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The Clinical Practice of Neurological and Neurosurgical Nursing

9781975100674
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9781975100674
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July 1, 2019
2019-07-1
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  • Description
    Base your care of neurological patients on evidence-based best practices, with the completely updated, fully illustrated The Clinical Practice of Neurological and Neurosurgical Nursing , 8th Edition.

    This is the most current and comprehensive neuroscience nursing text, written to support you in the everyday high-level assessments, information processing and decision making required of the neurological nurse. A must-have for offering accurate, efficient care of adult/geriatric neuroscience patients, this is ideal for both beginning and advanced neuro nurses and nursing students.
    • NEW chapter on hydrocephalus
    • NEW chapter on neurological care in the community
    • NEW and revised content throughout the text that reflects current best practices
    • Case studies that offer real-life scenarios to reinforce concepts
    • Treatment Summaries, Clinical Vignettes and Clinical Pearls that provide vital clinical tips
    • Sections covering a broad range of neuroscience care considerations:
      • Ethical perspectives and end-of-life care – Preparing and caring for patients after acute care, brain death and organ donation
      • Assessment and evaluation of neuroscience patients – Overview of neuroanatomy and neurophysiology, diagnostics for patients with neurological disorders, comprehensive neurological examination, neurological assessment
      • Common management challenges – Intracranial hypertension, hydrocephalus, management of patients with altered level of consciousness, evaluation/treatment of delirium, common neuroendocrine syndromes, neurosurgical procedures, rehabilitation
      • Nursing management of patients with injury to the neurological system; cranial nerve disorders and peripheral nerve injuries; neoplasms of the neurological system; cerebrovascular disease; pain, seizures, and CNS infections; movement disorders; neurodegenerative and neuromuscular diseases
    • Ideal for nurses working in intensive care units, emergency departments, neuroscience specialty units and medical-surgical units that admit neuroscience patients
    • Nursing management guidance that is infused with pathophysiology content, providing a rationale for care and for identifying patient outcomes
    • Guide for establishing and updating a neuroscience patient database
    • Excellent study aid for preparing for the certified neuroscience registered nurse (CNRN) exam and stroke certification (SCRN)
    • Thorough overview of neurology team communications – Best practices for coordination, continuity, and patient safety
     
    Your book purchase includes a complimentary download of the enhanced eBook for iOS™, Android™, PC, and Mac. Take advantage of these practical features that will improve your eBook experience:
     
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    • Powerful search tools and smart navigation cross-links that allow you to search within this book, or across your entire library of VitalSource eBooks
     
     
    About the Clinical Editors
     
    Joanne V. Hickey, PhD, RN, ACNP, FAAN, FCCM, is Patricia L. Starck/PARTNERS Professor of Nursing,
    Department of Research at the Cizik School of Nursing, University of Texas Health Science Center at Houston at the University of Texas Health School of Nursing in Houston, Texas.

    Andrea L. Strayer, MS, NP, CNRN, is Inpatient Neurosurgery Nurse Practitioner at the University of Wisconsin Hospital in Madison, Wisconsin.
  • Specs
    Edition
    8
    ISBN/ISSN
    9781975100674
    Product Format
    HC-Printed Cover
    Trim Size
    8 3/8 x 10 7/8
    Pages
    816
    Table
    119
    Edition
    8
    Publication Date
    July 1, 2019
    Weight
    4.3
  • Joanne V. Hickey PhD, RN, APRN, ACNP-BC, F
    Joanne V. Hickey, PhD, RN, APRN, ACNP-BC, FAAN, FCCM
    Professor
    Patricia L. Starck/PARTNERS Professor of Nursing
    The University of Texas School of Nursing at Houston School of Nursing
    Houston, Texas
  • Table of contents
    Contributors ..................................................................... v
    Preface ........................................................................... ix
    SECTION 1
    NEUROSCIENCE NURSING: CONTEMPORARY
    PRACTICE ......................................................................1
    CHAPTER 1
    The State of the Science of Neuroscience
    Nursing Practice .. ..... ....... ..... ...... ....... ...... ..... ...... ...... ...... .1
    Joanne V . Hickey
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... ......1
    The State of Health Care and Practice ... ....... ..... ...... ...... .....1
    The Information Society .................................................2
    Trends Shaping Health Care Delivery ................................2
    National Agenda for Health .............................................5
