Investigation of the efficacy of colorimetric capnometry method used to verify the correct placement of the nasogastric tube.

OBJECTIVES: This present study was designed to determine the efficacy of the colorimetric capnometry method used to verify the correct placement of the nasogastric tube. METHODS: The present study comprised forty patients who had a nasogastric tube inserted and were being monitored in the adult intensive care unit. After the insertion of the nasogastric tube, 40 colorimetric capnometry and 40 auscultation measurements were performed. Auscultation and colorimetric capnometry results were compared with tube placement results confirmed radiologically. RESULTS: In the confirmation of the placement of the nasogastric tube, the consistency was 97.5% (p<0.05) between the colorimetric capnometry method and the radiological method, and 82.5% (p>0.05) between the auscultatory method and the radiological method. The oesophageal placement of the nasogastric tube was detected with the colorimetric capnometry method, but the gastric and duodenal insertions were not determined. While the sensitivity and specificity of the colorimetric capnometry method in determining the correct placement of the nasogastric tube were 1.00 and 0.667 respectively, those of the auscultatory method were 0.89 and 0.0 respectively. CONCLUSION: As a result, for the confirmation of the NGT placement, the colorimetric capnometry method is considered more reliable than the auscultatory method and is compatible with the radiological method. However, the colorimetric capnometry method is inadequate to distinguish between the gastric or duodenal insertion.

Abdominal Assessment.

Abdominal pain is one of the most common complaints by patients, and assessment of abdominal pain and associated symptoms can be challenging for home healthcare providers. Reasons for abdominal pain are related to inflammation, organ distention, and ischemia. The history and physical examination are important to narrow the source of acute or chronic problems, identify immediate interventions, and when necessary, facilitate emergency department care.

Control del bienestar fetal: monitorización biofísica intraparto / Control of fetal well-being: biophysics intrapartum monitoring

En este artículo se presenta una actualización sobre el control del bienestar fetal intraparto que comprende los siguientes aspectos: métodos de control de la frecuencia cardiaca fetal y de la dinámica uterina y parámetros de la contracción uterina. Asimismo, se describe la valoración de los registros cardiotocográficos intraparto analizando la frecuencia cardiaca fetal en relación con la dinámica uterina. Se evalúan los diferentes tipos de deceleraciones de la frecuencia cardiaca fetal: precoces, tardías y variables, su significado clínico y la conducta que seguir en cada una de ellas. Finalmente, se definen los parámetros que componen un registro cardiotocográfico normal (AU)

This article presents an update on the control of the intrapartum fetal wellbeing including the following aspects: methods of monitoring the fetal heart rate and the uterine dynamic and uterine contraction parameters. Moreover, the assessment of intrapartum CTG records is described by analyzing the fetal heart rate in relation to uterine contractions. The different types of fetal heart rate decelerations: early late and variable, its clinical significance and the guidelines to follow in each one of them are evaluated. Finally, the parameters that make up a normal CTG registration are defined (AU)

A critical review of auscultating bowel sounds.

Auscultation (listening for bowel sounds) is part of an abdominal physical assessment and is performed to determine whether normal bowel sounds are present. This article evaluates the technique involved in listening for bowel sounds and the significance of both normal and abnormal auscultation findings. Review of the relevant literature reveals conflicting information and a lack of available research on the topic of auscultating bowel sounds. The clinical significance of auscultation findings when there is no evidence base to support the practice of listening for bowel sounds is explored by further analysis of the literature and reflection by the author on the teaching she received and her own personal practice.

Nurse anesthesia program requirements for esophageal/precordial stethoscope earpieces: a survey.

Student nurse anesthetists are often required to purchase an auscultatory earpiece device for use in the clinical setting. Although the device is required, students have observed that many anesthesia providers in the clinical setting no longer use this piece of equipment. The purpose of this project was to determine the number of anesthesia programs that required mandatory purchase of the auscultatory earpiece by student nurse anesthetists. A brief survey was developed to collect data from the directors of all 105 accredited nurse anesthesia programs in the United States. The survey was completed by 63 (60%) of the program directors, and 62 completed surveys were used in the analysis. Results revealed that 95% of the responding nurse anesthesia programs (59 of 62) require esophageal/ precordial stethoscope earpieces for their students, but 46% (27) of those programs provide the earpieces. Most (76%) of the programs required the use of the earpieces in the clinical setting, but only 45% thought that they should be used for monitoring every anesthetic delivered.

The art of auscultation: evaluating a patient's respiratory pathology.

This article considers national policy drivers promoting the development of advanced assessment skills and practical procedures for the safe and effective use of the stethoscope in the clinical area. The evidence base underpinning effective use of the stethoscope in clinical practice is explored, including the preparation of the patient and the environment, applying infection control policies, and placing an emphasis on privacy and dignity. This is followed by a practical guide to auscultation technique of the respiratory system for nurses developing advanced practice skills.

An observational study on the open-system endotracheal suctioning practices of critical care nurses.

