Study nurse

Renzetti and Gobran carried out a controlled study on two groups of 20 female telephone-company employees working in adjacent rooms for a period of 120 days. Filters to remove eye irritants were switched periodically between the rooms, so that the two groups were alternately exposed to test and control conditions. Subjects were unaware of whether air was filtered or unfiltered at any given time, but they consistently reported eye irritation when the oxidant concentration exceeded 200 Mg/m. Eye irritation has also been previously cited as the most commonly reported symptom in the student-nurse study of Hammer et al. ... 

Hammer, D. I., V. Hasselblad, B. Portnoy, and P. Wehrle. Los Angeles student nurse study. Daily symptom reporting and photochemical oxidants. Arch. Environ. Health 28 255-260, 1974. 

Interim reviews of the data are an essential requirement to minimise risk during dose-escalation studies. After each study day, or certainly after a predefined number of volim-teers have received the next dose increment, the investigator, nurses, study physician and preferably one or two other experienced physicians who are not intimately involved with the study should meet to review the data. When the study is being conducted in a CRO, a sponsor company physician and a limited number of other personnel should participate by tele- or video-conference if not in person. A decision to stop, modify or continue dose escalation should be made jointly between the Principal Investigator at the CRO and the sponsor s physician. Such reviews should be conducted with maintenance of the double-blind and steps should be taken to avoid inadvertent unblinding, such as by coding of subject numbers. The data that should be reviewed are listed in Box 4.12. 

Every element has a chemical symbol. In many cases, the chemical symbol is the first two letters of the element s name. While 117 elements have been reported in the chemical literature, you are likely to encounter only 30-40 of these in your nursing studies. The following paragraphs outline a few chemical and physical properties of some common elements as well as some medical applications for the most common elements. This information is not presented for you to memorize. Rather, it is presented for you to gain an appreciation of the myriad of important roles these elements play in your careers in the medical field. 

Interim reviews of the data are an essential feature to minimise risk during dose-escalation studies. After each study day, or certainly after a predefined number of volunteers have received the next dose increment, the investigator, nurses, study physician and preferably one or two other experienced physicians who are not intimately involved with the study should meet to review the data listed in Box 4.11. 

The Nurses Health Study is characterized as generating much confusion and misinformation (Campbell, 2005, p. 272fT). This critique is directed mostly toward the Nurses Health Study findings that dietary (animal) fat and fiber did not relate to breast cancer risk. For still other criticisms of ihe nurses study, consult Chapter 14 of the book. 

De Leo, D. et al (1982). Anxiety and depression in general and psychiatric nurses A comparison. International Journal of Nursing Studies 19 173-5. 

Firth, H. et al (1987). Professional depression, burnout and personality in long stay nursing. International Journal of Nursing Studies 24 221-111. 

Agnew, C. and Flin, R. 2014. Senior charge mrrses leadership behaviours in relation to hospital ward safety A mixed method stu. International Journal of Nursing Studies, 51, 768-80. 

MTX is potentially toxic. Therefore, the nurse observes closely for development of adverse reactions, such as thrombocytopenia (see Nursing Alert in Gold Compounds section) and leukopenia (see discussion of adverse reactions associated with hydroxychloroquine). Hematology, liver, and renal function studies are monitored every 1 to 3 months with MTX therapy. The primary care provider is notified of abnormal hematology, liver function, or kidney function finding. The nurse immediately brings all adverse reactions or suspected adverse reactions to the attention of the primary health care provider. 

ANALEPTICS. When a CNS stimulant is prescribed for respiratory depression, initial patient assessments will include the blood pressure, pulse, and respiratory rate. It is important to note the depth of the respirations and any pattern to the respiratory rate, such as shallow respirations or alternating deep and shallow respirations. The nurse reviews recent laboratory tests (if any), such as arterial blood gas studies. Before administering the drug, the nurse ensures that the patient has a patent airway. Oxygen is usually administered before, during, and after drug administration. 

Before administering the first dose of heparin, the nurse obtains the patients vital signs. The most commonly used test to monitor heparin is activated partial thromboplastin time (APTT). Blood is drawn for laboratory studies before giving the first dose of heparin to obtain baseline data (See the discussion on preadministration assessment for the oral anticoagulants.)... 

During therapy, the nurse periodically obtains (daily or more frequently) serum electrolyte or bicarbonate studies to monitor therapy. 

Shah and Jenkins (2000) in a review of mental health economic studies from around the world identified 40 cost-of-illness studies, of which five covered all disorders, one neuroses, two panic disorders and one anxiety. All were from developed countries. There were numerous cost-effectiveness studies but none involving the anxiety disorders specifically. One study in the UK examined the cost-benefit analysis of a controlled trial of nurse therapy for neurosis in primary care (Ginsberg et al, 1984). 

Patients and nursing staff may use a range of applicators (pads, sponges, brushes, spatulas) during medicament administration, particularly for topical products. If reused, these easily become contaminated and may be responsible for perpetuating contamination between fresh stocks of product, as has indeed been shown in studies of cosmetic products. Disposable applicators or swabs should therefore always be used. 

Reproductive Effects. Operating room nurses exposed to trichloroethylene have been reported to have an increased incidence of miscarriages, but they were exposed to many other anesthetics as well (Corbett et al. 1974). Survey results of 1,926 women who had spontaneous abortions revealed a greater risk of abortion associated with trichloroethylene exposure (Windham et al. 1991). This study is limited by multiple chemical exposure. Humans exposed to trichloroethylene in the drinking water in certain areas of the country have not shown adverse reproductive effects (Byers et al. 1988 Freni and Bloomer 1988 Lagakos et al. 1986a). 

Reproductive Toxicity. Increased miscarriages were reported in one study of nurse-anesthetists exposed to trichloroethylene and other solvents (Corbett et al. 1974). A retrospective case-control study has should an approximate 3-fold increase in spontaneous abortion in women exposed to trichloroethylene and other solvents (Windham et al. 1991). Significant effects on sperm parameters were not observed in men occupationally exposed to trichloroethylene (Rasmussen et al. 1988). Adverse reproductive effects were not noted in humans that ingested water contaminated with trichloroethylene and other solvents (Byers et al. 

GIOVANNUCCI E, STAMPFER M J, COLDITZ G A, HUNTER J, FUCHS C, ROSNER B A, SPEIZER F E and WILLETT w c (1998) Multivitamin use, folate, and colon cancer in women in the Nurses Health Study , Ann Intern Med, 129, 517-24. 

TO, a 77-year-old male nursing home resident is admitted to the hospital with a 3-day history of altered mental status. The patient was unable to give a history or review of systems. On physical examination the vital signs revealed a blood pressure of 100/60 mm Hg, pulse 110 beats per minute, respirations 14/minutes, and a temperature of 101°F (38.3°C). Rales and dullness to percussion were noted at the posterior right base. The cardiac exam was significant for tachycardia. No edema was present. Laboratory studies included sodium 160 mEq/L (160 mmol/L), potassium 4.6 mEq/L (4.6 mmol/L), chloride 120 mEq/L (120 mmol/L), bicarbonate 30 mEq/L (30 mmol/L), glucose 104 mg/dL (5.77 mmol/L), BUN 34 mg/dL (12.14 mmol/L), and creatinine 2.2 mg/dL (194.5 pmol/L). The CBC was within normal limits. Chest x-ray indicated a right lower lobe pneumonia. 

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