As humans, our brains are essential to our existence and control everything in our day-to-day activities. However, the brain is not infallible and can be susceptible to various neurological alterations that can significantly impact how people carry themselves (Bohmwald et al., 2018). This paper aims to explore the different types of neurological alterations and the handling of the alterations by care providers. Understanding these alterations is crucial as it can help develop effective prevention and treatment methods for those affected.
Increased Intracranial Pressure
Increased intracranial pressure (ICP) is a medical condition with abnormal pressure buildup inside the skull. This pressure can be caused by various factors, including brain swelling, bleeding, or fluid accumulation, leading to brain tissue compression and potential brain damage. The symptoms are headache, nausea, vomiting, changes in vision, confusion, seizures, and in severe cases, loss of consciousness or even death.
Medical Management
Some medical strategies to manage patients with increased ICP include medications, sedation, and ventilation. In terms of medications, it can be used to treat the underlying condition and reduce brain swelling, such as corticosteroids, diuretics, and antiepileptic drugs. These medications help to reduce the amount of fluid in the brain, decreasing the pressure inside the skull. In terms of sedation, patients with increased ICP may be given sedatives to reduce their level of consciousness, thereby reducing the metabolic demand of the brain and decreasing cerebral blood flow. This can help to reduce the pressure inside the skull. Patients with increased ICP may require mechanical ventilation to maintain adequate oxygenation and ventilation in using the ventilation strategy. Positive pressure ventilation can help to reduce the pressure inside the skull by reducing the amount of carbon dioxide in the blood.
Communication/Teaching
Some vital communication and teaching needs entail explaining the condition since the patients and their families need to understand the cause and symptoms of increased ICP and the risks and complications associated with the condition.
The other need for communication and teaching is exploring the treatment options whereby the patients and their families must be informed about the available treatment options and their risks, benefits and potential side effects. Additionally, there is monitoring and follow-up as they need to be educated on the importance of continuous intracranial pressure monitoring and the signs and symptoms of increased pressure that should be reported immediately.
Cultural Considerations
Cultural considerations are essential in caring for patients with increased intracranial pressure, as cultural beliefs and practices can affect how patients and their families perceive the condition and the treatment options. Here are some cultural considerations to remember when caring for patients with increased intracranial pressure: Language barriers as patients may speak a different language, which can affect communication and understanding of the condition and treatment options. Therefore there is a need for interpreter services when healthcare providers encounter such a situation.
Additionally, beliefs about an illness should be considered as some may influence how patients and their families perceive the cause of the increased intracranial pressure and the appropriate treatment options. Therefore, to address the situation, healthcare providers should be aware of these beliefs and work with patients and their families to address any misunderstandings and develop a culturally appropriate treatment plan.
Nursing interventions
The three nursing interventions include frequent neurological assessment to monitor the patient’s level of consciousness, vital signs, pupil response, and motor function, as early identification can help prevent further neurological damage. Additionally, elevating the head of the bed to 30 degrees or higher can help reduce intracranial pressure by promoting venous drainage from the brain and administering medications as ordered to reduce intracranial pressure.
Rationales
Frequent Neurological Assessments.
They are essential for the early identification of changes in neurological status, which can help prevent further neurological damage and guide the need for further interventions. Changes in the patient’s level of consciousness, vital signs, pupil response, and motor function can indicate increasing intracranial pressure or neurological deterioration, which may require immediate intervention (Pinto et al., 2021).
Elevating the Head of the Bed.
Elevating it to 30 degrees or higher can help promote venous drainage from the brain. This intervention can be done continuously or intermittently, depending on the patient’s condition and the healthcare provider’s orders.
Administering Medications as Ordered.
Osmotic diuretics, such as mannitol or hypertonic saline, are critical in reducing intracranial pressure by decreasing the amount of fluid in the brain. Pain medications may also be necessary to help manage the patient’s discomfort and prevent further increases in intracranial pressure due to pain.
Skull Fractures
A skull fracture results when one or more bones of the skull break. The skull is composed of several bones that protect the brain, and a fracture can occur from a direct blow to the head or a violent shaking of the head. Skull fractures can range from minor to severe, and depending on the severity and location of the fracture, it can lead to potential complications such as brain injury, bleeding, or infection. Treatment of skull fractures may involve observation, medication, surgery, or a combination of these interventions.
Medical Management
The medical management of patients with skull fractures depends on the severity and location of the fracture, as well as the presence of other associated injuries. The common medical management strategies for patients with skull fractures are observation, medication and surgery (Stein, 2019).
