the highest incidence of deep sepsis (1.3%). The use of a vertical, unidrectional airflow system with a helmet aspirator suite was associated with the lowest incidence of deep sepsis (0.6%). Although patients with previous hip surgery had an increased incidence of deep sepsis regardless of the operating room environment, those procedures performed in a vertical, unidrectional facility had a lower incidence of deep sepsis. Newer techniques designed for the reduction of airborne contamination of the operative wound seem to reduce the incidence of deep-wound sepsis after total hip arthroplasty, especially in patients with previous hip surgery.

Deep infection following total hip arthroplasty.

Deep sepsis is a serious postoperative complication of total hip arthroplasty, causing additional suffering, loss of function, need for additional treatment, and possibly early death. In a series of sixteen patients, the only effective treatment was complete extirpation of all implants combined with appropriate long-term administration of antibiotics. In fifteen patients the original operative objectives were not achieved.

Five years experience with operating room clean rooms and personnel-isolator systems.

Two horizontal flow, laminar airflow type clean rooms have been used for almost all clean orthopedic surgery at St. Luke's Hospital in Denver since March 1971. This experience covers approximately 4000 cases, including 1100 total hip and total knee arthroplasties. Three different types of helmet aspirator systems have also been evaluated. Our conclusions from this experience are: (1) All types of orthopedic surgery may be easily and conveniently performed in the clean room and with scrubbed personnel wearing helmet aspirator systems; (2) mechanical upkeep of the clean room is minimal; (3) airborne bacteria counts have been reduced at least 80 percent compared to a regular operating room, and more than 90 percent when scrubbed personnel wear the helmet aspirator system; (4) sterile surface contamination, including the wound, has been reduced at least 80 percent; and (5) the deep infection rate for total hip replacements with at least a 2-year follow-up has been 7.6 percent (10/131) in a regular operating room and 1.6 percent (5/319) in the clean room. With the combined use of the clean room, helmet aspirator systems, and perioperative antibiotics, no infections have occurred in an additional 350 cases with a 1-year follow-up.

Solitary bone cyst with epiphyseal involvement: a case report.

A large solitary bone cyst involving the epiphysis produced 5.0 cm shortening of the proximal humerus in a 15-year-old girl. Biopsy revealed the cyst was filled with thin yellow fluid under pressure and lined by a fibrous membrane. X-rays 9 months after biopsy demonstrated progressive cyst obliteration. A review of literature revealed no similar case. It is postulated that solitary cysts rarely may involve the physeal and epiphyseal structures and thereby retard longitudinal bone growth.