Nursing management of elderly patients with asymptomatic bacteriuria

The present study has employed in vitro autoradiography to study the distribution and density of [3H]zolpidem binding sites, which are regarded as an index of ethanol-sensitive gamma-aminobutyric acid (GABA)A receptors, in the brains of alcohol-preferring Fawn-Hooded (FH) rats compared to non-alcohol preferring Wistar-Kyoto (WKY) rats. Binding of [3H]zolpidem showed a similar distribution profile in both rat strains examined and included cerebellum, globus pallidus, nucleus of the solitary tract and a number of midbrain/hindbrain nuclei. Densitometric quantitation of binding revealed that FH rats possessed a significantly higher density of [3H]zolpidem binding compared to WKY rats in cortical regions, substantia nigra pars reticulata and the ventral pallidum. These data indicate that FH rats may have an increased number of ethanol-sensitive GABA(A) receptors in regions intimately involved in reward processes, and may partially explain the alcohol-seeking nature of the FH rat.     

Nursing case management in the NICU: enhanced coordination for discharge planning

A primary goal of health care today is finding alternative ways to provide high-quality, cost-effective care. A model of care that addresses these issues is nursing case management. This article describes the development and implementation of nursing case management in a Level III regional center with the primary goal of enhancing coordination for discharge planning. The model involves development of clinical pathways and utilization of nurse practitioners as case managers. Decreased length of stay, charge per case, and readmission rates are demonstrated following implementation of this program.     

Nursing skills for monitoring patients

This paper analyses the constraints used to define the elements of mixing matrices employed in deterministic models of the transmission dynamics of sexually transmitted infections. These matrices define the degree to which the choice of sexual partners in a population is assortative (like with like) or dissassortative (like with unlike) in populatiions stratified by sexual activity (i.e. the number of different sexual partners per unit of time). An expanded set of constraints is described which defines patterns of mixing on the assortative to disassortative spectrum in populations of finite size. The relevance of these new constraints to past work in this area is assessed. Keywords: mixing matrices     

Nursing diagnoses in patients with leukemia

Valproate (VPA) has been shown to induce neural tube defects (NTDs) in humans and mice, but the mechanism of action has not been elucidated. Folate supplementation has been reported to prevent the defect. It was the aim of our experiment to reveal effects of VPA and of folate coadministration on amino acid metabolism in an NTD mouse model. After treating pregnant mice intraperitoneally with 2.1 mmol VPA/kg body weight, plasma homocysteine concentrations were found to be increased. Coadministration of 4 mg/kg folate decreased this level. Plasma methionine levels were reduced under both experimental conditions. Fifteen min after treating mice with 3 mmol VPA/kg body weight, hepatic levels of both S-adenosylmethionine (SAM) and S-adenosylhomocysteine were found to be increased by +175% and +348%, respectively; but the levels had normalized again 30 min after VPA injection. Simultaneously, plasma methionine and serine levels had decreased by -43% and -51%, respectively, while homocysteine and cysteine increased by +71% and +81%, respectively. Reduced glutathione (GSH) decreased by -45%, but total glutathione did not change. These changes were statistically significant, and they occurred dose-dependently. We proposed that VPA induces methionine deficiency inhibition of folate metabolism and homocysteine remethylation, increase in aminothiols, and suppression of the GSH system in maternal blood within 1 h after application. These changes may be responsible for the teratogenic potential of VPA. Folate may prevent NTDs by changing homocysteine catabolism.     

Nursing management of pressure ulcers using a hydrogel dressing protocol: four case studies

Okinawa prefecture has a unique socio-cultural status in Japan including the experience of having been occupied by the USA from the end of World War II to 1972. In this study, the longitudinal change in youth suicide mortality for those aged 10-29 years in Okinawa (1960-90) was compared with that for the same sex-age groups in mainland Japan (1950-90). In contrast with mainland Japan, no dramatic change in the youth suicide mortality was observed in Okinawa in the 1960s. The rise and fall of teenage suicide mortality in Okinawa during the 1970-80s might be associated with 'reversion anxiety', rather than with the traumatic experience of World War II itself. This seems to be inconsistent with previous speculation regarding the change in youth suicide mortality in mainland Japan. The suicide mortality for men aged 20-29 in Okinawa was significantly higher than that for the same sex-age group in mainland Japan through the observed period. The possible effects of the USA occupation, economic anomie or migration on the suicide in Okinawa should be further examined.     

