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Biomedical subjects

J K Keithley

Publications and source records attributed to J K Keithley.

At least 19 recordsLinked to original sources
PubMed2001

Management of antiretroviral-related nutritional problems: state of the science.

A number of new nutritional problems have been documented in HIV-infected persons treated with antiretroviral therapy, but only a limited amount of data exist on strategies to manage these problems. Initial studies have focused on drug therapy as the sole management strategy. Controlled trials are needed to confirm the benefits of drug therapy and to evaluate the usefulness of preventive measures, lifestyle changes, and complementary and alternative therapies in managing antiretroviral-related nutritional problems.

HIV Infections↗
PubMed2001

Management of antiretroviral-related nutritional problems: challenges and future directions.

Survival has been greatly enhanced with the adequate and effective treatment of HIV infection. Surviving and surviving well are important pieces of the disease management puzzle. Nutritional well-being has been closely associated with both survival and quality of life in HIV and other diseases. The effects and interactions of currently used antiretroviral therapies can compromise nutritional well-being. The challenges posed to researchers, clinicians, and patients in evaluating and treating nutrition-related effects of life-saving antiretroviral medications affect health care goals, recommendations, and decisions. Challenges include identifying emerging problems, prioritizing clinical problems, expediting the implementation of clinical trials, developing research-based interventions that are realistic and usable in practice, decreasing the time lag to incorporate research findings into practice, and developing or adapting evidence-based clinical guidelines. This article will explore these challenges, offer thought-provoking questions in the development of research and clinically viable solutions, and propose future directions for management strategies of antiretroviral-related problems.

Clinical Trials as Topic↗
PubMed2001

Antiretroviral-related nutritional problems: closing the science and practice gap.

Close collaboration between clinicians and researchers is essential for the development of databased strategies for antiretroviral-related nutritional problems. By working together to conduct feasible clinical intervention studies and to apply research findings to practice, clinicians and researchers can provide more efficient and effective nursing interventions to manage these rapidly emerging nutritional disorders.

Anti-HIV Agents↗
PubMed1998

Minimizing HIV/AIDS malnutrition.

HIV/AIDS malnutrition influences immune function, disease progression, and quality of life. Changes in dietary intake, altered metabolism, and malabsorption are among the mechanisms that contribute to the nutritional alterations seen in HIV/AIDS. Medical-surgical nurses can help their patients minimize HIV/AIDS malnutrition through early and ongoing assessment, which guides nutritional and pharmacologic interventions.

HIV Infections↗
PubMed1997

Nutritional needs and support of mechanically ventilated patients.

Malnutrition is common in patients who are mechanically ventilated. Poor nutritional status contributes to impaired respiratory muscle function, lung structure, ventilatory response, and resistance to infection. By detecting malnutrition in its early stages, carefully calculating energy needs, determining appropriate nutrition support, and avoiding nutrition support complications, medical-surgical nurses can provide effective nutrition care to mechanically ventilated patients. Improved nutritional status is associated with better pulmonary function and greater ease in weaning from mechanical ventilation.

Energy Metabolism↗
PubMed1993

The significance of enteral nutrition in the intensive care unit patient.

The gut and its nonimmunologic and immunologic barriers have an important role in the survival of critically ill patients. Burns, hemorrhagic shock, intestinal obstruction, protein-calorie malnutrition, and several therapies (e.g., parenteral nutrition, steroids), used in critically ill patients are known to promote the breakdown of the mucosal barrier and to permit translocation of intestinal pathogens. Enteral nutrition, in conjunction with the use of certain immunostimulatory nutrients, can now be used to prevent or minimize damage to the mucosal barrier and to enhance its immunologic function in critically ill patients.

Critical Illness↗
PubMed1992

Nutritional alterations in persons with HIV infection.

Potential relationships among nutritional status, immune function and quality of life were examined in a convenience sample of 40 outpatient homosexual and bisexual males stratified into five categories, using modified Walter Reed Staging Criteria. Nutritional status was assessed by measuring height, weight, triceps skinfold thickness, arm circumference, nutrient intake and serum albumin. Immune status was evaluated by determining T-helper cell numbers and percentages. The Quality of Life test was used to obtain information about life quality. Nutritional assessment failed to show significant differences among groups with the exception that serum albumin levels were reduced in persons with AIDS. The significance of change in serum albumin in regard to nutritional status is unclear, since serum albumin is affected by a number of non-nutritional factors, such as hydration status and liver function. The study also revealed a significant decline in T-helper percentages, but not absolute T-helper cell numbers as a function of disease stage. There were no statistically significant differences between the quality of life scores with respect to each grouping. These data suggest that asymptomatic patients as well as those with ARC or stable AIDS are able to maintain body weight and composition.

AIDS-Related Complex↗
PubMed1992

Advances in nutritional care of medical-surgical patients.

Malnutrition and its related complications occur at an alarming rate in medical-surgical patients. New technology and other advances in clinical nutrition can now significantly enhance the nutritional care that medical-surgical nurses provide to their patients.

