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.

Ethical dilemmas in critical care: nurse case managers' perspective.

Nurse case managers often face ethical dilemmas as they advocate for their critically ill and critically injured patients. They experience the tension that exists between advocating for the critically ill, the patient's right to self-determination, and the payer source constraints. When there are no good alternatives for the patient or the list of options include none that are desirable, the nurse case manager may experience an ethical dilemma. Working with the critically ill and injured inherently presents a spectrum of biopsychosocial complexities, which present potential ethical dilemmas for the nurse case manager. The three case studies presented posed particular challenges to the nurse case managers and deal with the ethical principles of beneficence, autonomy, veracity, and justice.

Cerebral injuries and intracranial hemorrhages as a result of trauma.

Cerebral injuries refer to an actual injury to the brain matter. Injuries seen are concussion, contusion, or diffuse axonal injury. Bleeding into any of the meningeal spaces, brain, or ventricles is known as intracranial hemorrhage. Seldom do cerebral injuries appear as distinct entities but rather as a combination of injuries. The neurologic dysfunction is the sum total of the injury. The significance of the initial injury lies in the development of secondary events, such as edema, hemorrhage, and swelling. These events may lead to further deterioration and neurologic dysfunction. Treatment is directed at preservation of brain homeostasis and prevention of secondary injury. Controlled hyperventilation is the mainstay in the treatment of increased ICP. Other therapies include barbiturate coma and the use of corticosteroids to reduce ICP. Nursing interventions focus on methods to promote cerebral perfusion and support other body systems affected by immobility and altered level of consciousness. Planning nursing care and activities to the patient's ICP and CPP responses is indicated.