    Professional Nursing and Neuroscience Specialty Practice ....6
    CHAPTER 2
    Ethical Perspectives and End-of-Life Care ..................... 10
    Shannon E. Pearce
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .... 10
    National Initiatives and Trends ...................................... 10
    An Ethical Perspective of Neuroscience Practice ... ...... ....... 11
    Ethics, Morality, and Legality ......................................... 12
    Framework for Ethical Decision Making .......................... 13
    Interdisciplinary Team ................................................. 14
    Decision-Making Capacity and Advance
    Directives and Living Wills . ....... ...... ...... ..... ...... ...... ..... 17
    End-of-Life Care . ....... ..... ....... ..... ...... ...... ...... ..... ....... ... 19
    National Palliative Care Guidelines ... ....... ..... ...... ...... ..... . 20
    Referral to Palliative Care ..... ...... ...... ...... ...... ..... ....... ..... 20
    Fostering Professional Growth in Ethical Decision Making ... 25
    CHAPTER 3
    Beyond the Hospital: Preparing and Caring for
    Neuroscience Patients After Acute Care ......................... 29
    Andrea L. Strayer, Rachel M. Kiley, and Nancy E. Villanueva
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .... 29
    Magnitude of the Challenge: The Number of People
    Living With Neurological Disorders .. ...... ...... ...... ...... .... 29
    Patient- or Person-Centered Care? Concepts in Evolution . .. 30
    Person- and Family-Centered Care Engagement and
    Outcomes ... ...... ...... ...... ..... ....... ..... ...... ...... ....... ..... .. 30
    Person- and Family-Centered Care:
    Evidence-Based Practice ............................................ 30
    Agenda for Nurse-Led Care Coordination . ....... ...... ..... ...... 32
    Care Coordination Communication .. ...... ..... ....... ...... ..... . 33
    Caregiving Settings Beyond Critical and Acute Care . ..... ..... 34
    Unique Discharge Challenges ........................................ 37
    Interprofessional Team ..... ....... ...... ...... ...... ...... ..... ...... .. 38
    Two-Way Communication ............................................ 38
    Caregiving by Family and Friends ................................... 40
    Care for the Caregiver ..... ...... ...... ...... ..... ..... ....... ..... ...... 42
    Research Gaps ............................................................ 42
    Future Directions ........................................................ 43
    SECTION 2
    ASSESSMENT AND EVALUATION OF
    NEUROSCIENCE PATIENTS ......................................... 47
    CHAPTER 4
    Overview of Neuroanatomy and Neurophysiology ... ...... 47
    Joanne V . Hickey
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .... 47
    Embryonic Development of the Nervous System ............... 47
    Cells of the Nervous System ... ...... ...... ...... ...... ..... ...... ..... 47
    Components of the Cell Body ..... ...... ...... ...... ..... ....... ...... 48
    Cell Processes: Axons and Dendrites .. ....... ..... ...... ..... ...... 49
    Physiology of Nerve Impulses . ...... ....... ..... ...... ....... ..... .... 50
    Functions and Divisions of the Nervous System ....... ...... .... 53
    Cranial and Spinal Bones ....... ...... ...... ..... ...... ....... ..... .... 53
    Spine ........................................................................ 55
    Ligaments of the Spine ................................................. 55
    Intervertebral Discs ... ....... ...... ...... ...... ..... ...... ...... ..... ... 55
    Meninges . ...... ..... ....... ..... ...... ...... ...... ...... ...... ...... ....... 56
    Cerebrospinal Fluid ..................................................... 58
    Cerebrovascular Circulation ..... ...... ..... ...... ...... ..... ....... .. 60
    Characteristics of the Cerebral Circulation . ....... ..... ....... ... 60
    Blood–Brain Barrier, the BBB ... ....... ..... ...... ....... ..... ...... .. 64
    Brain (Encephalon) .... ...... ...... ...... ...... ...... ..... ...... ....... .. 65
    General Functions of the Cerebral Cortex
    According to Lobes ... ....... ...... ...... ...... ..... ...... ...... ...... . 67
    Dominance of a Cerebral Hemisphere ............................. 69
    Corpus Callosum ... ....... ...... ...... ...... ..... ...... ....... ..... ...... 69
    Basal Ganglia .. ...... ...... ...... ..... ...... ...... ....... ...... ...... ..... . 69
    Diencephalon .. ..... ....... ...... ...... ..... ...... ...... ....... ...... ..... 69
    Internal Capsule ..... ...... ...... ...... ...... ...... ..... ...... ....... ..... 70
    Hypophysis (Pituitary Gland)......................................... 70
    Brainstem (Midbrain, Pons, and Medulla) ........................ 71
    Cerebellum ................................................................ 72
    Special Systems Within the Brain ................................... 72
    Spinal Cord ................................................................ 74
