The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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The patient with a diagnosis of SAH and subsequent vasospasm presents many nursing challenges and requires complex pharmacologic management. By paying careful attention to the therapeutic and potential side effects of the medications prescribed, the nurse can be instrumental in the patient's recovery.
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Chronic malignant pain is experienced by as many as 80% of patients with cancer. While these patients may experience either nociceptive or neuropathic pain, oftentimes a mixed presentation is encountered. ⋯ New evidence points to efficacy of opioids for neuropathic, in addition to nociceptive pain syndromes, further clarifying the use of these agents for this patient population. When used properly, opioids are a safe and effective tool for the management of cancer pain.
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Refractory intracranial hypertension (RICH) is defined as intracranial pressures that exceed 25 mm Hg for 30 minutes, 30 mm Hg for 15 minutes, or 40 mm Hg for 1 minute. RICH occurs in approximately 15% of patients with traumatic brain injury. ⋯ Pentobarbital sodium coma is a second-tier treatment that can be used to treat RICH. Understanding the principal mechanics of this therapy is key to the successful management of RICH and quality patient care.
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Patients experiencing subarachnoid hemorrhage (SAH) symptoms may delay seeking medical attention, not realizing the severity of these symptoms. The purposes of this study were to determine (a) the length of time between the development of SAH symptoms in patients and when treatment was initially sought and (b) whether the delay in hospital admission had an effect on patient outcomes. Inclusion criteria were age (18-75 years) and diagnosis of severe SAH. ⋯ The study also suggests that more severe symptoms upon admission to the ED were related to poorer outcomes. Initial clinical presentation is a useful predictor for SAH outcomes. This study supports the idea that the general public needs to be educated on the symptoms of SAH.
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Traditionally, surgical correction of craniosynostosis involves calvarial remodeling, large blood losses necessitating transfusions, hospital stays of several days, and less-than-satisfactory results. In this study, outcomes from a minimally invasive technique called endoscopic strip craniectomy, along with a postoperative molding helmet, to correct craniosynostosis in young infants were evaluated. The endoscopic strip craniectomy was performed on 185 patients with clinical signs of craniosynostosis, with the following distribution: 107 sagittal, 42 coronal, 37 metopic, and 7 lambdoid, for a total of 198 sutures. ⋯ All but six patients were discharged on the first postoperative day. A majority of the patients achieved or approached normocephaly, and there were no complications. Neuroscience nurses need to be aware of this technique when they discuss treatment options with the families of infants with craniosynostosis.