Biomedical subjects
Publications and source records attributed to Kenneth J Rempher.
Smoking is a known risk factor for cardiovascular disease and has been implicated in sudden cardiac death. Hypertension, hypercholesterolemia, physical inactivity, and smoking are the leading contributors to poor cardiovascular health. This article reviews the cardiovascular pathology inherent with smoking and provide insight to help develop an appropriate plan of care.
The use of personal digital assistants (PDAs) in healthcare has expanded exponentially in the past several years. In addition to common feature functions such as contact lists, calculators, calendars, and expense logs, current PDAs boast a wide variety of practical healthcare-related applications such pharmacologic databases, infectious disease programs, medication calculators, and patient scheduling and billing applications. This article examines PDAs in general and the Palm series of handheld devices in particular for use in the advanced practice setting. These devices have several implications for advanced practice nursing including support of both differential diagnosis and diagnostic reasoning, reduction of medication errors, and development of effective treatment protocols. Personal digital assistant technology will inevitably become part and parcel of advanced practice nursing. The rapid, almost daily, changes in the healthcare environment require immediate access to the myriad resources and databases used by advanced practice nurses. Personal digital assistant technology provides such access.
An estimated 4.8 million Americans are diagnosed with heart failure. Of those, 5% to 10% meet criteria for the refractory state of the disease. While therapeutic interventions continue to evolve with the changing conceptualization of heart failure pathophysiology, overhydration and its deleterious sequelae remain a problem for those in the refractory state. The incidence of heart failure continues to rise in older individuals. As baby-boomers age across America, greater focus on new, more effective therapies must be considered for treatment of this disease. Continuous renal replacement therapy (CRRT) is one such treatment. The gentle removal of fluid and metabolites while maintaining electrolyte balance helps reduce the effects of overhydration in patients with heart failure. Increasing use of the therapy in the refractory state of heart failure is generating support for early initiation as it continues to demonstrate positive effects. Reduction in edema, attenuation of the sympathoadrenal cascade, and improved respiratory status have all been documented using the therapy. The intent of this article is to provide information for advanced practice nurses and direct care providers regarding CRRT for the treatment of heart failure refractory to typical therapy.
Heart failure is the leading cause for hospitalization in the United States, resulting in over $8 billion in costs annually. Over 4.8 million Americans are afflicted with the disease and the number is increasing as the baby boomer generation continues to age. It is imperative that new and innovative modalities of therapy and diagnosis evolve as we continue to redefine the nature of heart failure and discover more about this debilitating disease. This article addresses the implications for endogenous brain (B-type) natriuretic peptide (BNP) testing in patients diagnosed with heart failure as well as the implications for the first available form of exogenous BNP, nesiritide. In addition, the pathophysiology of heart failure and traditional treatment modalities are discussed.
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Critically ill patients present with a myriad of hematologic problems of various etiologies. The astute advanced practice nurse carefully reviews laboratory data incorporating principles of diagnostic reasoning and critical thinking while developing the plan of care. An in-depth understanding of hematology including red blood cells, red blood cell indices, and coagulation laboratory data is essential in the quest to understand the patient's pathophysiology. With every decade, nurses and physicians learn more about diseases that have plagued mankind for centuries--learning in greater detail about the deleterious effects and subsequent outcomes that often begin as subtle changes in traditional laboratory data. Greater focus on interpreting hematologic data and seeking support for diagnoses in clinical correlates will serve nurses well. This article intends to move advanced practice nurses beyond their current understanding of hematologic values--enabling them to understand that how and why we measure is as important as what we measure. No longer is it enough to simply measure physiologic data to develop a care plan driven by the patient's diagnoses. The contemporary nurse understands the importance of assigning meaning to data. Meaningful data are manageable data.