    Dorsal (Sensory) Roots ..... ...... ..... ....... ..... ....... ..... ...... ... 76
    ContentsVentral (Motor) Roots .................................................. 76
    Classification of Nerve Fibers ... ...... ...... ...... ..... ....... ..... ... 76
    Motor System ............................................................. 78
    Sensory System .... ....... ..... ...... ..... ....... ...... ...... ..... ....... . 78
    Autonomic Nervous System .......................................... 81
    Cranial Nerves ............................................................ 86
    CHAPTER 5
    Diagnostics for Patients With Neurological Disorders ..... 93
    Nicole Bennett
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .... 93
    Patient and Family Teaching .... ....... ..... ...... ...... ...... ...... .. 93
    X-Rays of the Head and Vertebral Column ... ...... ...... ...... ... 94
    Structural Neuroimaging Techniques of the Brain
    and Spinal Cord ........................................................ 95
    Functional Neuroimaging Techniques of the Brain........... 102
    Cerebrospinal Fluid and Spinal Procedures .................... 103
    Cerebrovascular Neuroimaging .. ...... ...... ...... ...... ..... ..... 105
    Biopsies ... ..... ...... ...... ...... ...... ...... ..... ....... ..... ....... ..... 107
    Nervous System Electrical Activity and Conduction .... ..... 108
    Genetic Testing . ..... ...... ...... ...... ..... ....... ...... ...... ...... ... 111
    Neuropsychologic Examination ................................... 111
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 112
    CHAPTER 6
    Comprehensive Neurological Examination................... 113
    Joanne V . Hickey
    Purposes ................................................................. 113
    The Neurological Examination ... ....... ..... ....... ...... ..... .... 114
    Conducting the Neurological Examination .... ...... ...... ..... 116
    Level of Consciousness ..... ..... ....... ...... ..... ...... ..... ....... . 116
    Mental Status Examination ... ....... ..... ...... ....... ..... ...... .. 116
    Cranial Nerve Examination ......................................... 121
    Motor System Examination ..... ...... ....... ...... ..... ...... ...... 134
    Upper Extremities ..................................................... 135
    Lower Extremities ..................................................... 135
    Sensory System Examination .... ....... ...... ..... ...... ...... ..... 142
    Cerebellar System Examination ................................... 146
    Reflexes ..... ...... ...... ...... ..... ...... ....... ..... ....... ..... ....... .. 146
    The Neurological Examination of the
    Comatose Patient ..... ...... ...... ..... ...... ...... ....... ..... ...... 149
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 153
    Acknowledgment .... ..... ...... ....... ..... ...... ...... ..... ...... .... 154
    CHAPTER 7
    Neurological Assessment ............................................ 154
    Joanne V . Hickey
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 154
    Establishing a Nursing Database .................................. 154
    Overview of Neurological Assessment ........................... 155
    Frequency of Assessment and Documentation ... ....... ..... . 156
    Concept of Consciousness ....... ...... ..... ...... ..... ....... ...... . 156
    Identifying the Levels of Consciousness . ...... ...... ...... ..... . 159
    The Glasgow Coma Scale ............................................ 160
    Changes in Level of Consciousness ............................... 161
    Recovery and Rehabilitation . ...... ..... ...... ...... ..... ....... .... 164
    Behavior and Stream of Mental Activity ......................... 164
    Cranial Nerve Assessment . ...... ..... ...... ...... ...... ...... ..... .. 164
    Assessment of Visual Fields (Optic Nerve) ... ...... ...... ...... . 165
    Assessment of Pupils (Oculomotor Nerve) ... ...... ....... ..... . 166
    Assessment of Extraocular Movement (Oculomotor,
    Trochlear, and Abducens Nerves) ..... ...... ...... ...... ...... .. 171
    Assessment of the Conscious, Cooperative Patient .... ...... . 171
    Assessment of the Unconscious Patient ... ....... ...... ...... ... 172
    Assessment of Motor Function .. ...... ...... ...... ...... ..... ...... 172
    Assessment of Muscle Strength .... ...... ...... ....... ..... ...... .. 174
    Involuntary Movement, Posture, and Gait ...................... 175
    Sensory Assessment ... ..... ....... ..... ...... ..... ....... ...... ..... .. 175
    Frequency and Documentation of Sensory Data ..... ....... .. 175
    Assessment of Cerebellar Function ...... ...... ..... ....... ...... . 175
    Vital Signs and Clinical Implications . ....... ...... ...... ..... .... 176
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 181
    SECTION 3
    NEUROSCIENCE NURSING: COMMON
    MANAGEMENT CHALLENGES ... ..... ....... ...... ...... ..... .. 183
    CHAPTER 8
    Intracranial Hypertension: Theory and Management
