Critical care nursing
BASICS OF NEUROLOGICAL NURSING
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| 6. BASICS OF NEUROLOGICAL NURSING.
Introduction. Neurological or neuroscience nursing is a specialty focused on preventing and treating conditions related to the nervous system, including the brain, spinal cord, and nerves. It is a distinctive area within the discipline of nursing that focuses on the care of individuals with brain, spine and nervous system disorders. Neuroscience nurses work in a wide range of settings from academic medical centers to skilled nursing facilities, rehabilitation units to epilepsy monitoring units. Neuroscience nurses are registered nurses (RNs) skilled in providing care and preventive services to people from birth to the elderly with conditions or injuries affecting their brain or nervous system. They are responsible for the assessment, diagnosis, and intervention of patients with a neurological injury or illness. They monitor the patient's neurological status, recommend interventions, administer medications, and assist with retraining the individual to return to their activities of daily living. Scope of neurological nursing. This is a specialized field of nursing that focuses on providing care to patients with brain and nervous system conditions. Major categories of conditions of concern to neurological nursing include degenerative diseases (such as multiple sclerosis and Alzheimer’s disease), tumors of the nervous system, neuromuscular diseases (such as myasthenia gravis), traumatic injury to the brain and spine, stroke and other cerebrovascular diseases, seizures, pain, diseases of the spine, movement disorders (such as Parkinson’s disease and dystonia), and developmental problems of the nervous system. As a neurological nurse, your primary role is to assess, monitor, and manage the neurological status of patients. This involves conducting thorough neurological assessments to evaluate their cognitive function, motor skills, sensory perception, and overall neurological health. By closely monitoring their condition, you can detect any changes or complications that may arise. In addition to assessments, you'll also be responsible for administering medications and treatments specific to neurological conditions. This could include administering medications to manage seizures, providing pain relief, or administering clot-busting medications in the case of a stroke. You'll need to have a strong understanding of different medications and their potential side effects to ensure safe and effective care.. Key Responsibilities of Neurosurgical Nurses are Conducting neurological tests and physical assessments of patients. Obtaining patient history and communicate to consulting neurologist. Monitoring patients' neurological activity. Assisting neurologists in diagnosing patients with brain and nervous system illnesses. Providing holistic nursing care to patients suffering from nervous disorders. ANATOMY AND PHYSIOLOGY OF THE NERVOUS SYSTEM Structure and Function of the Brain General Overview of the Brain: The brain is the center of the human nervous system. It is a complex organ, weighing approximately 1.4 kilograms (3 pounds) and occupying the cranial vault of the skull. As the center of cognitive, emotional, and physiological functions, it consists of various interconnected structures. The brain is situated within the cranial cavity, protected by the meninges and cerebrospinal fluid, vital for cushioning and maintaining a stable environment for this delicate organ. The brain is divided into various parts: 1. Cerebrum: This is located in the largest part of the brain and is further divided into two hemispheres which are the right and left hemispheres. These hemispheres comprises of four lobes: frontal, parietal, temporal, and occipital. i. Frontal Lobe: Left Hemisphere: Manages speech production, language comprehension, and logical thinking. Right Hemisphere: Engaged in creativity, artistic abilities, and spatial orientation. ii. Parietal Lobe: Left Hemisphere: Controls sensation, spatial perception, and understanding of numbers. Right Hemisphere: Handles attention, perception of stimuli, and awareness of space. iii. Temporal Lobe: Left Hemisphere: Responsible for language comprehension and long-term memory. Right Hemisphere: Involved in musical awareness and emotional tone in language. iv. Occipital Lobe: Left Hemisphere: Controls vision-related functions, including reading and visual interpretation. Right Hemisphere: Participates in visual imagery and appreciation of spatial relationships. The cerebrum's lobes, each located in the left and right hemispheres, serve distinct functions, and while certain core functions might be predominantly associated with one hemisphere, both hemispheres work together for many complex activities and cognitive processes. 2. Thalamus: Positioned atop the brainstem and functions as a relay station for sensory information, transmitting it to the cerebral cortex. Plays a crucial role in processing sensory information and regulating consciousness. It also acts as a sensory relay center, routing sensory signals to the cerebral cortex for interpretation. 3. Hypothalamus: Situated below the thalamus and governs autonomic functions, maintaining homeostasis. Regulates body temperature, hunger, thirst, and the release of hormones from the pituitary gland. 4. Cerebellum: Located beneath the occipital lobes of the cerebrum, at the base of the brain. Coordinates voluntary muscle movements, balance, and posture. 5. Brainstem: At the base of the brain and includes the midbrain, pons, and medulla oblongata. Governs fundamental physiological functions: heartbeat, breathing, swallowing, and consciousness. 6. Limbic System: Comprised of various structures, including the hippocampus, amygdala, and cingulate gyrus. Manages emotions, behavior, and memory formation. Structure of the spinal Cord and its function Structure of Spinal Cord: The Spinal cord runs through a hollow case from the skull enclosed within the vertebral column. Spinal nerves arise from different regions of the vertebral column and are named accordingly, the regions are – Neck, chest, pelvic and abdominal. Cross-section of spinal cord displays grey matter shaped like a butterfly surrounded by a white matter. Grey matter consists of the central canal at the centre and is filled with a fluid called CSF (Cerebrospinal fluid). It consists of horns (four projections) and forms the core mainly containing neurons and cells of the CNS. There are two dorsal and two ventral horns. The white matter consists of a collection of axons permitting communication between different layers of CNS. A tract is a collection of axons and carries specialized information. Ascending tracts and descending tracts send and transmit signals from the brain respectively to various nerve cells across the body. Spinal nerves act as mediators, communicating information to and from the rest of the body and the spinal cord. We have 31 pairs of spinal nerves; three layers of meninges surround the spinal cord and spinal nerve roots. Dura mater, Arachnoid mater and Pia mater. Dura mater consists of two layers- periosteal and meningeal. Epidural space is present between the two layers while Subarachnoid space lies between the arachnoid mater and pia mater. It is filled with cerebrospinal fluid. Function of Spinal Cord: Forms a connecting link between the brain and the PNS Provides structural support and builds a body posture Facilitates flexible movements Myelin present in the white matter acts as an electrical insulation Communicates messages from the brain to different parts of the body COMMON NEUROLOGICAL DISORDERS. STROKE A stroke, or brain attack, happens when blood flow to your brain is stopped. It is an emergency situation. The brain needs a constant supply of oxygen and nutrients in order