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Teaching patients with cancer the skill of self-advocacy shifts the focus of their cancer care on what is important to them, leading to optimized patient-centered care. As oncology nurses, providing support to our patients as they self-advocate to get their needs met fosters a collaborative relationship, creating an environment in which patients feel comfortable verbalizing their needs and concerns. This article provides oncology nurses with background knowledge of self-advocacy; key ways in which they can support patients in self-advocating; and a case study to provide contextual understanding of how and why nurses can promote patient self-advocacy.

Purpose To explore which factors influence opioid analgesia use in older women during the 48-hour period after hospital discharge following initial breast cancer surgery. Design This cross-sectional, descriptive study involved a cohort (n = 57) of older women recruited for a larger study of breast cancer patients. Methods We gathered patient-reported data pertinent to perioperative and post-discharge pain control. Data were analyzed using linear regression to explore those characteristics that had the greatest influence on the amount of post-discharge opioid analgesia required. Results After hospital discharge, 29 older women (51%) with breast cancer avoided opioid analgesia for various reasons. The number of prescribed opioid tablets each woman self-administered determined the total dosage of analgesia required 48 hours post-discharge. Conclusions The majority of this sample of older women with early-stage breast cancer experienced adequate pain relief after surgery and required little or no postoperative or postdischarge opioid analgesia. Optimization of the pain control experience for older women with breast cancer requires thorough pain assessment from diagnosis through survivorship through the end of life. This can be achieved by equipping women in this population to advocate for their pain control needs in real time. Future studies that elucidate preferences, beliefs, and current pain control practices before, during, and after breast cancer surgery will improve safety and efficacy of pain control for this fast-growing population.

Incorporating omics into non-pharmacological intervention research design could provide a better understanding of the variability in response to these interventions. It would also provide evidence for precision-based non-pharmacological interventions, including interventions focused on symptoms. The purpose of this manuscript was to present examples of studies that have used omics to examine response to non-pharmacological intervention. Using the interventions of exercise, diet (related to obesity), cognitive based therapy, and alternative mind-body practices (meditation, yoga, and tai chi), PubMed was searched to identify studies that incorporated genomic or other omic approaches as part of a non-pharmacological intervention. The review identified genes associated with the effectiveness of each of the interventions. Although there were no genes that were associated with all four interventions, there were nine genes that were the focus of more than one intervention ( ACE, BDNF, COMT, CXCL8, IL6, SL6A4, TNF, GSTM1, PTGER3). All nine of these genes were either directly or indirectly biologically related to one another, suggesting that this cadre of genes could serve as an initiation point for investigations using omic approaches to better understand response to non-pharmacological interventions.

Problem statement To define the Oncology Nursing Society Research Agenda for 2019-2022. Design Multimethod, consensus-building approach by members of the Research Agenda Project Team. Data sources Expert opinion, literature review, surveys, interviews, focus groups, town hall, and review of research priorities from other cancer care organizations and funding agencies. Analysis Content analysis and descriptive statistics were used to synthesize research priority themes that emerged. Findings Three priority areas for scientific development were identified. Implications for nursing The Research Agenda can be used to focus oncology nurses' research, scholarship, leadership, and health policy efforts to advance quality cancer care, inform research funding priorities, and align initiatives and resources across the ONS enterprise.

Purpose. The purpose of this study was to estimate radiation-induced nausea (RIN) prevalence and severity among 183 women with early-stage breast cancer and to identify its predictors. Methods. Among participants who underwent radiotherapy, a case-control design compared those who experienced RIN to those who did not. Nausea was measured weekly and operationalized on an 11-point scale with ‘0’ representing “no nausea” and ’10’ representing the “worst nausea ever experienced.” Participants self-reported these symptoms while undergoing radiotherapy. Predictor variables were identified using multivariable binary logistic regression for RIN prevalence and multiple linear regression for RIN severity. Results. Over forty percent (n=75) of participants undergoing radiotherapy experienced RIN, with a mean nausea severity rating of 3.27/10. Significant predictors of RIN prevalence were higher pain levels (pConclusions. The RIN prevalence of 41.0 percent among study participants was higher than previously reported for patients undergoing breast radiotherapy. This could be due to the collection of weekly self-reported data that quantified RIN severity. Younger age, history of nausea, and higher average pain levels should be identified as potential RIN risk factors among patients with early-stage breast cancer. Risk factor identification at the onset of radiotherapy would allow for increased prophylactic mitigation of RIN.

