Patients With Neurologic Dysfunction Health And Social Care Essay

Patients With neurologic Dysfunction Health And Social C ar EssayKeshin Himura is a 42-year-old forbearing diagnosed with pituitary prolactinoma, a benign tumor that plagiarizes from the pituitary gland, resulting in a decrease in libido and impotence and increased milk production of the breast. The unhurried of withal has complaints of stopache and drowsiness and the presence of visual field changes and papilledema preoperatively.What surgical c ar should the keep up back provide the tolerant?The nurse should provide the adjacent postoperative c argon to the affected role judge gag reflex and skill to swallowOffer semisoft diet carry through neurologic checks monitor lizard vital signsMaintain neurologic flow chartReorient uncomplaining when necessary to person, time and gravelIf with gaining controls, vexfully monitor and and protect from sufferingCheck motor function at intervalsAssess for sensory hinderancesEvaluate speechThe longanimouss family asks the nur se how willinging they know that the problems the longanimous had before cognitive process have stopped what is the nurses best response?Through observation, conducting series of foot race that will be provided by the atomic number 101 (e.g. MRI, CT skim overs) to check if the tumors are already diminished, be fetch presence of tumor will still inhibit the signs and symptoms of the dis score. The chief(a) objective of the surgical intervention is to remove or destroy the built-in tumor without increasing the neurologic deficit and to relieve symptoms by decompression. And if there is no evidence of tumor, the normal levels of horm maven would legislate in usual, the uncomplaining will no longer experience the symptoms of the disease.What management st regularizegies should the nurse lodge will be legitimate to bursting charge for diabetes insipidus if it occurs?The objective of the therapy isTo replace vasopressinTo ensure adequate wandering replacementTo correct the underlying intracranial problem (pituitary prolactinoma)A melted deprivation test is staged by the physician to confirm for the diagnosis of diabetes insipidus bywithholding melteds by 8 to 12 hoursPatient is weighed frequently during the testPlasma and pissing osmolality studies are performed at the beginning and end of the test.The inability to increase the specific gloominess and osmolality of the urine is an indication of Diabetes insipidusPharmacologic TherapyAdminister Desmopressin (DDAVP) intranasally, BID as orderedNursing focussingEstablish baseline data ( weight, BP, I/O patter), Monitor BP and weight frequently throughout therapy and report sudden changes to physicianMonitor I/O and specific gravity and serum osmolality as orderedIf long-suffering of has Coronary artery disease, use this drug with tutelage as this drug causes vasoconstrictionAvoid concentrated fluids as this increase urine volumeWhat discharge instructions should the nurse provide the patient an d family? just about patients will spend at least one(a) night in the intensive care unit (ICU) and then typically 2 or 3 additional nights on a first-string (non-ICU) ward later on surgeryThe patient will likely have some incisional twinge and mild to moderate headache for which he will be given(p) pain medication.A CT s sensnister or MRI will be ordered before dischargeAsk patient to return 2-3weeks later on surgeryInform patient to return 2-3months after maiden check-upInform family to watch out for signs of DI (intense thirst, frequent urination). Refer immediatelyManagement of Patients with Neurologic DysfunctionCase Study 2Hiehachi Nishima, a 22-year-old patient who weighs 150 pounds, presents to the emergency de mathematical functionment (ED) after being thrown from his vaulting horse and passing out for a few proceedings he regained ken. The patron who was also riding a horse called the squad. The patient presented with a GCS of 15, and the neuro mental test was within normal limits (WNL). The ED physician wrote the orders for a CT scan without contrast of the head, CBC, renal and metabolic profile, PT, PTT, and INR. The nurse sent the labs and had the IV of NS at keep-open rate per ED protocol hanging. The nurse was awaiting radiology to call for the patient to go for the CT when the patient had an epileptic cry, became unconscious, stiffened his entire body, and then had convulsive muscle contractions. The respirations are very shallow, and the lips and nail bed became blue. The patient disordered control of bladder and bowel. The patient bit his tongue and blood is plan of attack from the mouth. The radiology de regionment calls and is ready for the patient.List in the correct order the actions that should be