    of Increased Intracranial Pressure . ..... ...... ....... ..... ...... .. 183
    Joanne V . Hickey and JJ Baumann
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 183
    Concept of Intracranial Pressure .................................. 183
    Pathophysiology ... ...... ..... ....... ..... ...... ...... ..... ...... ....... 189
    Herniation Syndromes of the Brain . ...... ...... ..... ....... ..... . 190
    Signs and Symptoms of Increased Intracranial Pressure .... 196
    Management of Patients With Intracranial Hypertension:
    An Interdisciplinary Collaborative Problem ................. 200
    Monitoring Intracranial Pressure .. ...... ..... ...... ...... ...... ... 210
    Special Syndromes: Benign Intracranial Hypertension and
    Hydrocephalus ....................................................... 214
    CHAPTER 9
    Hydrocephalus ..... ...... ....... ..... ...... ...... ...... ..... ....... ...... . 217
    Nancy E. Villanueva
    Pathophysiology ... ...... ..... ....... ..... ...... ...... ..... ...... ....... 218
    Etiologies .... ..... ....... ...... ..... ...... ...... ..... ....... ...... ...... .. 218
    Classification of Hydrocephalus ................................... 218
    Communicating Hydrocephalus . ..... ...... ...... ...... ...... ..... 218
    Noncommunicating Hydrocephalus ............................. 219
    Assessment .... ...... ...... ...... ...... ..... ...... ....... ..... ...... ..... 220
    Operative Procedures . ...... ...... ...... ..... ...... ...... ..... ...... .. 221
    Shunt Malfunction..................................................... 222
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 227
    CHAPTER 10
    Management of Patients With an Altered Level
    of Consciousness ........................................................ 227
    Joanne V . Hickey and Bahia Elkamand
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 227
    Immobility .. ...... ...... ...... ..... ...... ...... ....... ..... ....... ...... . 228
    Specialty Beds and Support Surfaces ... ....... ..... ...... ....... . 228
    The Consequences of Immobility: Management
    of the Patient With Altered Consciousness ... ...... ....... ... 234
    Questions ................................................................ 238
    The Care Environment ............................................... 244
    Communications ...................................................... 244
    Regaining Consciousness . ...... ...... ...... ...... ...... ...... ...... . 245
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 245
    xii ContentsCHAPTER 11
    Neuroendocrine Disorders in Neuroscience Patients . .... 247
    Laura J. Griffin
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 247
    Hypothalamic–Pituitary Axis....................................... 247
    Hypothalamic–Pituitary–Adrenal Axis .... ...... ..... ...... ..... 250
    Fluid and Sodium Regulation ... ....... ..... ...... ....... ..... ...... 251
    Dysfunction of Hypothalamic–Pituitary Axis ... ....... ..... ... 252
    Sodium Disturbances . ...... ....... ...... ..... ...... ...... ..... ...... . 253
    Syndrome of Inappropriate Secretion of
    Antidiuretic Hormone .... ...... ...... ...... ..... ...... ...... ...... . 255
    Cerebral Salt Wasting .. ...... ...... ...... ...... ...... ..... ...... ...... 256
    Hypernatremia ......................................................... 257
    Diabetes Insipidus .... ....... ...... ...... ..... ...... ..... ....... ...... . 257
    Other Common Electrolyte Imbalances . .. ..... ...... ...... ..... 259
    Hypothalamic–Pituitary–Adrenal Axis Dysfunction ..... .... 261
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 262
    CHAPTER 12
    Neurosurgical Procedures: Patient Care
    Management .. ...... ...... ...... ..... ....... ...... ..... ...... ....... ..... . 264
    Lori Kennedy Madden, Mary Anne Ruiz, and Kia Shahlaie
    The Preoperative Phase .............................................. 264
    The Perioperative Phase ... ...... ...... ...... ..... ...... ....... ...... . 266
    Neurosurgical Procedures and Other Related
    Therapeutic Techniques ........................................... 271
    Postoperative Phase ... ...... ...... ....... ...... ..... ...... ...... ...... 277
    Postoperative Management and
    Prevention of Complications ..................................... 282
    Neurological Deficits in the Postoperative Period ............ 286
    Nurse’s Role in Rehabilitation and Discharge Planning ..... 287
    Selected Neurosurgical Procedures ... ...... ...... ...... ..... ..... 288
    Future Trends .. ...... ...... ...... ...... ..... ....... ...... ..... ...... .... 291
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 292
    CHAPTER 13
    Rehabilitation of Patients With Neurological
    Disorders .................................................................... 293
    Joanne V . Hickey and Lisa W. Thomas
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 293
    Framework for Disability ............................................ 293
