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MedicalMedical--Surgical Surgical Nursing CareNursing Care

Second EditionSecond Edition

Karen Burke

Medical-Surgical Nursing Care, 2eKaren Burke, Priscilla LeMone, and Elaine Mohn-Brown

Copyright ©2007 by Pearson Education, Inc.

Chapter 38Chapter 38Caring for Clients withCaring for Clients withIntracranial DisordersIntracranial Disorders

Priscilla LeMoneElaine Mohn-Brown

Intracranial DisordersIntracranial Disorders

Increased intracranial pressureIncreased intracranial pressureHead injuriesHead injuriesBrain tumorsBrain tumorsCerebrovascular accidentsCerebrovascular accidents



Cerebrovascular accidentsCerebrovascular accidentsSeizuresSeizuresIntracranial infectionsIntracranial infections

Increased Intracranial PressureIncreased Intracranial Pressure

Components of craniumComponents of craniumBrainBrainBlood in cerebral vesselsBlood in cerebral vesselsCerebrospinal fluidCerebrospinal fluid



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Increased ICPIncreased ICP

Common causesCommon causesTraumatic brain injuryTraumatic brain injuryCerebral edemaCerebral edemaBrain tumorBrain tumor



Cerebral hematomaCerebral hematomaCerebrovascular accidentCerebrovascular accidentBrain infectionsBrain infections


ManifestationsManifestationsChange in LOCChange in LOC

Earliest signEarliest signCan progress to comaCan progress to coma

P ilP il



PupilsPupilsSluggish to fixed and dilatedSluggish to fixed and dilated

VisionVisionBlurryBlurryDiplopiaDiplopia


Manifestations Manifestations Motor functioningMotor functioning

HemiparesisHemiparesisHemiplegiaHemiplegiaP t iP t i



PosturingPosturingDecorticateDecorticateDecerebrateDecerebrate

Difficulty speakingDifficulty speaking

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Manifestations Manifestations Altered vital signsAltered vital signs

Cushing’s triad (Cushing’s response)Cushing’s triad (Cushing’s response)Widening pulse pressureWidening pulse pressureSlow bounding bradycardic pulseSlow bounding bradycardic pulse



Slow bounding bradycardic pulseSlow bounding bradycardic pulseAlteration in respiratory patternAlteration in respiratory pattern

Change in body temperatureChange in body temperatureHeadacheHeadacheProjectile vomitingProjectile vomiting


Fatal Complications Fatal Complications Brain herniationBrain herniation

Shifting of brainShifting of brainCompression of brain/brainstemCompression of brain/brainstem

B i d hB i d h



Brain deathBrain deathCessation of cerebral blood flow/vital functionsCessation of cerebral blood flow/vital functions


Assessing for IICPAssessing for IICPCerebral monitoringCerebral monitoring

Determining the causeDetermining the causeCT scan or MRICT scan or MRI



Cerebral angiographyCerebral angiographyLumbar punctureLumbar punctureDiagnostics: Altered LOCDiagnostics: Altered LOC

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Increased ICP Increased ICP –– Lab TestsLab Tests

Blood glucoseBlood glucoseArterial blood gasesArterial blood gasesToxicology screeningToxicology screeningSerum creatinine/BUNSerum creatinine/BUN



Serum creatinine/BUNSerum creatinine/BUNLiver functionLiver functionComplete blood countComplete blood count

Increased ICP Increased ICP -- MedicationsMedications

Osmotic diuretics/loop diureticsOsmotic diuretics/loop diureticsMonitor client for fluid and electrolyte imbalancesMonitor client for fluid and electrolyte imbalancesMonitor client for dehydrationMonitor client for dehydration

CorticosteroidsCorticosteroids



Assess for GI irritation/ulcersAssess for GI irritation/ulcersAdminister H2 blockers and/or antacids concurrentlyAdminister H2 blockers and/or antacids concurrently

Increased ICP Increased ICP -- MedicationsMedications

AnticonvulsantsAnticonvulsantsMonitor for signs of seizure activityMonitor for signs of seizure activityDocument cessation of signs of seizure activityDocument cessation of signs of seizure activity

Barbiturate therapy for severe TBI, IICPBarbiturate therapy for severe TBI, IICP



py ,py ,Artificial coma requiring ICU monitoringArtificial coma requiring ICU monitoring

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Increased ICP Increased ICP –– Nursing CareNursing Care

AssessmentAssessmentLOC/vital signsLOC/vital signsAltered cognitive functioningAltered cognitive functioningHeadacheHeadache