Nursing management innovations: a need for systematic evaluation

tert.-Butyl hydroperoxide has been utilized to study the effect of oxidative stress on living cells; however, its effect on DNA bases in cells has not been characterized. In the present work, we have investigated DNA base damage in mammalian cells exposed to this organic hydroperoxide. SP2/0 derived murine hybridoma cells were treated with 4 concentrations of tert.-butyl hydroperoxide for varying periods of time. Chromatin was isolated from treated and control cells and subsequently analyzed by gas chromatography-mass spectrometry with selected-ion monitoring for DNA base damage. Quantification of damaged DNA bases was achieved by isotope-dilution mass spectrometry. The amounts of 8 products were significantly higher than control levels in cells treated with tert.-butyl hydroperoxide at a concentration range of 0.01-0.1 mM. At concentrations from 1.0 to 10 mM, product formation was inhibited and the amounts of products were similar to those in control cells. The bimodal nature of the dose-response may be qualitatively analogous to previous reports of bimodal killing of E. coli bacteria by hydrogen peroxide. The nature of the identified DNA base lesions suggests the involvement of the hydroxyl radical in their formation. tert.-Butyl hydroperoxide is known to produce the tert.-butoxyl radical in reactions with metal ions. However, it is unlikely that the tert.-butoxyl radical produces these DNA lesions. It is suggested that DNA base damage arises from tert.-butyl hydroperoxide-mediated oxidative stress in cells, resulting in formation of hydroxyl radicals in close proximity to DNA. The inhibition of product formation at high concentrations of tert.-butyl hydroperoxide may be explained by the scavenging of tert.-butoxyl radical by tert.-butyl hydroperoxide resulting in inhibition of oxidative stress. The plausibility of the scavenging mechanism was evaluated with a mathematical simulation of the dose-response for DNA damage in solutions containing hydrogen peroxide. The simulation model predicted a bimodal dose-response which agreed qualitatively with the results in this study and with other in vivo and in vitro studies reported in the literature.     

Nursing care of patients with idiopathic parkinsonism

Through the discussion of the work of a movement disorder clinic in British Columbia, this paper focuses on the unique contribution of nursing care in the effective management of idiopathic parkinsonism. It follows on from a paper discussing the aetiology and treatment of the disease published on April 20 in Nursing Times.     

Anesthetic management for bronchoscopy in patients with congenital tracheomalacia

We experienced the anesthetic management for two patients with congenital tracheomalacia. Inhaled anesthetics are considered to worsen the respiratory condition of tracheomalacia because of its bronchodilating effect. Thus we tried awake intubation in one case, but it was difficult. In another case, we used slow induction with sevoflurane and the trachea was intubated smoothly. Inhaled anesthetics have possibility of worsening the degree of tracheomalacia and have been used very carefully. However, we considered that slow induction with inhaled anesthetics in children with congenital tracheomalacia is a safe and necessary technique, under careful observation of respiratory conditions.     

Clients' functioning and need for case management

This paper describes the transition and reorganization of a Community Support Service, previously functioning as a traditional management program with high caseloads. Through the development and use of a tier system, based on functioning, clients were provided service commensurate with need.     

Nursing management of anxiety and panic

There are many aspects of everyday life that provoke anxiety. Visits to hospitals, emergency departments, or outpatient clinics are among the most anxiety producing. Anxiety exists on a continuum from normal, which alerts us that we need to pay attention to what is happening to us, to severely dysfunctional, as occurs with some of the anxiety disorders. Regardless of where patients fall on the continuum, nursing interventions can be very helpful. The etiology of anxiety disorders is multidimensional, including genetic vulnerability, neurophysiological dysregulations, stressful life events, and developmental antecedents. Because of the complex nature of anxiety, treatment is usually a combination of medications (benzodiazepines and antidepressants), education (particularly self-management techniques), sensory interventions, psychotherapy, and cognitive-behavioral interventions. The nurse's role in assessment, intervention, and referral is critical.