Effect of hypotensive challenge on systemic hemodynamics and cerebral blood flow in persons with tetraplegia

Introduction  Individuals with tetraplegia have impaired central control of sympathetic vascular modulation and blood pressure (BP); how this impairment affects cerebral blood flow (CBF) is unclear. Objectives  To determine if persons with tetraplegia maintain CBF similarly to able-bodied controls after a hypotensive challenge. Methods  Seven individuals with chronic tetraplegia and seven age-matched, non-SCI control subjects underwent a hypotensive challenge consisting of angiotensin-converting enzyme (ACE) inhibition (1.25 mg enalaprilat) and 45° head-up tilt (HUT). Heart rate (HR), low frequency systolic BP variability (LFsbp), brachial mean arterial pressure (MAP) and middle cerebral artery CBF were measured before and after the challenge. Group differences for the baseline (BL) to post-challenge response were determined by repeated measures ANOVA. Results  HR did not differ between the groups in response to the hypotensive challenge. LFsbp response was significantly reduced in the tetra compared to the control group (−38 ± 51 vs. 72 ± 93%, respectively). MAP did not differ between the groups at BL but was significantly lower in the tetra compared to the control group post-challenge (55 ± 13 vs. 71 ± 9 mmHg, respectively); the percent change in MAP was significantly greater in the tetra than in the control group (−29 ± 14.1 vs. −13 ± 9%, respectively). However, CBF did not differ between the groups at baseline or post-challenge; the percent change in CBF post-challenge was not different between the tetra and control groups (−29 ± 13.2 vs. −23 ± 10.3%, respectively). Interpretation  Despite impaired sympathetic vasomotor and BP control, CBF in persons with tetraplegia was comparable to that of control subjects during a hypotensive challenge.     

Cognitive Therapy: A Well-Thought-Out Strategy

Designing strategies for nursing care is a complex process. Carefully evaluating the nature of the client's problem is a beginning step in the eventual design of a strategy. In this case a careful review of the problem of depression led to the discovery of faulty reasoning mechanisms used by clients who experience depressive episodes. Once the theoretical roots of the problem become clear, the design of the strategy is a natural progression. The success or failure of a strategy is measured by research. The author uses selective examples to describe how various aspects of cognitive therapy can be incorporated into the client's plan of care.     

Does nursing education promote ageism?

The literature is replete with diverse studies about gerontological nursing education on the attitudes of nursing students This study examined the effect of a 3-year curriculum on ageism over all 3 years Students were exposed first to well elderly subjects, then hospitalized older subjects, then severely ill older subjects They were tested with the Kogan's Old People Scale and a semantic differential scale to seehow their attitudes towards older people changed according to their experiences The Kogan scale was most sensitive and showed that older students and those with grandparent role models had better attitudes towards older adults Also, there were great increases in positive attitudes towards ageing in year 1 that slowly decreased by the end of year 3     

Barriers to the Use of Nursing Diagnosis Language in Clinical Settings

Ongoing evaluation of the use of nursing diagnoses at the clinical level is critical to the facilitation of further development and refinement of the language of nursing. Therefore, the purpose of this study was to identify the status of utilization of nursing diagnosis in Illinois. A survey instrument was mailed to 239 Illinois hospitals 139 (58%) responded. Results included: 78% of the responding hospitals had implemented nursing diagnosis, with almost all (95%) utilizing NANDA terminology. Components of continuing education efforts related to nursing diagnosis were identified by 75% of the hospitals. Ongoing monitoring of quality improvement methods was reported by 45% of the respondents. The barriers to implementation cited most frequently included: limited ongoing education, lack of motivation to learn, or nurses' difficulties in adjusting to its use .     

Children and Violence

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