VomitingVomiting


AssessmentAssessmentSensory alterations: vision/hearingSensory alterations: vision/hearingNumbness or tingling in extremitiesNumbness or tingling in extremitiesHistory; medication/alcohol useHistory; medication/alcohol use



Reflexes; posturingReflexes; posturing


Nursing DiagnosesNursing DiagnosesIneffective Tissue PerfusionIneffective Tissue PerfusionIneffective Breathing PatternIneffective Breathing PatternRisk for Imbalanced NutritionRisk for Imbalanced Nutrition



Risk for Impaired Skin IntegrityRisk for Impaired Skin IntegrityImpaired Physical MobilityImpaired Physical MobilityRisk for InfectionRisk for Infection

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EvaluationEvaluationLOCLOCGrips, gaitGrips, gaitAbsence of deficitsAbsence of deficits




Interdisciplinary CareInterdisciplinary CarePharmacotherapyPharmacotherapyRespiratory supportRespiratory supportNutritional supportNutritional support



SurgerySurgeryDischarge planningDischarge planning

Skull FracturesSkull Fractures

LinearLinearSimple clean break in skullSimple clean break in skull

ComminutedComminutedSkull in fragmented piecesSkull in fragmented pieces



g pg p

DepressedDepressedSkull bone fragments pushed into brainSkull bone fragments pushed into brain

BasilarBasilarAt base of skull, may extend to temporal boneAt base of skull, may extend to temporal bone

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Skull FracturesSkull Fractures

Leakage of blood or CSF from nose/earsLeakage of blood or CSF from nose/earsBattle’s signBattle’s sign“Raccoon” eyes“Raccoon” eyes



Open Head InjuryOpen Head Injury

Opening through skull and duraOpening through skull and duraSevere blunt traumaSevere blunt traumaPenetrating injuriesPenetrating injuries

Brain exposed to external environmentBrain exposed to external environment



ppRisk of meningitis; brain damageRisk of meningitis; brain damage

Closed Head InjuryClosed Head Injury

CoupCoup––contrecoup phenomenoncontrecoup phenomenonBruising of brain at two pointsBruising of brain at two pointsBrain damageBrain damage

Focal symptoms related to area of brain injuredFocal symptoms related to area of brain injured



Focal symptoms related to area of brain injuredFocal symptoms related to area of brain injuredPossible increased ICPPossible increased ICP

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Concussion r/t shaking of brainConcussion r/t shaking of brainImmediate loss of consciousness < 5 minImmediate loss of consciousness < 5 minDrowsiness, confusionDrowsiness, confusionHeadache, blurred/double visionHeadache, blurred/double vision




Contusion: bruising/swelling of brain tissueContusion: bruising/swelling of brain tissueInitial loss of consciousnessInitial loss of consciousnessMotionless, pale, clammyMotionless, pale, clammyHypotensive weak pulse shallow respirationsHypotensive weak pulse shallow respirations



Hypotensive, weak pulse, shallow respirationsHypotensive, weak pulse, shallow respirationsAltered motor responseAltered motor response

Epidural HematomaEpidural Hematoma

Arterial bleed between skull and duraArterial bleed between skull and duraCan be caused by skull fracture/contusionCan be caused by skull fracture/contusionBrief loss of consciousness short period of alertness Brief loss of consciousness short period of alertness rapid progression to comarapid progression to coma



rapid progression to comarapid progression to comaPosturing, pupil changes, seizures; IICPPosturing, pupil changes, seizures; IICP

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Subdural HematomaSubdural Hematoma

Venous bleed between dura and subarachnoid layerVenous bleed between dura and subarachnoid layerAcuteAcute

Rapid progression to coma, pupil dilation, contralateral Rapid progression to coma, pupil dilation, contralateral hemiparesishemiparesis



SubacuteSubacuteSymptoms 48 hrs to 2 wks; alert period then slow Symptoms 48 hrs to 2 wks; alert period then slow progression to comaprogression to coma

Subdural HematomaSubdural Hematoma

ChronicChronicSymptoms weeks to months laterSymptoms weeks to months laterImpaired thinkingImpaired thinkingConfusionConfusion



DrowsinessDrowsinessPupil changesPupil changesMotor deficitsMotor deficits

Intracerebral HematomaIntracerebral Hematoma

Bleeding into brain tissueBleeding into brain tissueDecreasing LOCDecreasing LOCPupil changesPupil changesMotor deficitsMotor deficits