    Concepts of Rehabilitation ... ...... ....... ..... ...... ...... ..... .... 294
    A Philosophy of Rehabilitation . ...... ..... ....... ..... ...... ...... . 294
    Assessment of Activities of Daily Living ......................... 297
    Principles of Rehabilitation Nursing .. ...... ..... ....... ...... .... 298
    The Basis of Movement and Treatment of
    Movement Disorders ............................................... 299
    Management of the Skin ... ..... ...... ...... ...... ...... ...... ...... . 307
    Sensory–Perceptual Deficits .. ...... ....... ..... ...... ..... ...... ... 307
    Communication Deficits .... ...... ....... ..... ...... ....... ..... ..... 309
    Swallowing Deficits ................................................... 309
    Bladder Dysfunction and Retraining ............................. 312
    Bowel Elimination and Dysfunction ... ...... ...... ...... ..... .... 317
    Cognitive Rehabilitation . ..... ...... ...... ...... ...... ..... ....... ... 319
    Home-Based Care of the Patient Who is Ventilator
    Dependent .... ...... ...... ...... ...... ..... ...... ...... ...... ...... .... 319
    Discharge Planning.................................................... 319
    Rehabilitation Legislation and Entitlement Programs ...... 320
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 320
    SECTION 4
    NURSING MANAGEMENT OF PATIENTS WITH
    INJURY TO THE NEUROLOGICAL SYSTEM .. ...... ...... .. 327
    CHAPTER 14
    Craniocerebral Injuries ................................................ 327
    Norma D. McNair
    Scope of the Problem ................................................. 327
    Overview of Craniocerebral Trauma .. ....... ...... ..... ....... ... 327
    Pathophysiology ... ...... ..... ....... ..... ...... ...... ..... ...... ....... 328
    Primary Brain Injury ...... ...... ...... ...... ...... ...... ..... ....... .. 329
    Secondary Brain Injury .... ...... ...... ...... ...... ...... ..... ....... . 330
    Primary Injury: Diagnosis
    and Management .... ....... ...... ...... ..... ...... ...... ...... ...... 332
    Other Injuries Related to Traumatic Brain Injury . ...... ...... 340
    Management of the Traumatic Brain Injury Patient:
    The Continuum of Care ............................................ 341
    Prehospital Management ... ....... ...... ..... ...... ...... ...... ..... 344
    Emergency Department or Trauma Center Management .. 345
    Intensive Care Unit Management of Severe Traumatic
    Brain Injury ... ...... ....... ...... ..... ...... ..... ....... ...... ...... ... 346
    Management of Severe Traumatic Brain Injury During
    the Postacute Phase . ....... ...... ...... ..... ...... ...... ...... ...... 356
    Rehabilitation ...... ...... ...... ...... ...... ..... ...... ....... ...... ..... 356
    Predicting Outcome from Traumatic Brain Injury . ...... ..... 356
    Prevention of Traumatic Brain Injury ............................ 357
    Management of Traumatic Brain Injury: A Dynamic
    Process Through Research ..... ...... ...... ...... ..... ....... ..... 357
    Assessment and Clinical Reasoning: Key Role of
    the Neuroscience Nurse in Patient Care . ...... ..... ...... ..... 358
    Nursing Management of Traumatic Brain Injury ... ...... ..... 360
    Nursing Management for Special Problems . ...... ....... ..... . 361
    Summary and Future Trends ....................................... 362
    CHAPTER 15
    Spine and Spinal Cord Injuries .. ....... ...... ..... ....... ..... ..... 365
    Andrea L. Strayer
    A Perspective ... ...... ...... ...... ..... ...... ...... ...... ...... ..... .. ... 365
    Understanding the Spine and Spinal Cord Injuries . ...... .... 366
    Specific Categories of Injuries ...... ...... ...... ..... ...... ...... ... 367
    Acute Spinal Cord Trauma .......................................... 384
    Early Management of Patients With Spinal Cord Injury ..... 387
    Surgical Management of Spinal Cord Injury .. ...... ....... ..... 391
    Nonsurgical Management of Spinal Fractures
    and Spinal Cord Injuries . ..... ...... ....... ..... ...... ...... ...... . 392
    Focus on Collaborative Management in the Acute
    and Postacute Phases .............................................. 394
    Major Patient Management Responsibilities of the Nurse ....395
    Research ...... ...... ...... ...... ..... ...... ...... ..... ....... ....... ..... . 412
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 413
    CHAPTER 16
    Back Pain and Spinal Disorders .. ....... ..... ...... ...... ...... .... 417
    Andrea L. Strayer
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 417
    Conditions Related to Back or Neck Pain ....................... 417
    Low Back Pain .......................................................... 420
    Neck Pain . ...... ...... ...... ..... ...... ....... ..... ...... ...... ...... ..... 422
    Herniated Intervertebral Discs .... ...... ....... ..... ...... ...... ... 423
    Contents xiiiAdditional Common Diagnoses ................................... 436
    Recurrent Symptoms After Surgery . ...... ...... ...... ...... ...... 447