to work well. If blood supply is stopped even for a short time, this can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen. Types of stroke Ischemic stroke: This is the most common type of stroke. It happens when the brain's blood vessels become narrowed or blocked, causing severely reduced blood flow (ischemia). Blocked or narrowed blood vessels are caused by fatty deposits that build up in blood vessels or by blood clots or other debris that travel through the bloodstream, most often from the heart, and lodge in the blood vessels in the brain. Hemorrhagic stroke: Hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect the blood vessels. Factors related to hemorrhagic stroke include: Uncontrolled high blood pressure, Bulges at weak spots in your blood vessel walls (aneurysms), Trauma (such as a car accident), and Protein deposits in blood vessel walls that lead to weakness in the vessel wall (cerebral amyloid angiopathy) Causes of stroke. There are two main causes of stroke: a blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (hemorrhagic stroke). Ischemic strokes and hemorrhagic strokes can occur for many reasons. Ischemic strokes usually occur because of blood clots which may result from conditions such as: Atherosclerosis Clothing disorders Atrial fibrillation (especially due to sleep apnea). Heart defects (atrial septal defect or ventricular septal defect). Microvascular ischemic disease (which can block smaller blood vessels in your brain). Risk factors for stroke: Anyone can have a stroke at any age. But the chances of having a stroke increases with certain risk factors. Some risk factors can be changed or managed, while others can’t. Risk factors for stroke that can be changed, treated, or medically managed: High blood pressure: Blood pressure of 140/90 or higher can damage blood vessels (arteries) that supply blood to the brain. Heart disease: Heart disease is the second most important risk factor for stroke, and the major cause of death among survivors of stroke. Heart disease and stroke have many of the same risk factors. Diabetes: People with diabetes are at greater risk for a stroke than someone without diabetes. Smoking: Smoking almost doubles your risk for an ischemic stroke. Birth control pills (oral contraceptives) Risk factors for stroke that can’t be changed: Older age. For each decade of life after age 55, your chance of having a stroke more than doubles. Gender. Stroke occurs more often in men, but more women than men die from stroke. History of prior stroke. You are at higher risk for having a second stroke after you have already had a stroke. Heredity or genetics. The chance of stroke is greater in people with a family history of stroke. Clinical manifestation of stroke. A stroke is an emergency situation. It’s important to know the signs of a stroke and get help quickly. Treatment is most effective when started right away. Each person’s symptoms may vary. Symptoms may include: Weakness or numbness of the face, arm, or leg, usually on one side of the body Having trouble speaking or understanding Problems with vision, such as dimness or loss of vision in one or both eyes Dizziness or problems with balance or coordination Problems with movement or walking Diagnosis of stroke Physical examination: A doctor will ask about the person’s symptoms and medical history. They will check muscle strength, reflexes, sensation, vision, and coordination. They may also check blood pressure, listen to the carotid arteries in the neck, and examine the blood vessels at the back of the eyes. CT scan of the brain: An imaging test that uses X-rays to take clear, detailed images of the brain. A brain CT scan can show bleeding in the brain or damage to brain cells caused by a stroke. It is used to find abnormalities and help find the location or type of stroke. MRI: This test uses a combination of large magnets, radiofrequencies, and a computer to make detailed images of organs and structures in the body. An MRI uses magnetic fields to find small changes in brain tissue that help to find and diagnose stroke. Surgical management. Several types of surgery may be done to help treat a stroke, or help to prevent one. These include: Carotid endarterectomy. Carotid endarterectomy is surgery to remove plaque and clots from the carotid arteries, located in the neck. These arteries supply the brain with blood from the heart. Endarterectomy may help stop a stroke from occurring. Carotid stenting. A large metal coil (stent) is placed in the carotid artery much like a stent is placed in a coronary artery. Surgery to repair aneurysms and AVMs (arteriovenous malformations). An aneurysm is a weakened, ballooned area on an artery wall. It is at risk for bursting (rupturing) and bleeding into the brain. An AVM is a tangle of arteries and veins. It interferes with blood circulation and puts a person at risk for bleeding. Pharmacological Management. Anti-platelet drugs. Platelets are cells in the blood that form clots. Anti-platelet drugs make these cells less sticky and less likely to clot. The most commonly used anti-platelet medication is aspirin and clopidogrel. Anticoagulants. These drugs reduce blood clotting. Heparin is fast acting and may be used short-term in the hospital. Slower-acting warfarin may be used over a longer term. Several newer blood-thinning medications (anticoagulants) are available for preventing strokes in people who have a high risk. These medications include dabigatran (Pradaxa), rivaroxaban (Xarelto). Complications. A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part is affected. Complications may include: Paralysis or loss of muscle movement on one side of the body, or loss of control of certain muscles, such as those on one side of the face or one arm. Difficulty talking or swallowing, also may have difficulty with language, including speaking or understanding speech, reading, or writing. Memory loss or thinking difficulties; difficulty thinking, reasoning, making judgments and understanding concepts. Pain, numbness or other unusual sensations may occur in the parts of the body affected by stroke. EPILEPSY Epilepsy is a disorder of the brain that causes seizures. Epilepsy is a neurological disorder characterized by recurring seizures, which are sudden bursts of electrical activity in the brain. A seizure is like a temporary electrical storm in the brain that causes the body to act strangely. Seizures can cause a range of symptoms, from mild to severe, and they can vary in type, frequency, and duration. Causes There is no single cause of epilepsy, several possible factors that can lead to the development of the condition but it can be caused by genetic factors, head trauma, infections, or brain tumors. Epilepsy is not contagious and it's not a mental illness. It's also possible for the cause of epilepsy to be idiopathic. Seizures can also be triggered by certain medications, alcohol or drug use, or sleep deprivation. In rare cases, epilepsy can be caused by an underlying autoimmune condition. Signs and symptoms There are many possible signs and symptoms of epilepsy, and they can vary greatly from person to person. Common symptoms include: Recurring seizures Sudden, involuntary movements Loss of consciousness Complications Epilepsy can have several possible complications, including: Injuries sustained during seizures, such as fractures or head injuries Learning and memory problems Psychological problems, such as anxiety or depression There is no cure for epilepsy, but it can often be managed with medication or surgery. Treatment and Management. Treatment for epilepsy usually involves a combination of medication and lifestyle changes. Medications are the mainstay of treatment, and there are many different types that can be used. The goal of medication is to control seizures while minimizing side effects. Lifestyle changes that can help