The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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Review Case Reports
Using the BIS monitor in palliative care: a case study.
The majority of deaths occur in the hospital setting, and of these deaths, 20% are in an intensive care unit (ICU). Care provided on the ICU shifts from curative to palliative when a patient's death appears to be imminent. Nursing care decisions made at the end of life are critical to the experience of the patient, and leave a lasting impression on the patient's family and the nurses involved in providing care. ⋯ Assessing comfort can be especially difficult in the patient who is unresponsive. One tool that can assist the nurse in the assessment and management of analgesic effectiveness is the Bispectral (BIS) Index Monitor. As the use of BIS monitoring grows in the ICU setting, more information will be available that will help all involved in the palliative care process ensure patients have a peaceful death.
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Hyperglycemia in acute stroke patients increases cerebral infarct size and worsens neurologic outcome with and without preexisting diabetes mellitus. Hyperglycemia results from metabolic alterations in glucose metabolism, and is most common in patients with acute illness such as stroke. ⋯ Insulin treatment protocols developed and implemented by multidisciplinary teams allow for rapid and effective control of hyperglycemia. Nurses who know about hyperglycemia's often-neglected and detrimental effects can play a vital role in influencing outcomes in stroke patients.
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Neuroleptic malignant syndrome (NMS) is a potentially lethal condition that has been described in patients with idiopathic Parkinson's disease (PD) after long-term dopaminergic medications are suddenly stopped or moderately decreased. If patients with PD develop severe rigidity, stupor, and hyperthermia, L-Dopa withdrawal should be suspected and the dopaminergic drug restarted as soon as possible to prevent rhabdomyolysis and renal failure. Nurses who are knowledgeable about NMS can provide prompt identification of the PD patient's condition and prevent a potentially lethal cascade of symptoms.