Evidence-Based Nursing Care for Stroke and Neurovascular Conditions E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 400

Veröffentlichungsjahr: 2012

Beschreibung

With the aging population ever growing, healthcare for persons suffering from stroke and related illnesses is increasingly important. Evidence-Based Nursing Care for Stroke and Neurovascular Conditions provides a comprehensive and practical guide for novice, experienced and advanced practice nurses working with patients suffering from stroke and other neurovascular conditions.

With a focus specifically on neurovascular disorders, this highly detailed text offers easy-to-find information on evidence-based care guidelines. The book begins with a thorough introduction to normal cerebrovascular anatomy and physiology and common pathologic mechanisms, describing the unique challenges in working with this patient group.  Later chapters provide the pathophysiology, diagnostic and current nursing interventions for the care of patients with neurovascular disorders including transient ischemic attacks, ischemic stroke, hemorrhagic stroke, Moyamoya, Migraines and more.

Evidence-Based Nursing Care for Stroke and Neurovascular Conditions is a must-have resource for practitioners caring for patients enduring stroke and other neurovascular conditions.

Leseprobe

Contents

Cover Page

Title Page

Copyright

Epigraph

Contributors

Preface

Acknowledgments

Chapter 1: Introduction

NEUROVASCULAR NURSING

SPECIALIZED CELLS OF THE CENTRAL NERVOUS SYSTEM

BRAIN STRUCTURE

CEREBRAL BLOOD FLOW

BLOOD BRAIN BARRIER

ANTERIOR CIRCULATION

POSTERIOR CIRCULATION

FACTORS INFLUENCING CEREBRAL BLOOD FLOW

REFERENCES

Chapter 2: Transient Ischemic Attacks

DEFINITION

EPIDEMIOLOGY

PATHOPHYSIOLOGY

PHYSIOLOGIC CAUSES

PREVENTION

DIAGNOSIS

DIAGNOSTIC TESTING RECOMMENDED

REFERENCES

Chapter 3: Ischemic Stroke

DEFINITION

PREVALENCE/INCIDENCE

ACUTE MEDICAL EVENTS THAT RESULT IN CEREBRAL ISCHEMIA

CHRONIC CAUSES OF ISCHEMIC STROKE

STROKE PREVENTION

RISK FACTOR MODIFICATION

ACUTE CARE

LONG-TERM CARE OF THE STROKE PATIENT

POST-ACUTE-STROKE PLACEMENT AND CARE

SUMMARY

REFERENCES

Chapter 4: Intracerebral Hemorrhage

RISK FACTORS

MORTALITY AND PROGNOSIS

CLASSIFICATION

DIAGNOSIS

CLINICAL MANIFESTATION

MANAGEMENT

REFERENCES

Chapter 5: Subarachnoid Hemorrhage

PATHOPHYSIOLOGY

PREVENTION

DIAGNOSIS

ACUTE CARE

LONG-TERM CARE

REFERENCES

Chapter 6: Cerebral Amyloid Angiopathy

DEFINITION

HISTORICAL PERSPECTIVE

EPIDEMIOLOGY

PATHOPHYSIOLOGY

DIAGNOSIS

CAA COMPLICATIONS

RELATED ISSUES IN CAA

DRUG RESEARCH AND DEVELOPMENT

REFERENCES

Chapter 7: Vascular Malformations

CEREBRAL ANEURYSM

ARTERIOVENOUS MALFORMATION

CEREBRAL CAVERNOUS MALFORMATION

REFERENCES

Chapter 8: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL)

PATHOPHYSIOLOGY

SYMPTOMS

DIAGNOSIS

PREVENTION OF ACUTE STROKE

MANAGING SYMPTOMS

REFERENCES

Chapter 9: Migraine Headache

PATHOPHYSIOLOGY

DIAGNOSIS

PREVENTING MIGRAINES

TREATING MIGRAINES

ADDITIONAL RESOURCES

REFERENCES

Chapter 10: Moyamoya Disease

PATHOPHYSIOLOGY

DIAGNOSIS

MEDICAL TREATMENT

SURGICAL TREATMENTS

REFERENCES

Chapter 11: Binswanger's Disease

PATHOPHYSIOLOGY

DIAGNOSIS

PREVENTION

SYMPTOM MANAGEMENT

REFERENCES

BIBLIOGRAPHY

Chapter 12: Antiphospholipid Syndrome (APS)