Humans↗
PubMed1991

Coordinating clinical research. A collaborative approach for perioperative nurses.

Overall, the study progressed smoothly during the six months it took to collect data on 125 patients. A number of factors contributed to the success of the study. By using a collaborative approach, we assembled a team with expertise in the content area, the clinical setting, and research design and methodology. This diverse mixture of knowledge, experience, and skills enabled us to plan carefully and anticipate many problems when writing the proposal and designing the study. While planning and implementing the study, we made an effort to keep communication flowing at all levels so problems could be quickly detected and addressed. We worked from the premise that we were collaborating with all of the OR nursing staff. We tried to use their time wisely, give them a meaningful role, respect their other responsibilities and commitments, and provide them with opportunities to share in the positive feelings that come from successfully completing a difficult job. We believe we achieved some measure of success. Since finishing the study, many staff members expressed an interest in participating in future studies--a good indication that they find research less formidable. They view participation in studies as a way to progress through the clinical ladder system and realize a full professional role. Most importantly, they see participating in research as a way to improve the quality of patient care they provide.

Clinical Nursing Research↗
PubMed1991

Histamine H2-receptor antagonists.

In summary, histamine initiates acid secretion by stimulating the H2 subtype histamine receptor on parietal cells. Cimetidine, rantidine, famotidine, and nizantidine are histamine H2-receptor antagonists that block this action of histamine, reducing gastric acid output and concentration under both basal and stimulated conditions. These agents are used for treatment and prevention of peptic and stress ulcers as well as for hypersecretory states. Because of their effectiveness and low incidence of side effects, H2-antagonists have largely replaced more traditional antiulcer regimens.

Gastric Acid↗
PubMed1990

Factors that contribute to pressure sores in surgical patients.

In this prospective study examination was made of whether (a) time on the operating table, (b) proportion of intraoperative diastolic hypotensive episodes, (c) age, (d) preoperative serum albumin, (e) preoperative total protein levels, and (f) preoperative Braden scores could identify those patients who do and do not develop pressure sores during elective surgery. The stratified sample consisted of 125 adult patients. Fifteen patients (12%) developed a total of 23 pressure sores. A discriminant function using time on the operating table, extracorporeal circulation, and age emerged as the best predictor correctly classifying 12 of 15 patients who developed pressure sores and 83 of 110 patients who remained pressure sore free.

Adult↗
PubMed1989

Enteral nutrition. Potential complications and patient monitoring.

Enteral feedings are safely tolerated by most patients. When complications occur, gastrointestinal disturbances are most frequently encountered, followed by mechanical and metabolic complications. Nurses can prevent many of the problems associated with enteral feeding through careful monitoring. Based on the current literature, the authors make the following recommendations: 1. All patients receiving tube feedings should be placed on a protocol that provides guidelines for (a) confirming correct tube placement; (b) preventing/managing tube obstruction; (c) handling and selecting formulas; (d) administering formulas; and (e) monitoring patients. 2. Fine-bore tubes are easily misplaced or dislodged; ensure correct positioning both before and during feeding. Food coloring should be added to all feedings to help detect aspiration/tube displacement. 3. Multiple factors can cause diarrhea in tube-fed patients and, therefore, require periodic assessment. These factors include concomitant drug therapy; malnutrition/hypoalbuminemia; formula-related factors (for example, lactose content, osmolality); and bacterial contamination. 4. Urine sugar and acetone levels should be checked every 6 hours (until stable). Vital signs and fluid intake and output should be determined every 8 hours, and weight should be measured on a daily basis. Serum electrolytes, blood urea nitrogen, and glucose levels should be determined daily, until serum levels stabilize. Weekly measurements of trace elements should be made to ensure adequate mineral replacement. 5. Use a controller pump to administer continuous feedings at a constant rate or to administer formulas that are viscous. Flush feeding tubes with water every 4 hours during continuous feedings, after giving intermittent feedings, after giving medications, and after checking for gastric residuals. If tube obstruction occurs, attempt to irrigate the tube with either water or cola. 6. Select feedings that contain appropriate nutrient sources, caloric density, and osmolality; handle feedings in a way that minimizes bacterial contamination. 7. Ongoing nutritional assessments are necessary to provide information about the overall adequacy of the enteral feeding in restoring or maintaining nutrition.

Diarrhea↗
PubMed1983

Infection and the malnourished patient.

The synergistic effects of infection and malnutrition represent a significant challenge to the critical care nurse. When diet does not adequately meet energy needs, the calorie deficiency must be made up from body fuel reserves. The status of these stores can be assessed by easily performed clinical and laboratory measurements. If malnutrition occurs, the capacity of the patient to resist the occurrence and consequences of infection lessens. With the advent and application of sound enteral and parenteral feeding techniques, however, it has become possible to break the cycle of malnutrition and infection.

Antibody Formation↗