Bed Sharing,SIDS Research,and the Concept of Confounding: A Review for Public Health Nurses

Confounding is an important concept for public health nurses (PHNs) to understand when considering the results of epidemiological research. The term confounding is derived from Latin, confundere, which means to “mix‐up” or “mix together”. Epidemiologists attempt to derive a cause and effect relationship between two variables traditionally known as the exposure and disease (e.g., smoking and lung cancer). Confounding occurs when a third factor, known as a confounder, leads to an over‐ or underestimate of the magnitude of the association between the exposure and disease. An understanding of confounding will facilitate critical appraisal of epidemiological research findings. This knowledge will enable PHNs to strengthen their evidence‐based practice and better prepare them for policy development and implementation. In recent years, researchers and clinicians have examined the relationship between bed sharing and sudden infant death syndrome (SIDS). The discussion regarding the risk of bed sharing and SIDS provides ample opportunity to discuss the various aspects of confounding. The purpose of this article is to use the bed sharing and SIDS literature to assist PHNs to understand confounding and to apply this knowledge when appraising epidemiological research. In addition, strategies that are used to control confounding are discussed.     

Home monitoring of infants at increased risk of sudden death

• Home apnoea and cardiorespiratory monitors are commonly used in the UK, the rest of Europe and USA in infants at increased risk of ‘sudden infant death’.
• The efficacy of apnoea and cardiorespiratory monitors remains unknown.
• The use of transcutaneous oxygen monitoring is presented as an alternative method of home monitoring.
• Recommendations are proposed regarding nursing practice and the future of home monitoring in infants at increased risk of sudden death.

     

Application of Orem's Self‐Care Deficit Theory and Standardized Nursing Languages in a Case Study of a Woman with Diabetes

PURPOSE. This paper aims to illustrate the process of theory‐based nursing practice by presenting a case study of a clinical nurse specialist's assessment and care of a woman with type 2 diabetes. DESIGN. Orem's self‐care deficit theory and standardized nursing language, NANDA, NIC (Nursing Interventions Classification), and NOC (Nursing Outcomes Classification), guided assessment and the identification of outcomes and interventions related to the client's management of diabetes. FINDINGS. Theory‐based nursing care and standardized nursing language enhanced the client's ability to self‐manage the chronic illness: diabetes. CONCLUSION. Nursing theory and standardized nursing language enhance communication among nurses and support a client's ability to self‐manage a chronic illness.     

Nurse Anesthetist Follow-up of an Adolescent Female With Gunshot Trauma: A Case Study

PURPOSE.  This case study was written to demonstrate the usefulness of standardized nursing diagnoses, outcomes, and interventions in nurse anesthetist care of an adolescent trauma patient.
DATA SOURCES.  Literature reviews using Academic Premier, Google Scholar, and CINAHL databases were done to find current, relevant articles concerning evaluation and support of female African-American adolescents living in socially vulnerable and economically exploited environments.
DATA SYNTHESIS.  A case is presented and evidence from current publications is analyzed to support the diagnosis, outcomes, and interventions.
CONCLUSION.  The investment in extra time, care, and effort sometimes required for the full development of a treatment plan for teenagers who live where they are at high risk for violence and other consequences of stressful environments is a worthwhile one, even if results may require contact over an extended time period.
PRACTICE IMPLICATIONS.  Nurses of all specialty backgrounds need to be concerned with the progress of their patients. Sometimes nurses can best serve their patients by stepping away from the physiological event and focusing instead on responses in the domain of coping and stress tolerance as the root of difficulties.     

Nurse Anesthetist Follow‐up of an Adolescent Female With Gunshot Trauma: A Case Study

PURPOSE. This case study was written to demonstrate the usefulness of standardized nursing diagnoses, outcomes, and interventions in nurse anesthetist care of an adolescent trauma patient. DATA SOURCES. Literature reviews using Academic Premier, Google Scholar, and CINAHL databases were done to find current, relevant articles concerning evaluation and support of female African‐American adolescents living in socially vulnerable and economically exploited environments. DATA SYNTHESIS. A case is presented and evidence from current publications is analyzed to support the diagnosis, outcomes, and interventions. CONCLUSION. The investment in extra time, care, and effort sometimes required for the full development of a treatment plan for teenagers who live where they are at high risk for violence and other consequences of stressful environments is a worthwhile one, even if results may require contact over an extended time period. PRACTICE IMPLICATIONS. Nurses of all specialty backgrounds need to be concerned with the progress of their patients. Sometimes nurses can best serve their patients by stepping away from the physiological event and focusing instead on responses in the domain of coping and stress tolerance as the root of difficulties.     

呼气末正压通气在治疗体外循环心内直视术后急性呼吸窘迫综合征病人中的应用

[目的]观察不同压力水平呼气末正压通气(PEEP)对全身氧动力学的影响,探讨改善体外循环心内直视术后急性呼吸窘迫综合征(ARDS)病人最佳PEEP使用方法。[方法]依次按PEEP为0kPa、0.4kPa、0.9kPa、1.6kPa递增的水平进行调节,用热稀释法测定4次平均后的心脏指数(CI),同时进行血气分析,以观察不同压力水平PEEP对气体交换功能和氧动力学的影响。[结果]当PEEP为0.4kPa时,PaO2开始升高,并随着PEEP的增加逐渐升高。PaCO2在PEEP增加过程中无明显变化。CI在PEEP为0.4kPa时开始下降,且PEEP压力水平越高,CI下降越明显。全身氧供给(DO2)在PEEP为1.6kPa时出现显著降低。[结论]PEEP治疗体外循环心内直视术后ARDS病人PaO2有一定提高,但高压力水平的PEEP反而会使DO2下降。所以应使用依次递增的方法,并根据病人生命体征、中心静脉压(CVP)、末梢血氧饱和度的变化选择最佳PEEP值。即在未使用血管活性药物及正性肌力药物的条件下,病人无氧分压下降时的PEEP值为最佳。