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Biomedical subjects

M L Noll

Publications and source records attributed to M L Noll.

At least 19 recordsLinked to original sources
PubMed1995

Chronotherapy in acutely ill patients with respiratory disorders: Part I. Respiratory chronobiology and chronopathology.

Chronotherapy is a relatively new approach in patient care that is based on knowledge of the various biologic rhythms of the body. Treatment is aimed at supporting normal rhythms or altering therapies based on known variations in body rhythms. Application of chronotherapy concepts to the pathology of respiratory diseases is discussed to provide a basis for altering pharmacologic therapy in the care of critically ill patients with respiratory disorders.

Acute Disease↗
PubMed1995

Chronotherapy in acutely ill patients with respiratory disorders: part II. Application of chronopharmacology in patient care.

Tailoring medication administration to obtain the optimal chronobiologic function of individuals with respiratory disorders has been studied by numerous researchers. Integration of chronobiologic concepts into therapeutic regimens for patients with chronic airflow obstruction has been successful in reducing nocturnal symptoms of reduced airflow. Application of chronotherapeutic concepts in administration of commonly used respiratory medications is presented. Pharmacologic and nonpharmacologic chronotherapeutic implications for providing care for critically ill patients with respiratory disorders are discussed.

Acute Disease↗
PubMed1994

Comparison of SVO2, SpO2, and clinical parameters with arterial blood gases during ventilatory weaning after cardiac surgery.

Correlations of mixed venous and arterial oxygen saturation, heart rate, respiratory rate, and mean arterial pressure with arterial blood gas variables were computed for 57 sets of data obtained from 30 postoperative coronary artery bypass graft patients who were being weaned from mechanical ventilation. Arterial oxygen saturation and respiratory rate correlated significantly, although moderately, with blood gases.

Arteries↗
PubMed1993

Preparing the CNS for participation in quality assurance activities.

Preparation of CNSs must include advanced knowledge in the area of clinical specialty and experience in the various subroles of the clinical specialist. In order to enhance students' knowledge and skills related to these subroles, the authors instituted a clinical project focusing on quality assurance activities for students enrolled in the medical-surgical nursing major in a large graduate nursing program. Students begin the project during the clinical practicum by identifying an area in need of quality assurance monitoring. Students then develop monitoring tools, collect data, and make recommendations for changes in clinical practice. The project gives the students practical experience in an important area of clinical specialist practice and can be adapted or expanded for any clinical major.

Education, Nursing, Graduate↗
PubMed1992

Fluctuation in mixed venous oxygen saturation in critically ill medical patients: a pilot study.

OBJECTIVE: To determine fluctuation in mixed venous oxygen saturation in critically ill medical patients during a period of rest. DESIGN: Nonexperimental, descriptive. SETTING: The medical and coronary intensive care units in a large county hospital in south-central Texas. PATIENTS: Twenty critically ill patients, aged 19 to 85, who had placement of a pulmonary artery catheter capable of continuous monitoring of mixed venous oxygen saturation. The majority had a diagnosis of respiratory failure and required mechanical ventilation. METHODS: Mixed venous oxygen saturation was recorded each minute for a 2-hour period in either early morning or late afternoon hours. Minute-by-minute values obtained during a 30-minute period of rest were used to determine fluctuation. The lowest and highest mixed venous oxygen saturation values during the period were used to calculate percent changes from average values (fluctuation). RESULTS: The range of fluctuation was +/- 6% of the average mixed venous oxygen saturation value for 80% of the sample. Four patients had a greater range of fluctuation: however, their actual mixed venous oxygen saturation values were within a clinically acceptable range. No significant differences in percentage of low or high fluctuation were noted for the following variables: time of day, medication administration, oxygen delivery, oxygen consumption and average mixed venous oxygen saturation. The percentage of low fluctuation was significantly lower for four patients who were not mechanically ventilated. CONCLUSIONS: Knowledge of normal fluctuation enables the care giver to evaluate changes in mixed venous oxygen saturation in response to activities and/or treatments. Additional study of fluctuation in homogenous groups of critically ill patients is warranted.

Adult↗
PubMed1991

Choosing a master's program in critical care.

This article has presented information to assist you in selecting a master's program that best suits your interests and needs. You should plan your education and career with the above information in mind. Regardless of which program you select, graduate school is an exciting experience that will provide you with numerous opportunities as you continue in your nursing career.

Choice Behavior↗
PubMed1990

The long-term acute care hospital: a new option for ventilator-dependent individuals.

Improved health care and sophisticated medical technology have improved the outcome for many people who suffer a critical illness. One group of people who have benefited are ventilator-dependent individuals (VDIs), as evidenced by the increased number of children and adults requiring long-term mechanical ventilation. Significant changes in this nation's health care reimbursement structure have made a substantial negative impact on the availability of traditional long-term care options for these patients. In response, a new health care environment has emerged. Now available are specialty hospitals providing general hospital services, which allow for long-term acute care intervention. The Vencor Corporation has successfully established this innovative care environment in a cost-effective manner. There are currently nine Vencor hospitals specializing in providing long-term acute care to VDIs and other catastrophically ill patients.

