4 Collaborative Care Aspirin? Vitamin K? Oxygen Anti-convulsants Blood pressure control Thrombolytics
5 Prevent Re-bleed (hemorrhage) 24-48 hours post hemorrhage 7-10 days post hemorrhage Keep BP low Head up Vitamin K (Aquamephyton)?
6 Clipping and Coiling Web resource: http://www.mayoclinic.org/cerebral- aneurysm/treatment.htmlhttp://www.mayoclinic.org/cerebral- aneurysm/treatment.html Clipping: The most common surgical treatment for a cerebral aneurysm involves placing a metal clip around the neck of the aneurysm to prevent rupture Coiling: Endovascular therapy in which a neuroradiologist passes a catheter through an artery and deposits detachable platinum coils in the aneurysm. This prevents bleeding and protects against subarachnoid hemorrhage.
16 Traumatic Brain Injury Open Closed Photo Source: U.S. National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program, http://training.seer.cancer.gov/index.html http://training.seer.cancer.gov/index.html
17 Open Head Injuries Linear skull fracture Depressed skull fracture Open fracture Basilar skull fracture
21 Brain Lacerations Epidural hematoma Brief loss of consciousness Period of lucidity Rapid decrease in LOC Watch! pupils, extremity movements Photo Source: Lippincott, Williams, & Wilkins Connection Image Bank, http://connection.lww.com/products/smeltzer9e/imagebank.asp http://connection.lww.com/products/smeltzer9e/imagebank.asp
31 Spinal Cord Injury Prevention Common areas injured Photo Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMSD) http://images.niams.nih.gov/SearchResults.cfm?start=Allhttp://images.niams.nih.gov/SearchResults.cfm?start=All
32 Types of Lesions Complete Incomplete Central cord syndrome Anterior cord syndrome Brown-Sequard syndrome Cauda equina
33 AreaCauseSensory Loss Motor Loss Intact Central Cord Hyper- extension pain & temp below injury Upper extremities Lower extremity motor Anterior Cord FlexionPinprick, temp Complete motor loss Position, proprio- ception, vibration, deep pressure Brown- Sequard Knife, bullet Complete loss opposite side Complete loss same side Bowel, bladder, walk with assist Cauda equina Lumbar disk herniation Perineal anesthesia Areflexic bowel, bladder Upper extremities, thorax
34 Initial Assessment/Care Stabilize neck/back Watch! Respiratory failure C2-3 Assess Motor signs Assess Sensory signs Incontinence Superficial signs Pain
57 Nursing Care Cognitive stimulation Structure environment Prevent over-stimulation Provide consistency Promote independence Promote bowel, bladder continence Assist with facial recognition
58 Promote Communication Attract patient’s attention before talking Avoid environmental distractions Speak directly to patient, distinctly and in clear, short sentences Ask patient to perform one task at a time, giving plenty of time & breaking down into small steps