Objective To synthesize research findings about reproductive decision making among women who are BRCA positive. Data Sources PubMed and CINAHL. Study Selection Articles published in English between 2000 and June 28, 2020, about the reproductive decision making of women with a confirmed BRCA1 or BRCA2 mutation. Data Extraction We extracted data about participants, study design, analysis, follow-up, and results. We used the modified Downs and Black checklist and Kennelly’s qualitative data analysis to rate studies for quality and applicability by using. Data Synthesis We included five of 257 screened articles in our synthesis. The total sample size of the five studies was 1,468 women. The most prevalent factors related to reproductive decision making were the impending decisions regarding childbearing and family choices, including decisions about biological children, preventive surgery, preimplantation genetic diagnosis, and prenatal diagnosis to prevent further transmission of a BRCA mutation, and family planning. Conclusion A lack of knowledge exists about the reproductive decision-making processes of women who are BRCA positive. A better understanding of this process would provide nurses and other clinicians with the knowledge needed to support these women through their reproductive life choices.

Depression following the diagnosis of breast cancer has been well documented, and occurs in as many as 40% of women. The serotonin transporter gene SLC6A4 and its functional polymorphism 5-HTTLPR have been extensively studied as factors in the development of depression. Many research studies have demonstrated conflicting results, and the contribution of 5-HTTLPR to depression is unclear. The purpose of this study was to compare the relationship between depressive symptoms and serotonin transporter gene polymorphisms between women with early-stage breast cancer 1 year following initial diagnosis and surgery and matched controls. Participants (N = 125), included postmenopausal women following breast cancer surgery (n = 80) and age-and education-matched healthy controls (n = 45). The genetic elements of interest were the long (LA) and short (S) alleles of 5-HTTLPR, as well as the single nucleotide polymorphism rs25531 A > G within the L-allele (LG). DNA was extracted from either blood or saliva and analyzed for the SLC6A4 polymorphisms. The outcome measures for this longitudinal study included Beck Depression Inventory scores and physical function domain scores from the Medical Outcome Study Short Form 36. Results: Women with breast cancer demonstrated greater depressive symptomatology and decreased physical function compared to healthy controls. The LA/LA genotype was associated with increased depressive symptomatology in the overall sample and within the controls. The LA/LA genotype appeared with greater frequency in the experimental group, but the relationship with increased depressive symptoms was not observed. Physical function was a significant (p

For precision health care to be successful, an in-depth understanding of the biological mechanisms for symptom development and severity is essential. Omics-based research approaches facilitate identification of the biological underpinnings of symptoms. We reviewed literature for omics-based approaches and exemplar symptoms (sleep disruption, cognitive impairment, fatigue, gastrointestinal [GI] distress, and pain) to identify genes associated with the symptom or symptoms across disease processes. The review yielded 27 genes associated with more than one symptom. ABCB1 (MDR1), APOE, BDNF, CNR1, COMT, DAT1 (SLC6A3), DRD4, ESR1, HLA-DRB1, IL10, IL1B, IL6, LTA, PTGS2 (COX-2), SLC6A4, and TNF were associated with cognitive impairment and pain, which had the most genes in common. COMT and TNF were related to all symptoms except sleep disruption. IL1B was associated with all symptoms except cognitive impairment. IL10, IL1A, IL1B, IL1RN, IL6, and IL8 (CXCL8) were linked with all the exemplar symptoms in various combinations. ABCB1 (MDR1) and SLC6A4 were associated with cognitive impairment, GI distress, and pain. IL10 and IL6 were linked to cognitive impairment, fatigue, and pain. APOE and BDNF were associated with sleep disruption, cognitive impairment, and pain. The 27 genes were associated with canonical pathways including immune, inflammatory, and cell signaling. The pathway analysis generated a 15-gene model from the 27 as well as 3 networks, which incorporated new candidate genes. The findings support the hypothesis of overlapping biological underpinnings across the exemplar symptoms. Candidate genes may be targeted in future omics research to identify mechanisms of co-occurring symptoms for potential precision treatments.

