RESUMO
The vasodilation of pregnancy is thought by many to be due to increased endothelial production of prostacyclin, a vasodilatory prostanoid. Indomethacin, a potent inhibitor of prostaglandin synthesis, is known to increase the maternal blood pressure response to angiotensin II infusion. We sought to measure directly the hemodynamic effects of a short course of indomethacin. Twenty-three healthy pregnant women with uncomplicated pregnancies between 26-32 weeks' gestation completed the study. Using Doppler technology, we determined cardiac output, stroke volume, and total peripheral resistance before and after three 25-mg doses of indomethacin. Although blood pressure did not change, peripheral resistance rose and stroke volume fell following indomethacin administration. Our findings support the hypothesis that indomethacin interferes with tonic prostaglandin-induced vasodilation in pregnancy. However, the increase in vascular resistance was very slight, suggesting that other vasodilators are also at work in pregnancy. We recommend that indomethacin be used judiciously in hypertensive pregnant patients until more information concerning possible adverse hemodynamic effects becomes available.
Assuntos
Hemodinâmica/efeitos dos fármacos , Indometacina/farmacologia , Gravidez/fisiologia , Pressão Sanguínea/efeitos dos fármacos , Débito Cardíaco/efeitos dos fármacos , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Gravidez/efeitos dos fármacos , Resistência Vascular/efeitos dos fármacosRESUMO
The hemodynamics of six pregnant women with hyperthyroidism were studied before and after therapy. Cardiac output was measured by Doppler technique, and blood pressure by automated cuff. When compared with values in euthyroid pregnant women, blood pressure (83.6 mmHg, P less than .001), heart rate (89.2 beats per minute, P less than .001), cardiac output (11.2 L/minute, P less than .001), and stroke volume (123 mL, P less than .001) were significantly elevated. Total peripheral resistance was significantly reduced (609 dyne.second.cm-5, P less than .001). Despite normalization of thyroid indices after therapy, cardiac output remained markedly elevated (9.7 L/minute, P less than .001) and vascular resistance remained reduced (708 dyne.second.cm-5, P = .01). Although the hemodynamics of pregnant thyrotoxic women normalize with therapy, they remain significantly hyperdynamic.
Assuntos
Hemodinâmica/fisiologia , Hipertireoidismo/fisiopatologia , Complicações na Gravidez/fisiopatologia , Ecocardiografia Doppler , Feminino , Humanos , Hipertireoidismo/tratamento farmacológico , Gravidez , Complicações na Gravidez/tratamento farmacológico , Resultado da Gravidez , Propiltiouracila/uso terapêutico , Testes de Função TireóideaRESUMO
A pressure-measuring Moore-type endoprosthesis was implanted in a seventy-three-year-old patient who had sustained a displaced fracture of the femoral neck. The measurement and telemetry of contact pressures in the hip began in the operating room, and data were acquired periodically for more than thirty-six months. Unexpectedly high localized contact pressures between the acetabular cartilage and the prosthesis were recorded. Early in the period of recovery, activities such as using a bedpan or performing isometric exercise produced pressures that were close to those recorded during normal walking. The highest pressure, eighteen megapascals, was recorded one year postoperatively, while the patient was rising from a chair. High pressures occurred in the superior and posterior aspects of the acetabulum.
