Journal of neurosurgical nursing最新文献

Tension pneumocephalus occurs when intracranial air exists under pressure, resulting in neurologic deterioration. The syndrome is precluded by an extracranial-intracranial communication and a difference in extracranial-intracranial pressure with the latter being greater. Although most frequently associated with head trauma, a variety of situations, including an operative sitting position and use of nitrous oxide anesthesia, have been known to contribute to this potentially life-threatening complication. This article will address pathogenesis, assessment parameters, and medical and nursing approaches utilized to reduce and minimize further entrapment of air. A case report will be presented illustrating this condition.

Transsphenoidal surgery has many advantages in providing access to the sella turcica. It is associated with relatively low morbidity and mortality but it should be recognized that it is not without risk. Often, signs and symptoms of complications from transsphenoidal surgery are observed by the nurse. With early detection and prompt management, patients need not suffer the serious disabilities that may ensue.

Idiopathic spasmodic torticollis (IST) is discussed from the perspective of definition and description, clinical presentation, and modes of treatment including a new, innovative, surgical approach. The role of the physician and the neurosurgical nurse in the management of idiopathic spasmodic torticollis is considered.

Misunderstanding of the postictal confusional state that follows the complex partial seizure has caused emotional and physical harm to patients. Concern about this phenomenon and its effects upon the patient prompted this study to explore, describe, and document one method of intervention to lessen these harmful effects. An evaluative descriptive research design was employed to assess patient safety during and after the postictal confusional phase following a complex partial seizure. A closed-structured questionnaire and participant observation were the methods used to collect data for this study. A Level of Safety Tool was specifically designed for this study.

The newer beta-lactam antimicrobials offer an expanded spectrum of activity and a similar safety profile compared to their older counterparts. The penicillins appear to be useful in the combination treatment of systemic Pseudomonal infections, and cefuroxime and the third generation cephalosporins may be valuable in the management of meningitis caused by susceptible organisms. However, to avoid the emergence of resistance and to help contain the cost of antimicrobial therapy, these newer agents should be reserved for those clinical situations where older beta-lactams would not be indicated.

Selected postoperative complications following a craniotomy are discussed in relation to assessment and nursing care. Clinical differentiation between structural and metabolic postoperative complications is emphasized. The signs, symptoms, diagnostic aids and nursing implications related to each of these two major classifications of complications are presented. The specific postoperative complications discussed include: cerebral edema, intracranial bleeding, hydrocephalus, cerebral infarction, tension pneumocephalus, hypoxia, water and electrolyte imbalances, hypoglycemia, endocrine disturbances, hyperthermia, and seizures.

Recently, investigation into an experimental treatment for patients with Alzheimer's disease has begun utilizing surgical implantation of a continuous infusion device to deliver a muscarinic agonist, bethanechol chloride, directly into the cerebrospinal fluid (CSF). The nurse research assistant has been very active in this study being involved in patient evaluation, preoperative and postoperative patient education, collection of data, and refill of the infusion device. The neurosurgical nurse also plays an active role in patient education, immediate preoperative and postoperative care, and careful observation and recording of patient behavior and general well-being. Success of continued research based on this protocol will be enhanced by the contributions of the nurse research assistant and neurosurgical nurse familiar with the study and with her/his anticipated role.

If left undetected and untreated in the operating room, air embolism can be a potentially lethal event. It is important to be aware of the specific positions and surgical procedures that put a patient at risk for air emboli. This article will define air embolism, discuss its occurrence and effects on the body, review specific monitoring techniques used to detect intravascular air, and present techniques used for prevention and treatment by the operating room staff.

Brain and spinal cord injuries are a frequent cause of death and long-term disability in motor vehicle accidents. Helmet use reduces death and head injury severity in motorcycle accidents. Proper use of child restraints can prevent death from falls and vehicle crashes. Auto lap and shoulder restraints, when in use, reduce death from accidents and falls from cars. Passive protections, such as air bags, vehicle design for crashworthiness, and automatic seatbelt systems are less available for economic reasons. Voluntary use of available devices is the remaining viable option. One-to-one education may help promote use of protective devices. The greatest impact lies in legislative requirements for self-protection. It is ethically justifiable to require use of devices such as child restraints, seatbelts, and motorcycle helmets to prevent death and disability.

Diffuse axonal injury (DAI), the severest form of diffuse brain injury, causes extensive damage throughout the cerebrum, diencephalon and brainstem. The effects of this injury, however, are not isolated to the brain. This paper discusses diffuse axonal injury, the metabolic complications to be anticipated from the systems' response to cerebral trauma in general, and the nursing implications.