Neurological alterations are conditions that may result in structural or metabolic diseases in the brain, spinal cord, and nerves. The causes of neurological issues can vary, but they often include genetic illnesses, infections, brain injury, or nerve injury. All the neurological problems result from damage to the nervous system, regardless of the source, which affects human vision, hearing, movement, and cognition.
Increased Intracranial Pressure
Increased intracranial pressure (ICP) may be caused by increased cerebrospinal fluid pressure, which envelops the spinal cord and brain. This may be brought on by bleeding into the brain or swelling inside the brain. Increased intracranial pressure threatens life, so a person with its symptoms should seek immediate emergency medical attention.
Medical Management
If the intracranial pressure is higher than 20 mmHg, it is classified as high intracranial pressure, or in other words, intracranial hypertension (HICP) (Robba & Citerio, 2019). Sedation, cerebrospinal fluid drainage, and osmotherapy with either mannitol or hypertonic saline should all be part of the medical management of elevated intracranial pressure.
Communication/teaching
Before delivering medical care to patients, nurses and other medical workers must know that the pressure can be decreased by utilizing various techniques. Patients with HICP symptoms should be informed to get hyperventilation, as it lowers intracranial pressure by causing cerebral vasoconstriction and decreasing cerebral blood volume.
Cultural Considerations
It is important to remember that the risk factors for idiopathic intracranial hypertension include being overweight and female sex. In other words, the issue primarily affects women, with less than 10% of patients with HICP being men (Hornby et al., 2018). Moreover, the risk of increased intracranial hypertension increases with increasing body mass.
Nursing Interventions and Rationales
HICP can result in subsequent brain damage and death, so the issue should be quickly treated. The first ICP lowering treatments are keeping the client’s neck in place, maintaining an average body temperature, and elevating the head of the bed up to a 30-degree angle (Robba & Citerio, 2019).
Skull Fracture
Skull fracture is a traumatic injury to the integrity of the skull. They are usually accompanied by the spread of the brain and its membranes. Therefore, it belongs to a group that poses a threat to life.
Medical Management
Medical management of patients with skull fractures includes continuous observation in the hospital. All patients with traumatic brain injury must be immediately taken to the hospital (Wang et al., 2018). Moreover, as it sometimes needs surgical treatment, the patients are prescribed medication to ease the pain in the healing process.
Communication/teaching
The patient with a skull fracture needs to know that treatment for different age groups is other. Patient and their families should never forget that diagnosis relies on physical examination and scanning of the head (Han, 2018). Therefore, if the skull is damaged, it is crucial to get urgent medical treatment.
Cultural Considerations
Indications for surgical intervention for fractures of the base of the skull in the acute period may be damage to the facial or optic nerve and, in the long-term – the continued outflow of cerebrospinal fluid from the ear canals or nasal passages. The prognosis for skull fractures depends on the severity of the traumatic brain injury and does not depend on the cultural differences of the patients (Stein, 2019).
Nursing Interventions and Rationales
Skull fracture should be ruled out in all patients with traumatic brain injury. The three primary nursing interventions for patients with skull fractures are monitoring airway and respiratory status, evaluating drainage to prevent nose bleeds, and evaluating cranial nerve function.
Spinal Cord Injury
Damage to the small network of nerves and cells that transmits and receives messages from the brain to the rest of the body is known as a spinal cord injury (SCI). SCI has severe long-term effects on the patient, leaving them with significant psychological aftereffects and physical reliance.
Medical Management
Medical management of the trauma begins before entering the hospital. Traumatic spinal cord injuries can happen during extraction, transport, or handling up to 25% of the time (Sandean, 2020). Therefore, spinal immobilization is a top priority for patients with injuries consistent with spinal damage.
Communication/teaching
Systemic consequences can manifest in patients with spinal cord injury and put them at risk for regurgitation and pulmonary aspiration. The risk can be mitigated by decompressing the stomach using a nasogastric tube (Sandean, 2020). The patient has to be properly scanned and examined for spinal damage by neurological evaluation.
Cultural Considerations
Living with a spinal cord impairment or damage requires constant adjustment. Adjustment focuses on mourning the loss and understanding the injury when a patient is first hurt. The objectives are to take care of themselves as independently as the condition permits and to start the process of creating a life that is not solely centered around the impairment.