with epilepsy include getting enough sleep, avoiding alcohol and drugs, and reducing stress. MULTIPLE SCLEROSIS Multiple sclerosis (MS) is a condition that happens when the immune system attacks the brain and spinal cord. MS is an inflammatory demyelinating condition that results from an autoimmune attack on myelin, the fatty insulation that surrounds the nerves in the brain and spinal cord. This disrupts the electrical impulses that are sent through the nerves to the rest of the body and results in scars (plaques or sclerosis). Types MS can present in a variety of ways including: Clinically isolated syndrome (CIS): describes an episode of neurologic symptoms that are the first clinical sign of possible MS; Secondary progressive (SPMS): after living with RRMS for a long period of time, relapses decrease and symptoms continue progressively without relapses or remissions; and Primary progressive (PPMS): starting from the initial symptoms, the disease gradually progresses and gets worse without any clear relapses or remissions. Symptoms Symptoms of multiple sclerosis can be different from person to person. They can come and go or get worse over time. Its symptoms can worsen with heat or during other infections such as urinary tract or respiratory infections. They can include: Difficulty walking or keeping balance Numbness or weakness especially in the arms and legs Muscle stiffness Causes It is not known what triggers the immune system to attack myelin, but genetic and environmental factors are thought to play a role. MS happens most commonly in young to middle-aged adults, more in females than males, and is more common in higher latitudes, possibly due to sun exposure and vitamin D. Diagnosis: MS is a diagnosis of exclusion and there are no definitive diagnostic tests. Magnetic resonance imaging (MRI) can help with diagnosis by showing plaques or sclerosis on the brain and spinal cord. Other tests such as lumbar puncture, optical coherence tomography (OCT) and visual evoked potentials can also help support the diagnosis. Management of multiple sclerosis The following are the goals for managing Multiple sclerosis: Treat flare-ups. Control symptoms. Improve physical function. The management of multiple sclerosis (MS) typically involves a multidisciplinary approach and can include the following components: A). Medications: Disease-modifying therapies (DMTs): These drugs can help slow the progression of MS and reduce the frequency and severity of relapses. Symptomatic treatments: Medications to manage specific symptoms like fatigue, spasticity, pain, and bladder issues. B). Rehabilitation: Physical therapy: To improve mobility and strength. Speech therapy: If MS affects speech and swallowing. Cognitive rehabilitation: To address cognitive changes. Lifestyle modifications: A healthy diet and regular exercise can support overall well-being. Managing stress can help reduce the impact of MS symptoms. Adequate rest and sleep are important for managing fatigue. D). Regular monitoring: Ongoing follow-up with a neurologist to track the progression of the disease and adjust treatment plans as needed. ALZHEIMER'S DISEASE Alzheimer’s disease is a form of dementia, which is just an umbrella term used to describe loss of memory, language, problem solving, and other thinking abilities. More specifically, Alzheimer’s disease is a progressive, neurodegenerative disease that is categorized by a loss of memory, along with basic life skills like eating, bathing, talking, etc. Symptoms: Common symptoms include: memory loss, paranoia, depression, anger, aggression, anxiety, apathy, loneliness, and psychosis. These symptoms vary from person to person. Progress: In the first stages of Alzheimer’s disease, there is usually very mild memory loss or problems with thinking abilities. The person may have a hard time remembering where they placed something or have a hard time recalling the right word to say. However, they still are independent, meaning they can still take care of themselves and do things like driving. During the middle stages of Alzheimer’s disease, the cognitive processes get worse. Now the person may not be able to remember their personal history, like their address or phone number. They also may have a hard time recalling memories or remembering something from their past. When the person hits stage 2, they will need a caregiver to assist them with their tasks and the care giving will increase as the disease progresses. The final stage of Alzheimer’s disease is when people begin to lose sense and control of the environment around them. By this point, the cognitive abilities of the individual have tremendously decreased. They can no longer speak in long formulated sentences; instead they speak in short fragments or words. They have trouble completing everyday tasks like walking, sitting, eating, and drinking. This means that they require around the clock assistance to make sure that they are remembering to eat and to help them eat. Cause: The cause of Alzheimer’s disease is still being researched, but researchers have identified what they believe to be the main culprits of the disease: plaques and tangles. Plaques are deposits of amyloid beta that forms between nerve cells that blocks the signals and stops the right materials from being sent to the nerve for survival. In a healthy brain, amyloid beta is used to help support neural repair and growth. However, in Alzheimer’s disease, there is an overproduction of this amyloid beta protein that disturbs these cells and eventually causes the death of the cells. The death of the old cells causes the loss of old memories and information.The blocking of nerve cells can stop the production of new connections, which means short term memories are not being accurately encoded in the brain to become long term memories. Tangles are made up of twisted tau that builds up between cells. In a healthy brain, it is used to help support neural strength and is important in keeping stability in the cells. However, a build up leads to the cells not being able to receive signals and the supplies it needs to function (i.e. energy). These lead to death of the cells, leading to loss of information and life skills. PARKINSON'S DISEASE Parkinson's disease is a neurodegenerative disorder characterized by the gradual loss of dopamine-producing neurons in the brain, resulting in motor symptoms such as tremors, bradykinesia (slowness of movement), and rigidity, as well as non-motor symptoms like depression and cognitive impairment. It is a chronic, progressive condition that affects not only the quality of life for patients but also places a significant burden on healthcare systems and caregivers. Symptoms And How Parkinson Disease Affect the Brain Parkinson's disease is characterized by a range of motor and non-motor symptoms, and it primarily affects the brain, particularly the basal ganglia. Motor Symptoms: Resting tremors, often in the hands, are a classic symptom. Bradykinesia: Slowness of movement and difficulty initiating movements. Rigidity: Increased muscle tone leading to stiffness and reduced range of motion Postural Instability: Impaired balance and coordination, leading to an increased risk of falls . Non-Motor Symptoms: Depression: A common non-motor symptom, affecting mood and overall well-being Cognitive Impairment: Many individuals with Parkinson's disease experience cognitive changes, including memory and executive function deficits. In the brain, Parkinson's disease primarily affects the basal ganglia, a group of nuclei responsible for controlling movement. The substantia nigra, a specific part of the basal ganglia, experiences the loss of dopamine-producing neurons. This loss of dopamine disrupts the balance of neurotransmitters, particularly dopamine and acetylcholine, which leads to motor symptoms. Causes of Parkinson's disease The exact causes