...Nursing Management of a Patient with Raised Intracranial Pressure after Traumatic Brain Injury and Dealing with Family Anxiety. Introduction The aim of this assignment is to explore, analyse and evaluate the nursing management of raised intracranial pressure (ICP) and family anxiety after head injury. In order to obtain a wider knowledge of the care of patients with raised ICP, a literature review was carried out. From this information I hope to improve the standard of care and ultimately patient outcome. The anxiety felt by family members are large and therefore I have decided to discuss this in my assignment. Consent has been sought from the next of kin. Confidentiality will be maintained in accordance with Nursing and Midwifery Council (NMC 2008). Patient’s Presentation Aldi is a 42 year old male who was found by police lying in the street, with loss of consciousness and believed to be assaulted. His eyes, lips and face was swollen. He was brought to the nearest hospital via ambulance as he had a seizure episode. In A&E it was noted that Aldi has sustained a head injury associated with a decrease level of consciousness and seizure activity. His pupils are both 2mm and reacting to light. His Glasgow Coma Scale (GCS) was 9-10. Opening eyes on pain, incomprehensible sound and moving all limbs. GCS is a worldwide recognized scale for documenting neurological assessment (Mavin,2008). After the initial presentation in A&E his neurological condition was rapidly...
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...Japanese Encephalitis is identified as a leading form of viral encephalitis that is known to be spreading globally. Belonging to the genus Flavivirus and the family of Flaviviridae, Japanese encephalitis exists in a zoonotic cycle that occurs in mosquito and vertebrate hosts, such as water birds and pigs. Epidemiological patterns of Japenese encephalitis have been discovered in both epidemic and endemic regions. Shlim and Solomon's (2002) research found: In northern temperate areas (Japan, Taiwan, China, Korea, northern Vietnam, northern Thailand, Nepal, and northern India), large epidemics occur during the summer months (roughly, May to October). In Southern tropical areas (southern Vietnam, southern Thailand, Indonesia, Malaysia, Philippines, Sri Lanka, and southern India), JE tends to be endemic; here, cases occur sporadically throughout the year, with a peak after the start of the rainy season. (p. 184) Japanese encephalitis has been more commonly seen in children or in visitors to areas of the endemic region than in resident adults. In endemic countries, adults acquire immunity through natural infection. Solomon's (2004) research found: In rural Asia, where exposure to infected mosquitos is unavoidable, serologic surverys show that almost everyone is exposed to Japanese encephalitis virus during childhood. However, fever develops in only a small proportion (about 1 in 300) of those exposed, and neurologic disease develops in even fewer persons. Thus, Japanese...
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...NURSING CARE PLAN GOAL The Child with Bacterial Meningitis RATIONALE EXPECTED OUTCOME INTERVENTION 1. Inability to Sustain Spontaneous Ventilation related to level of consciousness NIC Priority Intervention: Respiratory Monitoring: Collection and analysis of patient data to assure airway patency and adequate gas exchange. The child’s respiratory failure does not progress to respiratory arrest. ■ NOC Suggested Outcome: Vital Sign Status: Pulse, respiration, and blood pressure are within expected range for age. ■ Place the child on a cardiorespiratory monitor with a 20-second alarm. Have resuscitation equipment, including oxygen, resuscitation bag with mask, and suction apparatus at bedside. Stimulate child if apneic; if no response, begin manual ventilations and call for emergency resuscitation. The alarm on the monitor alerts staff that the child is having bradycardia or an apneic spell. Equipment should be at bedside in case of respiratory arrest. Bag-valve mask ventilation is recommended as the child’s respiratory secretions contain bacteria. Stimulation may encourage spontaneous respirations; if not, ventilation is necessary. Calling for emergency resuscitation ensures help in managing the child in a timely manner. The apneic child may have bradycardia resulting from cardiac hypoxia. The child’s respiratory failure is easily managed with prompt assessment and treatment. ■ ■ ■ ■ ■ Monitor heart rate and perform compressions if necessary...
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...BRAIN ABSCESS Definition -an infection in the brain that is encapsulated (confined within its own area) and localized to one or more areas inside of the brain -a collection of immune cells, pus, and other material in the brain, usually from a bacterial or fungal infection -occur in all children, but are more common in young school-aged children and occur twice as often in males than in females -usually associated with congenital heart disease in young children Etiology -Direct extension of cranial infections (osteomyelitis, mastoiditis, sinusitis, subdural empyema) -Penetrating head wounds (including neurosurgical procedures) -Hematogenous spread (in bacterial endocarditis, congenital heart disease with right-to-left shunt, or IV drug abuse) Signs and Symptoms * FRONTAL LOBE: * Hemiparesis * Aphasia * Seizure * Frontal headache * TEMPORAL LOBE: * Localized headache * Changes in vision * Facial weakness * Aphasia * CEREBELLAR ABSCESS: * Occipital headache * Ataxia (inability to coordinate movements) * Nystagmus (rhythmic, involuntary movements of the eye) * In babies and younger children: * Fever * A full or bulging fontanelle (soft spot located on the top of the head) * Sleepiness or fewer alerts than usual * Increased irritability * High-pitched cry * Poor feeding * Projectile vomiting * Seizures * In older children: * Fever * Complaints of severe...
