The Clinical Practice of Neurological and Neurosurgical Nursing

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