You are preparing to work as a nurse in the neurology unit. The preceptor informs you to be prepared to discuss the following topics as they are commonly seen on the unit. In order to prepare, choose one of the following topics of interest as your initial discussion posting. Use this course’s resources and one evidenced-based article to explore the topic of your choice.

1. How do you assess a client when the nurse suspects onset of CVA?
2. Provide discharge information for a client with mild TBI.
3. Discuss surgical management of brain tumors.
4. Describe postoperative complications of a craniotomy.

When responding to the initial posting, provide an evidence based article to support your response. Respond to two other topics different than your initial topic.

Due dates for your initial and response posts can be found by checking the Course Syllabus and Course Calendar.

RESPONSE POST 1

Assessment when the nurse suspects onset of CVA.

The nurse needs to act fast to determine the onset of symptoms to provide the essential need for treatment of the type of CVA.

CVA is defined as a cerebrovascular accident also known as stroke. The first responder of a CVA performs an initial neurologic assessment using a well-established stroke assessment tool. Nurses start by performing a complete neurologic assessment to determine the type of treatment the patient needs while prioritizing ABCs (airway, breathing, and circulation). NIHSS (National Institutes of Health Stroke Scale) is the most common and reliable tool nurses use as soon as possible that patient arrives in the ED to complete the assessment to determine the patient’s eligibility for IV fibrinolytic. (Powers et al., 2018). The major area to assess is the client’s level of consciousness (LOC). GCS (Glasgow Coma Scale) or NIHSS is used to constantly monitor changes in LOC throughout the patient’s stay in the acute care unit. If a sudden decrease in LOC observes, promptly determine if it is hypoglycemia or hypoxia as these conditions can mimic an emergent neurologic disorder.

The patient’s ability to effectively cough should be performed per facility policy as some agencies allow nurses to use one of the varieties of screening tools to assess for the existence of dysphagia (Miller et al.,2017).

The five most common symptoms of stroke include:

1. Sudden confusion: trouble speaking or understanding.
2. Trouble seeing in one or both eyes.
3. Sudden severe headache with unknown cause.
4. Sudden loss of balance or coordination, dizziness.
5. Sudden numbness or weakness of the face, arm, or leg.

References:

D.,Workman, L.M., Rebar, C.R., & Heimgartner, N.M. (2021). Medical-surgicalnursing:). Elsevier.

Kristine K Miller,Rebecca E Porter, Erin DeBaun-Sprague, Marieke Van Puymbroeck, Arlene ASchmid

Topicsin stroke rehabilitation 24 (2), 142-148, 2017

RESPONSE POST 2

A craniotomy is a surgical procedure to the brain via an opening of the skull. A craniotomy is performed for various reasons, such as removing a brain tumor or hematoma. (Boling & Pravikoff, 2018).

Describe postoperative complications of a craniotomy. There are two stages of postoperative complications of a craniotomy: early and late. In the early stage, complications include increased intracranial pressure, hematomas, hypoxia, subdural hematoma, epidural hematoma, hypovolemic shock, subarachnoid hemorrhage, and hydrocephalus, respiratory complications, atelectasis, pneumonia, and neurogenic pulmonary edema. In the late stage, seizure, wound infection, meningitis, dehydration, hyponatremia, hypernatremia, fluid and electrolyte imbalances, cerebrospinal fluid leak, and cerebral edema. (Ignatavicius et al., 2021). Other postoperative complications of a craniotomy include headache, paralysis, swallowing impairment, balance impairment, and behavioral and cognitive changes. (Boling & Pravikoff, 2018).

References: Boling B; Pravikoff D; (2018). Craniotomy; Nervous System Diseases; Postoperative Complication Database: Nursing Reference Center Plus.

Ignatavicius, D.D., Workman, L.M., Rebar, C.R., & Heimgartner, N.M. (2021). Medical-surgical nursing: Concepts for interprofessional collaborative care (10th ed.). Elsevier.

2. Provide discharge information for a client with mild TBI.

Those with mild TBI are usually sent home from the emergency department with instructions for home-based observation and primary health care provider follow-up. In some cases, the patient is hospitalized for 23-hour observation by staff. Cerebral perfusion is not typically affected by a mild TBI.

Patient and Family Education: Preparing for Self-Management

Mild Brain InjuryFor a headache, give acetaminophen every 4 hours as needed.Avoid giving the person sedatives, sleeping pills, or alcoholic beverages for at least 24 hours after TBI unless the primary health care provider instructs otherwise.Do not allow the person to engage in strenuous activity for at least 48 hours.Teach the caregiver to be aware that balance disturbances cause safety concerns and that he or she should provide for monitored or assisted movement.If any of these symptoms occur, take the person back to the emergency department or call 911 immediately:SeizureSevere, or worsening, headachePersistent or severe nausea or vomitingBlurred visionClear drainage from the ear or noseIncreasing weaknessSlurred speechProgressive sleepinessUnequal pupil sizeKeep follow-up appointments with the primary health care provider.

The patient with a mild brain injury recovers at home after discharge from the emergency department (ED) or hospital (see the Patient and Family Education: Preparing for Self-Management: Mild Brain Injury box).

Those with mild TBI are usually sent home from the emergency department with instructions for home-based observation and primary health care provider follow-up. In some cases, the patient is hospitalized for 23-hour observation by staff. Cerebral perfusion is not typically affected by a mild TBI.

Reference

Ignatavicius, D.D., Workman, L.M., Rebar, C.R., & Heimgartner, N.M. (2021). Medical-surgical nursing: Concepts for interprofessional collaborative care (10th ed.). Elsevier.