    Research and Future Trends in Practice ..... ....... ...... ...... . 447
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 447
    SECTION 5
    NURSING MANAGEMENT OF CRANIAL NERVE
    DISORDERS AND PERIPHERAL NERVE INJURIES .... 449
    CHAPTER 17
    Cranial Nerve Diseases ..... ....... ..... ...... ..... ...... ....... ..... .. 449
    Mary McKenna Guanci
    Trigeminal Nerve .... ...... ....... ...... ..... ...... ...... ..... ...... .... 449
    Trigeminal Neuralgia ................................................. 449
    Bell’s Palsy................................................................ 452
    Ménière’s Disease ...................................................... 454
    Glossopharyngeal Neuralgia ..... ...... ...... ...... ...... ..... ...... 455
    CHAPTER 18
    Peripheral Nerve Injuries ............................................. 456
    Miriana Popadich and Andrea L. Strayer
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 456
    Nerve Anatomy ... ...... ..... ...... ....... ...... ..... ...... ...... ...... . 457
    Pathophysiology of Acute Nerve Injury .......................... 458
    Pathophysiology of Chronic Nerve Injury ....................... 460
    Approach to Patient Care . ..... ...... ..... ....... ...... ..... ....... .. 460
    Diagnosis of Peripheral Nerve Injuries ... ....... ..... ....... ..... 463
    Types of Peripheral Nerve Trauma ................................ 463
    Planning and Implementation Treatment ...................... 467
    Entrapment Neuropathies........................................... 468
    Selected Chronic Peripheral Neuropathies ..................... 471
    Collaborative and Nursing Management of the
    Patient With Peripheral Nerve Trauma and
    Chronic Illness–Related Neuropathies ........................ 472
    Research and Future Trends in Practice ..... ....... ...... ...... . 473
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 474
    SECTION 6
    Nursing Management of Patients With
    Neoplasms of the Neurological System ................. 477
    CHAPTER 19
    Brain Tumors ...... ...... ...... ...... ..... ...... ..... .. ..... ...... ...... .... 477
    Jennifer E. Cahill
    Overview of Brain Tumors .... ..... ....... ...... ..... ...... ...... .... 477
    Signs and Symptoms of Brain Tumor .... ....... ..... ...... ...... . 487
    Associated Increased Intracranial Pressure Signs ............ 489
    Approach to the Patient with a Brain Tumor ... ...... ..... ..... 490
    Nursing Management of the Patient with a Brain Tumor ... 501
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 510
    CHAPTER 20
    Spinal Cord Tumors ..................................................... 511
    Julie G. Walker
    Epidemiology ........................................................... 511
    Classification .... ....... ...... ...... ..... ...... ..... ...... ....... ...... .. 511
    Pathophysiology ... ..... ...... ....... ..... ...... ...... ..... ...... ....... 513
    Signs and Symptoms Associated with Spinal
    Cord Tumors ..... ...... ...... ..... ...... ....... ..... ...... ...... ...... 515
    Diagnosis . ...... ...... ..... ....... ...... ..... ...... ...... ...... ...... ..... 517
    Principles of Treatment .............................................. 518
    Nursing Management of the Patient with a Spinal
    Cord Tumor ........................................................... 521
    SECTION 7
    NURSING MANAGEMENT OF PATIENTS WITH
    CEREBROVASCULAR DISEASE . ..... ...... ...... ...... ...... .... 527
    CHAPTER 21
    Transient Ischemic Attacks and Acute Ischemic Stroke ....527
    Sarah L. Livesay and Joanne V . Hickey
    Disease-Specific Certification: Stroke Centers
    of Excellence ... ....... ..... ...... ...... ...... ...... ...... ..... ....... . 528
    Public and Professional Education ..... ...... ...... ..... ....... ... 528
    Transient Ischemic Attacks ......................................... 529
    Definition and Classification of Stroke ...... ...... ...... ..... .... 529
    Ischemic Stroke Subtypes ........................................... 531
    Anatomy, Atherogenesis, and Pathophysiology Related
    to Acute Ischemic Stroke .... ..... ...... ...... ...... ..... ....... ... 533
    Signs and Symptoms of Stroke Syndromes According to
    the Involved Vessel .................................................. 534
    Medical Management and Treatment of Acute
    Ischemic Stroke ...................................................... 540
    General Nursing Management
    of the Stroke Patient ................................................ 548
    CHAPTER 22
    Intracerebral Hemorrhagic Stroke . ...... ....... ...... ..... ..... .. 557
    Joanne V . Hickey and Sarah L. Livesay
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 557
    Overview ................................................................. 557
    Etiology of Intracerebral Hemorrhage ........................... 557
    Pathophysiology of Intracerebral Hemorrhagic Stroke ... ... 558
    Clinical Presentation of ICH ........................................ 559
