Journal of neurosurgical nursing最新文献

The implications of the prospective payment system are far-reaching and have specific impact on nurses. It is essential that nurses fully understand the ramifications of this system and appreciate their critical role in making health care most cost-effective for both the patient and the institution. This article will compare a retrospective, cost-based reimbursement system with a prospective reimbursement system. The role of the nurse as a Patient Advocate under prospective reimbursement will be examined. A case presentation will demonstrate the types of choices nurses must make to balance technology with cost-containment measures.

This study was undertaken to determine the incidence of ulnar nerve compression in patients on bedrest and to determine which historical risk factors and assessment measures were most predictive of ulnar nerve compression. Thirty subjects were chosen from the orthopedic, neurological/neurosurgical, and rehabilitation units of two teaching hospitals. The incidence of ulnar nerve compression in this population was 23 percent (seven cases). The overall incidence of compression was then compared with the incidence of subjects having certain risk factors. A combination of two risk factors in subjects carried a greater relative risk of ulnar nerve compression than the presence of single risk factors alone. Using multiple regression analysis, the best multivariate model consisted of four variables which explained 72.8 percent of the variance in ulnar nerve compression. The findings suggest the use of an elbow flexion test and simple questioning as a method for screening patients at higher risk of ulnar nerve compression.

The full importance of olfaction has received minimal attention until recently renewed interest reveals that it becomes necessary not only for protection but also for digestion, memory, emotions, motor skills, and sexual performance. By reviewing the interrelationship of olfactory anatomical structures with the brain, examining precipitating factors contributing to olfactory disorders and recognizing the resulting pathophysiological conditions, nursing can contribute to future research by documenting systemic assessments which pay particular attention to the history of olfactory dysfunction.

The amenorrhea-galactorrhea syndrome in prolactin-secreting pituitary tumors is described. The role of prolactin in the development of amenorrhea and galactorrhea is discussed along with the other endocrine abnormalities that overproduction of prolactin may cause. The diagnostic tests that are commonly performed to identify this disease entity are presented with reference to the nurse's role in preparing patients for the diagnostic work-up. Recent advances in transsphenoidal surgery, radiotherapy, and the use of Bromocriptine as therapeutic modalities for this disorder are described. Nursing guidelines that accompany planning care for patients undergoing these treatment regimes are provided.

Nonatherosclerotic occlusive disease--narrowing of the carotid lumen without atherosclerosis--describes an uncommon but known group of angiographic defects. This phrase includes the entities: fibromuscular disease, moyamoya syndrome, arterial dissection, and extracranial carotid aneurysms. Although nursing care of these patients is often the same as for those patients with atherosclerotic occlusive disease, there is a dearth of information available in nursing literature for use in patient education. This article will present definitions, symptoms (which may be the same as for those patients with atherosclerotic occlusive disease), treatment, and prognosis to aid the development of patient teaching plans.

Trauma to the brachial plexus may have unfortunate physical, psychological, and social effects. Because this nerve network provides motor and sensory innervation to the arm and hand, an injury may result in functional impairment with concomitant loss in confidence and self-image. It is important for nurses to understand the properties of peripheral nerves and to appreciate the ramifications of injuries to these nerves.

A quick and easy guide with step-by-step pictorial descriptions has been developed for use as a uniform approach to neurological assessment by the nurse. It is the packaging of the information and the visual aids that may be useful, educational tools for nurses in performing a systematic assessment of the patient.

In response to baccalaureate student requests for additional clinical experience and expanded opportunities in neurological and neurosurgical nursing, an experimental course was designed for the winter session semester in cooperation with a local teaching hospital. A three-credit elective, "Discovering Neuroscience Nursing," was offered to senior students for five weeks. The course included thirty hours of lecture and laboratory, field trips, and over 200 hours of clinical experience. A student stipend was provided by the hospital. Goals for the course centered on providing an opportunity for the student to gain competence and confidence in caring for patients with neurological dysfunctions and providing family support. Students were assigned staff nurse preceptors as they rotated to every clinical setting caring for patients with alterations to the nervous system. Evaluations from students and staff preceptors indicated the successful acceptance of the program which will be modified and continued as a senior elective.

The findings of an investigational study comparing a hand held tongue depressor pupil gauge with a printed millimeter scale sheet are the focus of this article. A historical perspective of the development of various millimeter measurement scales and devices is included as well as a brief overview of the anatomy and physiology of the oculomotor (III) cranial nerve. The results of the study provide support for the use of millimeter scales as an effective means of measurement of pupil size. Increased reliability with the use of a hand held tongue depressor pupil gauge is demonstrated. Implications for nursing practice are summarized.

Although the indications and effectiveness of the operation remain controversial, extracranial-intracranial (EC-IC) bypass surgery has become a common method in the treatment of patients with cerebral vascular disease. The technical feasibility of the procedure and its low mortality and morbidity rates are well established. However, its usefulness remains unproven in a variety of clinical, angiographic and regional cerebral blood flow patterns. This discussion focuses on the purpose of EC-IC bypass surgery as well as the procedure itself and postoperative nursing care.