Motor deficitsMotor deficits

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Head Injuries Head Injuries –– Diagnostic TestsDiagnostic Tests

Skull series: xSkull series: x--rayrayCT scanCT scan



IICP in Head InjuriesIICP in Head Injuries

IICP results from:IICP results from:Direct trauma to the brain tissueDirect trauma to the brain tissueCerebral edemaCerebral edemaHematomasHematomas



Head Injuries Head Injuries –– Nursing CareNursing Care

Discharge teaching topicsDischarge teaching topicsSymptoms of IICPSymptoms of IICPFrequent monitoring at homeFrequent monitoring at homePostconcussion syndromePostconcussion syndrome



Necessity for rehabilitationNecessity for rehabilitationNecessity for longNecessity for long--term careterm care

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Brain TumorsBrain Tumors

Abnormal growths within the craniumAbnormal growths within the craniumBenign or malignantBenign or malignantPrimaryPrimary

Arising from brain cells/structuresArising from brain cells/structures



SecondarySecondaryMetastasis from other primary site of cancerMetastasis from other primary site of cancer

Brain TumorBrain Tumor

GliomaGliomaAstrocytomaAstrocytomaGlioblastomaGlioblastoma

MeningiomaMeningioma



ggAcoustic neuromaAcoustic neuromaMetastatic brain tumorsMetastatic brain tumors

BOX 38BOX 38--55 Manifestations of Brain Tumors.Manifestations of Brain Tumors.



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Brain Tumors Brain Tumors –– Diagnostic TestsDiagnostic Tests

CT scan or MRICT scan or MRIEEGEEGCerebral angiogramCerebral angiogramStereotactic needle biopsyStereotactic needle biopsy



Stereotactic needle biopsyStereotactic needle biopsy

Brain Tumors Brain Tumors -- MedicationsMedications

ChemotherapyChemotherapyOmmaya reservoirOmmaya reservoirWafers in tumor cavityWafers in tumor cavity

Assess for bone marrow suppressionAssess for bone marrow suppression



Assess for bone marrow suppressionAssess for bone marrow suppression

Brain Tumor Brain Tumor –– Nursing CareNursing Care

AssessmentAssessmentCognitive changesCognitive changesPainPainSensory changes: vision, hearingSensory changes: vision, hearing



ParesthesiasParesthesiasVital signs, LOCVital signs, LOCStrength, movementStrength, movementGait, coordinationGait, coordination

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DiagnosesDiagnosesAnxietyAnxietyDisturbed Body ImageDisturbed Body Image




EvaluationEvaluationEffectiveness of interventions: postop craniotomyEffectiveness of interventions: postop craniotomy

Absence of neurologic deficitsAbsence of neurologic deficitsNo signs of infectionNo signs of infection

K l d f llK l d f ll hh



Knowledge re: followKnowledge re: follow--up care at homeup care at home

Cerebrovascular AccidentCerebrovascular Accident

Terms preferred by National Stroke Association:Terms preferred by National Stroke Association:Stroke or brain attackStroke or brain attack

Affects 700,000 people in the U.S. per yearAffects 700,000 people in the U.S. per yearThird leading cause of death in the U.S.Third leading cause of death in the U.S.



ggMost frequent cause of chronic neurologic disabilityMost frequent cause of chronic neurologic disability

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Stroke/Brain AttackStroke/Brain Attack

Risk FactorsRisk FactorsRace: African AmericanRace: African AmericanHypertensionHypertensionObesityObesity



Diabetes mellitusDiabetes mellitusAtrial fibrillationAtrial fibrillationAtherosclerosisAtherosclerosis


Other Risk Factors: Lifestyle ChoicesOther Risk Factors: Lifestyle ChoicesSmokingSmokingHigh cholesterolHigh cholesterolExcessive use of alcohol, cocaine, and heroinExcessive use of alcohol, cocaine, and heroin



Oral contraceptive use by womenOral contraceptive use by women

Transient Ischemic Attack (TIA)Transient Ischemic Attack (TIA)

Temporary reduction in cerebral blood flowTemporary reduction in cerebral blood flowReversible neurologic deficitsReversible neurologic deficits

Several minutes to 24 hoursSeveral minutes to 24 hours

Warning sign of an impending or future strokeWarning sign of an impending or future stroke



Warning sign of an impending or future strokeWarning sign of an impending or future strokeCarotid endarterectomyCarotid endarterectomy

