Page 254 - Critical Care Nursing Demystified

Chapter 5 CARE OF THE PATIENT WITH NEUROLOGICAL NEEDS 239

11. Prevent hips and chest flexion to prevent intraabdominal and intratho-
racic pressure, which in turn will increase ICP.
12. Avoid placing the patient in the prone position, which can also increase
ICP.
13. Administer sedatives and analgesics. Consider the use of propofol or
barbiturate coma if restlessness increases ICP. This keeps the patient
comfortable and decreases energy demands, which increase ICP.
14. Plan nursing procedures to space them apart to decrease external stimu-
lation, which can increase ICP.
15. Teach the patient and family about ICP monitoring with results, dura-
tion, and complications in mind. This decreases fear of this complex
device.
16. Apply cooling blankets and antipyretic medications to reduce and con-
trol episodes of hyperthermia, which will increase body metabolism
leading to increases in ICP.

Medications That Help With Symptoms

A variety of medications are used in the care of a patient with neurological Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
deficits. These include seizure medications, medications to induce barbiturate
coma, and diuretics (see Table 5–6).

Medical Conditions Requiring Complex Care

Status Epilepticus (SE)

What Went Wrong?
Neurological disorders such as trauma, epilepsy, electrolyte imbalances, hypoxia,
and brain tumors can lead to seizures, which are abnormal and repetitive elec-
trical discharges within the brain. These are caused by hyperexcitability of neu-
rons due to changes in the flow of ions across the cell membranes.
SE is diagnosed when seizures are unrelieved with treatment. It is generally
defined as constant generalized seizures lasting between 5 and 30 minutes or
two or more seizures during which the patient does not return to his or her
previous level of consciousness. These repetitive seizures occur so frequently
and repeatedly that brain function cannot return to normal between attacks.
Also, increased metabolic demands cannot be met or achieved, resulting in
permanent neurological damage.