HISTORICAL PERSPECTIVE

DEFINING APS

TYPES

PATHOGENESIS

PREVALENCE

LABORATORY TESTING

CLINICAL MANIFESTATIONS

APPROACH TO DIAGNOSIS

TREATMENT

SUMMARY

REFERENCES

Chapter 13: Vasculitis of the Central Nervous System and Cranial Vessel (Arteritis)

HISTORICAL PERSPECTIVE

DEFINITION AND CLASSIFICATION

EPIDEMIOLOGY AND PATHOGENESIS

PATHOPHYSIOLOGY

DIAGNOSTIC APPROACH

DIAGNOSIS

CLINICAL FEATURES

DIAGNOSTIC TESTING

TREATMENT

PROGNOSIS

REFERENCES

Index

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Library of Congress Cataloging-in-Publication Data

Evidence-based nursing care for stroke and neurovascular conditions / editor Sheila A. Alexander. p. cm. Includes bibliographical references and index. ISBN 978-0-470-95875-9 (pbk. : alk. paper) 1. Cerebrovascular disease--Treatment. 2. Evidence-based nursing. I. Alexander, Sheila A. RC388.5.E976 2013 616.8′10231--dc23

2012028347

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

“Nursing encompasses an art, a humanistic orientation, a feeling for the value of the individual, and an intuitive sense of ethics, and of the appropriateness of action taken.”

Myrtle Aydelotte, PhD, RN, FAAN

Contributors

Tarek Dakakni, MD Translational Acute Brain Injury Research Group Department of Anesthesiology Department of Medicine (Neurology) Duke University Durham, North Carolina, USA

Alice E. Davis, PhD, APRN Assistant Professor School of Nursing University of Hawaii, Hilo Hilo, Hawaii, USA

Michael L. “Luke” James, MD Assistant Professor Translational Acute Brain Injury Research Group Department of Anesthesiology Department of Medicine (Neurology) Duke University Durham, North Carolina, USA

Preface

Nursing is a profession that requires significant didactic and clinical training for entry into practice. Development into an expert in this field, as with any other, requires scholarly inquiry, continuous evaluation of current practices, and experience only gained over time. There are limited resources available for the neuroscience nurse, and even fewer specific to those who further specialize in the neurovascular nursing specialty. An aging population has been supported by advancements in care allowing individuals to survive who once would not, and an increase in population growth have led to a larger aging population with significant neurovascular disease. These changes have led to an increase in both quantity and quality of life, but also an increase in workload for health care providers and a need for knowledge about the evidence driving care practices including diagnostic tools and surgical, medical, and behavioral interventions. Nursing, neuroscience nursing, and neurovascular nursing in particular are advancing at a rapid pace. Increased knowledge about pathology driving various diseases has led to rapid advancements in care including newly developed interventions and challenges to existing treatment protocols that are known to lack efficacy. It is difficult for the new bedside nurse and for the practicing nurse to develop and maintain expertise within the context of rapidly changing standard of care protocols. Patients are better served by clinicians with specialized knowledge and experience in similar populations. As we continue to focus on more specialized areas of care and populations, it becomes more and more difficult for the clinician at any point in the spectrum to keep up on best practices to maximize patient outcomes. There are few text resources for the neuroscience nurse, and while there are some very excellent texts available, there are none specific to neurovascular nursing. The complexity of neurovascular disease and the body's response to critical events in the context of pre-existing co-morbidities requires nurses to provide care based on evidence, but also perform critical thinking that requires a strong knowledge base and foundation for care. The special needs of these patients' demands that nurses have detailed knowledge of the pathophysiologic underpinnings driving disease development, progression, symptoms, and the care we provide. This book was written out of the need for bedside nurses from novice to expert in all roles for a single source to begin the learning process around the area of neurovascular nursing. It is meant to serve the novice nurse as a single source to initiate the process of development into expert, but also to serve the expert nurse as a source of reference for existing care and foundational understanding to aid in the development of standard protocols. It brings together the knowledge gained through personal experiences of the various contributors, a lifetime of mentors, and an exhaustive search of the literature to find rationale for current practices.

This book is the first effort to bring together knowledge from the many disciplines on which nursing draws to develop a framework for care of some common and not so common neurovascular diseases. Each chapter includes a clear description of the known pathophysiology of the disease process and the impact that pathophysiology has on individual patients. Current evidence-based care is described with rationale for each intervention provided. In cases where there is no proven, efficacious treatment regimen available, a current state of the knowledge of existing treatments with appropriate rationale has been provided. This has been provided to promote the understanding of disease and interventions and critical thinking. It is not meant to be the final decision for patient care, but rather a starting point upon which nurses can gain meaningful command of the knowledge and build on that understanding to offer individual patients the best care. It has also been written so that the reader may better understand the impact of as yet unidentified interventions and their potential impact on patient recovery.