Patients with mild or moderate skull fractures may be observed for signs of complications, such as infections, through frequent neurological assessments and vital signs monitoring to detect changes in the patient’s condition. Furthermore, pain medications may be prescribed to help manage the patient’s discomfort.
Finally, surgical intervention may be necessary for patients with severe skull fractures. The type of surgery required will depend on the fracture’s location and severity. Surgical interventions may include a craniotomy, which involves removing part of the skull to relieve pressure on the brain, or a cranioplasty, which involves repairing or replacing the removed bone.
Communication/Teaching
Effective communication and patient education are essential components of care for patients with skull fractures and their families. The communication and teaching needs include explaining the diagnosis since the patient and family should be informed about the diagnosis, the potential complications, and the treatment plan. Also, education on the signs and symptoms to monitor and medication management on the correct dosage, frequency, and potential side effects.
Cultural Considerations
Healthcare providers should consider language barriers as some patients do not speak English; therefore, communication between the two parties may be a challenge; in this case, the care provider should seek translation services for effective communication. The other one is the patient’s beliefs about illness and healing, as different cultures may have distinct beliefs about the causes of illness and how to promote healing. Family involvement should also be considered; therefore, it is vital to understand the family’s role in the patient’s care and involve them in the treatment plan, if appropriate.
Nursing interventions
The interventions include assessing and monitoring neurologic status through monitoring the patient’s level of consciousness, vital signs, and neurological functions such as pupillary response, motor function, and sensory function. Additionally, pain management is provided through administering medications as prescribed, positioning the patient for comfort, and alternative therapies such as relaxation techniques or distraction. The other intervention is preventing complications through turning and repositioning the patient to prevent pressure ulcers, providing appropriate wound care to prevent infection and monitoring for signs and symptoms of increased intracranial pressure or bleeding.
Rationales
Assessing and Monitoring Neurologic Status.
The intervention is critical because it allows for early detection and intervention of patient condition changes. For example, changes in the patient’s level of consciousness or pupillary response may indicate increased intracranial pressure or other neurological problems.
Providing Pain Management.
It is essential since it promotes comfort, decreases anxiety, and can aid in the patient’s recovery. The interventions can also help prevent complications such as developing deep vein thrombosis or pneumonia, which may arise from immobility or shallow breathing due to pain.
Preventing Complications.
The intervention is essential because these patients are at increased risk for complications such as increased intracranial pressure, bleeding, or infection. The intervention can help minimize the risk of these adverse events and promote better patient outcomes.
Spinal Cord Injury
This is damage to any part of the spinal cord or the nerves at the end of the spinal canal. In most cases, it results in permanent changes in strength, sensation, and other bodily functions below the injury site. It results primarily from traumatic injury, such as a car accident or fall, but can also result from non-traumatic causes, such as infections or tumors. SCI can significantly impact an individual’s physical, emotional, and social well-being. Therefore, multidisciplinary care for optimal management and rehabilitation is required.
Medical Management
The medical management of patients with spinal cord injury involves several interventions, including immobilization which is the first step in preventing further damage to the spinal cord. This is typically done through cervical collars, backboards, or other immobilization devices. Medications are the other management intervention used to manage pain, muscle spasticity, and other complications of spinal cord injury. These may include nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, muscle relaxants, or antispasticity drugs (Karsy & Hawryluk, 2019). Surgery is the other option. It may stabilize the spine, remove bone fragments or foreign objects, or repair damaged tissue. It may be performed immediately after the injury or after a period of observation and stabilization.
Communication/Teaching
Effective communication and patient education are essential to caring for patients with spinal cord injury and their families. Some of the communication and teaching needs are that it allows for an explanation of the injury by giving information on the location of the injury, the potential for recovery, and the impact on daily functioning. The other one is that managing physical and emotional changes is essential since the patients may experience a range of physical and emotional changes.
Cultural Considerations
Cultural considerations play an important role in the care of patients with spinal cord injuries. Patients from different cultural backgrounds may have unique beliefs, values, and practices that influence their experiences and responses to spinal cord injury. Some critical cultural considerations for patients with spinal cord injury include Beliefs about disability, as some cultures may view disability as a personal failing or a punishment for wrongdoing. The other consideration is spiritual and religious beliefs, which influence the patient’s response to the disease.
Nursing interventions
Monitoring respiratory function as the patients may experience respiratory complications due to paralysis of the diaphragm and intercostal muscles. Additionally, preventing skin breakdown as the patients may have limited mobility and sensation, which can put them at risk for skin breakdown and pressure ulcers. The other intervention measure is emotional support, as the injury can be traumatic and life-changing for patients and their families.