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...confidentiality in line with the Nursing and Midwifery Council’s (NMC) code of conduct a pseudonym of Mrs Smith will be used (NMC 2008). Mrs Smith was admitted to hospital following a collapse at home. An emergency craniotomy and evacuation of a blood clot following a large Posterior Fossa Haemorrhage was performed. After the surgical procedure an external ventricular drain (EVD) was inserted. An EVD is a drain that is inserted through the skull into the area of the brain that encountered the haemorrhage, this allows any extra fluid and blood to be drained, and it also assists with maintaining the intracranial pressure (ICP) within the brain at a therapeutic level. An alternative that can be used is an intracranial skull bolt, although this does not enable drainage of fluid it does provide accurate ICP readings, however the EVD drain is considered the gold standard for measuring ICP (Rickert and Sinson 2003). It is important to identify at this time that the patient had no significant...
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...Name And Student Number (Bolded)Course, Semester, Year | SITI ROHAIDA BINTE RAHMAT12B057ZADVANCE DIPLOMA IN NEUROSCIENCE, 2012 | Managing Client with Cerebrovascular Disease Introduction Stroke is a part of a cardiovascular disease that occurs when the supply of blood or oxygen to the brain is disrupted by a blockage in the artery or when there is usually a trauma that causes spontaneous bleeding in the brain (Duncan, Zorowitz & Lambert, 2005). Bleeding in the brain, is referred to as a haemorrhagic stroke which results from either ruptured blood vessels or due to an abnormal vascular structure such as arterio-venous malformation. Although stroke can be classified into two different categories (ischemic and haemorrhagic), one should note the indispensable relationship between the two. This would be later explained at a greater detail into the case study. The following would be a brief introduction of my chosen case study. Emergency Department A 22 year old gentleman was brought to the Emergency Department at 1235hrs on 28th October 2012 via ambulance. Patient was unresponsive upon arrival, GCS= 3, E1V1M1, bilateral pupils non-reactive to light and slight epistaxis noted. History obtained from eye-witnesses stated that patient just finished boxing practice and complained of severe giddiness before fainting shortly after and never regained consciousness. On arrival at Emergency Department, patient was sent for a CT (computed tomography) Brain with chest and cervical...
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...External Ventricular Drainage Intracranial pressure refers to the pressure exerted by the brain, blood and cerebrospinal fluid in the skull. The normal range for ICP measurement is 0-15 mmHg. The cerebral perfusion pressure indirectly reflects the adequacy of cerebral blood flow. The CPP is derived by a mathematical calculation subtracting ICP from the mean arterial pressure (MAP). The normal range for adults is approximately 60-100 mmHg or a mean of 80 mmHg. The optimal CPP for a given patient depends on the clinical condition. Clinical conditions that frequently result in an increased ICP are traumatic brain injury, subarachnoid hemorrhage, intraparenchymal hemorrhage, brain tumor, meningitis and hydrocephalus. Increasing ICP causes decrease CPP, impaired autoregulation, hypotension, hypoxemia, cerebral ischemia, hypercarbia, hyperthermia and hypo/hyperglycemia. The goal of care is to prevent the secondary brain injury that results from increased ICP. An EVD (external ventricular drain) may be indicated in these cases. It is considered the most accurate ICP monitor while allowing for drainage of CSF. The procedure to place drain may be performed at the bedside under sterile conditions or in the OR. Nursing Considerations * Obtain pre procedure assessment to provide baseline data including vital signs, LOC, sensation and motor function, cranial nerve function and mental status. * Obtain...
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...Small Group Discussion 3.2: Outline of a Research Article The Use of Hypothermia as a Treatment for Traumatic Brain Injury 1. Introduction and core story elements a. What is the overview of the purpose of the study and the problem discussed? i. Research has shown that hypothermia has neuroprotective effects and might be an effective source of treatment for patients with head injuries. When discussing the treatment of patients with traumatic brain injuries, hypothermia is a controversial issue. The purpose of this study was to compare existing research on the use of hypothermia with TBI patients to determine if it is an adequate form of treatment. b. Is the problem clearly stated? . Yes. Hypothermia has been shown to have neuroprotective effects and may have benefit in the treatment of head injuries. However, it is a controversial treatment in traumatic brain injury. c. Is the problem clearly supported with literature? . The question is supported by literature but the conclusion is not. d. What are the research questions? . Is hypothermia an adequate form of treatment to prevent secondary injury in patients with a TBI? e. Are the questions clearly stated? . The question was not clearly stated within this article. The introduction leads up to the idea that hypothermia is an effective treatment for TBI but there is not a clear PICOT formed question. Evaluate the literature reviewed . What literature was reviewed to support the purpose and need for the study...
