Management of Patients With Neurologic Dysfunction
The central nervous system contains a vast network of neurons controlling the body’s vital functions. Yet this system is vulnerable, and its optimal function depends on several key factors. First, the neurologic system relies on its own structural integrity for sup-port and homeostasis. Examples of structural disruption include head injury, brain tumor, intracranial hemorrhage, infection, and stroke. As brain tissue expands in the inflexible cranium, ICP rises and cerebral perfusion is impaired. Further expansion places pressure on vital centers, which can cause permanent neurologic deficits or lead to brain death.
Second, the neurologic system also relies on the body’s ability to maintain a homeostatic environment. It requires the body to deliver the essential elements of oxygen and glucose and to filter out substrates toxic to the neurons. Sepsis, hypovolemia, myo-cardial infarction, respiratory arrest, hypoglycemia, electrolyte imbalance, drug and/or alcohol overdose, encephalopathy, and ketoacidosis are all examples of circumstances in which the neuro-logic system is depressed due to a toxic metabolic effect or due to the body’s mechanical inability to provide essential substrates.Some conditions can be treated and neurologic impairments can be reversed; others result in permanent deficits.
Although neuroscience nursing is a specialty requiring an un-derstanding of neuroanatomy, neurophysiology, neurodiagnostic testing, critical care nursing, and rehabilitation nursing, nurses in all settings care for patients with neurologic disorders. Ongoing assessment of the patient’s neurologic function and health needs, identification of problems, mutual goal setting, development and implementation of care plans (including teaching, counseling, and coordinating activities), and evaluation of the outcomes of care are nursing actions integral to the recovery of the patient. The nurse also collaborates with other members of the health care team to provide essential care, offer a variety of solutions to prob-lems, help patients and families gain control of their lives, and ex-plore the educational and supportive resources available in the community. The goals are to achieve as high a level of function as possible and to enhance the quality of life for the patient with neurologic impairment and his or her family.
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