Biomedical subjects
Publications and source records attributed to M Nield.
The results of the American Association of Critical-Care Nurses Demonstration Project support the contention that high quality critical care nursing can be provided to patients at a reasonable cost. In addition, the data refute the notion that elements influenced by nurses--supplies and nursing care--are the most costly portion of the total hospital charge.
Ineffective airway clearance occurs when an artificial airway is used because normal mucociliary transport mechanisms are bypassed and impaired. Nursing assessment and intervention are the keys to maintaining airway patency in the patient with an artificial airway in place. The assessment of breath sounds is critical to making a valid clinical judgment about airway patency. Nursing interventions such as tracheobronchial suctioning, postural drainage, and providing exogenous humidity to the inspired air are indicated to maintain airway patency, which is the goal of treatment. Suggested areas for future research related to this diagnosis include validation of the signs and symptoms which are proposed as being specific to the causes of ineffective airway clearance and the continuation of experimental studies to demonstrate the efficacy of various interventions for this nursing diagnosis.
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Dyspnea, the unpleasant subjective sensation of difficult breathing, is one of the most common symptoms experienced by patients with pulmonary and cardiac disorders. This article reviews the research concerning dyspnea and proposes it for consideration as a nursing diagnosis. The etiologies are categorized according to the neurosensory, neurochemical, cognitive, and affective mechanisms. The defining characteristics include the subjective words describing dyspnea, such as shortness of breath, suffocation, and tightness. The most supported objective sign of dyspnea in the literature is an increased use of accessory muscles of respiration. Nursing interventions for dyspnea relief are geared toward reducing the afferent activity from receptors in the respiratory muscles and dealing with the affective component of dyspnea. These interventions include pacing activities, breathing techniques, and inducing the relaxation response. Because most research for interventions to reduce dyspnea have focused on patients with obstructive lung disorders who have chronic dyspnea, recommendations for further research include using acutely ill patients and those with a variety of medical conditions.
The reliability of magnitude estimation with an open scale was evaluated in a physiologically stable population of adults with chronic respiratory disease who experienced chronic dyspnea. Magnitude estimation was used to measure one dimension of dyspnea, perceptual sensitivity. The relationship between external inspiratory resistive loads (stimuli) and numbers that reflected the perceived intensity of the breathing effort (response) as expressed by a power function was measured on three visits 3 to 5 days apart. The correlations of the exponent of the power function between visits were high and stable.
Magnitude estimation, a psychophysic method, allows examination of variables associated with the respiratory sensation of loaded breaths. The subject's perceptual sensitivity can be quantified by magnitude-scaling exponents which describe the rate of growth of the dyspnea sensation associated with increases in the magnitude of the stimulus. Measurement of the perception of dyspnea by magnitude estimation can complement other measurements of variables that contribute to this complex sensation. Use of magnitude estimation techniques can enhance the study of similar clinical problems such as pain and fatigue.