Acknowledgments

There has been considerable effort on the part of many individuals resulting in this final book. I would like to extend appreciation and thanks to each of those people because without their input this final product would never have been completed. My colleague and friend, Gretchen Zewe, worked with me to identify the most clinically necessary topics for this book and identify others with appropriate expertise to assist in the writing. The other contributing authors of this book, Lori M. Massaro, Alice E. Davis, Tarek Dakakni, and (Michael) Luke James have my eternal gratitude for thankless sharing of their time, energy, experience, expertise, and brain power to produce this work. Additional recognition and thanks go out to Melissa Wahl, Senior Editorial Assistant, and Carrie Horn, Senior Production Editor, at Wiley for their pleasant and persistent tolerance of my untraditional working style. Finally to my colleagues, friends, family, and my dear husband who were so supportive as I worked on this piece. It is through the efforts of all of these individuals that this final product has come to fruition.

1

Introduction

Sheila A. Alexander

Neurovascular nursing

Specialized cells of the central nervous system

Brain structure

Cerebral blood flow

Blood brain barrier

Anterior circulation

Posterior circulation

Factors influencing cerebral blood flow

References

NEUROVASCULAR NURSING

With the advancement of health care, several subspecialties have developed within the discipline of nursing. Neuroscience nursing was one of the first specialties, with the American Association of Neuroscience Nursing being established in 1968. The complexity of the central nervous system (CNS), disease processes impacting the CNS, and further advancements in health care of this population has resulted in increased specialization within neuroscience nursing. Neuroscience nurses now practice in clinical settings that specialize in spinal cord injury, traumatic brain injury, neuro-oncology, medical neurology, surgical neurology, neurovascular conditions, neurologic rehabilitation (some of which have specialty units within the overall setting), and general medical practices. They provide neuroscience specific care, as well as general care, to patients in inpatient settings, outpatient settings, community settings, and in individual's homes. The neurologic specialized educational needs of these nurses are vast, and available resources for nurses practicing in these settings are scarce. This book will serve as a resource for nurses providing care at all levels to individuals suffering from neurovascular conditions.

SPECIALIZED CELLS OF THE CENTRAL NERVOUS SYSTEM

Neurons

Neurons are specialized cells that reside within the CNS, and some extend out to organs and tissues within the body making up the peripheral nervous system. The structure of neurons is variable, with some common features (Figure 1.1). The dendrites of the neuron serve to receive chemical signals from other neurons. The soma, or cell body, of the neuron houses the nucleus and many organelles. Transcription and translation, resulting in protein production, occurs in the soma. The axon of the neuron carries the chemical signal from the dendrites/soma to the axon terminal, often called the buton. There are many microfilaments and microtubules within the axon that serve to maintain form and as a tract for transportation of substances made in the soma to the axon terminal. The structures of the neuron are important for neuronal communication. In a resting state, the extracellular fluid is more positive than the intracellular fluid. When a signal is received by the dendrite, the cell membrane becomes depolarized and positive ions flow into the cell so that the intracellular fluid is more positive than the extracellular fluid. This is known as the phase of the action potential. Upon reaching maximum membrane polarization, ion channels close so no further ion influx occurs, and sodium-potassium pumps are activated to pump sodium ions out of the cell in exchange for fewer potassium ions. These pumps serve to restore homeostasis within the cell, bringing the membrane polarization to its normal range. The polarization normalizes during the phase of an action potential. As there is some delay in cellular recognition of the membrane polarization returning to normal, the polarization drops below normal so that the intracellular fluid is more negative than normal and then rises to normal again. This is known as the phase. When the action potential reaches the end of the neuron, and the axon terminal depolarizes, vesicles filled with neurotransmitters move to the edge of the cell membrane, merging with that membrane and dumping their contents out of the neuron and into the synaptic cleft (see ). The neurotransmitter released will bind with receptors on the cell upon which the original neuron synapsed and generate action within the receiving neuron. Some neurotransmitters are excitatory, initiating an action potential in the receiving cell. Other neurotransmitters are inhibitory, blocking an action potential being passed on to the receiving cell. It is through a balance of excitatory and inhibitory communications that neurons drive functions within the body.