Antihypertensive treatment for the neurological patient: a nursing challenge.

The neuroscience nurse's role in hypertensive management for patients with neurological injury can be challenging. This is especially true for patients whose cerebral autoregulation is affected by chronic hypertension or a cerebral insult. Hypertensive management involves more than the mere administration of medications. The nurse is responsible for monitoring the effects of drugs, lowering the blood pressure to a safe level and observing for any neurological deficits which may ensue from cerebral hypoperfusion. The nurse must collaboratively be able to determine if the patient's hypertensive episodes are caused by ineffective antihypertensives or a new cerebral insult. Knowledge of hypertension management helps maintain adequate cerebral perfusion and ultimate neurological functioning of the patient.

Thrombotic thrombocytopenic purpura: pathophysiology, treatment, and related nursing care.

The patient diagnosed with TTP presents to the critical care unit with myriad life-threatening problems. Knowledge of the pathophysiology and treatment of this rare syndrome is essential to plan care appropriately. However, despite immediate diagnosis and intervention, the outcome may not be successful. Critical care nurses play a vital role in caring for these patients, as well as helping family members deal with this devastating disease.

Hyperbaric oxygen therapy for rhinocerebral fungal infection.

Rhinocerebral mucormycosis is an acutely fatal fungal infection that usually arises in the ethmoid sinuses, spreads into the orbits and then into the cranial cavity. It is typically seen in diabetic or immunocompromised patients. Therapy includes aggressive surgical debridement, administration of high-dose amphotericin-B and control of underlying predisposing conditions. Adjunctive hyperbaric oxygen (HBO) is another treatment modality that appears to be promising; oxygen in sufficient concentrations is fungicidal and decreases acidosis thereby increasing tissue survival. It is important for the neuroscience nurse to have an understanding of this deadly infection and the role in preparing the patient for HBO therapy to better plan care.

Venous stroke in the pregnant and postpartum patient.

Cerebral infarction is often considered a disease of middle-aged or elderly patients; it is uncommon in young adults. Venous stroke, however, has been recognized for many years as a hazard in young females during pregnancy and the postpartum period. Occlusion by thrombus is the most common abnormality and can be caused by alteration in blood viscosity, changes in blood volume and a hypercoagulable state. Because the neuroscience nurse may be faced with the challenge of caring for this different type of patient, an understanding of venous stroke, its manifestations and treatment is necessary in order to establish a plan of care.

Central pontine myelinolysis: a multidisciplinary approach to care.

Central pontine myelinolysis (CPM) is a neurological disorder with a variety of manifestations which may be fatal or result in permanent disabilities. Various factors, most commonly too rapid correction of serum sodium, have been implicated in the development of this osmotic demyelinating syndrome. The patient's survival depends on accurate assessment and prompt intervention by the neuroscience nurse. Optimal outcome depends on collaboration by all members of the health care team.

Enhancing recovery via neuro-rehab rounds.

The neurologically injured patient experiences physiological and psychological disruptions regardless of the type of severity of injury. Through increased knowledge, nurses planning care can minimize loss of functional ability, anticipate complications and enhance recovery. Neuro-rehab rounds were developed to increase the involvement of support therapies for the patient in the neurotrauma intensive care unit (ICU) of a particular hospital. Increasing the critical care nurses' awareness of rehabilitation principles was the secondary goal. This protocol decreased length of stay, increased mobilization of patients in the ICU and provided for continuity of care for the neurologically injured patient. Rounds also redirected and expanded the focus for critical care nurses from episodic to one more outcome related.