The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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The purpose of this study was to determine the validity and reliability of the SjO2 catheter in neurologically impaired patients. Cerebral hypoxia and ischemia are two of the most important causes of secondary injury after brain trauma. Early detection and treatment of cerebral ischemia may prevent additional damage to the injured brain. ⋯ The initial milestones by Myerson et al. and Gibbs et al. have served as the basis for more refined research on cerebral tissue oxygenation and metabolism. The unreliability of the SjO2 catheter demonstrates how little we still know about cerebral physiology. In spite of the many advancements in healthcare technology, limiting secondary brain injury and improving neurologic outcome have remained elusive.
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Alcohol abuse and alcohol dependence are common problems. It is estimated that more than 10 million Americans have problems with alcohol dependence that adversely affect their lives and the lives of their families. Many of these patients, if hospitalized, have the potential to experience symptoms of alcohol withdrawal. ⋯ A protocol was established for identifying and treating patients at risk for alcohol withdrawal. The initiation of the treatment protocol is history- and symptom-based; treatment is symptom-triggered on the basis of frequent objective assessments. The purpose of the protocol is to prevent and control withdrawal symptoms without heavily sedating or hindering a patients' neurological assessment.
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A significant improvement in patient outcomes can be achieved by in-hospital interventions aimed at the prevention of secondary brain injury. The Guidelines for the Management of Severe Head Injury is a scientific, evidence-based document that evaluates the current evidence for practice and interventions to reduce secondary brain injury and improve outcome for traumatic brain injury (TBI) patients. ⋯ Head injury care requires an interdisciplinary approach involving emergency room personnel, trauma nurses, and critical care nurses. Critical care nurses will find this document especially applicable because secondary brain injuries are often the result of events that occur in the ICU setting: hypoxemia, hypotension, and intracranial hypertension.
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Review Case Reports
Using transcranial Doppler sonography to augment the neurological examination after aneurysmal subarachnoid hemorrhage.
Vasospasm is the leading cause of death in patients who survive initial subarachnoid hemorrhage (SAH). Evidence of blood in the subarachnoid space on computed tomography (CT) scan can often predict the occurrence of vasospasm. Clinically, the onset of new or worsening neurological symptoms is the most reliable indicator of vasospasm. ⋯ Although vasospasm can only be definitively diagnosed by cerebral angiogram, TCD sonography provides a noninvasive, low-risk assessment tool that can be done at the beside. By coupling a patient's vital neurological data with blood flow velocity trends, the neuroscience nurse can anticipate the onset or worsening of vasospasm. This advanced nursing assessment allows for collaboration with the medical team to initiate and adjust appropriate therapies to improve patient outcomes.