taken by the nurse.Before and during a seizure, the patient is assessed and the future(a) items are papersedThe circumstances before the seizureThe occurrence of gentle windThe first thing the patient does in the seizure wh ere movements or cogency begins, conjugate gaze vex, position of headThe type of movements in the part of the body involvedThe welkins of the body involvedThe size of the pupils and whether the eyes are openWhether the eyes or the head are turned to one side of meatThe presence or absence of automatismsIncontinence of urine or stoolUnconsciousness and its durationAny obvious paralysis or weakness of arms or legs after the seizureInability to verbalize after the seizureMovements at the end of the seizureWhether or not the patient sleeps or not afterwardsCognitive status after the seizureIn addition to providing data about the seizure, care for care is directed at preventing trauma and supporting the patient not that sensiblely but also psychologically. Consequences such(prenominal) as anxiety, embarrassment, fatigue, and depression can be devastating to the patient.After the patient has a seizure, the nurses role is to document the events leading to and occurring during and after the seizure to prevent complications.Explain what type of seizure the patient is having, and describe the three phases of the patients seizure and the specific nursing care for each stage.The patient had a tonic-clonic (gran mal) seizure. There are three phases that is to say the airwave, the tonic and the clonic phase.In the aviation phase is the forewarning of an epileptic attack. It characterized by episodes of Dj vu or Jamais vu. The client whitethorn also have auditory, olfactory, or even visual hallucinations, abnormal tastes, and tingling sensations. corporeal symptoms include dizziness, headache, lightheadedness, nausea, numbness. Though in this case, the client did not show signs of the aura phase.*Nsg MgtProvide privacy and protect the patient from curious onlookersPatients who have an aura may have time to seek a safe, private placeEase the patient to the floor, if possibleLoosen constrictive clothe shake up aside all furniture that may injure the patient d uring a seizureIf an aura precedes the seizure, insert an oral airway to scale down the curtain raising of the patients biting the tongueThe next is the tonic phase. It is usually the shortest part of the seizure, long-lived not more than only a few seconds. In this case, it is when the patient had an epileptic cry, became unconscious and stiffened his entire body.*Nsg MgtProtect the head with a launching pad to prevent injury from striking a hard surfaceIf the patient is in bed, remove pillows and raise side railsThe last is the clonic phase. It is when the client had violent muscle contractions, very shallow respirations, the lips and nail beds became blue, at sea control of bladder and bowel and bit his tongue.*Nsg MgtDo not taste to pry open jaws that are clenched in a muscle spasm or to insert anything. Broken dentition and injury to the lips and tongue may result from such an action.No attempt should be made to bind the patient during the seizure because muscular cont ractions are strong and restraint can cause injuryIf possible, place the patient on one side with head flexed forward, which allows the tongue to fall forward and allays drainage of saliva and mucus. If sucking is available, use if necessary to clear secretions.The ED physician orders the following diazepam (diazepam) 10 mg every 10 to 15 minutes as required for seizures (maximum dose of 30 mg). Once seizures stop, administer Dilantin (phenytoin) 10 mg/kg IVPB. ECG monitoring continuously, VS, GCS, neuro checks every 30 minutes. Explain what meds the nurse should provide, in what order, and how they should be administered.The nurse should provide Valium injection (diazepam) 10 mg IM PRN every 10 to 15 mins. (max 30mg) for his seizure to reliever the muscle spasm. For the long term relief, administer Dilantin (phenytoin) 10 mg/kg IVPB loading dose STAT, once the seizures stop. Dilantin (phenytoin) is an anti-seizure medication (anticonvulsant), in particular to prevent tonic-cloni c (grand mal) seizures and complex partial seizures (psychomotor seizures).We use piggyback to administer variant IV drugs at different times. Dilantin can cause toughness to the veins and can cause serious tissue and/or nerve vituperate if it infiltrates. So we should administer it with normal saline. Draw up the drugs in a syringe and attach it to the piggyback port on the IV metro cassette, which is run concurrently with the primary IV fluid (normal saline). Run it slow and keep an eye on the ECG monitor. This ECG monitoring should be done continuously to help line