of Parkinson's disease are not fully understood, but both genetic and environmental factors are believed to contribute to its development. Genetic Factors: Some individuals with a family history of Parkinson's disease have a higher risk of developing the condition. Specific genetic mutations, such as those in the LRRK2 and SNCA genes, have been associated with an increased risk of Parkinson's disease (Lesage & Brice, 2009). Environmental Factors: Exposure to certain environmental toxins, such as pesticides, herbicides, and industrial chemicals, has been linked to an elevated risk of Parkinson's disease. Research suggests that long-term exposure to these toxins may contribute to the development of the disease (Goldman, 2014). Diagnosis The presence of at least two of these four motor symptoms, along with a positive response to dopaminergic medication, can support a diagnosis of Parkinson's disease (Gelb et al., 1999). Bradykinesia: Slowness of movement and difficulty initiating movements. Rigidity: Increased muscle tone leading to stiffness. Postural Instability: Impaired balance and coordination. Nursing Management of Parkinson's Disease: Medication Management Education and Support Monitoring for Adverse Effects Fall Prevention Physical Therapy Treatment of Parkinson's Disease The treatment for Parkinson's disease typically involves a combination of medication, surgical interventions, and therapy to manage symptoms and improve the patient's quality of life. Medications: Levodopa and Carbidopa: These are the most effective medications for managing motor symptoms by increasing dopamine levels in the brain Dopamine Agonists: These drugs mimic the effects of dopamine in the brain and are often used in conjunction with levodopa. MAO-B Inhibitors and COMT Inhibitors: These drugs help prolong the effects of levodopa by inhibiting enzymes that break it down. Surgical Interventions: Deep Brain Stimulation (DBS): This surgical procedure involves implanting electrodes in specific brain regions to help regulate abnormal electrical activity and control motor symptoms. Physical Therapy: Physical therapy can help improve balance, mobility, and flexibility, making it an essential part of managing Parkinson's symptoms Neurological assessment of Stroke and epilepsy Stroke History taking: During history taking for a stroke, the healthcare provider will typically ask about the patient's symptoms, their medical history, their family history, and their lifestyle. Physical Examination: The physical examination for a suspected stroke typically includes a neurological exam, which involves testing the patient's reflexes, muscle strength, sensation, coordination, and cognitive function. Diagnostic Tests: One of the most commonly used diagnostic scales for stroke is the National Institutes of Health Stroke Scale (NIHSS). This scale is used to assess the severity of the stroke and to help determine the most appropriate treatment. The scale includes 11 different tasks, each with a score of 0-4, with 4 being the most severe. The total score ranges from 0 to 42, with higher scores indicating more severe strokes. The scale is used by healthcare providers to monitor the progress of a patient's recovery after a stroke. In addition to the NIHSS, another diagnostic scale that may be used for stroke is The Glasgow Coma Scale (GCS): This scale measures the level of consciousness in a person who has had a stroke. Glasgow Coma Scale (GCS) The Glasgow Coma Scale (GCS) is often used to assess the severity of a stroke. The GCS is particularly useful in determining the severity of a hemorrhagic stroke, which is a type of stroke that occurs when a blood vessel in the brain ruptures. In addition to assessing the severity of the stroke, the GCS can also be used to track the patient's progress over time. A low GCS score at the time of the stroke may indicate a more severe injury, while an increasing GCS score over time may indicate that the patient is recovering from the stroke. Other tests may be used to assess a stroke, are CT scan or MRI. A CT scan can show the location of the stroke and any associated bleeding in the brain. An MRI can provide a more detailed image of the brain, which can help to identify the location and cause of the stroke EPILEPSY History Taking Physical Examination A physical examination for epilepsy may include a neurological examination, which can help to identify any problems with the brain or nervous system. This may include tests such as: A cranial nerve examination: This test assesses the function of the cranial nerves, which are responsible for controlling facial movement, eye movement, and hearing. A motor and sensory examination: This test assesses the strength and sensation of the limbs. A reflex examination: This test assesses the function of the reflexes. A gait examination: This test assesses how the patient walks. Diagnostic Tests In addition to the examinations and tests mentioned above, the healthcare provider may also order the following diagnostic tests to assess for epilepsy: A blood test: This test may be used to check for infections, genetic disorders, or other conditions that may cause seizures. A lumbar puncture: This test involves taking a sample of the fluid that surrounds the brain and spinal cord. This fluid can be tested for signs of infection or other conditions that may cause seizures. Nursing medication administration for neurological patient. Medication administration for neurological patients requires careful attention and adherence to the prescribed treatment plan. It's essential to follow these general guidelines: Prescription Review: The nurse should ensure the correct medication and dosage as per the patient's prescription. Documentation: Maintain accurate records of the medication administered, including the date, time, dose, and any adverse reactions. Dosage and Timing: Administer the medication as prescribed by the healthcare provider. Pay attention to the timing, especially with medications that need to be taken at specific intervals. Route of Administration: Be aware of the correct route (oral, intravenous, intramuscular, etc.) for medication delivery. Seizure management for neurological patient Preventive Measures: Medication Adherence: Ensure that the patient takes prescribed antiepileptic medications regularly as directed by their healthcare provider. Lifestyle Modifications: Encourage patients to maintain a regular sleep schedule, manage stress, and avoid triggers that can induce seizures. Seizure Response: Safety First: During a seizure, prioritize the patient's safety by clearing the area of hazards and gently guiding them to the ground if necessary. Cushion the Head: Place a soft support under the patient's head to prevent head injury. Do Not Restrain: Avoid restraining the patient's movements during the seizure, as it can lead to injury. Turn to the Side: If possible, gently roll the patient onto their side to help keep the airway clear. Timing: Note the start and end times of the seizure. If it lasts longer than five minutes, call for medical assistance. Recovery Position: After the seizure ends, help the patient into a comfortable recovery position on their side. Mobility and rehabilitation of neurological patients Exercises and activities are designed to address the patient's specific neurological deficits and mobility issues. For patients with neurological conditions affecting speech and language, speech therapists can help improve communication skills. They may also address issues with swallowing and eating. Depending on the patient's needs, mobility aids such as wheelchairs, walkers, or orthotic devices may be recommended. Pain management for neurological patients Pain management for neurological patients can be challenging, as it often involves chronic pain associated with conditions like neuropathy, migraines, or central nervous system disorders. Here are some strategies for effective pain management: 1. Medication: Neurologists may prescribe medications specifically tailored to the patient's condition. This can include antiepileptic drugs, muscle relaxants, or antidepressants, depending on the nature of the pain. 2. Pain Management Clinics: Consider referring the patient to a pain management clinic or specialist who can offer a variety of treatments, including nerve blocks, injections, and other interventional procedures. 