The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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The epidural route of administration can be used safely for acute and chronic pain control. Although most frequently used in the obstetrical setting, the epidural route has been used more recently for pain control in general surgical and oncology patients. Nursing policies, physician order sets and nursing documentation provide a consistent approach to patients receiving epidural analgesia. Continuous quality improvement helps to assure patient satisfaction and program quality.
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Study of a number of routine nursing care activities has suggested a relationship between activities and intracranial pressure (ICP). The purpose of this study was to focus on the relationship between nursing care activities and variations in ICP. A case study method was used to study ICP in five brain-injured patients with a Glasgow Coma Scale (GCS) score of 4 or more. ⋯ During the bathing procedures only two baths elicited an ICP greater than 20 mm Hg. All other bathing procedures elicited minimal increases in ICP. These findings further support the need for nurses to be aware of the patient's ICP prior to turning and suctioning.
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Though scientific knowledge is presumed to be true, misconduct in generation and reporting of research has occurred. Causes of scientific misconduct may be personal, such as excessive ambition, or organizational, such as withholding negative results about a product for economic gain. ⋯ Nurses must conduct scientific endeavors and practice the science of nursing with integrity. Maintaining integrity is essential for the advancement of nursing as a science, and therefore, ongoing improvement in nursing care.
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The purpose of this study was to examine the relationship of the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) scores in pediatric and adult patients having surgical entry into the cranium for diagnostic or therapeutic purposes after brain insult. In this retrospective record review, the predictor variable was the coma-associated GCS score (GCS score 3-8) obtained 24 hours after surgery. The outcome variable was the combined Glasgow Outcome category: recovery/moderate disability; severe disability/vegetative state; and death; ascertained 14 days postoperatively. ⋯ Considering the GCS components, the eye scores significantly discriminated one outcome, the motor scores two outcomes, and the verbal scores two outcomes (p < .001 to .005). The unweighted GCS scores in adults significantly discriminated all three outcomes and in children two outcomes; the weighted GCS scores in both children and adults significantly discriminated all three outcomes. The approximately 25% misclassification rate for outcomes, however, would preclude using the scales in a predictive or prescriptive manner.
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Hyponatremia frequently complicates the clinical course for patients with aneurysmal subarachnoid hemorrhage (SAH). Although commonly attributed to the syndrome of inappropriate antidiuretic hormone (SIADH), emerging evidence suggests a range of pathological conditions may produce the abnormality. Effective management requires an approach to data collection which avoids suppositions about etiology, as incorrect assumptions may result in selection of interventions leading to further clinical deterioration. Adherence to comprehensive monitoring and management protocols ensures rapid detection and efficient management of this common problem after SAH.