irregular heartbeats. For the vital signs, Glasgow apathy scale and neuro V/S, it should be check every 30 minutes to provide reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment. pigeonholing AssignmentsHave each member address nursing management cogitate to to caring for an unconscious patient.Preventing Urinary RetentionPalpate bladder at interval s to contain whether urinary retention is presentIf patient is not voiding, an indwelling catheter is inserted and connected to a closed drainage system as orderedObserve for fever and cloudy urine for infectionObserve the area around the urethral orifice for any drainageAs curtly as consciousness is regained, a bladder-training program initiatedPromote Bowel lickAssess abdomen for distention by listening for bowel sounds (irregular gurgling sounds should be heard every 5-20sec)Measuring the girth of the abdomen with a tape measure.Monitor for the number and consistency of bowel movementsPerform rectal testing for signs of fecal impaction as ordered.Stool softeners may be incontrovertible and can be administered with tube feedingsGlycerin suppository may be indicated to facilitate bowel emptyingMay require enema every some other day to empty lower colonMaintain Skin and formulate IntegrityMonitor pressure areas for possible ulcerationsEstablish a regular schedule of turning to avoid pressure, which can cause breakdown and necrosis of the clamberThis provides kinesthetic, proprioceptive and vestibular stimulationAvoid dragging and puff the patient up in the bed, because this creates a shearing force and clash on the skin surfaceMaintain correct body positionPassive exercise of the extremities is important to prevent contracturesSplints or foam boots may be used to prevent foot liquidate and pressure of provide on the toesTrochanter rolls may be used to support the hip joints and keep the legs in proper alignmentProviding Mouth CareInspect mouth for dryness, inflammation, and crustingCleanse and rinse mouth carefully to remove secretions and crusts and to keep the mucous membranes moistAdminister petrolatum on the lips to prevent drying, cracking and encrustations.If patient has an endotracheal tube, the tube should be moved to the opposite side of the mouth and lipsPerform routine tooth brushing every 8hrs to decrease ventilator-associated pneum oniaMaintaining the AirwayElevate the head of bed to 30 degrees to prevent aspiration.Place the client in lateral pass position to allow the jaw and tongue to fall forward to publicize drainage of secretions.Suction for secretions as neededMaintain oral hygieneChest physiotherapy and postural drainage to advertize pulmonary hygieneAuscultate the patients chest every 8 hours to assess for any deviated hint sounds.If the patient has a mechanical ventilator, maintain the patency of the endotracheal tube or tracheostomy, provide oral care, monitor arterial blood gas measurements and maintaining ventilator settings.Protecting the PatientRaise side rails up as always to prevent injuryEnsure the patients dignity during altered LOC, oratory to the client during nursing care activities.Maintaining Fluid Balance and Managing Nutritional needAssess skin turgor and mucous membrane for drynessMonitor for intake and output and determine the needs for catheterizationPreserving Corneal Inte grityPatients eyes may be cleansed with cotton balls moistened with sterile normal saline to remove any discharge.For artificial tears (prescription by the physician), may introduce every 2 hours.Maintaining Body TemperatureThe surround can be adjusted (depending on the patients condition) to promote normal body temperature.If body temperature is elevated, a minimum amount of bedding is used.For geriatric patients and doesnt have any elevated temperature, a warmer environment is needed.Providing Sensory StimulationCommunicate with patient, and encourage the family members to do it so.Orient the patient to time, date, and place once for every 8 hours.Have each theme member develop a nursing diagnosis cerebrate to a patient with an altered level of consciousness. Identify potential problems and complications related to the nursing diagnosis.Nursing diagnosingPotential Problems and Complications1. Ineffective airway clearance related to altered level of consciousnessAspiration2. Ris k for impaired skin integrity related to prolonged immobilityBed sore hale ulceration3. Impaired Urinary elimination retention related to disability in neurologic sensing and controlBladder distention infectionFormation of stones4. Impaired tissue integrity of cornea related to diminished or absent corneal reflexPeriorbital edemaUlcerationsCorneal abrasions5. Deficient fluid volume related to inability to take fluids by mouth vaporCerebral