    Diagnostics ... ...... ...... ...... ...... ...... ...... ..... ....... ..... ...... 560
    Nursing Management of the Hemorrhagic
    Stroke Patient ... ....... ..... ....... ..... ...... ...... ...... ..... ....... 565
    Coordination and Transitions in Care
    and Discharge Planning ........................................... 567
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 569
    CHAPTER 23
    Intracranial Aneurysms .. ....... ...... ..... ...... ....... ..... ...... .... 572
    Tina Resser and Andrea L. Strayer
    Overview ................................................................. 572
    Locations of Aneurysms and Size ................................. 575
    Clinical Grading Scales .... ...... ...... ...... ...... ..... ...... ...... .. 578
    Complications of Ruptured Aneurysm . ...... ...... ...... ...... .. 587
    Nursing Management of the Patient With a
    Cerebral Aneurysm ...............................................................................593
    Pharmacologic Dual Antiplatelet Therapy With
    Stent-Assisted Embolization and Flow Diversion
    in Neuroendovascular Surgery .... ...... ...... ...... ..... ...... .. 596
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 598
    Acknowledgment .... ..... ...... ....... ..... ...... ...... ..... ...... .... 598
    xiv ContentsCHAPTER 24
    Arteriovenous Malformations and Other
    Cerebrovascular Anomalies ......................................... 601
    JJ Baumann
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 601
    Classifications of Vascular Malformations .... ...... ...... ...... 601
    Arteriovenous Malformations in the Adult: An Overview .. 605
    Pediatric Arteriovenous Malformations ... ...... ...... ...... .... 611
    Arteriovenous Malformations and Pregnancy ....... ..... ..... 618
    Nursing Management of Arteriovenous Malformations .... 618
    Acknowledgment .... ..... ...... ....... ..... ...... ...... ..... ...... .... 619
    SECTION 8
    NURSING MANAGEMENT OF PATIENTS WITH
    PAIN, SEIZURES, AND CNS INFECTIONS .................. 621
    CHAPTER 25
    Chronic Pain ............................................................... 621
    Maureen F . Cooney
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 621
    Definition of Terms ...... ..... ....... ...... ...... ..... ...... ...... ..... 622
    Pain Theories .. ....... ..... ...... ..... ....... ..... ...... ...... ....... .... 623
    Anatomy and Physiology of Pain .. ...... ...... ...... ..... ...... .... 624
    Assessment and Management of Chronic Pain ...... ....... ... 625
    Overview of Management and Treatment Options
    for Chronic Pain . ..... ....... ..... ...... ....... ..... ...... ...... ...... 630
    Nursing Management of Patients With Chronic Pain . ..... .. 635
    Pain Management and the Future . ...... ...... ...... ..... ....... .. 636
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 636
    CHAPTER 26
    Headaches .. ...... ...... ...... ..... .. ..... ...... ..... ...... ....... ....... ... 638
    Amy F . Larson
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 638
    Pain-Sensitive Cranial Structures and Pathophysiology .... 639
    Classification of Headaches ...... ...... ..... ....... ..... ....... ..... 639
    Approach to Management of Headaches .... ..... ....... ...... .. 641
    Nursing Management of the Patient With Headache ........ 648
    Research Trends ... ...... ...... ...... ...... ..... ...... ...... ...... ...... 651
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 651
    CHAPTER 27
    Seizures and Epilepsy ... ....... ..... ...... ...... ...... ...... ...... ..... 652
    Kathy M. England and Madona Plueger
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 652
    Entry into Health Care ... ...... ...... ...... ...... ..... ...... ...... .... 652
    Background and Definitions ..... ..... ...... ....... ..... ...... ...... 652
    Seizure Classification and Observations/Identification .... 658
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 664
    Treatment .... ....... ...... ...... ..... ...... ...... ...... ...... ..... ....... 664
    First-Generation AEDs ............................................... 667
    Second- and Third-Generation AEDs .. ...... ...... ...... ...... ... 669
    Other Treatment Options .... ..... ....... ..... ...... ...... ..... ...... 672
    Management of Seizures and Status Epilepticus ... ....... .... 673
    Nursing Management of Patients With Epilepsy:
    Community-Based Care ........................................... 675
    Future Directions ...................................................... 679
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 679
    CHAPTER 28
    Infections of the Central Nervous System .................... 681
    Michelle VanDemark
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 681
    Meningitis................................................................ 681
    Encephalitis ............................................................. 688
    Other Viral Organisms that Attack the