Nursing Interventions and Rationales
Maximizing respiratory function, preventing spinal cord injury, promoting mobility and independence, preventing or minimizing complications, supporting the patient’s psychological adjustment, and providing information about the injury, prognosis, and treatment are among the nursing care planning and goals for patients with spinal cord injuries.
Cerebrovascular disease
Numerous blood artery problems that affect the brain’s blood flow are referred to as cerebrovascular illnesses. Any decrease in blood flow to the brain, which accounts for a sizeable amount of the body’s blood flow, might cause a stroke.
Medical Management
A cerebrovascular illness can frequently be treated using a variety of approaches and cutting-edge new technology. Medical management approaches include microsurgery, which is used for direct, minimally invasive surgery on sensitive cerebral blood arteries.
Communication/teaching
When the blood flow to a portion of the brain is blocked or diminished, brain tissue cannot receive oxygen and nutrients, which results in an ischemic stroke. A stroke is a medical emergency; getting help quickly is essential. Early intervention can lessen problems and brain damage.
Cultural Considerations
Cultural considerations should be considered when treating any neurological disease, including cerebrovascular disease. For instance, in China, stroke is the leading cause of disability and fatalities(Liu et al., 2019). In this case, the multimodal therapy of ischemic cerebrovascular disorders is vital in China.
Nursing Interventions and Rationales
Possible nursing interventions for cerebrovascular disease include maintaining excellent body alignment, relieving pressure, and preventing contractures, assuming the appropriate position. After being admitted to the hospital, the stroke patient’s initial nursing assessment should include checking their vital signs, especially their oxygen saturation, blood pressure, and temperature.
Status Epilepticus
In the United States, status epilepticus is a growingly acknowledged public health issue. The length of time in status epilepticus before receiving treatment, the cause of the disease, and the patient’s age all contribute to the syndrome’s high death rate as new medicines become available and the course of treatment changes.
Medical Management
Utilizing powerful intravenous medicines with potentially life-threatening side effects is necessary to treat status epilepticus. Maintaining oxygenation and circulation, determining the etiology, conducting laboratory tests, getting intravenous access, and starting medication therapy are all necessary actions.
Communication/teaching
Status epilepticus is an emergency case and should be treated immediately. The patients should be taught to call emergency services if they think they can be in status epilepticus. To prevent damage, the patient should be gently placed on the floor or a bed.
Nursing Interventions and Rationales
The nurses should evaluate the patient’s oxygenation and check the blood pressure and pulse. Moreover, a neurologic screening exam should also be carried out by the medical workers.
Conclusion
Depending on the type of condition and the particular location of the affected body, the symptoms of neurological disorders can vary greatly. The patient may occasionally feel emotional problems while others only experience physical symptoms. In both cases, if experiencing any neurological symptoms, the patient should get immediate medical care.
References
Han, S. (2018). How serious is a fractured skull?MedicalNewsToday.
Hornby, C., Mollan, S. P., Botfield, H., O’Reilly, M. W., & Sinclair, A. J. (2018). Metabolic concepts in idiopathic intracranial hypertension and their potential for therapeutic intervention.Journal of Neuro-Ophthalmology, 38(4), 522-530.
Liu, L., Chen, W., Zhou, H., Duan, W., Li, S., Huo, X., Xu, W., Huang, L., Zheng, H., Liu, J., Liu, H., Wei, Y., Xu, J., & Wang, Y. (2020). Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases.Stroke and Vascular Neurology.
Robba, C. & Citerio, G. (2019). How I manage intracranial hypertension. Critical Care, 23.
Sandean, D. (2020). Management of acute spinal cord injury: A summary of the evidence pertaining to the acute management, operative and non-operative management.World Journal of Orthopedics, 11(12), 573-583.
Stein, S. C. (2018). The evolution of modern treatment for depressed skull fractures.World Neurosurgery, 121,186-192.
Wang, H., Zhou, Y., Liu, J., Ou, L., Han, J., & Xiang, L. (2018). Traumatic skull fractures in children and adolescents: A retrospective observational study.Injury, 49(2), 219-225.