AIM AND OBJECTIVES: The purpose of this study was to investigate open system endotracheal suctioning (ETS) practices of critical care nurses. Specific objectives were to examine nurses' practices prior to, during and post-ETS and to compare nurses' ETS practices with current research recommendations. BACKGROUND: ETS is a potentially harmful procedure that, if performed inappropriately or incorrectly, might result in life-threatening complications for patients. The literature suggests that critical care nurses vary in their suctioning practices; however, the evidence is predominantly based on retrospective studies that fail to address how ETS is practiced on a daily basis. DESIGN AND METHOD: In March 2005, a structured observational study was conducted using a piloted 20-item observational schedule on two adult intensive-care units to determine how critical care nurses (n = 45) perform ETS in their daily practice and to establish whether the current best practice recommendations for ETS are being adhered to. RESULTS: The findings indicate that participants varied in their ETS practices; did not adhere to best practice suctioning recommendations; and consequently provided lower-quality ETS treatment than expected. Significant discrepancies were observed in the participants' respiratory assessment techniques, hyperoxygenation and infection control practices, patient reassurance and the level of negative pressure used to clear secretions. CONCLUSION: The findings suggest that critical care nurses do not adhere to best practice recommendations when performing ETS. The results of this study offer an Irish/European perspective on critical care nurses' daily suctioning practices. RELEVANCE TO CLINICAL PRACTICE: As a matter of urgency, institutional policies and guidelines, which are based on current best practice recommendations, need to be developed and/or reviewed and teaching interventions developed to improve nurses' ETS practices, particularly in regard to auscultation skills, hyperoxygenation practices, suctioning pressures and infection control measures.

Nutritional support via enteral tube feeding in hospital patients.

Patients receiving enteral tube feeding are often encountered in the ward environment of an acute care setting. Patients may receive enteral tube feed through tubes intended for short-term feeding, or they may have a long-term feeding tube in situ. This article aims to provide a practical overview of feeding solutions and administration to enable nursing staff to understand prescribed regimens and provide patients with optimum care.

Respiratory assessment in adults.

Respiratory disorders are among the most common reasons for admission to critical care units in the U.K. However, anecdotal evidence suggests that nursing assessment of patients' respiratory function is not performed well because it is not considered a priority and the implications of respiratory dysfunction are underestimated. It is essential that nurses are able to recognise and assess symptoms. of respiratory dysfunction to provide early, effective and appropriate interventions, thus improving patient outcomes. This article highlights the role of the nurse in respiratory assessment and discusses the implications of clinical findings.

Detecting changes in the respiratory status of ward patients.

This article outlines the principles of respiratory assessment. It is intended to be a learning tool for all nurses, however, it may have more relevance for nurses on general wards. Such nurses, unlike those who work in intensive care units and accident and emergency (A&E) departments, do not have the advantage of frequent presence of medical staff and may have to intervene promptly and autonomously in response to detected changes.

Respiratory auscultation: how to use a stethoscope.

This article outlines the correct procedure for respiratory assessments using a stethoscope, how to use a stethoscope and how to interpret your findings.

Esophageal nasogastric tube misplacement in an infant following laser supraglottoplasty.

Nasogastric (NG) tube misplacement continues to be one of the most common problems associated with enteral tube feedings. Current methods of testing appropriate NG tube placement are ineffective in detecting tube misplacement in a clinically significant number of infants and children. This case study describes an NG tube misplacement into the esophagus in an infant following laser supraglottoplasty; the misplacement was detected on a radiograph obtained as part of a study protocol. Other testing methods used failed to detect the tube misplacement, which could have led to aspiration pneumonia or other complications if the radiograph had not shown the misplacement.

Observing the sick child: Part 2a. Respiratory assessment.

As the focus on evidence-based healthcare delivery gains momentum, nurses need to critically reflect on their traditional practice base. Assessment is the cornerstone of safe and effective practice and goes hand in hand with the process of prioritising a sick child's needs. This article begins with a practical and critical review of the validity and reliability of basic respiratory assessment focused on measurement of respiratory rate, rhythm and depth. Part 2b in February 2007 will be a practical step-by-step introduction to the theory and practice of advanced respiratory assessment using palpation. Part 2c in the following month will focus on respiratory auscultation methods.

A comparison of two methods of blood pressure measurement.

In current practice, a two-stage approach to measuring blood pressure (BP) has been widely accepted as the most accurate and reliable method. However, by changing the local haemodynamics, this procedure might alter the blood pressure. In a study of 39 subjects, blood pressure was measured using two indirect methods (two-stage and one-stage approaches). Results showed no statistically significant difference in values for systolic blood pressure obtained from the two methods. Statistically significant lower diastolic blood pressure values were obtained using the two-stage compared to the one-stage approach. It is proposed that initial inflation of the cuff to estimate systolic blood pressure in the two-stage approach might lead to reactive hyperaemia and, therefore, a lower diastolic value. This two-stage approach might not provide the accurate readings it claims, and in addition it requires more time and subjects the patient to longer periods of stress.

The process of conducting a physical assessment: a nursing perspective.

Physical assessment is a new responsibility for many nurses in the UK who are expanding their parameters of advanced clinical practice. A physical assessment framework can be used by both community and acute care nurses as a guide to the process of conducting a physical assessment. The framework presented here consists of the following sequence of steps: identifying the purpose of the assessment; taking a health history; choosing a comprehensive or focused approach; and examining the patient using the sequence of inspection, palpation, percussion and auscultation. The next step, interpretation of the clinical findings, which results in either the recognition of abnormality or identification of a differential diagnosis, then becomes the basis for clinical decision making. This paper describes a comprehensive, head-to-toe assessment as one example of the application of this physical assessment framework in clinical practice.