Precision medicine refers to the practice of determining a patient’s unique genetic, biomarker, and other characteristics for the purpose of improving his or her clinical outcomes. Not all patients with the same clinical diagnosis respond equally to identical treatment regimens. By examining patients at the molecular level, health-care providers will be better able to apply the most effective therapies that each individual requires. To understand precision medicine, nurses must have a solid understanding of genomics and proteomics. The purpose of this article is to (1) provide a historical review of what and how we have learned about the genome, particularly in the past century, (2) explain the processes whereby genetic information in cellular DNA is transcribed to messenger RNA and translated to protein, and (3) introduce genetic and epigenetic mechanisms that regulate gene expression.

Background: In the past, elderly women with breast cancer were not offered surgery because of beliefs that they would experience serious complications from comorbidities and increased chronological age. Today the decision to offer surgery is based on a woman's fitness rather than her age. Objective: The purpose of this study is to compare the experience of postoperative nausea and vomiting (PONV), anxiety, and reported pain levels in women who represent four different age groups after breast cancer surgery. This study employed a prospective comparative design. A large women's hospital which houses a Comprehensive Breast Care Program. Women diagnosed with early stage breast cancer and scheduled for surgical resection. Methods: Postoperative pain was measured in the postanesthesia care unit using an 11-point verbal pain scale, PONV was measured categorically, and if present, severity of nausea was assessed. Anxiety was measured preoperatively by the short-form Profile of Mood States. Findings: A total of 97 women aged 37-78 participated in this study. Overall, 35% of all women experienced PONV; only two women (18%) in the highest age range (70-79) experienced PONV, yet they reported significantly more pain than women in the other age groups. Understanding the difference in postoperative symptoms experienced by older woman after surgery for breast cancer will support the development of age-specific strategies.

To provide the best available evidence-based care to their patients, advanced practitioners (APs) must become proficient in genomic competencies and remain informed regarding the availability of pharmacogenomic tests. Databases, such as the Centers for Disease Control and Prevention's "Genomic Testing," provide guidance about pharmacogenomic testing, but many APs are not aware of these resources. This study employed a quasi-experimental pretest/posttest design using a convenience sample of APs in a large clinical outpatient breast cancer clinic to assess the knowledge base, beliefs, attitudes, and barriers regarding pharmacogenomic testing among front-line APs and increase knowledge through a targeted educational intervention. The objectives of the educational intervention were to (1) increase knowledge of the clinical indication for testing; (2) increase collaboration among the interprofessional team; and (3) identify correctly when the plan of care should be modified based on pharmacogenomic test results to optimize patient outcomes. Responses showed that these oncology APs possess a strong foundation in genetics and support the addition of new pharmacogenomic tests to their practice.