Adult↗
PubMed1990

Closed tracheal suction systems: effectiveness and nursing implications.

Closed tracheal suction systems (CTSS) are currently being used to minimize complications associated with endotracheal suctioning. Advantages of CTSS include improved oxygenation, decreased clinical signs of hypoxemia, maintenance of positive end-expiratory pressure, infection control, convenience, cost, and reduced patient anxiety. Some concerns related to use of CTSS include autocontamination, decreased effectiveness, difficult to use, excess negative pressure, and airway trauma. Strategies for reducing these and other concerns are shared. Recommendations for nursing practice and nursing research are discussed.

Adult↗
PubMed1990

Collaboration to facilitate baccalaureate education in emergency departments.

The use of emergency departments for baccalaureate nursing education has proved to be a rewarding experience for students, emergency department (ED) staff, and nursing school faculty. The primary factor for the success of this experience was the collaborative interaction of ED nursing personnel, and school of nursing faculty in designing the educational experience. ED staff complemented the faculty role and facilitated clinical experiences for the nursing students. This article identifies various teaching principles and strategies ED staff used to create a successful clinical experience for baccalaureate nursing students.

Curriculum↗
PubMed1990

Effect of backrest position on mixed venous oxygen saturation in patients with mechanical ventilation after coronary artery bypass surgery.

A quasi-experimental study was conducted to examine the effect of backrest position on mixed venous oxygen saturation (SvO2) in patients with mechanical ventilation after coronary artery bypass graft surgery. A convenience sample of 30 subjects was randomly assigned to one of three positions: 20 degrees, 40 degrees, or flat (control). Baseline data were collected with patients in the flat position. The backrest was elevated according to the position designated for each group, and data were collected at 0, 5, 15, and 30 minutes. Subjects in the experimental groups were then returned to the flat position, and measurements were repeated. By use of two-way analysis of variance statistics, no significant differences from baseline were found in SvO2 among the three groups, among the measurement times, or among the positions and times. Findings support elevating the backrest up to 40 degrees according to patient comfort, for patients 6.0 to 9.5 hours after coronary artery bypass graft surgery if they are up to 70 years of age, have no lung disease, are receiving optimal ventilation with up to 5 cm H2O of positive end-expiratory pressure, have normal temperature, and are hemodynamically stable.

Catheterization, Swan-Ganz↗
PubMedDate not supplied

Usefulness of measures of Svo2, Spo2, vital signs, and derived dual oximetry parameters as indicators of arterial blood gas variables during weaning of cardiac surgery patients from mechanical ventilation.

OBJECTIVES: To determine whether combined use of the parameters of mixed venous oxygen saturation, arterial oxygen saturation obtained by pulse oximetry (Spo2), and vital signs correlated with arterial blood gas variables (ABGs) better than each individual variable during weaning of postoperative cardiac surgery patients from mechanical ventilation; and to evaluate the relationship of derived parameters: oxygen extraction index and ventilation/perfusion index (VQI), and ABGs. DESIGN: Secondary analysis of previous correlational study. SETTING: The cardiac care unit in a large medical center in central Florida. PATIENTS: Thirty postoperative coronary artery bypass graft patients being weaned from mechanical ventilation. METHODS: After a change in ventilator settings during systematic weaning towards extubation, measurements of variables were taken during a 30-minute period. At 30 minutes, an ABG was drawn for comparison. Data were collected after two ventilator changes. A total of 57 data sets were used for analysis. RESULTS: By use of multiple regression analyses, statistically significant (p < 0.01) independent variables predicting pH and partial pressure of carbon dioxide were Spo2 and respiratory rate. The independent variable contributing to the model versus partial pressure of oxygen was Spo2. The oxygen extraction index did not correlate with ABGs; however, the VQI correlated significantly with all ABG variables except bicarbonate. CONCLUSIONS: The use of multiple parameters was no more useful in predicting ABGs than individual variables of Spo2 and respiratory rate. The derived VQI parameter correlated with ABGs. The use of VQI in conjunction with Spo2 and respiratory rate may assist in patient monitoring during weaning and reduce the number of ABGs needed.

Adult↗
PubMedDate not supplied

Re-evaluating the role of the charge nurse.

Charge nurses are used in most critical care units to facilitate quality patient care by serving as resources to the nursing staff. These authors suggest strategies for initiating or evaluating the charge nurse role in critical care. Interviews with critical care charge nurses show how different viewpoints remain regarding this key role of the charge nurse.

Communication↗
PubMedDate not supplied

Should charge nurses be paid a differential?

A charge nurse in a critical care unit assumes responsibility for the care of several acutely ill patients for an 8- to 12-hour period. Should a salary differential be paid to compensate for the responsibility? Arguments for and against paying a charge-nurse differential are presented in the following article.

Humans↗