Chapter 66 - Describe the pre-, intra, and post-procedure

Adult Health 2

Learning Objective #1: Describe the pre-, intra-, and post-procedure nursing actions for a lumbar puncture, including any contraindications to the procedure.

Brunner and Suddarth Chapter 66 

Reading: 

· altered level of consciousness, pp. 1972-1979

· increased intracranial pressure, pp. 1979-1989

· intracranial surgery 1989-1996

Charts/Tables/Figures

· Figure 66-1, Posturing

· Table 66-1, Assessment of unconscious patient

· Figure 66-6, Neuro flow sheet

· Table 66-2, IICP with interventions

Learning Objective #1: Use the nursing process as a framework for care of the multiple needs of the patient with altered level of consciousness. 

a. What are the focused assessments for patients with altered LOC?

b. List the specific nursing interventions common to patients with altered LOC.

c. How do nurses compensate for the patient’s loss of protective reflexes?

d. Discuss dignity and privacy considerations for patients with altered LOC.

e. How can a nurse support the family of a patient with altered LOC?

Learning Objective #2: Differentiate between the early and late clinical manifestations of increased intracranial pressure.

a. Define intracranial pressure (ICP) and note the general causes and pathologic effects of increased ICP. 

b. Explain the Monro–Kellie doctrine and the compensatory mechanisms that affect and maintain ICP. 

c. Define autoregulation and explain the cerebral responses to increased ICP to maintain blood flow.

d. What are the early and late signs and symptoms of increased ICP?

e. What is Cushing’s triad?

f. Why is it important to detect subtle changes in patient assessment findings early?

g. Define and describe the herniation of brain tissues.

h. Define and describe projectile vomiting, Cheyne–Stokes breathing, and pupillary changes as they relate to ICP.

Learning Objective #3: Apply the nursing process as a framework for care of the patient with increased intracranial pressure.

a. What are the focused assessments for a patient with increased ICP?

b. Describe ICP monitoring, including ICP waveforms, positioning of the monitoring system, and importance of aseptic technique when manipulating the monitoring system.

c. What are the nursing diagnoses common to all patients with increase ICP?

d. List the collaborative problems, planning considerations, and goals common to patients with increased ICP.

e. What actions would increase ICP. Consider positioning and breathing patterns.

f. What are the interventions to prevent further increases in ICP? Consider fluid administration and I/Os, also. 

g. Discuss the treatment of SIADH and diabetes insipidus as it relates to a patient with ICP.

Learning Objective #4: List specific nursing interventions for patients undergoing intracranial surgery. Consider strategies to reduce cerebral edema and to prevent increasing ICP.