Background Postoperative nausea and vomiting (PONV) are two of the most frequent and distressing complications following surgical procedures, with as many as 80% of patients considered to be at risk. Despite recognition of well-established risk factors and the subsequent use of clinical guidelines, 20–30% of women do not respond to antiemetic protocols, indicating that there may be a genetic risk. Objective The purpose of this pilot study was to describe the incidence and explore the risk factors associated with PONV after surgery in women diagnosed with early stage breast cancer. Methods A prospective cohort design was employed to measure PONV in women recruited prior to surgery. DNA was extracted from saliva samples collected prior to discharge. Polymorphisms for seven candidate genes with a known role in one of the neural pathways associated with PONV were included in this study; serotonin receptor (HTR3A), serotonin transport (SLC6A4), tryptophan (TPH), dopamine receptors (DRD2/ANKK and DRD3), catechol-O-methyltransferase (COMT) and histamine (H1). Results Twenty-nine (29.8%) women experienced nausea and 10 (11%) experienced nausea and vomiting while in the PACU despite administration of multiple antiemetic medications. Women who experienced PONV had higher levels of pain and received more opioids than those women who did not experienced PONV. Odds ratios demonstrated that alleles for the COMT, DRD3, and TPH genes were associated with decreased PONV. Conclusion The understanding of the multifactorial nature of PONV and the recognition of genetic risk will ultimately lead to the development of personalized interventions to manage these frequent and often debilitating symptoms.

Nausea and vomiting are two of the most common and debilitating side effects following surgery. About half of all patients experience postoperative nausea and vomiting (PONV) during the 24 hours following surgery, or postdischarge nausea and vomiting (PDNV) when they return home following surgery (Cruthirds, Sims, & Louis, 2013). About 80% of patients are considered high-risk, particularly women nonsmokers with a positive history of PONV and who use opioids for relief of pain (Apfel, Korttila, et al., 2004). Opioids given for postoperative pain often are considered the primary cause of PONV (Watcha & White, 1992). Women with breast cancer undergoing mastectomy are particularly high-risk for PONV, with a reported incidence rate of 60%–80% in patients receiving no antiemetic medications (Lee et al., 2008). PONV and PDNV can lead to aspiration; wound dehiscence; bleeding; hematoma; dehydration; electrolyte imbalance; exhaustion; and delayed mobilization, recovery, and ability to begin oral medications (Jolley, 2001; Miaskowski, 2009). PONV is one of the strongest predictors of prolonged hospital stays and unanticipated admission for outpatients following breast cancer surgery (Marla & Stallard, 2009), accounting for millions of dollars of healthcare costs annually (Apfel, Kranke, & Eberhart, 2004). For some women with breast cancer, PONV and PDNV can be more problematic than pain. In scenario studies, when surgical patients were given limited amounts of money to hypothetically “buy away” potential postoperative complications, nausea and vomiting were chosen before pain (Kerger et al., 2007; Macario, Weinger, Carney, & Kim, 1999). Patients with nausea also reported greater impairment in quality of life and psychological distress (Pirri et al., 2013). The American Society of Clinical Oncology indicated that the goal for managing treatment-induced nausea and vomiting (from surgery, chemotherapy, or radiation) should be complete antiemetic response (Basch et al., 2011). However, even when the best available antiemetic medications are applied correctly, that goal has remained elusive (Gan et al., 2007). Documented risk factors for PDNV differ slightly than those for PONV, and include younger age, history of PONV in the postanesthesia care unit, female gender, and use of opioids for pain (Apfel, Philip, et al., 2012). However, female gender is a better independent predictor than history of PONV (Lee et al., 2008), and nonsmoking has not been found to influence PDNV (Apfel, Philip, et al., 2012). The increased risk for PDNV in female patients is not yet understood, but this increased risk persists throughout life, even following menopause (Apfel, Kranke, et al., 2004). In addition, patients scheduled for breast cancer surgery frequently experience high levels of distress, which also may contribute to PONV and PDNV (Montgomery, Schnur, Erblich, Diefenbach, & Bovbjerg, 2010). The significant impact of post-treatment nausea on quality of life in patients with cancer has been reported both as a single symptom and as a symptom cluster with vomiting and appetite loss. Patients with nausea had significantly higher quality-of-life impairment and psychological distress, as well as greater cancer distress (Pirri et al., 2013). To develop effective strategies for the prevention and management of PONV and PDNV in women following breast cancer, understanding the physiologic basis of these problems is important.

