In The Name of God (A PROJECT OF NEW LIFE HEALTH CARE SOCIETY, KARACHI) Advanced Concept of Nursing- II UNIT- VIII Advance Nursing Management Of neurovascular Diseases. Shahzad Bashir RN, BScN, DCHN,MScN (Std.DUHS) Instructor New Life College of Nursing Updated on June 17, 2016
Objectives At the end of the unit, students will be able to: 1. Utilize Functional health pattern to identify patients problems related to neurovascular disorders including: CVA Meningitis & seizures Headaches & associated pains Alzheimer disease 2. Integrate pathophysiology and pharmacology concepts of disease. 3. Apply nursing process with support on Evidence-Based Nursing (EBN) to provide to the clients with neurovascular disorders. 4. Discuss the holistic approach for nursing management of the patient with neurovascular diseases. 5. Develop a teaching plan for a client experiencing disorders of the neurovascular disorders.. 8/22/2016 Shahzad Bashir NLCON 2
Meningitis Etiology and risk factors Inflammation of the meningeal coverings of the brain and spinal cord caused by either viruses or bacteria Signs and symptoms Headache, nuchal rigidity (stiffness of the back of the neck), irritability, diminished level of consciousness, photophobia (sensitivity to light), hypersensitivity, and seizure activity Positive Kernig s sign and Brudzinski s sign Medical diagnosis Lumbar puncture to obtain CSF for lab analysis
Classification of Meningitis Classification of Meningitis Septic Bacteria Aseptic Virus Lymphoma, leukemia, or human immunodeficiency virus (HIV)
KERNIG S SIGN when leg is flexed at the knee the patient will not be able to extend the same leg. Figure 27-16A
BRUDZINSKI REFLEX bend up head (flex neck) and hip flexes Figure 27-16B
Meningitis Medical treatment Bacterial infections usually respond to antimicrobial therapy, but no specific drugs effective against most viral infections Anticonvulsants used to control seizure activity if necessary
Meningitis: Nursing Care Assessment Assess vital signs and neurologic status frequently to determine further deterioration or onset of complications
Meningitis: Nursing Care Interventions Ineffective Tissue Perfusion Ineffective Breathing Pattern Acute Pain Risk for Injury Deficient Fluid Volume
Complications Visual impairment Deafness Seizures Paralysis Hydrocephalus and Septic shock
Seizure Disorder Electrical impulses in the brain are conducted in a highly chaotic pattern that yields abnormal activity and behavior Related to trauma, reduced cerebral perfusion, infection, electrolyte disturbances, poisoning, or tumors Medical diagnosis Accurate history of the seizure disorder Electroencephalogram (EEG)
Seizure Disorder: Classification Partial seizures Simple Part of one cerebral hemisphere; consciousness not impaired Complex Consciousness impaired; may exhibit bizarre behavior Generalized seizures Involve the entire brain from the onset Consciousness lost during the ictal (seizure) period Types: tonic- clonic, absence, myoclonic, and atonic
Seizure Disorder: Phases of generalized tonic-clonic seizure (grand mal) Tonic phase Loss of consciousness, falling, crying and generalized stiffness. Clonic phase Jerking of the limbs Salivary frothing Postictal phase Deep sleep, extreme tiredness Headaches, confusion, irritability, vomiting
Seizure Disorder Status epilepticus Medical emergency: continuous seizures or repeated seizures in rapid succession for 30 minutes or more Aura (Partial seizures) Dizziness, numbness, visual or hearing disturbance, noting an offensive odor, or pain may precede a seizure minutes to seconds before a seizure. Medical treatment Resolution of the underlying condition Anticonvulsant drug therapy
Seizure Disorder Surgical treatment Removal of seizure foci in the temporal lobe (amygdala and hippocampus) and pallidotomy or vagal nerve stimulator
Seizure Disorder: Nursing Care Assessment Describe the seizure episode, including the postictal period (altered state of consciousness after an epileptic seizure) (following the seizure), and document drug therapy
Seizure Disorder: Nursing Care Risk for Injury Side rails of bed up and padded, suction machine readily available, bed maintained in the low position Quickly move objects away from the patient Do not attempt to restrain the patient Ineffective Coping and Deficient Knowledge Teach family and patient about the seizure disorder and the therapy Teaching must be directed toward helping the patient and family adjust to a chronic condition Encourage questions and concerns
References Porter, P. A & Perry, A. G. (2003). Basic Nursing: Essentials for practice (5th ed.) St. Louis: Mosby. Erb, G. K., (2000). Fundamentals of Nursing: Concept, process and practice (5th ed.). Addison: Wesley. Bruner, L.S., & Suddarth, D.S. (2001). Text book of Medical-Surgical Nursing (9th Ed.). Philadelphia: Lippincott. 8/22/2016 Shahzad Bashir NLCON 18
THANKS 8/22/2016 THANKS Shahzad Bashir NLCON 19