System Specific Effects of Therapeutic Hypothermia with Neonatal Encephalopathy: Pearls for Clinicians

Neonatal encephalopathy (NE) is defined as a condition of impaired neurological function often caused by a peripartum event that impairs gas exchange resulting in hypoxia, hypercapnia, cerebral ischemia, and metabolic acidosis. NE is a significant cause of neonatal morbidity and mortality. Therapeutic hypothermia (TH) is the standard of care for the treatment of moderate and severe NE and has significantly improved long-term outcomes for affected infants. There are extensive systemic physiologic effects associated with TH that clinicians need to be aware of to optimize care for these infants. There is a paucity of literature that comprehensively identifies causal relationships between the physiologic and biochemical effects of TH. This can leave neonatal clinicians devoid of a comprehensive understanding of the medical management of NE. Therefore, this article seeks to help fill this gap, improve clinician knowledge base, and ultimately improve the care of infants undergoing TH.

Rapid evidence assessment of approaches to community neurological nursing care for people with neurological conditions post-discharge from acute care hospital

Neurological conditions represent leading causes of non-fatal burden of disease that will consume a large proportion of projected healthcare expenditure. Inconsistent access to integrated healthcare and other services for people with long-term neurological conditions stresses acute care services. The purpose of this rapid evidence assessment, conducted February-June 2016, was to review the evidence supporting community neurological nursing approaches for patients with neurological conditions post-discharge from acute care hospitals. CINAHL Plus with Full Text and MEDLINE were searched for English-language studies published January 2000 to June 2016. Data were extracted using a purpose-designed protocol. Studies describing community neurological nursing care services post-discharge for adults with stroke, dementia, Alzheimer's disease, Parkinson's disease, multiple sclerosis or motor neurone disease were included and their quality was assessed. Two qualitative and three quantitative studies were reviewed. Two themes were identified in the narrative summary of findings: (i) continuity of care and self-management and (ii) variable impact on clinical or impairment outcomes. There was low quality evidence of patient satisfaction, improved patient social activity, depression scores, stroke knowledge and lifestyle modification associated with post-discharge care by neurological nurses as an intervention. There were few studies and weak evidence supporting the use of neurology-generalist nurses to promote continuity of care for people with long-term or progressive, long-term neurological conditions post-discharge from acute care hospital. Further research is needed to provide role clarity to facilitate comparative studies and evaluations of the effectiveness of community neurological nursing models of care.

[Neurologically critical patient. Nurses' care]

Handling a neurologically critical patient requires some necessary knowledge and aptitudes in order to avoid risks and complications which could worsen a patient's prognosis. To that end, in this article the author deals with two important points nursing personnel need to bear in mind: the distinct methods and catheters which can be used to monitor intracranial pressure, obtaining an important parameter for evaluation purposes and therapeutic follow-up on these patients, placing special emphasis on ventricular drainage and nursing care, and the operations nurses take when dealing with patients who present a risk of intracranial hypertension, setting up a protocol based on seven necessities in the Virginia Henderson model: breathing, elimination, temperature, hygiene and skin, feeding and hydration, mobility and safety. In each of these necessities, the author studies the problems these patients present, identifying them with a series of diagnoses according to NANDA (North American Nursing Diagnosis Association), and defining the care or nursing activities for each of them, which will prove essential to prevent cerebral ischemia after suffering a primary cerebral injury due to a "TCE"(Cranial Encephalic Trauma) hemorrhage, etc. Nurses' role in caring for neurologically critical patients proves to be of vital importance since these professionals must be capable of evaluating, preventing, controlling and identifying those risk situations which neurologically critical patients could present, avoiding possible complications, aiding their recuperation, and providing quality health care.