3. Complementary and Alternative Therapies: Techniques like acupuncture, yoga, or meditation may provide relief for some patients and can be used in conjunction with traditional medical treatments... NEUROLOGICAL EMERGENCIES. TRAUMATIC BRAIN INJURY: Traumatic brain injury as a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury. Traumatic brain injury (TBI) can occur from direct contact to the head or when the brain is shaken within the skull, such as from a blast or whiplash during a car accident. The person may also have a loss of memory for the time immediately before or after the event that caused the injury. Types Concussion: This is the most common type of traumatic brain injury. When a strong force strikes the head, the brain moves in the direction of the force until it collides with the skull, causing damage. Contusion: This is essentially a bruise on the brain, which means it is a mild form of bleeding. One type of contusion where injury occurs in two parts of the brain is referred to as a coup-contrecoup injury. If a contusion does not heal on its own, it can turn into a hematoma, which doctors can remove through surgery. Brain hemorrhage: A brain hemorrhage refers to uncontrolled bleeding on the surface of the brain or within the brain tissue itself. Hemorrhages that occur in the space surrounding the brain are known as subarachnoid hemorrhages, while those that originate in the cerebral matter are called intracerebral hemorrhage Intracranial haemorrhage: Hematomas are collections of blood outside of blood vessels. Large hematomas that occur in the brain can lead to serious injury and even death if left untreated. There are several different types of brain hematomas, including Epidural hematomas: Blood collection between the skull and brain Subdural hematomas: Blood collection under the thin layer of protection surrounding the brain Intracerebral hematoma: Collection of blood within the brain itself. DIFFUSE AXONAL INJURY (DAI): Diffuse axonal injuries are one of the most severe types of traumatic brain injury. They occur when the brain is shaken or twisted inside the skull. As the brain twists, the cerebral tissue slides back and forth until the long connecting fibers in the brain (called axons) tear. Doctors refer to this as axonal shearing. The axonal shearing disrupts messages that neurons send, resulting in loss of function. Because most diffuse axonal injuries result in only microscopic tears, they can be hard to detect on an MRI. Causes Traumatic brain injury is usually caused by a blow or other traumatic injury to the head. Common events causing traumatic brain injury include the following: Falls. Falls from bed or a ladder, down stairs, in the bath, and other falls are the most common cause of traumatic brain injury overall, particularly in older adults and young children. Vehicle-related collisions. Collisions involving cars, motorcycles or bicycles — and pedestrians involved in such accidents — are a common cause of traumatic brain injury. Violence. Gunshot wounds, domestic violence, child abuse and other assaults are common causes. Shaken baby syndrome is a traumatic brain injury in infants caused by violent shaking. Sports injuries. Traumatic brain injuries may be caused by injuries from a number of sports, including soccer, boxing, football, baseball, lacrosse, skateboarding, hockey, and other high-impact or extreme sports. These are particularly common in youth. Explosive blasts and other combat injuries. Explosive blasts are a common cause of traumatic brain injury in active-duty military personnel. Clinical Manifestation. Traumatic brain injury can have wide-ranging physical and psychological effects. Some signs or symptoms may appear immediately after the traumatic event, while others may appear days or weeks later. Mild traumatic brain injury The signs and symptoms of mild traumatic brain injury may include: Physical symptoms: Headache, Nausea or vomiting, Fatigue or drowsiness, Problems with speech, Dizziness or loss of balance. Sensory symptoms: Blurred vision, ringing in the ears, a bad taste in the mouth or changes in the ability to smell, Sensitivity to light or sound Cognitive, behavioral or mental symptoms: Loss of consciousness for a few seconds to a few minutes, confused or disoriented, Memory or concentration problems, Mood changes or mood swings, Feeling depressed or anxious, Difficulty sleeping, Sleeping more than usual Moderate to severe traumatic brain injuries Moderate to severe traumatic brain injuries can include any of the signs and symptoms of mild injury, as well as these symptoms that may appear within the first hours to days after a head injury: Loss of consciousness from several minutes to hours Persistent headache or headache that worsens Repeated vomiting or nausea Risk factors The people most at risk of traumatic brain injury include: Children especially newborns to 4-year-olds, Young adults especially those between ages 15 and 24, Adults age 60 and older, Males in any age group. Complications Several complications can occur immediately or soon after a traumatic brain injury. Altered consciousness: Moderate to severe traumatic brain injury can result in prolonged or permanent changes in a person's state of consciousness, awareness or responsiveness. Different states of consciousness include: Coma: A person in a coma is unconscious, unaware of anything and unable to respond to any stimulus. This results from widespread damage to all parts of the brain. After a few days to a few weeks, a person may emerge from a coma or enter a vegetative state. Minimally conscious state: A minimally conscious state is a condition of severely altered consciousness but with some signs of self-awareness or awareness of one's environment. It is sometimes a transitional state from a coma or vegetative condition to greater recovery. Brain death: When there is no measurable activity in the brain and the brainstem, this is called brain death. In a person who has been declared brain dead, removal of breathing devices will result in cessation of breathing and eventual heart failure. Brain death is considered irreversible. Diagnostic test Imaging Test Computerized tomography (CT): X-rays from many angles to create a complete picture of the brain. It can quickly show whether the brain is bleeding or bruised or has other damage. Magnetic resonance imaging (MRI). MRI uses magnets and radio waves to produce more detailed images than CT scans. An MRI likely would not be used as part of an initial TBI assessment, because it takes too long to complete. It may be used in follow-up examinations, though. Glasgow's coma scale: The GCS gives healthcare providers a way to measure a person’s functioning in three key areas: Ability to speak, such as whether the person speaks normally, speaks in a way that doesn’t make sense, or cannot speak at all. Ability to open eyes, including whether the person opens his or her eyes only when asked. Ability to move, ranging from moving one’s arms easily and on purpose to not moving even in response to pain. Treatment The treatments for TBI depend on many factors, including the size, severity, and location of the brain injury. For mild TBI, the main treatment is rest. If headache persists, over the counter drugs can be used. For moderate to severe TBI, the first thing is stabilization to prevent further injury, manage