Purpose/Objectives: To advance the goals of evidence-based care and prioritize the knowledge generation that addresses contemporary challenges in oncology nursing. Results are used to inform the development of the Oncol-ogy Nursing Society (ONS) Research Agenda and by the ONS Foundation to develop strategic research initiatives.Design: Descriptive, cross-sectional survey. Setting: Web-based survey.Sample: 8,554 ONS members from all levels of education. All doctorally prepared members were invited to partici-pate. A random stratified sample was obtained from the remainder of the membership. Methods: The ONS Research Priorities Survey project team created the survey and analyzed and interpreted the results. Members received an email invitation and follow-up reminders for survey completion.Main Research Variables: Oncology nursing research and evidence-based practice topic questions.Findings: The response rate was 11%, which is compa-rable to previous surveys. Topics ranked included descrip -tive research on patient adherence; intervention studies to optimize adherence, achieve concordance with cancer screening guidelines in minority populations, manage neu -rologic and cardiovascular late effects, and manage symp -toms and symptom clusters; and studies to identify optimal delivery models for survivorship care. These findings have direct implications for translating existing evidence into practice and underscore the need for intervention research focused on improving patient-centered outcomes. Conclusions: Results provide a broad assessment of mem -ber views regarding oncology research priorities. Given the response rate, additional strategies to encourage member participation will be considered. Implications for Nursing: The results, together with the updates of the ONS Research Agenda, can guide ONS and ONS Foundation research and evidence-based practice initiatives. Key Words: evidence-based practice, clinical practice

The CYP2D6 gene encodes for an enzyme that is involved in the metabolism of more than 25% of all medications, including many opioids and antiemetics. It may contribute to the risk of postoperative nausea and vomiting (PONV), a common surgical complication. However, little research has been conducted in this area. The purpose of this study was to explore the association of CYP2D6 genotypes with PONV in adult surgical trauma patients. Data from 112 patients (28% female) with single extremity fractures, aged 18–70 years, were analyzed. PONV was defined as present if patients reported nausea, were observed vomiting, or received medication for PONV. Saliva samples collected for DNA extraction and Taqman® allele discrimination and quantitative real time polymerase chain reaction (qRT-PCR) were used to collect genotype data that were then used to assign CYP2D6 phenotype classification. The incidence of PONV was 38% in the postanesthesia care unit and increased to 50% when assessed at 48 hr. CYP2D6 classification results were 7 (6%) poor metabolizers, 34 (30%) intermediate metabolizers, and 71 (63%) extensive metabolizers. No ultrarapid metabolizers were identified. Patients who were classified as poor metabolizers had less PONV and higher pain scores. Gender and history of PONV, but not smoking, were also significant risk factors. Findings suggest variability in CYP2D6 impacts susceptibility to PONV.

The purpose of this study was to compare the efficacy of transtracheal (TT) oxygen delivery to that of nasal cannula delivery in subjects with chronic obstructive pulmonary disease (COPD). Twenty subjects (14 men, 6 women) were followed for 6 months during nasal cannula delivery. A TT catheter was then inserted, and measurements were repeated during TT use. With TT delivery, subjects required 45% less oxygen at rest and 39% less during exercise (p less than 0.0001). Oxygen use, measured by pounds of oxygen delivered to the home, also decreased, but the magnitude of change was less than anticipated (mean, 14%; range, +4% to -32%). Hospital days decreased from 12 +/- 10 during nasal cannula use to 4 +/- 6 during TT use (p less than 0.002). Exercise tolerance, as measured by a 12-min walk distance, was greater during TT use (p less than 0.0001). No change was seen in spirometry or acid-base balance. Also, no change was seen in Profile of Mood States, Sickness Impact Profile or Katz Adjustment Scale scores. Some problems were encountered relating to use of the catheter (displacement, mucus balls), but they were minor, and most were confined to the initial 2 months of TT use when the tract was immature. Our experience suggests that, in addition to decreasing oxygen flow rate, use of TT delivery may confer benefits that result in improved exercise tolerance and decreased hospitalization in patients with COPD.

