Patients With Neurologic Dysfunction HEALTH INSURANCE AND Social Good care Essay

Keshin Himura is a 42-year-old patient diagnosed with pituitary prolactinoma, a benign tumor that comes from the pituitary gland, producing a decrease in sex drive and impotence and increased dairy creation of the breasts. The patient also has complaints of headache and drowsiness and the occurrence of visible field changes and papilledema preoperatively.

What postoperative care and attention if the nurse supply the patient?

The nurse should supply the following postoperative care to the individual:

Evaluate gag reflex and capacity to swallow

Offer semisoft diet

Perform neurologic checks

Monitor vital signs

Maintain neurologic circulation chart

Reorient patient when necessary to person, time and place

If with seizures, carefully keep an eye on and and guard against injury

Check engine function at intervals

Assess for sensory disturbances

Evaluate speech

The patient's family asks the nurse how will they know that the problems the patient got before surgery have quit; what is the nurse's best response?

Through observation, conducting group of test that'll be provided by the physician (e. g. MRI, CT scans) to check on if the tumors already are diminished, because existence of tumor will still inhibit the signs and symptoms of the disorder. The primary target of the surgical intervention is to remove or destroy the entire tumor without increasing the neurologic deficit and also to ease symptoms by decompression. And if there is no proof tumor, the standard degrees of hormone would go back in usual, the patient will no longer experience the symptoms of the condition.

What management strategies should the nurse anticipate will be bought to look after diabetes insipidus if it occurs?

The goal of the therapy is:

To replace ADH

To ensure sufficient fluid replacement

To perfect the root intracranial problem (pituitary prolactinoma)

A liquid deprivation test is ordered by the medical doctor to confirm for the medical diagnosis of diabetes insipidus by:

withholding liquids by 8 to 12 hours

Patient is weighed frequently during the test

Plasma and urine osmolality studies are performed at the start and end of the test.

The incapability to increase the specific gravity and osmolality of the urine can be an sign of Diabetes insipidus

Pharmacologic Therapy

Administer Desmopressin (DDAVP) intranasally, BID as ordered

Nursing Management

Establish baseline data ( weight, BP, I/O patter), Keep an eye on BP and weight frequently throughout therapy and report quick changes to physician

Monitor I/O and specific gravity and serum osmolality as ordered

If patient has Coronary artery disease, utilize this drug with caution as this medicine causes vasoconstriction

Avoid concentrated liquids as this increase urine volume

What release instructions should the nurse supply the patient and family?

Most patients will spend at least one nighttime in the rigorous care device (ICU) and then typically 2 or 3 3 additional times on a regular (non-ICU) ward after surgery

The patient will likely involve some incisional pain and gentle to moderate headaches for which he may get pain medication.

A CT scan or MRI will be purchased before discharge

Ask patient to come back 2-3weeks after surgery

Inform patient to return 2-3months after 1st check-up

Inform family to watch out for signs of DI (intense thirst, regular urination). Refer immediately

Management of Patients with Neurologic Dysfunction

Case Study 2

Hiehachi Nishima, a 22-year-old patient who weighs 150 pounds, presents to the crisis division (ED) after being tossed from his equine and fainting for a few momemts; he regained awareness. The friend who was simply also riding a horse called the squad. The patient presented with a GCS of 15, and the neuro exam was within normal limitations (WNL). The ED medical professional wrote the purchases for a CT scan without compare of the head, CBC, renal and metabolic profile, PT, PTT, and INR. The nurse dispatched the labs and acquired the IV of NS at keep-open rate per ED protocol suspending. The nurse was awaiting radiology to call for the patient to travel for the CT when the individual got an epileptic cry, became unconscious, stiffened his human body, and then got violent muscle contractions. The respirations are extremely shallow, and the mouth and nail became blue. The individual lost control of bladder and colon. The patient amount his tongue and blood vessels is from the mouth area. The radiology office calls and is also ready for the patient.

List in the correct order the activities that should be used by the nurse.