Rationales
Monitoring Respiratory Functions
Complications due to paralysis of the diaphragm and intercostal muscles may affect the patient. Therefore, the nurses should assess the patient’s respiratory rate, depth, and effort for signs of respiratory distress.
Preventing Skin Breakdown
Limited mobility and sensation may jeopardize the patient, putting them at risk for skin breakdown and pressure ulcers (Bryce et al., 2021). Regular assessment o the skin for any signs of redness, swelling, or breakdown by nurses should be encouraged, and steps should be taken to prevent pressure ulcers from forming.
Providing Emotional Support
Spinal cord injury can be traumatic and life-changing for patients and their families. It is, therefore, crucial for nurses to provide emotional support to help the patient and family cope with the diagnosis and adjust to their new circumstances.
Cerebrovascular Disease
Cerebrovascular disease is a medical condition that affects the blood vessels supplying oxygen and nutrients to the brain. The disease can result in brain damage due to a condition that leads to reduced blood flow to the brain. The most common types of cerebrovascular disease include ischemic stroke, hemorrhagic stroke, and transient ischemic attack (TIA). They can directly affect someone’s physical, emotional and cognitive functioning.
Medical Management
The medical management of patients with cerebrovascular disease depends on the specific type and severity of the condition. In the case of ischemic stroke, where blood clots block blood flow into the brain, clot-busting medications such as tissue plasminogen activator (tPA) or mechanical thrombectomy procedures could be employed to restore blood flow to the affected areas.
Hemorrhagic stroke, on the other hand, requires surgical interventions to repair the ruptured blood vessel or to remove a blood clot or hematoma that is causing pressure on the brain to prevent further damage to the brain by stopping bleeding (Caprio & Sorond, 2019).
Finally, for a Transient ischemic attack (TIA), identifying and addressing the underlying risk factors for stroke, such as high cholesterol, diabetes, and high blood pressure, is advisable as the disease is a warning sign of a more cerebrovascular severe condition.
Communication/Teaching
One of the needs for effective communication and teaching is for the patient and the family members to understand the diagnosis and treatment of the disease. There is a need to understand the condition, the underlying causes, and the available treatment options, including the benefits and risks of each option.
There is also a need to understand the prevention measures that could be employed for cerebrovascular events, such as information on maintaining a healthy diet, engaging in regular exercise, controlling blood pressure and cholesterol, and avoiding tobacco use.
Finally, there is a need for the patient and the family members to recognize the symptoms of the disease since prompt recognition and treatment can help minimize the damage caused by these events and improve the chances of recovery.
Cultural Considerations
Some of the cultural considerations that a care provider should consider while handling such patients are the patient’s beliefs about the illness, as some cultures may attribute the illness to spiritual or supernatural causes. In contrast, others may emphasize the importance of herbal remedies or traditional healing practices.
The other consideration is the communication styles, as patients and families from different cultural backgrounds may have different communication styles and preferences. Therefore, it is prudent to remember that some cultures may place a greater emphasis on indirect communication. In contrast, others may prefer more direct and explicit communication when dealing with these patients.
Nursing interventions
Monitoring the vital signs and neurological status by observing the patient’s level of consciousness, motor function, speech, and sensory perception for any worsening neurological status. Th other intervention is administering medications such as anticoagulants, antiplatelet agents, thrombolytics, or antihypertensives as prescribed. The other intervention is educating and supporting the patient and the family on managing the risk factors associated with cerebrovascular disease.
Rationales
Monitoring Vital Signs and Neurological Status.
It is critical for the early detection and intervention of complications such as stroke, hypertension, or intracranial hemorrhage. Changes in vital signs or neurological status can indicate a worsening patient’s condition and prompt the healthcare team to implement appropriate interventions.
Administration of Medications.
Medications such as anticoagulants, antiplatelet agents, thrombolytics, or antihypertensives are commonly prescribed for patients with the cerebrovascular disease to prevent or manage complications such as blood clots, stroke, or hypertension. Therefore, administering these medications as prescribed is essential for preventing further damage and improving outcomes.
Education and Support.
Patient and family education on managing risk factors for cerebrovascular disease, adopting healthy lifestyle behaviors, and recognizing warning signs of complications can help prevent future events and promote recovery. This, coupled with emotional support, can help the patient and family manage the disease and adjust to lifestyle changes.
Status Epilepticus
This medical emergency is characterized by a prolonged seizure or a series of seizures lasting longer than five minutes without full recovery of consciousness in between. It is a life-threatening condition that requires prompt recognition, intervention, and management to prevent further neurological damage and potential mortality.
