• Title/Summary/Keyword: Amount of Urination

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Effect of Changing Amniotic Fluid Osmolarity on the $Li^+$ Transport Through the Membrane Surrounding Amniotic Fluid in the Rabbit

  • Chang, Jin-Keun;Lee, Sang-Jin;Sung, Ho-Kyung
    • The Korean Journal of Physiology
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    • v.27 no.1
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    • pp.13-25
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    • 1993
  • To study the regulation of amniotic fluid volume and electrolyte concentration by the Membranes surrounding the amniotic fluid, the rate of $Li^+$ disappearance from amniotic sac of expired fetuses were examined while increasing the amniotic volume and osmolarity in rabbits. After intraamniotic injection of 1 ml isosmotic saline (about 20% of the amniotic fluid volume) containing 15 mM LiCl and 0.5 g/L Censored, the time courses of $Li^+$ and Censored disappearance were determined. From there the $Li^+$ clearance through the extrafetal routes was estimated and compared with that obtained from living fetuses. The volume, $Na^+$ concentration and osmolarity of amniotic fluid were measured and their relationships with $Li^+$ disappearance were evaluated. The fellowing results were obtained: 1. The rate of disappearance from amniotic fluid of living fetuses during the first 30 minutes was strikingly higher for $Li^+$ than for Censored, suggesting that extrafetal routes exist. At 60 and 90 minutes, however, the disappearance rate of $Li^+$ was less than that of Censored, suggesting the possibility of $Li^+$ reentry through fetal urination. 2. The disappearance of $Li^+$ from the amniotic fluid of the expired fetus was substantial, although lower than that of living fetuses, throughout the experimental period. 3. The $Na^+$ concentration and the osmolarity of the amniotic fluid of expired fetus measured 30 minutes after an intraamniotic injection of isoosmotic saline showed wide variation, but thereafter they changed gradually towards the normal extracellular fluid level. 4. When the amniotic fluid was iso- or hyposmolar, the rate of $Li^+$ disappearance from the amniotic fluid of the expired fetuses showed little variation. However, when the amniotic fluid was hyperosmolar, the rate at 30 minutes was markedly lower than those of isosmotic or hyposmotic amniotic fluid. At 90 minutes, the rate of $Li^+$ disappearance in hyperosmolar fluid reached a similar level to the rate in isosmolar fluid. 5. The intraamniotic injection of 400 mOsm/L saline solution decreased the disappearance rate of $Li^+$ from expired fetuses, while the injection of mannitol into the maternal vein induced no significant change. From these results it is concluded that: 1) a significant amount of $Li^+$ may leave the amniotic fluid via filtration through the membranes surrounding the amniotic fluid, 2) during hyperosmolar challenge to amniotic fluid, osmotic bulk flow might counteract the filterable loss, and 3) $Li^+$ disappearance might continue even after the volume and osmolarity of the amniotic fluid have recovered to control values.

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A Study to Determine the Effectsiveness of Severance Hospice Home Care Program (호스피스케어에 대한 평가 연구 - 세브란스호스피스 중심으로)

  • Kingsley, Marian R.N.;Cho, Won-Jung;Kim, Cho-Ja;Lee, Won-Hee;Yoo, Ji-Soo
    • The Korean Nurse
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    • v.29 no.4
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    • pp.51-72
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    • 1990
  • The purpose of this study was to determine whether Severance Hospice Home Care Pro gram was able to meet its objectives. This was done in order to show in detail the effects of hospice home care on the quality of life of terminally ill patients and to provide rationale for setting up more hospice home care programs in korea. The results of the study were as follows: The subjects of the study were 100 terminally ill patients who hnd died 'while in the hospice program and 64 family members who were registered with Severance Hospice Home Care Program between march 1988 and Feb. 1990. The nursing needs of these terminally ill patients were assessed by the nursing records of these patients. The need for pain control(82%) was the highest nursing need so far as the physical aspects were concerned. This was followed by poor appetite(37%), 8 dyspnea(34%), nausea and vomiting(30%) in that order of frequency. In reqard to spiritual needs, the need for religious' support was also high at 72%. Their main psychological symptoms were anxiety and fear(34% ). Burn-out was a major problem for 44% of the family members. The psychological process experiencel by the terminal ill patients was compared to the dying process, described by Kiibler Ross. In comparison of the five stages outlined by kubler Ross with the dying process of the subjects it was found that the subjects not only experienced the five stages but also experienced denial and doubt-fulness or denial with acceptance or acceptance with the expectation of a miracle. But rather than acceptance of the dying process, giving up was a frequent end point of the psychological process, of the subjects. However, when the combination of states was observed, most of the patients reached the state of acceptance in the dying process. It was difficult to identify a definite pattern of change in the psychological process of the subjects. Also it was difficult to identify the factors that influenced the psychological process. The symptoms of the terminally j]] subjects just before dying, that is, 3-4 days before dying included apparent signs of dying. These were a reduction of intake(77%), reduction of the amount of urination(63%), increase in sleeping time (64%) and acceptance of dying by patients and their families who had been unaccepting be before that time(66%). The primary care givers(family member's) degree of satisfaction with the care given to the patient by the hospice was 88.7%. The results of this study show that Severance Hospice Home Care Program had a positie effeet on the quality of life of the terminally ill patients and their family members as they faced the death of the patient. It can be seen from this study that there is an urgent need to extend hospice programs - in order to provide quality of care for terminally ill patient and their families. Based upon the reesults of this study several suggestions are presente as follows: 1) A follow up study should be carried out to identify the dying process as it is unique to Korea. 2) A comparison should be made of other hospice care programs. 3) A comparison study should- be made with subjects who do not receive any hospice care as compared to those who do by use of an experimental and control group methodology. 4) There is a need to determine a scientific method to adequeto measure the interventions carried out to meet the hospice patients nursing care needs. 5) A study should be made using quality research methodology to evaluate effects of hospiec care from the patients, their family members and the nurrse's perspective.

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