Before and during a seizure, the individual is assessed and the next items are recorded:

The circumstances prior to the seizure

The occurrence of aura

The very first thing the patient will in the seizure - where moves or stiffness starts, conjugate gaze position, position of head

The kind of actions in the part of the body involved

The parts of the body involved

The size of the pupils and if the eyes are open

Whether the eyes or the top are considered one side

The presence or lack of automatisms

Incontinence of urine or stool

Unconsciousness and its duration

Any apparent paralysis or weakness of hands or legs after the seizure

Inability to speak after the seizure

Movements by the end of the seizure

Whether or not the individual sleeps or not afterwards

Cognitive status following the seizure

In addition to providing data about the seizure, medical care is fond of preventing injury and supporting the individual not only literally but also psychologically. Results such as anxiousness, embarrassment, tiredness, and major depression can be damaging to the patient.

After the individual has a seizure, the nurse's role is to report the events resulting in and occurring after and during the seizure to avoid complications.

Explain which kind of seizure the individual is having, and describe the three phases of the patient's seizure and the precise nursing care for each and every stage.

The patient possessed a tonic-clonic (gran mal) seizure. You can find three phases particularly the aura, the tonic and the clonic stage.

In the aura stage is the forewarning of your epileptic harm. It characterized by shows of Dej  vu or Jamais vu. Your client could also have auditory, olfactory, or even visible hallucinations, abnormal tastes, and tingling feelings. Physical symptoms include dizziness, frustration, lightheadedness, nausea, numbness. Though in this case, the client did not show signs or symptoms of the aura period.

*Nsg Mgt:

Provide privateness and protect the patient from wondering onlookers

Patients who have an aura may have time to get a safe, private place

Ease the patient to the ground, if possible

Loosen constrictive clothing

Push away any furniture that could injure the patient throughout a seizure

If an aura precedes the seizure, insert an oral airway to lessen the possibility of the patient's biting the tongue

The next is the tonic period. It really is usually the shortest area of the seizure, lasting not more than just a few seconds. In cases like this, it is when the patient acquired an epileptic cry, became unconscious and stiffened his overall body.

*Nsg Mgt:

Protect the top with a pad to avoid injury from stunning a difficult surface

If the patient is in bed, remove cushions and raise part rails

The previous is the clonic stage. It really is when your client got violent muscle contractions, very shallow respirations, the mouth and nail mattresses became blue, lost control of bladder and colon and bit his tongue.

*Nsg Mgt:

Do not try to pry available jaws that are clenched in a spasm or even to insert anything. Broken teeth and injury to the mouth and tongue may derive from such an action.

No make an effort should be produced to restrain the individual during the seizure because muscular contractions are strong and restraint can cause injury

If possible, place the individual on one aspect with mind flexed forward, that allows the tongue to show up forward and facilitates drainage of saliva and mucus. If suction can be found, use if essential to clear secretions.

The ED medical doctor orders the following: Valium (diazepam) 10 mg every 10 to 15 minutes prn for seizures (maximum medication dosage of 30 mg). Once seizures stop, administer Dilantin (phenytoin) 10 mg/kg IVPB. ECG monitoring regularly, VS, GCS, neuro assessments every 30 minutes. Explain what meds the nurse should provide, in what order, and exactly how they should be administered.

The nurse should provide Valium treatment (diazepam) 10 mg IM PRN every 10 to 15 mins. (maximum 30mg) for his seizure to relief the muscle spasm. For the long term comfort, administer Dilantin (phenytoin) 10 mg/kg IVPB launching dose STAT, once the seizures stop. Dilantin (phenytoin) can be an anti-seizure medication (anticonvulsant), especially to prevent tonic-clonic (grand mal) seizures and complex partial seizures (psychomotor seizures). We use piggyback to administer different IV drugs at different times. Dilantin can cause irritability to the veins and can cause serious muscle and/or nerve destruction if it infiltrates. So we should administer it with normal saline. Draw up the drugs in a syringe and add it to the piggyback dock on the IV tubes cassette, which is run concurrently with the principal IV fluid (normal saline). Run it slowly and monitor the ECG monitor. This ECG monitoring should be achieved continually to help identify abnormal heartbeats. For the vital signs, Glasgow coma scale and neuro V/S, it should be check every thirty minutes to provide reliable, objective way of saving the conscious point out of any person for primary as well as succeeding assessment.