This paper is a report of a study to identify critical thinking learning needs of new and experienced nurses.Concern for patient safety has grown worldwide as high rates of error and injury continue to be reported. In order to improve patient safety, nurses must be able to recognize changes in patient condition, perform independent nursing interventions, anticipate orders and prioritize.In 2004-2006, a consecutive sample of 2144 newly hired nurses in a university-affiliated healthcare system completed the Performance Based Development System Assessment consisting of 10 videotaped vignettes depicting change in patient status. Results were reported as meeting or not meeting expectations. For nurses not meeting expectations, learning needs were identified in one of six subcategories.Overall, 74.9% met assessment expectations. Learning needs identified for nurses not meeting expectations included initiating independent nursing interventions (97.2%), differentiation of urgency (67%), reporting essential clinical data (65.4%), anticipating relevant medical orders (62.8%), providing relevant rationale to support decisions (62.6%) and problem recognition (57.1%). Controlling for level of preparation, associate (P=0.007) and baccalaureate (P0.0001) nurses were more likely to meet expectations as years of experience increased; a similar trend was not seen for diploma nurses (P=0.10). Controlling for years of experience, new graduates were less likely to meet expectations compared with nurses withor=10 years experience (P=0.046).Patient safety may be compromised if a nurse cannot provide clinically competent care. Assessments such as the Performance Based Development System can provide information about learning needs and facilitate individualized orientation targeted to increase performance level.

Introduction: Racial survival disparity in breast cancer persists despite advances in breast cancer screening and treatment. Attention has been recently focused on breast cancer treatment disparity as a causative etiology for breast cancer survival disparity. Our previous work has indicated that symptom related toxicity, specifically pain may interfere with the ability to receive full dose and timely chemotherapy among African American women receiving chemotherapy and that pain and nausea are two symptoms that present in a differential manner between races in the immediate breast cancer post-operative period. Pain and nausea were chosen for this study as possible dose limiting symptoms. We We compared pain and nausea between African American and White women as they underwent breast cancer chemotherapy. Experimental Procedures: Two large cohorts of women undergoing breast cancer treatment were combined. The first cohort of largely Caucasian women were recruited between 2006 and 2013 in order to study cognitive function among woman undergoing Anastrazole treatment for early stage breast cancer (AIM). One cohort underwent chemotherapy before Anastrazole therapy, and another received only chemotherapy. These groups constitute the first cohort for this study, from which baseline (before chemotherapy) and 6 month after initiation of chemotherapy measurements were abstracted. The second cohort was recruited into a study of only African American women recommended to receive breast cancer chemotherapy. Recruitment began December, 2009 and ended September, 2014. Measurement from both cohorts were at baseline (prior to chemotherapy) and at completion of chemotherapy (4-6 months after initiation). Pain was measured in the AIM study by the Brief Pain Inventory (PBI), using an 11-point scale increasing with severity. Nausea was measured using the Breast Cancer Prevention Trial (BCPT) symptom checklist as a 0-4 point scale. Symptoms in the ACTS study were measured with the McCorkle Symptom Scale on a 1-5 scale increasing with severity. Scores for all instruments were rescaled to categorical 0 (none/hardly any), 1 (minimal), 2 (moderate) or 3 (severe) to indicate worsening severity of symptoms. Descriptive analysis was used for demographics and chi square for group differences. Data Results: Data were combined for analysis. There were 297 women between the 2 studies with data for analysis, n=148 (White) and n=149 (African American). The mean age for the AIMS Study was 59.37 (5.74), the mean age for the ACTS study was 53.7 (9.83). At baseline, white women experienced significantly less pain (p < .001) and these differences persisted at 6 months. (p < .001). African American women reporting pain levels at 0 (None/Hardly) at baseline was N=51 and at 6 months N =42. White women reporting pain levels at O (None/Hardly) at baseline was N=90 and at 6 Months N=80. African American women reporting 3 (Severe) was N=31 at baseline and N=28 at 6 month measurement while N=0 white women reported severe pain at baseline and only N=2 at 6 month measurement. There were low levels of nausea with no racial differentiation at baseline and at 6 months. Of the white sample, 93.2 % and 93% of the African American women reported experiencing nausea “not at all” or “hardly ever” at baseline. At 6 months post-baseline, 98% of the white and 90.5% of the African American women reported experiencing nausea not at all or hardly ever. Conclusions and Implications for Practice: The results of this study document racial differences in symptoms in breast cancer. Understanding these differences is imperative, especially knowing that pain may be a primary reason for interruptions in the treatment plan. These interruptions cause treatment disparity in dose and completion rates which may be implicated in breast cancer survival disparity. Citation Format: Margaret Quinn Rosenzweig, Susan Wesmiller. Racial differential in pain and nausea during breast cancer chemotherapy. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C11.

