Nursing Management of the Adult Patient with Neurological Alterations

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Nursing Management of the Adult Patient with
Neurological Alterations

• Neuro Diagnostics IICP
• Tracy Heberlig, MSN, RN, CNE
• Spring 2009

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Brain Needs

• Blood flow
• Glucose
• Oxygen

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Cranial Concepts

• Blood-Brain Barrier
• Blood Flow Regulation

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Diagnostic Studies

• Skull and Spinal Radiology
• CT (Computerized Tomography)
• MRI (Magnetic Resonance Imaging)
• PET (Positron Emission Tomography)
• EEG (Electroencephalogram)
• EMG (Electromyelogram)
• Cerebral Blood Flow Studies

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Cerebral Angiography

• Pre-procedure Care
• Allergies
• NPO
• Education
• Post-procedure Care
• Activity
• Assessment
• Observations

http//www.ohsu.edu/health/health-topics/topic.cfm
?id13906parent12348
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Lumbar Puncture / Myelogram

• Pre-procedure Care
• NPO
• Education
• Post-procedure Care
• Activity
• Assessment
• Observations
• Complications
• Contraindications

http//www.nlm.nih.gov/medlineplus/ency/imagepages
/19078.htm
p. 2157
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Neurological Assessment

• Level of Consciousness (LOC)
• Pupils
• Vital Signs (VS)
• Neuromuscular status
• Response to stimuli
• Posturing
• Glasgow Coma Scale (GCS)

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Intracranial Pressure (ICP)

• Cranial Vault
• Brain tissue
• Blood
• Cerebrospinal fluid (CSF)
• Monroe-Kellie hypothesis
• Autoregulation

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Intracranial Pressure (ICP)

• Normal ICP 10 to 15 mmHg
• Cerebral Perfusion Pressure (CPP)
• CPP MAP ICP
• Normal CPP 70 to 100 mmHg
• Normal CSF 5 to 13 mmHg

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Increased Intracranial Pressure (IICP)
http//www.uihealthcare.com/topics/medicaldepartme
nts/neurosurgery/braininjury/07whatisintra.html
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IICP

• Rigid cranium
• Failed compensation
• Increased pressure

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IICP

• Symptoms
• Changes in level of consciousness (LOC)
• Deterioration in motor function
• Changes in vital signs (VS) / breathing pattern
• Change in pupils

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Cycle of Malignant Progressive Brain Swelling
? ICP
Cerebral vasodilation edema
? Cerebral brain flow
? pCO2 ? pH
Tissue hypoxia
Hudak, Gallo, Morton (1998) p. 640
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IICP
Increased SBP
?
?
Cushings Triad
?
Widening PP
Bradycardia
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Factors that Increase ICP

• Hypercarbia
• Increase in pressure
• Intrathoracic
• Intraabdominal

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Nursing Management of IICP

• Airway patency
• Positioning
• Pressure control
• Hyperoxygenation
• Avoid
• Clustering
• Overstimulation

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Management of IICP

• Goals
• Decreasing cerebral edema
• Lowering CSF volume
• Decreasing cerebral blood volume

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Management of IICP

• Ventriculostomy ICP Monitoring System
• Pre-insertion education
• Nursing management

http//www.nervous-system-diseases.com/ventriculos
tomy.html
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Complications of ICP Monitoring
http//www.merck.com/mmhe/sec06/ch087/ch087a.html
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Medications to Treat IICP

• Osmotic diuretics
• Corticosteroids
• Barbiturates
• Inotropics
• Antipyretics
• Anticonvulsants

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• Description
• Example
• Major side effects
• Nursing care

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Nursing Diagnoses
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References

• Deglin, J. H., Vallerand, A. H. (2005).
  Daviss drug guide for nurses (10th ed.).
  Philadelphia F.A. Davis.
• Hogan, M., Madayag, T. (2004). Medical-surgical
  nursing Reviews and rationales. Upper Saddle
  River, NJ Pearson Education, Inc.
• Hudak, C., Gallo, B., Morton, P. (1998).
  Critical care nursing A holistic approach (7th
  ed.). Philadelphia Lippincott.
• LeMone, P., Burke, K. (2008). Medical surgical
  nursing Critical thinking in client care. Upper
  Saddle River, NJ Pearson Education, Inc.

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References

• Smeltzer, S., Bare, B. (2004). Brunner
  Suddarths textbook of medical-surgical nursing.
  Philadelphia Lippincott, Williams, Wilkins.
• Wagner, K. D., Johnson, K., Kidd, P. S. (2006).
  High acuity nursing (4th Ed.). Upper Saddle
  River, N.J. Pearson Education Inc.
• Wilson, B. A., Shannon, M. T., Shields, K. M.
  (2009). Prentice Hall nurses drug guide 2009.
  Upper Saddle River, NJ Pearson Education, Inc.