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TIATIA

ManifestationsManifestationsDizzinessDizzinessLoss of vision in one eyeLoss of vision in one eyeNumbness, weaknessNumbness, weakness



One arm, hand, legOne arm, hand, legAphasiaAphasia

Stroke Stroke –– Diagnostic TestsDiagnostic Tests

CT scan/MRICT scan/MRICerebral arteriogramCerebral arteriogramDoppler ultrasoundDoppler ultrasoundPET scanPET scan



PET scanPET scanLumbar punctureLumbar puncture


Sudden loss of neurologic function due to decreased Sudden loss of neurologic function due to decreased blood supply to a local area of the brainblood supply to a local area of the brainIschemicIschemic

ThrombusThrombus



EmboliEmboli

HemorrhagicHemorrhagic

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Right Hemisphere ProblemsRight Hemisphere Problems

ManifestationsManifestationsLeft hemiplegia; visual field deficitsLeft hemiplegia; visual field deficitsSpatialSpatial--perceptual deficitsperceptual deficitsPoor judgment; easily distractedPoor judgment; easily distracted



ImpulsiveImpulsive

Left Hemisphere Problems Left Hemisphere Problems

ManifestationsManifestationsRight hemiplegia; visual field deficitsRight hemiplegia; visual field deficitsAphasiaAphasiaImpaired intellectImpaired intellect



Slow/cautious; high frustrationSlow/cautious; high frustration


Motor DeficitsMotor DeficitsContralateralContralateralHemiparesisHemiparesisHemiplegiaHemiplegia



Flaccidity moving to spacticityFlaccidity moving to spacticity

Problems associated with immobilityProblems associated with immobility

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Speech DeficitsSpeech DeficitsExpressive aphasiaExpressive aphasiaReceptive aphasiaReceptive aphasiaGlobal aphasiaGlobal aphasia



DysarthriaDysarthria


Visual DeficitsVisual DeficitsDue to parietal and/or temporal lobe damageDue to parietal and/or temporal lobe damageDiplopiaDiplopiaHomonymous hemianopiaHomonymous hemianopia




SensorySensory--Perceptual DeficitsPerceptual DeficitsAgnosiaAgnosiaApraxiaApraxiaUnilateral neglectUnilateral neglect



Alterations in perceptionAlterations in perceptionTemperature; vibration; pain; pressure; proprioceptionTemperature; vibration; pain; pressure; proprioception

Increased risk for injuryIncreased risk for injury

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Cognitive/Behavioral ChangesCognitive/Behavioral ChangesMemory loss; decreased attention spanMemory loss; decreased attention spanPoor judgment; inability to solve problemsPoor judgment; inability to solve problemsEmotionally labile/loss of selfEmotionally labile/loss of self--controlcontrol



Depression; stress manifesting as angerDepression; stress manifesting as anger


Urinary/Gastrointestinal ProblemsUrinary/Gastrointestinal ProblemsUrinary frequency, urgency, incontinenceUrinary frequency, urgency, incontinenceConstipationConstipationDysphagiaDysphagia



Choking, drooling, aspirationChoking, drooling, aspiration

Stroke/Brain Attack Stroke/Brain Attack --MedicationsMedications

Preventive post TIAPreventive post TIAAntiplateletsAntiplatelets

ThrombolyticsThrombolyticsOnly in ischemic strokeOnly in ischemic stroke



yyTime frame criticalTime frame critical

Major nursing responsibilityMajor nursing responsibilityAssess for bleedingAssess for bleeding

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Stroke/Brain Attack Stroke/Brain Attack --MedicationsMedications

Anticoagulants (thrombotic stroke)Anticoagulants (thrombotic stroke)Assess for bleedingAssess for bleeding

AntihypertensivesAntihypertensivesAssess BPAssess BP



Osmotic diuretics for IICPOsmotic diuretics for IICPMonitor I&OMonitor I&O

AnticonvulsantsAnticonvulsantsWatch for seizure activityWatch for seizure activity

Stroke/Brain Attack Stroke/Brain Attack –– Nursing Nursing CareCare

AssessmentAssessmentCognitive changesCognitive changesSensory changesSensory changesChange in motor functionChange in motor function



HeadacheHeadache


AssessmentAssessmentHistory of:History of:

HTN, TIA, diabetes, cardiac dysrhythmiasHTN, TIA, diabetes, cardiac dysrhythmiasAlcohol abuse, smokingAlcohol abuse, smokingU f ti l tU f ti l t



