Journal of neurosurgical nursing最新文献

This study examined the effects of 365 occurrences on the intracranial pressure (ICP) of four patients with severe head injuries and a Glasgow Coma Score below five. The occurrences were in: 1) health care activities, 2) patient-initiated activities, and 3) environmental stimuli. The health care activities that increased intracranial pressure were suctioning, turning, and flexion of the head; decreases were realized by elevating the head of the bed and repositioning the patient. The patient-initiated activities that increased intracranial pressure were flexion of extremities, rotation of the neck, and coughing. In contrast to previous reports, environmental stimuli did not affect intracranial pressure and bathing increased it. Recommendations for nursing care include: turning patients more slowly to less acute angles; proper head/neck positioning; and more direct psychosocial interactions with families of patients who have low Glasgow Coma Scores.

The cumulative effect of multiple patient deaths upon critical care staff may lead to emotional depletion and spiritual exhaustion. Attitudinal, behavioral, and social factors which contribute to such effects are examined. These factors include unresolved grief, the need to be perfect, projection of one's own needs, overseriousness, lack of sharing, inappropriate sharing at home, norms of solemnity, lack of structured opportunities for sharing, and administrative non-responsiveness. Empirical research to further define the nature and etiology of "staff burnout" is a logical, but most difficult, next step.

A patient returns from the operating room with an intracranial pressure (ICP) of 25 mm Hg as measured by an intraventricular catheter. What measures will decrease his ICP, what is the most threatening risk of an intraventricular catheter, and what nursing measures will decrease those risks? The clinical nurse caring for a patient with an intraventricular catheter must understand the dynamics of intracranial anatomy and physiology as well as the methods and rationale for medical and nursing management. An adequate knowledge base of each aspect of the intraventricular catheter and drainage system, from insertion to removal, is very important in decreasing the risks that confront these patients. These risks include infection, collapse of the ventricles, rapid ventricular drainage, increased potential for subdural hematoma, and subarachnoid hemorrhage. Familiarity with this information will minimize nursing uncertainties and fears, enabling the nurse to care for such patients with the required expertise and confidence.

Organ transplantation has greatly improved the grim outlook of patients suffering from end-stage organ failure. Unfortunately, many of these waiting patients will not realize their dream of being transplanted since the number of organ donors referred to transplant programs simply does not meet the need. This article describes the role the nurse can play in organ donation by discussing medical criteria needed to assess the donor, the determination of neurologic death, and guidelines to approaching families for consent.

Families of neurotrauma patients experience significantly increased stress during the acute phase of injury. It is important to recognize each family's needs during this period in order to enhance the potential for recovery. Assessment of individual needs, communication with the health care team, and genuine concern are necessary. One successful approach to the group process is "The Family Huddle", a technique which has enjoyed positive results at one institution.

Perceptual dysfunction is a complex problem and can be a serious barrier to the patient's recovery of independence. Nurses play a significant role in the identification of a possible perceptual deficit and in the use of nursing interventions that complement and are coordinated with the work of the occupational therapist. Four common categories of perceptual dysfunction are identified. One-sided neglect and apraxia are emphasized and specific assessment data and nursing interventions for these two problems are discussed. Agnosia and visual-spatial relationship problems are described briefly. The related problem of visual deficits is outlined and discussed with reference to perceptual dysfunction.

This study examined the reliability of the Levels of Cognitive Functioning Scale, an observational tool used to assess head-injured patients. Twenty-two undergraduate and ten graduate students viewed videotapes of four patients at various levels and rated each using the scale. Findings indicate a high percent agreement of subjects with each other for the four patient examples and with the correct level (p less than .001). These results suggest that this assessment tool may be useful in planning nursing interventions.

The purpose of this study was to learn more about problems stroke patients experience after rehabilitation and how they perceive and interact with their environment. Findings indicate that nurses need to consider individual life patterns, current goals and the resources and impediments of the home and community environment in planning interventions. Subjects wanted a challenging but not overly stressful environment. Most of their energy was consumed with accomplishing the activities of daily living. Complex planning and timing were necessary to continue a few pleasurable activities. Advocates are needed for better design and accessibility in the environment of our aging population, with increasing numbers of chronically ill and disabled, and for all people.

Arnold-Chiari malformation (ACM) is a malformation of the cervico-medullary junction characterized by displacement of the cerebellar tonsils, the brainstem and the fourth ventricle into the upper cervical canal. The clinical presentation of this anomaly is largely dependent upon age at onset, associated pathology, and the presence of hydromyelia. Considerable controversy exists within the literature concerning pathogenesis, signs and symptoms, diagnosis, and successful treatment of Arnold-Chiari malformation. This article will examine these issues and discuss the nursing management of patients with this syndrome.