edema6. Interrupted family processes related to changes in the cognitive and physical status of their loved oneCrisisSevere anxiety, denial, anger, remorse, grief, and reconciliation7. Risk for injury related to decreased LOCFalls8. Ineffective thermoregulation related to damage to hypothalamic centerHyperthermia9. Impaired oral mucous membrane related to mouth breathing , absence of pharyngeal reflex and altered fluid intakeDrynessInflammationCrusting10. Bowel incontinence related to constipation neurologic sensing and controlAbdominal distenti onDiarrhea frequent loose stoolsAs a group, identify potential complications that may arise in the postoperative phase of cranial surgery.Increased ICPMonro-Kellie hypothesis states that, because of the extra space for expansion within the skull, an increase in any one of the components causes a change in the volume of the others.because brain tissue has throttle space to expand, compensation typically is accomplished by displacing or shifty CSF, increasing the absorption or diminishing the production of CSF, or decrease cerebral volume resulting to an increase ICP.Bleeding and hypovolemic shockAn compendium of blood under the bone flap (extradural, subdural, or intracerebral hematoma) may pose a threat to life. A clot must be suspected in any patient who does not awaken as expected or whose conditions deteriorates.Fluid and electrolyte disturbancesIV solutions and blood component therapy for patients with intracranial conditions must be administered slowly. If they are administ ered too rapidly, they can increase ICP. The amount of money of fluids administered may be restricted to minimize the possibility of cerebral edema. transmissionThe risk of infection is great when ICP is monitored with an intraventricular catheter and increases with the duration of the monitoring.SeizuresUnderlying cause is an electrical disturbance in the nerve cells in one divide of the brain. An abnormal motor, sensory, autonomic, or physical activity that result from sudden high-spirited discharge from cerebral neurons.Have each group member identify a type of seizure. Describe clinical manifestations, diagnosis, and treatment of each.Generalized SeizuresThis are seizures that mainly involves electrical charges in the whole brain, its clinical manifestations includes loss of consciousness for a short or long period of time.Types of Seizureclinical ManifestationGrand Mal or Generalized tonic-clonicUnconsciousnessConvulsionsMuscle inflexibilityAbsenceShort loss of unconsciousn essMyoclonicIrregular jerky movementsclonicRepetitive jerky movementsTonicMuscle stiffness and rigidity lightLoss of muscle toneDiagnosisPhysical examination particularly neurologic examinationEEGFor temporary and reversible causes of seizuresBlood chemistryBlood sugarComplete Blood CountCerebrospinal fluid analysisKidney function testLiver function testsTest to determine the cause and locationEEG (electroencephalograph) to measure the electrical activity in the brainHead CT or MRI scanlumbar puncture-spinal tapTreatmentWhen a seizure occurs, protect the person from injury, touch on the environment safe for you and the patient.Protect the patients headLoosen tight clothingPlace the patient into a side-lying position if vomiting occursStay with patient until she or he is fully recoveredMonitor the patients vital signsMedications such as anticonvulsants may be given as ordered to reduce the number of future seizures.The DONTs During SeizuresDont restrain the patientDont place anyth ing between the patients teeth during a seizureDont move the patient unless he or she is in danger or near something hazardousDont try to stop the patient from convulsing.Partial SeizuresThis are seizures that mainly involves electrical charges in one part of the brain, its clinical manifestations includes abnormal muscle movements, automatisms, abnormal sensations, hallucinations, nausea, sweating, dilated pupils, rapid heart rate and pulse rate, changes in vision.Types of SeizureClinical ManifestationSimple(consciousness is intact)saccade movementsMuscle rigidity, spasmUnusual sensationMemory and emotional disturbanceComplex(consciousness is impaired)Automatisms lip smacking, chewing, walking and repetitive involuntary and coordinated movementsDiagnosisCT scanMRIEEGEEG-video recordingsTreatmentVagus aspect Stimulation in which a small battery is implanted in the chest wall which will program to deliver short bursts of zip fastener to the brain.Corpus Callosotomy is a type of sur gical intervention that will cut the connections between the two sides of the brain that will prevent drop attacks..Multiple sub-pial transection which is a surgical technique that will cut a certain connection between nerve cells.