blood pressure, check the pressure inside the skull, and make sure that there is enough blood and oxygen getting to the brain. Surgery is done to reduce additional damage to the brain, examples includes, removal of hematomas (clotted blood), getting rid of damaged or dead brain tissue, Repair skull fractures, Relieve pressure in the skull etc. Medications: To treat the symptoms of TBI and to lower some of the risks associated with it, such as: Anticoagulants to prevent blood clots Anticonvulsants to prevent seizures Muscle relaxants to reduce muscle spasms Rehabilitation therapy: which can include therapies for physical, emotional, and cognitive difficulties. Speech therapy: to help with speech and other communication skills and treat swallowing disorders Cognitive therapy: to improve memory, attention, perception, learning, planning, and judgment. Prevention. Seat belts and airbags, avoid alcohol and drug abuse, helmets while driving, Install handrails in bathrooms, put a non slip mat in the bathtub or shower, Install handrails on both sides of staircases, Improve lighting in the home, especially around stairs. Keep stairs and floors clear of clutter. INTRACRANIAL HEMORRHAGE: Intracranial hemorrhage (ICH) refers to any bleeding within the intracranial vault, including the brain parenchyma and surrounding meningeal spaces. It is a significant medical event that accounts for up to 15% of strokes. ICH may occur in multiple intracranial compartments and may be caused by diverse pathology. Intracranial hemorrhages (ICH) fall into four broad categories: Epidural hematoma Subdural hematoma Subarachnoid hemorrhage Intracerebral hemorrhage Pathophysiology Epidural hematoma (EDH) Epidural hematomas are accumulations of blood between the skull and the dura, and typically occur after significant blunt head trauma. Fractures of the temporal bone can disrupt the middle meningeal artery, leading to high-pressure bleeding within the cranial vault. Herniation can occur within hours if the hematoma is not evacuated. The classic description of an EDH is a brief loss of consciousness after a blow to the head, followed by a lucid period. Soon after, the level of consciousness deteriorates again, possibly progressing into herniation and death. Subdural hematoma (SDH) Subdural hematomas are extra-axial blood collections between the dura and the arachnoid mater. Subdural hematomas form when bridging veins are sheared during acceleration-deceleration of the head. Since the bleeding is venous and low-pressure, the hematoma can grow fairly slowly and the presentation can be delayed by days to weeks. This is particularly true in patients with brain atrophy, whose bridging vessels are more susceptible to shear and who can more readily accommodate the additional intracranial blood volume. These patients can present with an indolent decline in mental status, confusion, fatigue, or other subtle changes. Subarachnoid hemorrhage A subarachnoid hemorrhage occurs when there’s bleeding between the brain and the thin tissues that cover the brain. These tissues are called meninges. The most common cause is trauma, but it can also be caused by rupture of a major blood vessel in the brain, such as from an intracerebral aneurysm. A sudden, sharp headache usually comes before a subarachnoid hemorrhage. Typical symptoms also include loss of consciousness and vomiting. Intracerebral hemorrhage An intracerebral hemorrhage (ICH) is a type of stroke, called hemorrhagic stroke, or “brain attack.” Its name refers to the bleeding (hemorrhaging) within the brain (cerebrum) caused by a blood vessel that ruptures and creates a pool of blood called a hematoma in the brain. As the bleeding continues the hematoma gets larger, increasing the pressure inside the brain; the compression of the brain can cause damage to the brain and lead to neurological deficits, unconsciousness, or even death. Risk factors/causes Head trauma: Injury is the most common cause of bleeding in the brain for those younger than age 50. High blood pressure: This chronic condition can, over a long period of time, weaken blood vessel walls. Untreated high blood pressure is a major preventable cause of brain hemorrhages. Aneurysm: This is a weakening in a blood vessel wall that swells. It can burst and bleed into the brain, leading to a stroke. Blood or bleeding disorders: Hemophilia and sickle cell anemia can both contribute to decreased levels of blood platelets and clotting. Blood thinners are also a risk factor. Brain tumors Signs and symptoms A sudden severe headache, seizures with no previous history of seizures, nausea or vomiting, decreased alertness; lethargy, tingling or numbness, difficulty speaking or understanding speech, difficulty swallowing, difficulty writing or reading, loss of fine motor skills, such as hand tremors, loss of coordination, loss of balance, an abnormal sense of taste, Loss of consciousness. Complications Urinary tract infection Bedsores Cranial nerve damage Coma Diagnosis CT scan: This type of test creates images of the brain, which can confirm bleeding, and also assess for other evidence of trauma to the head. MRI scan: to help the doctor see the brain more clearly to better identify the cause of the bleeding. Angiogram: uses X-ray technology to take pictures of blood flow within an artery, and can reveal any abnormalities with the blood vessels themselves, such as aneurysms or arteriovenous malformations. Blood tests: to identify immune system disorders, inflammation, and blood clotting problems that can cause bleeding in the brain. Management ABC’s Initial assessment and stabilization of airway patency, breathing, and circulation. Neuroimaging: Once clinical stability is achieved, an urgent imaging study for rapid and accurate diagnosis should be performed. Standardized neurologic assessment to determine baseline severity. The National Institutes of Health Stroke Scale (NIHSS), if the patient is awake or drowsy, or the Glasgow Coma Scale (GCS), if the patient is obtunded or comatose, should be performed and clearly documented. Frequent neurological examinations, at least every hour to detect early clinical deterioration and signs of increased intracranial pressure (ICP) should be part of the routine initial management algorithm Medications like anticoagulants may need to be reversed, and seizure prophylaxis with medications like phenytoin may be considered. Nursing implications Monitor closely for neurologic deterioration, and maintain a neurologic flow record. Check blood pressure, pulse, level of consciousness, pupillary responses, and motor function hourly; monitor respiratory status and report changes immediately. Use anti-bedsores (water, air mattresses, donuts, pillows) Administer anticonvulsant drugs according to the prescription STATUS EPILEPTICUS: Status Epilepticus (SE) is a medical emergency characterized by prolonged and continuous seizure activity or recurrent seizures without regaining full consciousness between them. It is a critical neurological condition with potentially life-threatening consequences. Causes Epilepsy: Individuals with a history of epilepsy may experience status epilepticus. Brain Injury: Traumatic brain injury or damage to the brain's structures can trigger SE. Infections: Infections of the brain, such as encephalitis or meningitis, can lead to SE. Drug Withdrawal: Abrupt withdrawal from certain medications, especially anti-seizure drugs, can trigger seizures and, in some cases, SE. Signs and Symptoms The signs and symptoms of Status Epilepticus can be varied but often include: Continuous Seizures: The hallmark feature is a prolonged or recurrent seizure without full recovery between episodes. Altered Mental State: The person may be confused, disoriented, or unconscious. Muscle Rigidity or Jerking: Involuntary muscle contractions or jerking movements can occur. Difficulty