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...November 17, 2012 ASSESSMENT | DIAGNOSIS | SCIENTIFIC EXPLANATION | PLANNING | IMPLEMENTATION | RATIONALE | EVALUATION | Subjective:“hindi na siya makaramdam masyado sa kanan na bahagi ng katawan niya,” as verbalized by the SOindi naObjective: * response to stimuli: * pressure (-) * tickling (-) * pain (-) * on right side of the body * patient responds to normal tone and volume of voice but does not respond to whisper on both ears * trigeminal nerve assessment (sensory) * patient was unable to feel wisp of cotton when touched on face * decreased attention span * motor incoordination | Disturbed sensory perception related to altered sensory reception, transmission or integration secondary to injury on the temporal and parietal lobe(left hemisphere) | Chronic hypertensionorArteriovenous malformations↓Rupture of diseased blood vessel↓Formation of hematoma↓Increased pressure within the brain↓Disturbance of normal brain anatomy↓Affectation of the somatosensory area in the temporal and parietal lobe of the brain↓Disturbed sensory perception | Short Term:Within the course of therapeutic regimen, the client will be able to demonstrate techniques to compensate for altered sensory perception as evidenced by: * Turning head to see people or things * Following persons or objects by moving eyes * Scanning the room for persons or objectsLong term:With continuous therapeutic regimen, the client should be able to: * Compensate for the sensory impairments * Improve...
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...A kid with Hepatitis A can return to school 1 week within the onset of jaundice. 2. After a patient has dialysis they may have a slight fever...this is normal due to the fact that the dialysis solution is warmed by the machine. 3. Hyperkalemia presents on an EKG as tall peaked T-waves 4. The antidote for Mag Sulfate toxicity is ---Calcium Gluconate 5. Impetigo is a CONTAGEOUS skin disorder and the person needs to wash ALL linens and dishes seperate from the family. They also need to wash their hands frequently and avoid contact. positive sweat test. indicative of cystic fibrosis 1. Herbs: Black Cohosh is used to treat menopausal symptoms. When taken with an antihypertensive, it may cause hypotension. Licorice can increase potassium loss and may cause dig toxicity. 2. With acute appendicitis, expect to see pain first then nausea and vomiting. With gastroenitis, you will see nausea and vomiting first then pain. 3. If a patient is allergic to latex, they should avoid apricots, cherries, grapes, kiwi, passion fruit, bananas, avocados, chestnuts, tomatoes and peaches. 4. Do not elevate the stump after an AKA after the first 24 hours, as this may cause flexion contracture. 5. Beta Blockers and ACEI are less effective in African Americans than Caucasians. 1. for the myelogram postop positions. water based dye (lighter) bed elevated. oil based dye heavier bed flat. 2.autonomic dysreflexia- elevated bed first....then check foley...
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...receptors located? cardiac muscle What does a vegetative state refer to? depression of the RAS and inability to initiate action Which is NOT part of the criteria for a declaration of "brain death"? presence of any head injury What is the best definition of aphasia? inability to comprehend or express language appropriately What is an early indicator of increased intracranial pressure? decreasing responsiveness What is the rationale for vomiting with increased intracranial pressure? pressure on the emetic center in the medulla What is the typical change in blood pressure with increased intracranial pressure? increasing pulse pressure A brain tumor causes a headache because the tumor stretches the meninges and blood vessels wall Which of the following causes papilledema? increased pressure of CSF at the optic disc What is the effect of an enlarging brain abscess on cardiovascular activity? systemic vasoconstriction and slower heart rate As intracranial pressure rises, the pupil of the eye, ipsilateral to the lesion, becomes dilated and unresponsive to light because of the pressure on the: PNS fiber in cranial nerve III Which indicates that CSF is normal? clear and colorless fluid Which is TRUE about malignant brain tumors? primary brain tumors metastasize outside the CNS Which would be the...