Assuntos
Fraturas do Colo Femoral/cirurgia , Articulação do Quadril/fisiologia , Prótese de Quadril , Acetábulo/fisiologia , Idoso , Gráficos por Computador , Feminino , Cabeça do Fêmur/fisiologia , Humanos , Pressão , Telemetria/métodosRESUMO
The purpose of this descriptive study was to determine the relationship of demographic variables and mothers' perceived vulnerability to eight communicable diseases with immunization compliance. A random sample consisting of 40 mothers with preschool-age children 4-24 months of age was interviewed by means of the Communicable Disease Perceived Vulnerability Scale and the investigator-developed Demographic Data Collection Instrument. Data were analyzed with descriptive statistics and chi-square (p < or = .05). The average mother in the sample was White, had a 10th- to 12th-grade education, was 24-31 years old, and had a yearly income of $10,000-$45,000. Statistically there were no significant relationships between maternal characteristics or between maternal vulnerability beliefs and immunization compliance. However, it is clinically significant that the overall compliance rate of 70% in this rural area is much higher than the national average of 50%. Findings suggest that using health education materials at the time of newborn discharge, mailing reminder cards, and accessing a statewide computer recall system may increase immunization compliance. In addition, mothers who perceived a vulnerability to the diseases had a 60.6% compliance rate, suggesting that perception of vulnerability may be a useful predictor of immunization compliance.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Imunização , Mães , Cooperação do Paciente , Adulto , Feminino , Humanos , Mães/educação , Mães/psicologia , Estudos de AmostragemRESUMO
Children's pain is often poorly managed, and interventions other than medications are rarely used. Yet many nonpharmacological interventions are helpful in managing children's pain. These techniques are reviewed, and the physiological mechanisms underlying them are briefly addressed. A discussion of the three major classifications (sensory, cognitive, and cognitive-behavioral) of interventions follows. Factors that influence the use of nonpharmacological techniques, including type of pain and developmental level, are discussed.
Assuntos
Dor/enfermagem , Enfermagem Pediátrica/métodos , Terapia de Relaxamento , Adolescente , Fatores Etários , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Avaliação em Enfermagem , Medição da DorRESUMO
Children placed in foster care remain one of the country's most medically underserved groups. At the same time, health care problems are increasingly common in this population. The child welfare system is in a crisis as it struggles to place greater numbers of children with increasingly complex health care needs into limited foster care settings. Six solutions have been proposed in the literature, and are as follows: (a) designation of a particular agency or individual to serve as health care coordinator; (b) timely assessment and care provision; (c) use of a medical passport; (d) increased training for foster care providers and case workers; (e) advocating for improved legislation and standards; and (f) development of community-based clinics. Advanced practice pediatric nurses have the capability to play a key role in providing and coordinating care for children in foster care.
Assuntos
Proteção da Criança , Cuidados no Lar de Adoção , Profissionais de Enfermagem , Enfermagem Pediátrica , Administração de Caso , Criança , Humanos , Descrição de CargoAssuntos
Anticorpos/metabolismo , Imunoensaio , Ocitocina/metabolismo , Adulto , Animais , Bovinos , Feminino , Humanos , Trabalho de Parto , Período Pós-Parto , Gravidez , Coelhos , Soroalbumina Bovina , Soroalbumina RadioiodadaAssuntos
Glicemia , Insulina/sangue , Ocitocina/farmacologia , Plasma , Período Pós-Parto , Vasopressinas/farmacologia , Feminino , Humanos , GravidezAssuntos
Feto/metabolismo , Insulina/sangue , Placenta/metabolismo , Gravidez , Adulto , Feminino , Morte Fetal , Glucose , Humanos , Recém-Nascido , Pâncreas/fisiologiaAssuntos
Amenorreia/tratamento farmacológico , Clomifeno/uso terapêutico , Hormônio do Crescimento/sangue , Metirapona , Testes de Função Hipofisária , 17-Hidroxicorticosteroides/urina , Amenorreia/diagnóstico , Amenorreia/etiologia , Glicemia/análise , Feminino , Gonadotropinas/metabolismo , Humanos , Ovulação/efeitos dos fármacosRESUMO
The purpose of this study was to investigate the effectiveness of a distraction technique in reducing a child's perceived pain and behavioral distress during an acute pain experience. A convenience sample of 100 children, ages 3 years 6 months through 12 years 11 months, scheduled for routine blood draws, was recruited and randomly assigned to an experimental or control group. During venipuncture, the control subjects received standard preparation, which consisted of being comforted by physical touch and soft voices, while experimental subjects were encouraged to use a kaleidoscope as a distraction technique. Results of the MANCOVA, with age as a covariate, indicated a significant difference between the groups. Univariate post hoc tests confirmed that the experimental group perceived less pain and demonstrated less behavioral distress than the control group.