Breathing: Breathing may be labored, and oxygen levels can drop. Death: In severe cases, untreated Status Epilepticus can be fatal. ACUTE ISCHEMIC STROKE: Ischemic stroke occurs due to blockage of blood vessel which limits the blood supply to the brain while stroke is an acute episode of focal neurological dysfunction that persists for more than 24 hours. Another name for acute ischemic stroke is Transient Ischaemic Attack (TIA). Stages of ischemic stroke. There are multiples stages of ischemic stroke and they are: Early hyperacute: Patients presenting within 0- 6 hours of stroke onset constitute a category of stroke patient known as the "hyperacute stroke patient”. Late hyperacute: When a Patients is presenting within 6 -24 hours of stroke onset constitute a category of stroke patient known as the " late hyperacute stroke patient”. Acute: 24 hours to 1 week Subacute: 1 to 3 weeks. Chronic: more than 3 weeks. Types of ischaemic stroke. Strokes are divided into types: Haemorrhagic and Ischaemic. Ischemic strokes are further divided into 2 groups: Thrombotic strokes. These are caused by a blood clot that develops in the blood vessels inside the brain. Embolic strokes: occurs due to a buildup of fatty deposits and cholesterol forming an obstruction in the blood vessels of the brain. Thus, blood flow must be restored swiftly in order to reduce the likelihood of long-lasting brain damage. Causes/etiology Common causes are atherothrombotic occlusion of large arteries; cerebral embolism (embolic infarction); nonthrombotic occlusion of small, deep cerebral arteries (lacunar infarction); and proximal arterial stenosis with hypotension that decreases cerebral blood flow in arterial watershed zones (hemodynamic stroke). Pathophysiology of acute ischaemic stroke. Acute ischemic strokes result from vascular occlusion secondary to thromboembolic disease (see Etiology). Ischemia causes cell hypoxia and depletion of cellular adenosine triphosphate (ATP). Without ATP, there is no longer the energy to maintain ionic gradients across the cell membrane and cell depolarization. Management/treatment of acute ischaemic stroke. The main very early treatments for ischemic stroke are: Thrombolytic therapy – This involves giving a medication called alteplase (also known as tPA, for "tissue plasminogen activator"), or a similar medication called tenecteplase, by IV (through a vein). Others include: Clot-busting medication (tPA): If eligible, tissue plasminogen activator (tPA) may be administered intravenously to dissolve the blood clot causing the stroke. This treatment is time-sensitive and typically given within a specific time window from the onset of symptoms. Supportive care: Alongside clot-dissolving treatments, patients receive supportive care, including monitoring vital signs, managing blood pressure, and addressing any complications that may ensue. PEDIATRIC NEUROLOGICAL NURSING: DEVELOPMENTAL CONSIDERATIONS. Pediatric neurological disorders are a vital and often challenging area of healthcare that deeply impacts the lives of children and their families, and encompasses a wide range of conditions that affect the nervous system and development in children such as Autism spectrum disorders (ASD), Cerebral palsy, Epilepsy, Neuromuscular disorders, Pediatric stroke, Brain tumors, and other rare pediatric neurological disorders. These disorders not only affect physical health but can also have a significant impact on cognitive, emotional, and social development. Cognitive Development: Many neurological disorders can impact a child's cognitive development. For example, conditions like autism may affect communication and problem-solving abilities, while epilepsy can lead to cognitive deficits due to seizures. Emotional and Social Development: Children with neurological disorders may experience emotional and social challenges. They might struggle with building relationships, understanding social cues, or managing emotions, like in attention deficit hyperactivity disorder (ADHD). Motor Skills and Physical Development: Conditions such as cerebral palsy can affect a child's motor skills and physical development. Interventions are often focused on improving mobility and independence. Language and Communication: Children with certain neurological disorders, like speech and language disorders, may face difficulties in language acquisition and communication.. The following approaches can be taken to optimize development and quality of life while addressing the unique challenges posed by each specific condition. Age-Appropriate Assessments: Use age-specific assessment tools and techniques to evaluate a child's neurological development. An example is the Denver developmental screening test (DDST) for children from birth to 6 years. Early Intervention: Recognize the critical importance of early intervention in managing pediatric neurological disorders to optimize developmental outcomes. Growth and Maturation: Consider the child's ongoing growth and maturation when planning treatment strategies, as the nervous system continues to develop. Developmental Milestones: Monitor a child's progress in achieving developmental milestones and adapt treatment plans accordingly even as they transition from pediatric to adulthood. In conclusion, the developmental considerations surrounding pediatric neurological disorders emphasize the importance of a holistic and multidisciplinary approach to care. Understanding how these conditions impact a child's overall development is crucial in providing the best support and interventions, ensuring that their developmental needs are met as they grow and mature. LEGAL AND ETHICAL ISSUES IN NEUROLOGICAL NURSING. A. Informed consent Informed consent is a crucial legal and ethical consideration in neurological nursing. Nurses should ensure that patients have a clear understanding of their neurological condition, the proposed treatments or interventions, and any potential risks or side effects. Consent must be given voluntarily, without coercion or pressure from healthcare providers or others. Patients should have the freedom to accept or decline treatment. B. End of Life Care End-of-life care in neurological nursing is a complex area that involves various legal and ethical considerations. Respecting the patient's autonomy and their right to make decisions about their end-of-life care is paramount. This includes decisions about withholding or withdrawing life-sustaining treatments. C. Patients Right and Advocacy Patient rights and advocacy are fundamental aspects of ethical and legal considerations in neurological nursing. Advocating for patients' rights is a core responsibility for nurses in this field. They ensure that patients or their legal representatives are fully informed about their neurological condition, proposed treatments, and potential risks. Nurses advocate for the patient's right to make informed decisions about their care. Patient and family education. A. Teaching about Medications Teaching patients and their families about medication is crucial. Explain the names of the medications, both generic and brand names, describe why each medication is prescribed and its intended effects. Provide clear instructions on how much medication to take and when to take it and demonstrate the proper technique for medication administration. B. Home care Instructions If patient is being managed for an injury, demonstrate wound care procedures, dressing changes, and signs of infection and provide instructions for keeping the wound clean and dry. Schedule and explain the importance of follow-up appointments with healthcare providers. C. Support resources Describe available physical, occupational and speech therapy services for neuro related conditions and emphasize the role of rehabilitation in improving function and quality of life. Also discuss the availability of assistive devices