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...Pediatrics Ductus arteriosus: shunts blood from the pulmonary artery to the aorta, bypassing the lungs Foramen ovale: shunts blood from the right atrium to the left atrium, bypassing the right ventricle and pulmonary vasculature Gravida: # of previous pregnancies Para: # of previous births Erythroblastosis Fetalis- Hemolytic disease of the newborn resulting from fetal-maternal Rh incompatibility Apgar Scoring- Assessment of newborn well-being. The higher the score, the healthier the baby. Silverman Scoring- An index of respiratory distress. The lower the Silverman score, the healthier the child Choanal Atresia- obstruction of the nasal airway; can be caused by unilateral or bilateral membraneous or bony occlusion. Diagnosis can be confirmed by the inability to pass a catheter through the nares, by cessation of air movement when the mouth is held closed, and by X-ray. Persistent Pulmonary Hypertension of the Neonate (PPHN)- ADA Persistent Fetal Circulation (PFC) - characterized by pulmonary vasoconstriction which results in high pulmonary vascular resistance; this pulmonary hypertension in turn keeps open (or reopens) the fetal cardiac shunts (the foramen ovale and/or the ductus arteriosis). The end result is right-to-left shunting and hypoxemia. Nitric Oxide therapy new treatment for PPHN. Bronchopulmonary Dysplasia (BPD)- BDP is applied to those infants who require mechanical ventilation during their first week of life, who remain dependent...
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...anesthetics such as nitrous oxide, and as a supplement to local and regional anesthesia. Ketamine can be used concomitantly with muscle relaxants without complication because it does not provide muscle relaxation of its own. It is a fairly short-acting agent that provides a profound, rapid, dissociative state and a short recovery time. Mechanism: Although the exact mechanism of action is not known, ketamine appears to be an agonist at CNS muscarinic acetylcholine-receptors and opiate-receptors. Ketamine depresses the thalamocortical pathways involved in pain perception and has been shown to suppress spinal cord activity. Clinical effects observed following ketamine administration include a "dissociative anesthesia," increased blood pressure, and minimal respiratory depression. The patient's airway remains intact due to maintenance of pharyngeal and laryngeal reflexes. Pharmacokinetics: Ketamine is administered parenterally, either IV or IM. It is rapidly absorbed following IM injection and quickly distributed into the brain and other highly perfused tissues. The alpha phase (distribution phase) lasts ~45 minutes, with a half-life of 10 - 15 minutes. It is this first phase that corresponds clinically to the anesthetic effect of the drug. When administered intravenously, a sensation of dissociation occurs in about 15 seconds, and anesthesia occurs within 30 seconds. With IM injection, anesthesia onset is 3 to 4 minutes. The anesthetic effects are terminated by a combination...
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...CFRN test questions Contraindications to autotransfusion – bowel contents Enter scene and you feel tingling/numbness. What do you do? Can’t remember if they mentioned down power lines. Choices were similar to these - Stop where you are - Call for help and wait - Quickly retreat (definite choice on test) Hop on one foot to safe area (definite choice on test) Fractured larnynx Fremitus Changing vocal tones Which is the worse eye injury Flash (arc burn) Acid Alkali Decompression sickness – joint pain, how do you transport – lowest altitude Stagnant Hypoxia - patient has stagnant hypoxia and is a vent-dependent patient; what treatment is approx (can’t remember is decompensating or just a treatment that will improve the condition) Choices included: increasing PEEP, decreasing SVR Snake bites – removing jewelry Also one about what you do before treatment 4 hrs later with slight redness and swelling: Choices included: give antivenom, immobilize extremity Dig toxic: patient in AVB 2, type II; which do you use for treatment? Atropine of transcutaneous pacemaker. Can’t remember is patient was stable or unstable Change patient from transport pacemaker to facility pacer and don’t get capture. What do you do? CPR or place back on transport pacer. TCA OD. Patient received gastric lavage. Pt in ST with QRS 0.12 Answers include: treatment is working Expect cardiac abnormalities Suspect pneumo. Put in...
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...Crafters after locating new frames I had wanted for months. Since I needed a new prescription I felt it was the perfect time to get them. After attempting to check my vision and the pressure behind my eyes, the optometrist had determined there was excessive pressure behind my eyes. Because of the excess pressure she was unable to get an accurate reading for a prescription as my vision continued to fluctuate. Instead of leaving with a prescription or receipt for my new glasses in hand. I left with images of the pressure behind my eyes, a new diagnosis of papilledema and a referral to the emergency room. I was admitted into the hospital the same evening after leaving the eye doctor. The diagnosis that the optometrist had given was accurate. The emergency room physician had brought in an optical specialist to confirm there was excessive pressure behind both of my eyes. This is uncommon in young women my age, so the doctor asked many probing questions and concluded they wanted to do some additional test. This was the evening that I received my very first spinal tap. The spinal tap concluded that I had excessive cerebral spinal fluid on my brain. After spending three more days in the hospital I was introduced to my new neurologist. Before going home I was educated on my new diagnosis of intracranial hypertension. The doctors gave me a lot of reading material, and a follow up appointment with my neurologist to...
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