    Central Nervous System ........................................... 695
    Research ...... ...... ...... ...... ..... ...... ...... ..... ....... ....... ..... . 700
    Future ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... ...... .... 702
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 702
    SECTION 9
    NURSING MANAGEMENT OF PATIENTS WITH
    MOVEMENT DISORDERS, NEURODEGENERATIVE
    AND NEUROMUSCULAR DISEASES.......................... 705
    CHAPTER 29
    Parkinson’s Disease .... ...... ...... ...... ...... ..... ...... ....... ..... .. 705
    Susan L. Heath
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 705
    Surgical Management ................................................ 718
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 725
    Palliative Care Resources . ....... ...... ..... ...... ..... ....... ...... . 725
    CHAPTER 30
    Alzheimer’s Disease and Related Dementias .. ...... ...... .. 729
    Michele Grigaitis-Reyes
    Mild Cognitive Impairment ... ...... ...... ...... ...... ..... ....... .. 729
    Pathophysiology of MCI ... ...... ....... ..... ....... ..... ...... ...... . 730
    Dementia ..... ....... ..... ...... ...... ...... ..... ....... ...... ...... ...... 730
    Alzheimer’s Disease . ...... ....... ...... ...... ..... ....... ..... ..... ... 732
    Related Dementias .................................................... 735
    Research ...... ...... ...... ...... ..... ...... ...... ..... ....... ....... ..... . 739
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 740
    CHAPTER 31
    Multiple Sclerosis ..... ...... ....... ..... ...... ....... ..... ...... ...... ... 741
    Patricia Pagnotta
    Pathogenesis and Pathophysiology ............................... 742
    Signs and Symptoms ..... ..... ...... ...... ..... ....... ...... ..... ..... 744
    Diagnosis . ...... ...... ..... ....... ...... ..... ...... ...... ...... ...... ..... 746
    Magnetic Resonance Imaging, Evoked Potentials,
    and Optical Coherence Tomography . ...... ...... ...... ...... .. 747
    Treatment ..... ...... ...... ...... ..... ...... ...... ...... ...... ..... ....... 747
    Research ...... ...... ...... ...... ..... ...... ...... ..... ....... ....... ..... . 750
    CHAPTER 32
    Guillain–Barré Syndrome ............................................ 752
    Mary McKenna Guanci, Vanessa McKenna, and Jean Fahey
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 752
    Diagnosis . ...... ...... ..... ....... ...... ..... ...... ...... ...... ...... ..... 753
    Collaborative Management .... ...... ...... ...... ...... ..... ...... .. 754
    Medical Treatment .................................................... 754
    Nursing Management ..... ...... ...... ...... ..... ...... ....... ..... ... 754
    Neurological Examination........................................... 755
    Respiratory .............................................................. 755
    Hemodynamics ... ...... ...... ..... ...... ...... ...... ...... ...... ...... . 755
    Contents xvCHAPTER 34
    Amyotrophic Lateral Sclerosis...................................... 768
    Erin L. Springer
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 768
    Pathophysiology ... ...... ..... ....... ..... ...... ...... ..... ...... ....... 768
    Treatment and Management ....................................... 771
    Collaborative Teams .................................................. 773
    Palliative Care and End-of-Life Issues ..... ....... ...... ..... ..... 774
    Nursing Management ..... ...... ...... ...... ...... ..... ....... ..... ... 774
    Research ...... ...... ...... ...... ..... ...... ...... ..... ....... ....... ..... . 775
    Future Trends in Practice .. ..... ....... ...... ..... ...... ...... ...... . 775
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 775
    Index ..... ...... ...... ...... ..... ...... ....... ..... ...... ....... ...... ...... .... 777
    Pain .... ....... ...... ...... ...... ..... ...... ...... ...... ...... ....... ...... . 755
    Anxiety . ....... ...... ..... ...... ...... ...... ..... ...... ....... ...... ...... . 756
    Sleep ... ...... ..... ...... ...... ..... ....... ...... ..... ....... ...... ...... ... 756
    Mobility . ..... ....... ..... ...... ...... ....... ..... ...... ...... ....... ..... . 756
    Skin Integrity ...... ...... ...... ..... ...... ...... ....... ..... ...... ...... . 756
    Nutrition ................................................................. 757
    Transitions .. ..... ....... ...... ..... ...... ....... ..... ...... ...... ...... .. 757
    CHAPTER 33
    Myasthenia Gravis . ..... ....... ...... ..... ...... ....... ..... ...... ...... 758
    Wilma F . Koopman
    Introduction ..... ...... ...... ...... ..... ....... ..... ...... ...... ....... .. 758
    Neuromuscular Transmission and Pathophysiology ...... ... 758
    Nursing Management ..... ...... ...... ...... ..... ....... ...... ..... ... 766
    Summary ... ...... ...... ...... ..... ...... ...... ...... ...... ...... ...... ... 767
    xvi Contents
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