Use of anticoagulantsUse of anticoagulants

Vital signsVital signsFocused neurologic examFocused neurologic exam

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DiagnosesDiagnosesIneffective Tissue Perfusion: CerebralIneffective Tissue Perfusion: CerebralRisk for Ineffective Airway ClearanceRisk for Ineffective Airway ClearanceImpaired Physical MobilityImpaired Physical Mobility



Impaired Verbal CommunicationImpaired Verbal Communication


DiagnosesDiagnosesDisturbed Sensory PerceptionDisturbed Sensory PerceptionImpaired Urinary Elimination/ConstipationImpaired Urinary Elimination/ConstipationImpaired SwallowingImpaired Swallowing



SelfSelf--Care DeficitCare Deficit


EvaluationEvaluationAirwayAirwaySelfSelf--carecareCommunicationCommunication



CopingCopingKnowledge of medicationsKnowledge of medications

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Seizure DisordersSeizure Disorders

Abnormal electrical activity in brain cellsAbnormal electrical activity in brain cellsInvolving all or part of brainInvolving all or part of brainCan be isolated eventCan be isolated eventChronic pattern epilepsyChronic pattern epilepsy



Chronic pattern epilepsyChronic pattern epilepsy

Seizures Seizures

CausesCausesMost unknownMost unknownIn adults:In adults:

Brain infectionBrain infection



StrokeStrokeBrain tumorBrain tumorHypoglycemia, high fever, hypoxiaHypoglycemia, high fever, hypoxia

Seizures Seizures –– Diagnostic TestsDiagnostic Tests

RadiologicRadiologicSkull xSkull x--rays; CT; MRIrays; CT; MRI

EEGEEGCBC, electrolytes, BUN, glucoseCBC, electrolytes, BUN, glucose



CBC, electrolytes, BUN, glucoseCBC, electrolytes, BUN, glucoseTesting for syphilisTesting for syphilis

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SeizuresSeizures

SimpleSimpleJacksonian marchJacksonian marchFlashing lights; tingling sensation; hallucinationsFlashing lights; tingling sensation; hallucinations2020––30 secs; no loss of consciousness30 secs; no loss of consciousness



ComplexComplexAutomatismsAutomatismsAltered LOCAltered LOCAuraAura

SeizuresSeizures

AbsenceAbsenceBrief change in consciousnessBrief change in consciousnessMotor activity haltsMotor activity haltsTonicTonic--clonicclonic



AuraAuraTonic contractionsTonic contractions——rigidityrigidityClonic contractionsClonic contractions——muscle jerking; eyes roll; frothing at mouth; muscle jerking; eyes roll; frothing at mouth; incontinenceincontinencePostictal periodPostictal period

Status EpilepticusStatus Epilepticus

LifeLife--threatening emergencythreatening emergencyContinuous tonicContinuous tonic--clonic activity and loss of clonic activity and loss of consciousnessconsciousnessCan deprive brain of oxygen/glucoseCan deprive brain of oxygen/glucose



Can deprive brain of oxygen/glucoseCan deprive brain of oxygen/glucoseCauses physical exhaustion/respiratory distressCauses physical exhaustion/respiratory distressCan cause permanent brain damageCan cause permanent brain damage

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Seizures Seizures -- MedicationsMedications

Halting status epilepticusHalting status epilepticusValiumValiumAtivanAtivanPhenobarbitalPhenobarbital



LongLong--term seizure controlterm seizure controlAnticonvulsantsAnticonvulsants

Assess for effectiveness: monitor drug levelsAssess for effectiveness: monitor drug levels

Seizures Seizures –– Nursing CareNursing Care

AssessmentAssessmentSeizure experienceSeizure experience

Onset, duration, aura, postictal periodOnset, duration, aura, postictal period

History of intracranial disordersHistory of intracranial disorders



ObservationObservationPhysical symptoms before, during, and after seizurePhysical symptoms before, during, and after seizure

Seizures Seizures –– Nursing CareNursing Care

DiagnosesDiagnosesRisk for Ineffective Airway ClearanceRisk for Ineffective Airway ClearanceRisk for InjuryRisk for InjuryAnxietyAnxiety



EvaluationEvaluationSeizure controlSeizure controlSafetySafetyKnowledge of medicationsKnowledge of medications

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MeningitisMeningitis

Inflammation of the meninges: brain and spinal cordInflammation of the meninges: brain and spinal cordBacterialBacterialViralViral

