The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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Although the individual's baseline neurological status may appear normal, episodic dyscontrol syndrome presents with recurrent outbursts of rage. In some cases family may describe a history of personality traits reflective of minimal brain dysfunction, and the study by Elliot confirmed organic cerebral disorders in 94% of the sample. Due to difficulty of diagnosis and lack of reporting, as well as social factors, the prevalence of this syndrome may be underestimated. This article discusses the syndrome, reviews a case history and outlines the role of the neuroscience nurse.
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Pupil changes provide vital information related to the cause and location, and at times, severity of disease processes which alter level of consciousness. Size and reactivity are sensitive to a variety of influences including local eye damage, functional state of brainstem, local systemic drugs, seizures and anoxia. Therefore, accurate measurement of pupillary size and reactivity is essential. ⋯ There was no significant difference in the reliability of nurses assessing pupillary size regardless of whether they used a penlight pupil gauge to measure or used observation without a pupil gauge. Agreement among the nurses on the pupillary size was high. Agreement on the pupillary reaction, however, was poor to good.
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During the past two decades the subject of severe head injury has received much time, attention, and research funding. Although the number of persons in the United States suffering minor head injury is at least four times greater than the number with severe head injury, it has received less attention and resource allocation. The patient with minor head injury presents a clinically different picture as compared to severe head injury; posttraumatic problems also differ. Nursing care differs accordingly and will be the focus of this article.
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The Ommaya reservoir is an implantable device which allows percutaneous intraventricular administration of preservative-free morphine sulfate. Use of this device in select cancer patients has worked well in providing pain control when conventional methods have failed. ⋯ Teaching begins early so the patient can be discharged with a dose and schedule which provide pain control, and the responsible family member can be proficient in administration. Home care and follow-up are necessary to assure pain control and absence of complications.
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Alcoholism is a chronic, progressive disease that devastates the patient and family. The chronic abuse of alcohol results in a multitude of pathological changes, particularly in the central nervous system. The toxic effects of acetaldehyde, a metabolic by-product of alcohol, and alcoholic beverage congeners have been associated with pathological changes in the central nervous system. ⋯ The alcohol withdrawal syndrome poses a potential life-threatening complication for the alcoholic patient. This paper discusses the pathological changes in the central nervous system, pharmacology of alcohol, and the alcohol withdrawal syndrome. Nursing implications to assist the neuroscience nurse in providing a highly specialized plan of care for the alcoholic patient are presented.