Assuntos
Antimaníacos/administração & dosagem , Transtorno Bipolar/enfermagem , Cronoterapia/enfermagem , Ácido Valproico/administração & dosagem , Antimaníacos/efeitos adversos , Transtorno Bipolar/tratamento farmacológico , Ensaios Clínicos Controlados como Assunto , Preparações de Ação Retardada , Humanos , Ácido Valproico/efeitos adversosRESUMO
Cardiovascular indices, such as blood pressure, heart rate, cardiac output, and fibrinolytic factors, vary over a 24-hour period. For example, nocturnal blood pressure may decrease to 30-50 mm Hg and heart rate to 25 beats per minute. In addition, these cardiovascular rhythms interact and may trigger a cardiovascular catastrophe, such as a myocardial infarction, sudden cardiac arrest, or stroke, with the highest risk during the first 6 hours after awakening and arising. Understanding the fluctuations in cardiovascular indices and the rhythmic increase in risk is crucial in assessing patients and developing a protective plan of care. This article discusses the cardiovascular rhythms and the rhythmic increase in risk for cardiovascular catastrophes. A framework demonstrating the interaction of these rhythms provides the basis for the development and exploration of interventions, including modification of activity and medications, and nursing actions to protect patients during periods of high cardiovascular risk.
Assuntos
Cronoterapia/enfermagem , Infarto do Miocárdio/enfermagem , Infarto do Miocárdio/fisiopatologia , Avaliação em Enfermagem , Ritmo Circadiano , Humanos , Infarto do Miocárdio/prevenção & controleRESUMO
The concept of chronopharmacology has significant implications for drug delivery systems. Age and illness put the elderly at greater risk for adverse drug effects, and nurses caring for the elderly have a challenging opportunity to measurably improve the quality of their care by applying chronotherapeutic concepts. Pharmacologic chronotherapy is a developing science that holds much hope for increasing the effectiveness of drug therapy and for reducing the incidence of toxic drug reactions. Nurses who are aware of the principles on which chronotherapy is based are in a unique position to improve the effectiveness of pharmacotherapy for all clients. However, appropriate timing of medications is especially important among elderly clients whose physiological processes are altered or changed by age and chronic illness. In this article, the basis of chronotherapy is discussed, and several therapeutic applications are identified.
Assuntos
Idoso/fisiologia , Cronoterapia/métodos , Preparações Farmacêuticas/administração & dosagem , Relógios Biológicos , Cronoterapia/enfermagem , Ritmo Circadiano , Serviços de Informação sobre Medicamentos , Humanos , Preparações Farmacêuticas/metabolismoAssuntos
Antineoplásicos/administração & dosagem , Cronoterapia/métodos , Neoplasias do Colo/tratamento farmacológico , Terapia por Infusões no Domicílio/métodos , Cronoterapia/enfermagem , Feminino , Terapia por Infusões no Domicílio/enfermagem , Assistência Domiciliar , Humanos , Educação de Pacientes como AssuntoRESUMO
Understanding chronobiology--the study of biological rhythms--can help nurses care for their patients and themselves. This article discusses the internal and external factors which affect the body's daily rhythms, and the effectiveness of different drugs and procedures at certain times of the day. The author also offers advice for nurses anticipating night work to minimise disruption to their own circadian rhythm.
Assuntos
Fenômenos Cronobiológicos , Cronoterapia , Cronoterapia/métodos , Cronoterapia/enfermagem , Ritmo Circadiano , Depressão/etiologia , Humanos , Tolerância ao Trabalho ProgramadoRESUMO
A middle-range theory for Chronotherapeutic Intervention in Postsurgical Pain (CIPP) is presented. This theory supports time-dependent approaches to pain assessment and intervention that may be implemented by nurses in the clinical setting. CIPP was inductively derived from chronobiologic literature and validated through investigations in three separate chronobiologic studies. A circadian rhythm in pain was identified in Study I, with 19 postsurgical gynecologic oncology patients, and validated in Study II, with 45 postsurgical patients. Study III, a randomized clinical trial of 71 gynecologic oncology patients, compared the efficacy of chronotherapeutic versus continuous fixed-rate basal and demand-only PCA therapy for postoperative pain relief.
Assuntos
Cronoterapia/métodos , Cronoterapia/enfermagem , Teoria de Enfermagem , Dor Pós-Operatória/enfermagem , Analgesia Controlada pelo Paciente , Humanos , Avaliação em Enfermagem , Medição da Dor , Reprodutibilidade dos TestesRESUMO
Discontinuation of positive pressure mechanical ventilation results in decreased intrathoracic pressure. Although there has been extensive research into factors associated with weaning adults from mechanical ventilatory support, little attention has been paid to the role of left ventricular performance. Research also has not focused on interventions that might optimize ventricular performance. The purpose of this article is to explore the potential effect of cardiac dysfunction in weaning and the role of drug chronotherapy as a strategy to modify patients' responses to weaning from mechanical ventilatory support. Biophysical principles involved are reviewed, and the development of a chronotherapeutic intervention is described. Two case examples illustrate the use of drug chronotherapy during the weaning process.