like wheelchairs and how to obtain and use them. A CASE STUDY OF A PATIENT WITH STROKE. Patient personal data Name: Mr C.I Age: 67 years Sex: Male Marital Status: Married State of Origin: Imo LGA: Orlu East Nationality: Nigerian Religion: Christianity Occupation: Business Man Home address: GRA, Enugu Next of Kin: Mrs. E. I. Relationship: Wife Previous Medical History: High blood pressure, high blood cholesterol Medical diagnosis: Ischemic Stroke Clinical presentation Mr. C.I. was rushed into the emergency department of ESUTHP by his wife with hysterical complains of sudden confusion, onset of right-sided weakness, sudden trouble seeing in both eyes and difficulty speaking. Initial evaluation and imaging confirmed a diagnosis of ischemic stroke in the left middle cerebral artery territory. He was given IV alteplase [a tissue plasminogen activator (tPA)] within the thrombolytic window to stabilize him and then was admitted into the neurological ward by the senior registrar on call. Clinical manifestation Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. Sudden trouble seeing in one or both eyes. Sudden trouble walking. Sudden dizziness, loss of balance or coordination. Sudden, severe headache with no known cause. General medical management Diagnostic evaluation: Medical history and physical examination Head CT scan to show bleeding or damage of brain cells. MRI for higher sensitivity and specificity in diagnosis. Electrocardiogram (ECG) to measure the heart’s electrical activity. Blood tests to assess blood clotting factors. Medical management Lifestyle modifications including regular physical activity, choosing healthy food and drink options, keeping a healthy weight, stop smoking, limit alcohol intake, check cholesterol, control blood pressure. The main treatment for ischemic stroke is intravenous tissue plasminogen activator (tPA) which breaks up clots. Pharmacotherapy Serine protese(Alteplase, Reteplase, Tenecteplase) Mechanism of action: Alteplase binds to fibrin in a blood clot and activates the clot-bound plasminogen. Alteplase cleaves plasminogen at the site of its Arg561-Val562 peptide bond to form plasmin. Plasmin is a fibrinolytic enzyme that cleaves the cross-links between polymerized fibrin molecules, causing the blood clot to break down and dissolve, a process called fibrinolysis. Thienoopyridine antiplatelet (Clopidogrel, Ticagrelor, Prasugel) Mechanism of action: The active metabolite of clopidogrel specifically and irreversibly inhibits the P2Y12 subtype of ADP receptor, which is important in activation of platelets and eventual cross-linking by the protein fibrin. Platelet inhibition can be demonstrated two hours after a single dose of oral clopidogrel, but the onset of action is slow, so a loading dose of either 600 or 300 mg is administered when a rapid effect is needed Nursing management Close observation and monitoring: Mr. C.Is neurological status was assessed including level of consciousness, cranial nerve function, strength, sensation, and speech. Frequent neurological checks were conducted to monitor for any changes or deterioration in his condition. Vital signs, including blood pressure, heart rate, and oxygen saturation, were closely monitored to ensure they remained within target ranges. Medication administration: all medication administered and monitored the effects of medications such as antiplatelet and anticoagulants to prevent further complications and manage stroke risk factors. Rehabilitation Planning: This includes physical therapy, occupational therapy, and speech therapy to address the patients’ motor deficits, activities of daily living, and communication challenges. Dysphagia Management: Due to the patients’ speech difficulties and risk of aspiration, his swallowing function was closely monitored. Speech therapists assessed his swallowing ability and provided guidance on dietary modifications and safe swallowing techniques. Complications Complications of ischemic stroke include: Brain swelling Deep vein thrombosis Pulmonary embolism Falls and pressure sores Evaluation. Mr. C.I. received comprehensive care and rehabilitation during his hospital stay. With the support of the neurological nurse and the interdisciplinary team, he made significant progress in regaining motor function and communication abilities. He was discharged to a rehabilitation facility to continue his recovery and regain independence. The neurological nurse played a vital role in facilitating his transition to the next level of care while ensuring that his family was prepared to provide ongoing support and care. Conclusion of neurological nursing. In conclusion, neurological nursing is a vital and specialized field within the nursing profession that focuses on providing comprehensive care to individuals with various neurological conditions and disorders. It requires a deep commitment to patient care and a continuous pursuit of knowledge and skill development. They contribute significantly to the overall well-being of the patient. Neurological nurses play a critical role in the healthcare system, as they offer essential services that help patients with neurological issues achieve the best possible outcomes. These specialized nurses possess a unique set of skills and knowledge, allowing them to: Assess and monitor neurological status: They are skilled in conducting thorough neurological assessments to monitor patients' neurological functions and detect any changes in their condition promptly. Educate patients and families: These nurses are educators, providing patients and their families with the knowledge and tools they need to understand their condition, treatment plans, and self-care strategies. \Promote safety and prevention: They play a crucial role in educating patients and their relatives about safety measures and prevention strategies to minimize the risk of future neurological issues, such as stroke prevention or seizure management. Future trends in neurological nursing. Neurological nursing is a dynamic and evolving field with a promising future. Nurses in this specialty will need to adapt to new technologies, stay current with medical advancements, and continue to provide high-quality, patient-centered care while addressing emerging ethical and legal consideration. The field of neurological nursing is continually evolving as healthcare practices and technologies advance. Some future trends in neurological nursing which are expected to shape the profession and improve patient care include: Telehealth and Telemedicine: The integration of telehealth and telemedicine is becoming increasingly important in neurological nursing. Remote monitoring, virtual consultations, and tele-rehabilitation are expected to expand, providing more accessible care for patients with neurological conditions, especially those in remote or underserved areas. Wearable Technology: Wearable devices, such as smartwatches and sensors, are becoming more sophisticated in tracking neurological parameters like heart rate, sleep patterns, and activity levels. Neurological nurses may use this data to monitor patients remotely, detect changes in their condition, and provide timely interventions. Enhanced Patient and Family Engagement: There is a growing emphasis on involving patients and their families in care decisions. Neurological nurses will play a key role in facilitating communication, education, and shared decision-making, empowering patients to be active participants in their care. Ethical and Legal Considerations: As the field of neurology continues to advance, there will be complex ethical and legal challenges to navigate. Neurological nurses will need to stay informed about these issues, such as end-of-life care decisions, privacy concerns, and legal aspects of new treatments. Download 98.49 Kb. Share with your friends:
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