Relation of nursing activities to increases in intracranial pressure

Increased intracranial pressure (ICP), a frequent finding in head trauma and other cerebral pathology, poses a serious threat to patients' prognosis and recovery. While considerable attention has been given to medical therapies used in reducing ICP, only recently has nursing looked at the effect care specific activities may have. In this descriptive and observational study of nine patients with cranial pathology and a Richmond bolt for measuring ICP, findings confirmed that nursing activities and environmental factors are associated with pressure increases. Respiratory care activities (mean 12.7 mmHg) and repositioning (mean 12.6 mmHg) resulted in the highest increases while lesser increases were associated with doing neuro-assessments (mean 7.2 mmHg) and spontaneous movements (mean 7.9 mmHg) of the patient. When the conversation was directed to the patient, the pressure increased in 33 of the 86 observations (mean 8.6 mmHg), in 21 of the 35 conversations about the patient, the mean pressure increase was 9.03 mmHg. Because many activities occurred simultaneously, it was difficult to derive the extent of elevation associated with a specific activity. Findings from this study and studies by other nurse researchers suggest actions nurses can use to minimize pressure increases. Many areas for further study exist.

Intravascular temperature modulation in the neurosurgical critical care unit

A new technology for intravascular temperature modulation increasingly is being used for severely ill neurosurgical patients in tertiary care centers in the United States. The goal of this intervention is to minimize secondary brain injury. Because a 1 degrees C temperature reduction reduces cerebral metabolic demand by 10%, an efficient means of both lowering and maintaining optimal body temperature is crucial. The CoolGard intravascular catheter can lower body temperature at the rate of 3-4 degrees C per hour and maintain a steady state via feedback from a bladder catheter thermistor.

Pharmacologic management of integrative brain failure

Integrative brain failure is often a comorbidity of critical illness, and although not uncommon, is perhaps the least understood of all the various organ failure phenomena. Factors that contribute to integrative brain failure include inadequate management of pain, stress, anxiety, and the several underlying mechanisms that create agitation in the intensive care unit patient. Delirium, a resultant organic mental syndrome, is reversible when promptly recognized and aggressively managed. The nurse who is astute in clinical assessments and skillful in the management of the environment of care can prevent and control states of anxiety, irritability, restlessness, and sleep disturbances that contribute to the development of delirium.

Effect of head elevation on cerebral blood flow velocity in post-cerebral operation patients

This pre-experimental research measured patients' mean blood velocity (MV), peak systolic velocity (PSV), and end-diastolic velocity (EDV) of the middle cerebral arteries by using transcranial Doppler (TCD) to understand the immediate changes in cerebral blood flow (CBF) when head elevation degree changed, and whether CBF will return to stability after 10 minutes of elevation. Ten patients who underwent cerebral surgery were selected from one medical centre by purposeful sampling within five months. One-way ANOVA was used to analyze the data. The study results showed that MV, PSV, and EDV had obviously changed when head elevation was 15 degrees, 30 degrees, or 45 degrees from the horizontal at 10 seconds, and then recovered gradually. This study examined four head elevation degrees that affected cerebral blood flow. The results are likely to help nurses in caring for these patients.

The hypothalamus

The hypothalamus is an integral part of the neuroendocrine system. The anatomy, embryologic development, and normal function of the hypothalamus are described here. Pathophysiology of congenital abnormalities and brain injury is discussed and a case study examined. In addition, nursing implications of caring for such an infant are addressed.

Neurological rehabilitation nursing: a review of the research

Neurological rehabilitation is increasingly seen as a specialist form of rehabilitation requiring specialist nursing knowledge. However, as in many areas of nursing, nurses in this field recognize that there is a need to increase their knowledge base to ensure that they provide the best and most up-to-date quality care for their patients and their families. To achieve high levels of competence, neurological rehabilitation nurses need to be aware of the existing body of research in this field so that they can make sound decisions regarding their practice and future research endeavours. This review aims to validate the existing knowledge base in this area by identifying and critically analysing research conducted in the area of neurological rehabilitation nursing during the decade 1988-1998 and by identifying any gaps and weaknesses that may be addressed by future research. Studies were included in the review if they examined an aspect of rehabilitation nursing, were concerned predominately with the neurological patient and were conducted in an in-patient setting. Research with a medical focus was not included and only research published in English was reviewed. Relevant research located examined the following areas: (1) the role of the rehabilitation nurse; (2) specific problems concerning the neurological rehabilitation patient; (3) specific nursing interventions; (4) rehabilitation nursing practice; (5) the delivery of rehabilitation programmes and team working; and (6) the family of the rehabilitation patient. The review concludes that research in this speciality remains limited both in quantity and quality. Most of the studies lack rigour and, because they were conducted at a single site, their generalizability to other clinical sites may be limited.

