The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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By focusing our attention on the questions of "what are we trying to achieve" and "are we able to do it", the discussion of medical futility has contributed an important dimension to the ethics of treatment decision making near the end of life. It is not simply enough to ask and answer the question of what the patient wants. Healthcare professionals have a responsibility to offer only those life-sustaining efforts that have a reasonable chance of being beneficial. ⋯ The recognition of the significance of the concept of futility means that discussion needs to continue at another level as well. The questions of "what are we trying to achieve" and "are we able to do it" are not easily answered. It is especially important, we think, that those who are experienced in working with patients with neurological impairments contribute to the on-going reflection on what constitutes benefit or what is the appropriate use of life-sustaining interventions for such patients.
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The purpose of this study was to test the interrater reliability of the Glasgow Coma Scale (GCS) when used in assessing neurologically impaired patients. In order to control variables, a videotape was developed of seven patients with different neurological impairments. ⋯ The comparison showed a low disagreement rating and a moderate to high agreement rating demonstrating that this tool has good interrater reliability (p = 0.000). Nurses may use this tool with confidence as one measure of assessment in evaluating neurologically impaired patients.
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Computerized EEG (CEEG) monitoring has recently been introduced to intensive care units (ICU). Unlike the intermittent assessment using coma scales, CEEG monitoring provides continuous information about a patients' neurological condition. Patient status can be monitored more accurately with CEEG. ⋯ The goal of continuous CEEG monitoring is to recognize a decline in a patient's condition before physical signs and symptoms are present. The neuroscience nurse participates in the assessment of the EEG recording as well as in evaluating therapy. This article introduces the neuroscience nurse to the basic terminology, rationale for use and clinical application for continuous computerized EEG monitoring.
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Continuous epidural analgesic infusion is widely recognized to be helpful for pain relief in the patient with cancer pain, but it can be as beneficial for the patient with non-cancer pain. Cancer pain patients have been offered long-term epidural infusion for relief of chronic pain, but non-cancer pain patients have less frequently been provided the same opportunities for pain relief. Both patient outcome and cost-effectiveness must dictate treatments offered as alternatives to long-term use of oral or injectables, nonsteroidal anti-inflammatories and muscle relaxants. ⋯ Epidural infusion is a safe and effective route of pain relief if the medical criteria as been met for choosing the patients receiving the treatment, and if the caregivers understand the treatment and expected outcomes. This article discusses anatomic considerations in drug selection, physiology, patient selection, neuropharmacology and patient care for epidural infusion. This article is designed to assist the nurse in accomplishing the patient and physician goals in this treatment modality for chronic non-cancer pain.
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An acute spinal cord injury has been described as one of the most devastating traumatic types of neurological impairment. Twelve years ago I had the misfortune of experiencing this first hand. From the day of my brother's initial injury I began keeping a diary of what this experience was like. The concept of entitlement and indebtedness has been applied to my family's experience.