Transtracheal oxygen therapy is being used with increasing frequency because it is an effective mode of oxygen delivery and is well tolerated by patients. An increase in cough and mild intermittent hemoptysis are not uncommon in the early postinsertion period but usually resolve spontaneously. Herein we present two individuals of short stature with restrictive lung disease who had persistence of excessive cough and mild hemoptysis after insertion of a standard catheter (SCOOP). Bronchoscopic evaluation in one revealed erosions of the mucosa over the carina and take-off of the right main-stem bronchus. Symptoms resolved in both individuals following placement of a shorter catheter. We suggest that greater consideration be given to matching transtracheal catheter length to patient lung size, particularly in the face of severe restrictive lung disease.

Transtracheal (TT) oxygen delivery involves administration of oxygen percutaneously through a catheter inserted in the suprasternal trachea. Transtracheal oxygen delivery has been proposed as a means of overcoming the high visibility, inconvenience, and discomfort associated with nasal cannula use. This report describes our experience using TT delivery in 40 patients with chronic obstructive pulmonary disease (n = 32) and other types of lung disease (n = 8). Overall acceptance of TT catheter use was high and only 5 subjects elected to discontinue use. We believe the TT route is a relatively safe approach for oxygen administration and a promising method of improving patient compliance. It also offers the potential of more adequately oxygenating patients with refractory hypoxemia.

Previous studies have reported that exercise tolerance improves with transtracheal oxygen delivery. However, patients were not blinded to the delivery technique used, introducing a potential source of bias. The purpose of this study was to compare exercise tolerance during nasal cannula and transtracheal delivery using a randomized double-blinded technique. Subjects (n = 11) performed 12-min walks on the same day while receiving nasal cannula and transtracheal delivery. Nine of 11 subjects walked farther with transtracheal delivery, a significant increase (p less than 0.01). Mean increase in walk distance was 95 +/- 86 feet. In addition, a trend was seen toward greater improvement in walk distance with greater flows through the catheter (r = 0.58, p less than 0.06). Time into the walk when desaturation (SaO2 less than 90%) first occurred was not significantly different. We conclude that exercise tolerance improves when oxygen is delivered by transtracheal catheter. This improvement is unrelated to an increase in SaO2. We speculate that the increase in exercise tolerance may be related to other physiologic effects of flow through the catheter.

Interpretation and comparison of arterial blood gases and oximetry readings provide data quickly about a patient's oxygenation status. Factors that alter normal values or interfere with accuracy of readings must be considered. The nurse can use this information to assess the patient's respiratory needs and make appropriate changes in the plan of care.

Arterial blood gas (ABG) interpretation can be a source of concern. However with use of the review and principles discussed in this article, the nurse's role in blood gas interpretation can become much easier.