Describe the pre-, intra-, and post-procedure nursing actions for a lumbar puncture, including any contraindications to the pr

Learning Objective #1: Describe the pre-, intra-, and post-procedure nursing actions for a lumbar puncture, including any contraindications to the procedure.

Brunner and Suddarth Chapter 66 

Reading: 

· altered level of consciousness, pp. 1972-1979

· increased intracranial pressure, pp. 1979-1989

· intracranial surgery 1989-1996

Charts/Tables/Figures

· Figure 66-1, Posturing

· Table 66-1, Assessment of unconscious patient

· Figure 66-6, Neuro flow sheet

· Table 66-2, IICP with interventions

Learning Objective #1: Use the nursing process as a framework for care of the multiple needs of the patient with altered level of consciousness. 

a. What are the focused assessments for patients with altered LOC?

b. List the specific nursing interventions common to patients with altered LOC.

c. How do nurses compensate for the patient’s loss of protective reflexes?

d. Discuss dignity and privacy considerations for patients with altered LOC.

e. How can a nurse support the family of a patient with altered LOC?

Learning Objective #2: Differentiate between the early and late clinical manifestations of increased intracranial pressure.

a. Define intracranial pressure (ICP) and note the general causes and pathologic effects of increased ICP. 

b. Explain the Monro–Kellie doctrine and the compensatory mechanisms that affect and maintain ICP. 

c. Define autoregulation and explain the cerebral responses to increased ICP to maintain blood flow.

d. What are the early and late signs and symptoms of increased ICP?

e. What is Cushing’s triad?

f. Why is it important to detect subtle changes in patient assessment findings early?

g. Define and describe the herniation of brain tissues.

h. Define and describe projectile vomiting, Cheyne–Stokes breathing, and pupillary changes as they relate to ICP.

Learning Objective #3: Apply the nursing process as a framework for care of the patient with increased intracranial pressure.

a. What are the focused assessments for a patient with increased ICP?

b. Describe ICP monitoring, including ICP waveforms, positioning of the monitoring system, and importance of aseptic technique when manipulating the monitoring system.

c. What are the nursing diagnoses common to all patients with increase ICP?

d. List the collaborative problems, planning considerations, and goals common to patients with increased ICP.

e. What actions would increase ICP. Consider positioning and breathing patterns.

f. What are the interventions to prevent further increases in ICP? Consider fluid administration and I/Os, also. 

g. Discuss the treatment of SIADH and diabetes insipidus as it relates to a patient with ICP.

Learning Objective #4: List specific nursing interventions for patients undergoing intracranial surgery. Consider strategies to reduce cerebral edema and to prevent increasing ICP.

Brunner and Suddarth Chapter 67 

Reading: 

· Entire chapters

Charts/Tables/Figures

· Table 67-1, Comparison of Major Types of Strokes

· Figure 67-1, Patho of ischemic stroke

· Table 67-2, Neuro deficits of stroke

· Table 67-3, Comparison of L and R side stroke 

· Chart 67-2, Modifiable Risk Factors for Ischemic stroke

· Chart 67-3, Criteria for tPA

· Table 67-4, NIHSS 

· Figure 67-2, Carotid Endarectomy

· Chart 67-4, Assist devices

· Chart 67-5, Communication with the Patient with Aphasia

· Chart 67-6, Home care for stroke patient

Learning Objective #1: Compare the various types of cerebrovascular accidents (strokes), their causes, clinical manifestations, medical and nursing management.

a. Define stroke. Explain the use and reason for the term brain attack in describing stroke to the public. List the major types of stroke.

b. Describe ischemic stroke. List the types of ischemic strokes.

c. Describe the cascade of events and processes contributing to brain injury in ischemic stroke.

d. Describe the potential clinical manifestations of ischemic stroke, recognizing the location and size of the affected area and available collateral circulation. Use and define the medical terms associated with the manifestations. 

e. Describe transient ischemic attack (TIA) and its manifestations and causes. Why is it important to evaluate and treat TIA?

f. Describe the carotid endarterectomy. What are the indications for the procedure and what does it help prevent? 

g. Discuss preventive measures and secondary prevention of stroke for persons who have experienced TIAs or stroke. Discuss the medications in the detail.

h. Explain the medical management of stroke, emphasizing the need for prompt diagnosis and treatment, including diagnostic evaluation of stroke via imaging and standardized assessment tools.

i. What are the criteria for the administration of tissue plasminogen activator (t-PA) therapy? 

j. What ongoing assessments/monitoring while a patient is receiving t-PA? 

k. Describe t-PA action, administration, dosage, potential side effects. 

l. Describe other therapies used for the acute management of the patient experiencing a ischemic stroke.

m. Discuss the assessment of patients recovering from an ischemic stroke, including the acute phase and rehabilitation.

n. Describe hemorrhagic stroke, including its causes, pathophysiology, clinical manifestations.

o. What are the nursing interventions for hemorrhagic stroke?

p. Discuss the home care and patient and family education for a patient who has had a stroke. List and discuss the essential elements for developing a teaching plan.

Brunner and Suddarth Chapter 68 

Reading: Head injuries and brain injury, pp 2033-2048 

Charts/Tables/Figures

· Chart 68-1, Preventing Head and Spinal Cord Injuries

· Figure 68-1, Patho

· Figure 68-3, Types of bleeds

· Chart 68-2, Glasgow Coma Scale

· Table 68-1, Assessment

· Chart 68-5, Controlling ICP

· Chart 68-6, Home care for patient with TBI

Learning Objective #1: Use the nursing process as a framework for the care of patients with traumatic brain injury.

a. Compare and contrast the location, pathophysiology, symptoms, time frames, and treatment of epidural hematoma; acute, subacute, and chronic subdural hematoma; and intracerebral hemorrhage.

b. Explain the assessment of patients with brain injury, including the use of the Glasgow Coma Scale.

c. List specific nursing diagnoses common to patients with brain injury.

d. What are the collaborative problems, planning considerations, and goals for patients with brain injury? 

e. What are the specific nursing interventions for patients with brain injury, including interventions for agitated patients and measures to prevent increased ICP?