Group Assignments

Have each member address medical management related to looking after an unconscious patient.

Preventing Urinary Retention

Palpate bladder at intervals to ascertain whether urinary retention is present

If patient is not voiding, an indwelling catheter is placed and connected to a shut drainage system as ordered

Observe for fever and cloudy urine for infection

Observe the region across the urethral orifice for any drainage

As soon as awareness is regained, a bladder-training program initiated

Promote Colon Function

Assess tummy for distention by tuning in for bowel seems (unusual gurgling looks should be heard every 5-20sec)

Measuring the girth of the stomach with a tape strategy.

Monitor for the number and consistency of colon movements

Perform rectal exam for signals of fecal impaction as ordered.

Stool softeners may be recommended and can be implemented with pipe feedings

Glycerin suppository may be mentioned to facilitate bowel emptying

May require enema almost every other day to empty lower colon

Maintain Skin area and Joint Integrity

Monitor pressure areas for possible ulcerations

Establish a normal schedule of turning to avoid pressure, which can cause breakdown and necrosis of the skin

This provides kinesthetic, proprioceptive and vestibular stimulation

Avoid dragging and pulling the patient up in the bed, because this creates a shearing make and friction on the skin surface

Maintain appropriate body position

Passive exercise of the extremities is important to prevent contractures

Splints or foam boots enable you to prevent foot drop and pressure of bedding on the toes

Trochanter rolls enable you to support the hip joint parts and keep carefully the hip and legs in proper alignment

Providing Mouth area Care

Inspect mouth area for dryness, swelling, and crusting

Cleanse and rinse out mouth carefully to eliminate secretions and crusts and also to keep the mucous membranes moist

Administer petrolatum on the lip area to prevent drying, cracking and encrustations.

If patient has an endotracheal pipe, the pipe should be changed to the contrary side of the oral cavity and lips

Perform routine tooth cleaning every 8hrs to decrease ventilator-associated pneumonia

Maintaining the Airway

Elevate the top of foundation to 30 certifications to avoid aspiration.

Place the client in lateral position to allow the jaw and tongue to land forward to market drainage of secretions.

Suction for secretions as needed

Maintain dental hygiene

Chest physiotherapy and postural drainage to promote pulmonary hygiene

Auscultate the patient's breasts every 8 time to assess for any deviated breath sounds.

If the patient has a mechanised ventilator, keep up with the patency of the endotracheal tube or tracheostomy, provide dental care, keep an eye on arterial bloodstream gas measurements and preserving ventilator options.

Protecting the Patient

Raise side-rails up as always to avoid injury

Ensure the patient's dignity during modified LOC, speaking to the client during nursing care activities.

Maintaining Liquid Balance and Managing Nutritional Needs

Assess pores and skin turgor and mucous membrane for dryness

Monitor for intake and result and determine the needs for catheterization

Preserving Corneal Integrity

Patient's eyes may be cleansed with natural cotton balls moistened with sterile normal saline to eliminate any discharge.

For man-made tears (prescription by the physician), may introduce every 2 hours.

Maintaining Body Temperature

The environment can be altered (with regards to the patient's condition) to market normal body's temperature.

If body temperature is elevated, a minimum amount of home bedding can be used.

For geriatric patients and doesn't have any elevated temperature, a warmer environment is necessary.

Providing Sensory Stimulation

Communicate with patient, and encourage the family members to do it so.

Orient the patient to time, day, and place once for each 8 time.

Have each group member develop a nursing prognosis related to an individual with an transformed level of awareness. Identify potential problems and problems related to the medical diagnosis.

