Hydrogen bonding in hydrochloric Acid solutions.

The radial distributions of atom pairs in water and in solutions of hydrochloric acid have been measured by x-ray diffraction. The near-neighbor water correlations are strongly affected by the ions. Part of the experimental distributions is attributed to new oxygen-to-oxygen distances, associated with the presence of excess protons, and these distances become shorter as the concentration of the acid increases.

Special nursing considerations.

Caring for a critically ill patient with cancer requires another dimension of care when compared with caring for patients in a general ICU. The oncology critical care staff deals with an acute event and with the multidimensional aspects of care of a patient with a cancer diagnosis. Goals of care include a reduction in the number and severity of disease- and treatment-related adverse sequelae. Effective management requires a multidisciplinary approach to care. Skilled and knowledgeable care and communication among all members of the team are essential to prevent, minimize, and treat these symptoms and to achieve optimal patient outcomes.

Use of nursing resources and comfort of cancer patients with and without do-not-resuscitate orders in the intensive care unit.

BACKGROUND: Little is known about the level of comfort experienced by cancer patients with do-not-resuscitate orders and how use of nursing resources affects their comfort. OBJECTIVE: To explore the relationship between use of nursing resources and comfort in cancer patients with and without do-not-resuscitate orders in the intensive care unit. METHODS: The sample consisted of 30 adult patients who had do-not-resuscitate orders and 30 randomly selected patients who did not. Pairs consisting of 1 patient from each group were admitted to the study simultaneously and were evaluated during the same observation period. Level of comfort was assessed by using the PACU Behavioral Pain Rating Scale. Data on use of nursing resources, determined with the Therapeutic Intervention Scoring System, and on demographics and severity of illness were abstracted from the medical records. RESULTS: Chi-square analyses revealed no significant relationship between comfort and use of nursing resources. Differences between the 2 types of patients in comfort and in use of resources were not significant. Evaluation of the multivariate relationship between comfort and use of resources, with do-not-resuscitate status added as a further predictor variable, revealed no significant relationships. Severity of illness and a patient's number of visitors were predictors of use of nursing resources. CONCLUSIONS: Despite high use of nursing resources, nurses continue to focus on comfort as an outcome of care irrespective of patients' do-not-resuscitate status.

Comparison of two techniques for obtaining samples for coagulation studies: venipuncture and intraarterial line.

The purpose of this study was to compare blood coagulation values drawn by venipuncture and from an intraarterial catheter. A 10 ml discard was obtained from 50 consecutive patients before obtaining the coagulation sample from the intraarterial catheter, and a 0.5 ml discard was obtained from the venipuncture specimen. A two-tailed t test for related samples was performed. The results revealed no significant difference between the two methods (p less than 0.05). The small differences seen were attributed to sampling error. These results suggest that blood samples obtained from heparinized intraarterial catheters after a 10 ml discard provide an accurate assessment of patients' mean clotting time.

A comparison of four endotracheal tube holders.

OBJECTIVE: To compare four methods (Lillihei harness, Comfit, Dale, and SecureEasy) of securing endotracheal tubes in orally intubated adult patients in the intensive care unit. DESIGN: Prospective, quasiexperimental. SETTING: University-affiliated oncology critical care unit. SUBJECTS: One hundred twenty-one adult patients who were orally intubated. OUTCOME MEASURES: Endotracheal tube stability, facial skin integrity, patient and registered nurse satisfaction. INTERVENTION: Data collection was conducted on 121 orally intubated subjects. Subjects were evaluated every 12 hours for stabilization of the endotracheal tube and integrity of facial skin. On extubation, patient and nurse satisfaction with the method were assessed. RESULTS: Pearson chi square revealed the SecureEasy holder to be the most secure (p = 0.044). Of all variables that possibly affect extubation, presence of prolonged coughing and gagging had the greatest impact in terms of accidental extubation or dislocation of the endotracheal tube. The fewest incidents of facial skin breakdown occurred with the SecureEasy and Dale holders. Patient complaints regarding discomfort with turning were least common with the Lillihei harness. The SecureEasy holder was associated with the highest degree of nurse satisfaction. CONCLUSIONS: Results of this study suggest that the SecureEasy holder is the preferred alternative method for securing endotracheal tubes when the standard method with tape is not desirable. These results are similar to those reported in a previous investigation in which the adequacy of the SecureEasy holder was assessed.

QA in continuous arteriovenous hemofiltration.

As new treatment modalities pervade the clinical setting, quality monitoring tools must be developed to assess compliance with standards. Continuous arteriovenous hemofiltration, an alternative treatment of patients in renal failure, is becoming common in intensive care units. Because of the increased emphasis on specialization and in order to fulfill their responsibility to provide quality care, critical care practitioners can conduct concurrent evaluations for patients receiving this form of therapy.

Unit-based research forums: a model for the clinical nurse specialist to promote clinical research.

Although nurse researchers have generated research findings, practitioners in clinical practice have not consistently utilized them. Evaluation and modification of clinical practice through research is a key component of the role of the clinical nurse specialist (CNS). In this paper, an innovative model is described in which the Clinical Nurse Specialist coordinates specialty-based clinical research through the use of unit-based research forums, an outgrowth of unit-based quality assurance. Such a model allows staff at the unit level to engage in problem-solving dialogues, resulting in increased use of research findings and generation of original research.

The role of the advanced practice nurse in the care of patients critically ill with cancer.

Although the proliferation of potent standard and experimental protocols to combat cancer has resulted in life-threatening complications, growth and changes in the field of oncology and critical care have increased the life expectancy of patients with cancer. Several authors have describe the multifaceted role of the advanced practice nurse in critical care and oncology settings. How the critical care oncology advanced practice nurse translate these roles into practice is not known. In this article, the author describes the challenges of the critical care oncology advanced practice nurse to improve patient care, improve outcomes, and advance the nursing profession.

A vena cava filter using thermal shape memory alloy. Experimental aspects.

Surgical ligation of the vena cava in the treatment of pulmonary embolism is already being superseded by devices introduced via a peripheral vein. A new metal alloy (nitinol) with unique memory characteristics forms the basis of an experimental device which promises even greater safety, simplicity and speed of introduction. It is inserted as a straight thin wire via the small bore catheter used for angiographic diagnosis. Upon reaching the lumen of the inferior vena cava and sensing body temperature, it reverts to its preset complex filter shape and locks into place permanently. It will trap further thromboemboli from the pelvis or lower limbs.