1998 Fiscal Year Final Research Report Summary
Study on the home nursing care for the patients with neuromuscular disease who have chronic and progressive respiratory disorder
| Project/Area Number |
08672715
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Nursing
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| Research Institution | Tokyo Metropolitan Institute for Neuroscience |
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Principal Investigator |
USHIGOME Miwako Tokyo Metropolitan Institute for Neuroscience, Department of Health and Medical Sociology, Research Scientist, 東京都神経科学総合研究所・社会学研究部門, 副参事研究員 (10176654)
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| Co-Investigator(Kenkyū-buntansha) |
KASAI Hideko Tokyo Metropolitan Institute for Neuroscience, Department of Health and Medical Sociology, Research Scientist, 東京都神経科学総合研究所・社会学研究部門, 研究員
TOKUYAMA Sachiko Tokyo Metropolitan Institute for Neuroscience, Department of Health and Medical Sociology, Research Scientist, 東京都神経科学総合研究所・社会学研究部門, 主事研究員 (30291941)
WAKO Fumiko Tokyo Metropolitan Institute for Neuroscience, Department of Health and Medical Sociology, Research Scientist, 東京都神経科学総合研究所・社会学研究部門, 主事研究員 (70260312)
KATO Syuichi Tokyo Metropolitan Institute for Neuroscience, Department of Neuropathology, Research Scientist, 東京都神経科学総合研究所・神経病理学研究部門, 研究員
KAWAMURA Sawako Tokyo Metropolitan College of Health Sciences, Divison of Nursing Sciences, Professor, 看護学科, 教授 (30186142)
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| Project Period (FY) |
1996 – 1998
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| Keywords | intractable illness nursing / home nursing / respiratory disorder / nursing assessment / home mechanical ventilation (HMV) / pulse oximetry / percutaneous blood carbon dioxide determination |
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| Research Abstract |
[Purpose and method] : Due to the improvement in home medical care support system including the amendment medical insurance system, the number of patients with advanced respiratory disorders who require mechanical ventilation and oxygen therapy in home nursing is on the increase. This study was conducted for the purpose of investigating by non-invasive method the progress of respiratory disorder in the neuro-muscular disease patients who have chronic or progressive respiratory disorder and the usefulness of introducing appropriate medical care including ventilatory therapy as well as safe nursing activities in performing the care. The subjects of study included 13 patients with progressive muscular dystrophy (Duchenne type - 10, Fukuyama type - 3) and 10 with amyotrophic lateral sclerosis. The time course data which were obtained during the progress of disease were investigated and discussed with nurses specialized in neurological diseases and neurologists.
[Results and Discussion] : 1.
… More
The following is recommended to grasp the status of respiratory disorder in early stage. In the patients with progressive muscular dystrophy, it is useful to regularly determine the tidal volume (TV) and maximum vital capacity (MAX VC) using a respirometer (respirometry) in addition to checking the vital signs and subjective symptoms from the time before onset of respiratory disorder. When signs of respiratory disorder are expected to appear, it is useful to regularly assess the cough force by speak cough flow (PCF), determine the percutaneous blood oxygen saturation (pulse oximetry) during sleep all through the night and percutaneous blood carbon dioxide partial pressure. In the case of patients with amyotrophic lateral sclerosis, it is useful to observe subjective symptoms from the initial stage of onset and to determine TV and MAX VC by respirometer. After initial signs of respiratory disorder are noted, it is advisable to regularly determine the percutaneous blood oxygen saturation (pulse oximetry) during sleep all through the night and percutaneous blood carbon dioxide partial pressure. The above maybe used as the basic data for the nursing protocol during the introductory phase of home mechanical ventilation. 2. In those receiving mechanical ventilation, it is useful to regularly determine the percutaneous arterial blood oxygen saturation and percutaneous blood carbon dioxide partial pressure as indices for changing the ventilatory settings to cope with further progress in respiratory disorder. 3. It is essential for home nursing that the numbers of a nursing team should cooperate and that their activities should be planned with allowance for time so that the measured values may be appropriately interpreted and reflected in the treatment & nursing plan. Also important is the support to the patient to increase his/her self management ability. These are the tasks which we intend to perform in the future. Less
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