Nursing Diagnosis

Potential Problems and Complications

1. Ineffective airway clearance related to transformed degree of consciousness


2. Risk for impaired skin integrity related to long term immobility

Bed sore

Pressure ulceration

3. Impaired Urinary removal: retention related to impairment in neurologic sensing and control

Bladder distention


Formation of stones

4. Impaired tissue integrity of cornea related to diminished or absent corneal reflex

Periorbital edema


Corneal abrasions

5. Deficient substance quantity related to failure to take liquids by mouth


Cerebral edema

6. Interrupted family techniques related to changes in the cognitive and physical status of their adored one


Severe nervousness, denial, anger, remorse, grief, and reconciliation

7. Risk for personal injury related to decreased LOC


8. Ineffective thermoregulation related to harm to hypothalamic center


9. Impaired dental mucous membrane related to oral cavity breathing, lack of pharyngeal reflex and improved fluid intake




10. Colon incontinence related to impairment neurologic sensing and control

Abdominal distention


Frequent loose stools

As a group, identify potential problems that may come up in the postoperative stage of cranial surgery.

Increased ICP

Monro-Kellie hypothesis state governments that, as a result of limited space for expansion within the skull, a rise in any one of the components triggers an alteration in the volume of the others. because brain tissues has limited space to develop, compensation typically is achieved by displacing or shifting CSF, increasing the absorption or diminishing the development of CSF, or lessening cerebral volume bringing on a rise ICP.

Bleeding and hypovolemic shock

An build up of blood under the bone flap (extradural, subdural, or intracerebral hematoma) may create a threat to life. A clot must be suspected in virtually any patient who does not awaken needlessly to say or whose conditions deteriorates.

Fluid and electrolyte disturbances

IV solutions and blood component remedy for patients with intracranial conditions must be given slowly. If they are administered too quickly, they can increase ICP. The amount of fluids given may be restricted to minimize the possibility of cerebral edema.


The risk of infection is great when ICP is supervised with an intraventricular catheter and boosts with the length of time of the monitoring.


Underlying cause is an electrical disruption in the nerve cells in one portion of the mind. An abnormal motor, sensory, autonomic, or physical activity that result from sudden excessive release from cerebral neurons.

Have each group member identify a kind of seizure. Describe clinical manifestations, prognosis, and treatment of every.

Generalized Seizures:

This are seizures that mainly involves electrical charges in the complete brain, its medical manifestations includes loss of consciousness for a short or long time frame.

Types of Seizure

Clinical Manifestation

"Grand Mal" or Generalized tonic-clonic



Muscle rigidity


Short loss of unconsciousness


Irregular jerky movements


Repetitive jerky movements


Muscle tightness and rigidity


Loss of muscle tone


Physical examination especially neurologic examination


For temporary and reversible causes of seizures:

Blood chemistry

Blood sugar

Complete Bloodstream Count

Cerebrospinal fluid analysis

Kidney function test

Liver function tests

Test to look for the cause and location:

EEG (electroencephalograph) to measure the electrical power activity in the brain

Head CT or MRI scan

Lumbar puncture-spinal tap


When a seizure occurs, protect the individual from personal injury, make the surroundings safe for you and the individual.

Protect the patient's head

Loosen limited clothing

Place the individual into a side-lying position if vomiting occurs

Stay with patient until she or he is totally recovered

Monitor the patient's essential signs

Medications such as anticonvulsants may be given as ordered to reduce the amount of future seizures.

The DON'T's During Seizures:

Don't restrain the patient

Don't place anything between the patient's teeth during a seizure

Don't move the patient unless they're in danger or near something hazardous

Don't make an effort to stop the individual from convulsing.

Partial Seizures:

This are seizures that mainly entails electrical charges in a single area of the brain, its clinical manifestations includes irregular muscle activities, automatisms, abnormal feelings, hallucinations, nausea, sweating, dilated pupils, fast heartrate and pulse rate, changes in eye-sight.

Types of Seizure

Clinical Manifestation


(consciousness is intact)

Jerky movements

Muscle rigidity, spasm

Unusual sensation

Memory and emotional disturbance


(consciousness is impaired)

Automatisms: lip smacking, chewing, walking and repeated involuntary and coordinated movements


CT scan



EEG-video recordings


Vagus Nerve Stimulation in which a little power is implanted in the upper body wall which will program to provide brief bursts of energy to the mind.

Corpus Callosotomy is a kind of surgical treatment that will slice the connections between your two sides of the brain that will prevent drop problems. .

Multiple sub-pial transection which is a surgical approach that will cut a certain interconnection between nerve skin cells.

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