Medical Management
Administration of benzodiazepines, such as lorazepam, which act as GABA agonists and have anticonvulsant effects, is the first step of treatment. If the seizures persist despite benzodiazepine treatment, a second-line agent, such as phenytoin, fosphenytoin, or valproic acid, may be given to achieve seizure control. These drugs work by blocking voltage-gated sodium channels or enhancing GABAergic transmission. If the seizures continue despite second-line therapy, the patient may require general anaesthesia with propofol, midazolam, or pentobarbital medications.
Communication/Teaching
Patients and families must be educated about medication to control seizures and manage status epilepticus. They should be taught about these medications’ dosages, administration, and possible side effects. They should also be educated about seizure safety measures to avoid injury during seizures. This includes avoiding hazardous activities such as swimming or climbing ladders, ensuring the patient wears a medical alert bracelet and protecting the patient’s head during a seizure.
Cultural Considerations
In some cultures, epilepsy is stigmatized, and people may associate it with possession by evil spirits or witchcraft. These beliefs can lead to delayed or inadequate treatment of seizures, reluctance to seek medical help and social isolation for patients and their families. It is, therefore, important for healthcare providers to understand the patient’s cultural beliefs and values regarding the disease. Providers should approach patients and families respectfully and sensitively and avoid making assumptions based on cultural stereotypes. By recognizing and addressing cultural considerations, healthcare providers can promote trust, collaboration, and effective management of status epilepticus.
Nursing interventions
Administering antiepileptic medications such as benzodiazepines, phenytoin, or valproate. Also, monitoring vital signs and neurological status is needed. Finally, providing supportive care is critical.
Rationales
Administering Antipileptic Medications.
Antiepileptic medications such as benzodiazepines, phenytoin, and fosphenytoin are commonly used to manage status epilepticus. These medications work by suppressing excessive electrical activity in the brain, which is the underlying cause of seizures.
Monitoring Vital Signs and Neurological Status.
Frequent monitoring of vital signs such as blood pressure, heart rate, respiratory rate, and oxygen saturation is essential to detect any signs of deterioration early. Additionally, monitoring the patient’s neurologic status, such as level of consciousness, pupillary response, and motor function, can help identify any changes in the patient’s condition and adjust treatment as needed.
Supportive Care.
Supportive care entails oxygen therapy and mechanical ventilation. Oxygen therapy is essential for maintaining adequate oxygenation and preventing hypoxia (Treiman, 2020). Mechanical ventilation, on the other hand, may be required if the patient cannot breathe on their own.
Conclusion
Managing neurological conditions such as increased intracranial pressure, skull fractures, spinal cord injury, cerebrovascular disease, and status epilepticus requires a collaborative effort from the healthcare team, including nurses. The nursing interventions discussed in this paper, such as monitoring vital signs, providing education and support to patients and families, and implementing safety measures, aim to optimize patient outcomes and improve their quality of life. Cultural considerations must also be considered to ensure that care is delivered culturally, sensitively, and appropriately. As healthcare professionals, staying current with current evidence-based practices and guidelines is essential to provide the best possible care for patients with neurological conditions.
References
Bohmwald, K., Gálvez, N. M., Ríos, M., & Kalergis, A. M. (2018). Neurologic alterations due to respiratory virus infections. Frontiers in cellular neuroscience, 12, 386. https://www.frontiersin.org/articles/10.3389/fncel.2018.00386/full
Pinto, V. L., Tadi, P., & Adeyinka, A. (2021). Increased intracranial pressure. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482119/
Stein, S. C. (2019). The evolution of modern treatment for depressed skull fractures. World neurosurgery, pp. 121, 186-192. https://www.sciencedirect.com/science/article/abs/pii/S1878875018323416
Karsy, M., & Hawryluk, G. (2019). Modern medical management of spinal cord injury. Current Neurology and Neuroscience Reports, 19, 1-7. https://link.springer.com/article/10.1007/s11910-019-0984-1
Bryce, T. N., Huang, V., & Escalon, M. X. (2021). Spinal cord injury. In Braddom’s Physical Medicine and Rehabilitation (pp. 1049–1100). Elsevier. https://www.sciencedirect.com/science/article/pii/B9780323625395000497
Caprio, F. Z., & Sorond, F. A. (2019). Cerebrovascular disease: primary and secondary stroke prevention. Medical Clinics, 103(2), 295-308. https://www.medical.theclinics.com/article/S0025-7125(18)30123-8/fulltext
Treiman, D. M. (2020). Status epilepticus. In The medical treatment of epilepsy (pp. 183-194). CRC Press. https://www.taylorfrancis.com/chapters/edit/10.1201/9781003066736-20/status-epilepticus-david-treiman
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