Caring for a child with a progressive illness during the complex chronic phase: parents' experience of facing adversity

The qualitative study explored the day-to-day experiences of parents caring at home for a child with a progressive life-threatening illness at a certain point in their illness trajectory. This point in the trajectory is when the child lives with a complex chronic condition, and is in need of specialized and time-consuming care, but is not yet in a terminal phase. The naturalistic research design of phenomenology was chosen for the study's methodology. Parents' experiences of caring for their child were conceptualized as an ongoing process of 'facing adversity', as parents had continuously to redefine and then manage those changes resulting from the progressive nature of their child's condition. Concepts of normalization and chronic sorrow are considered in the conceptualization, as are the challenges of caregiving (particularly of mothers) who faced many hardships in their role, including the myriad of changes related to the increased burden of care. Implications for nursing practice are identified.

Nursing care of a patient with lupus cerebritis

Systemic lupus erythematosus (SLE) affects a large portion of the population, and over half of all SLE patients suffer from neurologic complications, referred to as lupus cerebritis. Through a patient case presentation, this article covers the pathophysiology, medication administration, and nursing considerations of a patient with lupus cerebritis.

Ifosfamide-induced neurotoxicity: associated symptoms and nursing implications

PURPOSE/OBJECTIVES

To review current understanding of the neurotoxicity associated with ifosfamide administration.

DATA SOURCES

Published studies of ifosfamide-induced neurotoxicity, published literature on other causes of neurotoxicity associated with cancer, and a case study.

DATA SYNTHESIS

Ifosfamide-induced neurotoxicity has not been well-described in the nursing literature. To correctly identify ifosfamide-induced neurotoxicity, nurses need to assess the patient's history and neurologic, affective, and cognitive status and implement appropriate nursing interventions.

CONCLUSIONS

Research aimed at accurate identification of ifosfamide-induced neurotoxicity and the most effective nursing interventions is needed.

IMPLICATIONS FOR NURSING PRACTICE

Judicious nursing assessment will facilitate differentiation of ifosfamide-induced neurotoxicity from other neurotoxicities associated with cancer and its treatment.

Computed tomography of the brain: a guide to understanding and interpreting normal and abnormal images in the critically ill patient

The computed tomography (CT) diagnosis of the neurologically impaired patient, both initially and as it evolves over time, is a critical factor in determining treatment and prognosis. As an integral part of the management team, it is vital that the critical care nurse have a firm understanding of the various diagnoses on an anatomic level. This article attempts to provide the fundamentals for understanding the technology and uses of CT imaging as well as performing a basic interpretation of normal and abnormal CT images in a variety of disease states.

[A prospective study on the behavior of pediatric intensive care unit nurses, concerning the care given to suicidal children]

Pediatric intensive care units use sophisticated medical technology and are staffed by deeply committed nurses who are subjected to significant psychological stress. This stress varies with the type of patient and influences the style and quality of care. With this respect, children and adolescents admitted after a suicidal attempt are considered catalysts. However, there have been no systematic studies of how pediatric intensive care nurses respond emotionally to their interactions with these patients. This epidemiological study conducted in five Parisian Teaching Hospital pediatric intensive care units used a specially designed questionnaire to evaluate nurses' responses on the basis of style of care. Children under 16 years of age admitted after attempted suicide were studied comparatively with same age children admitted for status asthmaticus or encephalopathy with seizures. Results highlighted the differences in nurses' psychological responses to these situations and their difficulties in interacting with patients. This study provides strict methodological guidelines for investigating an issue often discussed emotionally or on the basis of anecdotal data.