Less severeLess severe



Shorter courseShorter course

MeningitisMeningitisPositive Brudzinski’s signPositive Brudzinski’s signPositive Kernig’s signPositive Kernig’s signHeadache, photophobiaHeadache, photophobiaHigh fever, nausea, vomitingHigh fever, nausea, vomiting



g gg gRestlessness, confusion, seizuresRestlessness, confusion, seizuresAltered LOCAltered LOCSigns of IICPSigns of IICPAltered vital signsAltered vital signs

EncephalitisEncephalitis

Acute inflammation of white and gray matter: brain Acute inflammation of white and gray matter: brain and spinal cordand spinal cordDamage of nerve cellsDamage of nerve cells

Cerebral edema, necrosis, localized hemorrhageCerebral edema, necrosis, localized hemorrhage



, , g, , g

Manifestations similar to meningitisManifestations similar to meningitis

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Brain AbscessBrain Abscess

Collection of purulent material within the brainCollection of purulent material within the brainCaused by/often follow:Caused by/often follow:

Middle ear/sinus infectionMiddle ear/sinus infectionHead injury/intracranial surgeryHead injury/intracranial surgery



j y g yj y g yBacterial infections in hear, bone, lungBacterial infections in hear, bone, lung

Manifestations similar to meningitisManifestations similar to meningitis

Brain Infections Brain Infections –– Diagnostic Diagnostic TestsTests

Lumbar punctureLumbar punctureCulture, sensitivity and Gram stain of CSFCulture, sensitivity and Gram stain of CSFBlood, urine, throat, and nasal culturesBlood, urine, throat, and nasal culturesCT MRI skull xCT MRI skull x raysrays



CT, MRI, skull xCT, MRI, skull x--raysrays

Brain Infections Brain Infections -- MedicationsMedications

Antibiotics: teaching related to completionAntibiotics: teaching related to completionAntivirals: teaching related to completionAntivirals: teaching related to completionAnticonvulsants: monitor for seizuresAnticonvulsants: monitor for seizuresAntipyretics/analgesics: monitor tempAntipyretics/analgesics: monitor temp



Antipyretics/analgesics: monitor tempAntipyretics/analgesics: monitor tempOsmotic diuretics/corticosteroids: assess for signs of Osmotic diuretics/corticosteroids: assess for signs of IICPIICPAntiemetics: assess for nauseaAntiemetics: assess for nausea

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Brain Infections Brain Infections –– Nursing CareNursing Care

AssessmentAssessmentNausea, vomitingNausea, vomitingPhotophobia; stiff neckPhotophobia; stiff neckConfusion; headacheConfusion; headache



History of:History of:Head injury; brain surgery; infectionsHead injury; brain surgery; infections


AssessmentAssessmentVital signs/LOCVital signs/LOCChanges in vision/hearingChanges in vision/hearingBrudzinski’s and Kernig’s signsBrudzinski’s and Kernig’s signs



SeizuresSeizuresPetechial rashPetechial rash


DiagnosesDiagnosesRisk for Ineffective Tissue Perfusion: CerebralRisk for Ineffective Tissue Perfusion: CerebralHyperthermiaHyperthermiaAcute PainAcute Pain



EvaluationEvaluationAfebrileAfebrileAbsence of headache/signs of IICPAbsence of headache/signs of IICPKnowledge of antiKnowledge of anti--infective therapyinfective therapy

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Craniotomy Craniotomy

Surgical opening into the cranial cavitySurgical opening into the cranial cavityPurposes:Purposes:

Elevate a depressed skull fractureElevate a depressed skull fractureRemove foreign bodyRemove foreign body



g yg yEvacuate hematomaEvacuate hematomaDebulk/remove tumorDebulk/remove tumor

CraniotomyCraniotomy

Preoperative CarePreoperative CareRoutine preoperative care/teachingRoutine preoperative care/teachingAssess understanding of procedureAssess understanding of procedureAssess anxiety levelAssess anxiety level



Postoperative appearancePostoperative appearance

CraniotomyCraniotomy

Postoperative CarePostoperative CareMonitoringMonitoring

Vital signs, respiratory status oxygenation statusVital signs, respiratory status oxygenation statusIICP; CSF leak; manifestations of meningitis; seizuresIICP; CSF leak; manifestations of meningitis; seizures

P i l ibi i hP i l ibi i h



Pain control; antibiotic therapyPain control; antibiotic therapyPositioningPositioningCare of the wound/incisionCare of the wound/incision

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