Assuntos
Atenção , Sangria/psicologia , Dor/psicologia , Psicologia da Criança , Sangria/enfermagem , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Dor/enfermagem , Enfermagem Pediátrica , Percepção , Jogos e BrinquedosRESUMO
The assessment and treatment of neonatal pain remain inconsistent in spite of scientific evidence and agreement among practitioners that neonates do experience pain. In fact, pain forms the basis for many subsequent maturational events and may mediate future responses to pain. The article outlines the concept of pain in the neonate, provides suggestions for future research, and discusses the instrumental role of the advanced practice nurse in the recognition and treatment of neonatal pain.
Assuntos
Enfermagem Neonatal , Enfermeiros Clínicos , Pesquisa em Enfermagem , Dor/enfermagem , Humanos , Recém-Nascido , Descrição de Cargo , Medição da DorRESUMO
ISSUES AND PURPOSE: Distraction during painful procedures has been shown to be effective in previous studies, yet this simple intervention is not used routinely. This study examined the effectiveness and feasibility of distraction in reducing behavioral distress, pain, and fear during venipuncture or intravenous insertion. DESIGN AND METHODS: A two-group randomized design with 384 children in 13 children's hospitals. RESULTS: Age was a significant factor in observed behavioral distress, reports of fear, and self-reported pain. The use of a kaleidoscope, however, did not significantly reduce pain or distress during venipuncture or i.v. insertion. PRACTICE IMPLICATIONS: Failure of the distraction intervention to reach statistical significance in this study is puzzling, given anecdotal reports of clinical efficacy. Methodological issues may have obscured actual differences between experimental and control groups.
Assuntos
Atenção , Cateterismo Periférico/enfermagem , Dor/enfermagem , Flebotomia/enfermagem , Estresse Psicológico/enfermagem , Adolescente , Análise de Variância , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/psicologia , Criança , Pré-Escolar , Medo/psicologia , Feminino , Humanos , Masculino , Dor/etiologia , Dor/psicologia , Flebotomia/efeitos adversos , Flebotomia/psicologia , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Estados UnidosRESUMO
A metabolite of cyclosporine has been isolated and its structure identified through use of HPLC and tandem mass spectroscopy. Fast atom bombardment mass spectrometry of an HPLC fraction co-eluting with 1 eta hydroxy-cyclosporine (M17) indicated that the mass of this metabolite was 2 Da greater than that of cyclosporine. Further isolation by HPLC yielded a pure fraction, which we analyzed with tandem mass spectrometry. Linear acyl fragment ions originating from the metabolite under collision-induced dissociation were consistent with the difference in mass being associated with amino acid 9 in the cyclosporine backbone. We propose a nomenclature system for future discussion of cyclosporine metabolites.
Assuntos
Ciclosporinas/isolamento & purificação , Ciclosporinas/metabolismo , Sequência de Aminoácidos , Cromatografia Líquida de Alta Pressão , Dados de Sequência Molecular , Terminologia como AssuntoRESUMO
OBJECTIVE: Our study examined the effects of orthostatic stress and maternal hemodynamics on umbilical systolic/diastolic ratios in normal and hypertensive pregnancies. STUDY DESIGN: Eighteen normal and 20 hypertensive third-trimester pregnancies were examined in the left lateral recumbent, sitting, and standing positions. Measurements included umbilical systolic/diastolic ratio, maternal blood pressure, maternal cardiac output, and maternal total peripheral resistance. RESULTS: All patients demonstrated a fall in cardiac output and a rise in total peripheral resistance with standing. No change in systolic/diastolic ratio occurred with change to the upright position in patients with normotension. Patients with hypertension exhibited a significant increase in umbilical systolic/diastolic ratio with postural change. The increase was more marked in women who had hypertension with elevated peripheral resistance. CONCLUSION: Patients with hypertension are at increased risk of elevation of systolic/diastolic ratio with postural change; women with high-resistance hypertension may be at highest risk.