Documentation of neurotoxicity resulting from high-dose cytosine arabinoside

High-dose cytosine arabinoside or ARA-C (HDAC) has been shown to be an effective regimen in patients who are refractory to conventional doses. Neurotoxicity, a side effect associated with HDAC, has been reported in 7%-28% of patients. Both cerebellar and cerebral dysfunction have been reported. Neurotoxicity cannot be completely prevented, but a nurse's early detection of subtle changes can decrease toxicity severity. Assessment includes evaluating the patient's level of consciousness, speech patterns, vision, ocular movements, and coordination of upper and lower extremities. Early detection and intervention can lead to improved patient outcomes and enhanced quality of life. A neurotoxicity assessment tool and implications for its use are presented.

The changing health care system: neuroscience nursing practice in the 1990s

Radical changes in the health care system, including the paradigm shift from an acute to chronic illness model, and advances in managing major neuroscience patient populations are redefining neuroscience nursing practice in the 1990s. For example, advances in management mean that many more neurotrauma patients and patients with cerebrovascular disorders survive. Once stabilized, illness may become chronic and require long-term management. There are also promising developments in managing major neurological diseases. The decade of the 90s will require more collaboration, new practice models and a greater focus on rehabilitation. Research and education must support practice in reshaping neuroscience nursing.

The informal caregiver responsible for home care of the individual with cognitive dysfunction following brain injury

The brain-injured often require care long after they leave the acute care setting. Increasingly this care is being given at home. Informal caregivers are an important link to the brain-injured patient's achieving optimal health and wellness. Characteristics of caregivers are given and the AFFIRM model used as a guide to assist nurses in their preparation of caregivers. A case study illustrates use of the model.

Increased intracranial pressure and its systemic effects

The brain is capable of mediating complex regulatory functions in the cardiopulmonary and gastrointestinal systems. Increased intracranial pressure may have detrimental effects not only upon cerebral structure and function but also upon the cardiopulmonary and gastrointestinal systems. Although the manifestations of systemic dysfunction produced by cerebral disease have been defined, the precise role of the interaction and interrelationship of increased intracranial pressure and the nervous system pathways to specific organ systems in delineating the mechanisms of these manifestations continues to be a topic of inquiry.

Systemic cardiovascular effects of intracranial disorders: implications for nursing care

Autonomic nervous system imbalances are implicated in the genesis of cardiovascular systemic effects of brain disorders. With many potentially lethal cardiovascular problems, sympathetic predominance over parasympathetic stimuli prevails. Autonomic nervous system imbalances may be caused not only by over-activity or depression of either the sympathetic or parasympathetic nervous systems but also by unchanged activity of one and depression or overactivity of the other. Because the autonomic nervous system has representation in all levels of the brain, it becomes apparent why diverse brain disorders could trigger these effects. It is possible that more than one systemic effect may occur in a patient during the course of an acute brain insult. The hypothalamus, with its anterior parasympathetic nervous system centers and posterolateral sympathetic nervous system centers, plays an important role in the autonomic nervous system. Its role has been more clearly identified than other portions of the central autonomic system. Nursing implications for the care of patients with cardiovascular effects have been identified. Many of these effects may go unnoticed in the early stages because of lack of knowledge; consequently, opportunities for early therapeutic interventions are lost to the detriment of the patient. These effects, when unrecognized and untreated, compound the primary and secondary intracranial insults. They can contribute to the rapid deterioration and demise of the patient, especially if he is unstable and has lost intracranial compliance, autoregulation, and vasomotor tone. Because many of these patients, have had no evidence of cardiovascular problems prior to the acute brain insult, it behooves nurses to familiarize themselves with the signs and symptoms of the systemic cardiovascular effects and appropriately intervene to prevent or offset the complications they produce in the acutely brain-damaged patient.