Brunner And Suddarth\'s Textbook Of Medical Surgica
Brunner and Suddarth\'s Textbook of Medical Surgica
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Brunner and Suddarth's Textbook of Medical Surgical Nursing ; Chapter 66: Management of Patients with Neurologic Dysfunction
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Brunner and Suddarth\'s Textbook of Medical Surgica
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Brunner And Suddarth\'s Textbook Of Medical Surgica
A patient is being admitted to the neurologic ICU following an acute head injury that has resulted in cerebral edema. When planning this patient's care, the nurse would expect to administer what priority medication?
-Hydrochlorothiazide (HydroDIURIL)
-Furosemide (Lasix)
-Mannitol (Osmitrol...
brunner and suddarths textbook of medical surgical nursing chapter 66 management of patients with neurologic dysfunction
a patient is being admitted to the neurologic icu following an acute hea
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Brunner and Suddarth's Textbook of
Medical Surgical Nursing ; Chapter 66:
Management of Patients with Neurologic
Dysfunction
A patient is being admitted to the neurologic ICU following an acute head injury that has
resulted in cerebral edema. When planning this patient's care, the nurse would expect
to administer what priority medication?
Feedback: The osmotic diuretic mannitol is given to dehydrate the brain tissue and
reduce cerebral edema. This drug acts by reducing the volume of brain and extracellular
fluid. Spirolactone, furosemide, and hydrochlorothiazide are diuretics that are not
typically used in the treatment of increased ICP resulting from cerebral edema.
The nurse is providing care for a patient who is unconscious. What nursing intervention
takes highest priority?
-Maintaining accurate records of intake and output
- Maintaining a patent airway
- Inserting a nasogastric (NG) tube as ordered
- Providing appropriate pain control - Answer Maintaining a patent airway
Feedback: Maintaining a patent airway always takes top priority, even though each of
the other listed actions is necessary and appropriate.
The nurse is caring for a patient in the ICU who has a brain stem herniation and who is
exhibiting an altered level of consciousness. Monitoring reveals that the patient's mean
arterial pressure (MAP) is 60 mm Hg with an intracranial pressure (ICP) reading of 5
mm Hg. What is the nurse's most appropriate action?
-Position the patient in the high Fowler's position as tolerated.
-Administer osmotic diuretics as ordered.
,Brunner and Suddarth's Textbook of
Medical Surgical Nursing ; Chapter 66:
Management of Patients with Neurologic
Dysfunction
-Participate in interventions to increase cerebral perfusion pressure.
-Prepare the patient for craniotomy. - Answer Participate in interventions to increase
cerebral perfusion pressure.
Feedback: The cerebral perfusion pressure (CPP) is 55 mm Hg, which is considered
low. The normal CPP is 70 to 100 mm Hg. Patients with a CPP of less than 50 mm Hg
experience irreversible neurologic damage. As a result, interventions are necessary. A
craniotomy is not directly indicated. Diuretics and increased height of bed would
exacerbate the patient's condition.
The nurse is caring for a patient who is postoperative following a craniotomy. When
writing the plan of care, the nurse identifies a diagnosis of "deficient fluid volume related
to fluid restriction and osmotic diuretic use." What would be an appropriate intervention
for this diagnosis?
Feedback: The postoperative fluid regimen depends on the type of neurosurgical
procedure and is determined on an individual basis. The volume and composition of
fluids are adjusted based on daily serum electrolyte values, along with fluid intake and
output. Fluids may have to be restricted in patients with cerebral edema. Changing the
patient's position, maintaining an NPO status, and monitoring ABG values do not relate
to the nursing diagnosis of deficient fluid volume.
A patient with a documented history of seizure disorder experiences a generalized
seizure. What nursing action is most appropriate?
- Restrain the patient to prevent injury.
-Open the patient's jaws to insert an oral airway.
-Place patient in high Fowler's position.
, Brunner and Suddarth's Textbook of
Medical Surgical Nursing ; Chapter 66:
Management of Patients with Neurologic
Dysfunction
- Loosen the patient's restrictive clothing. - Answer Loosen the patient's restrictive
clothing.
Feedback: An appropriate nursing intervention would include loosening any restrictive
clothing on the patient. No attempt should be made to restrain the patient during the
seizure because muscular contractions are strong and restraint can produce injury. Do
not attempt to pry open jaws that are clenched in a spasm to insert anything. Broken
teeth and injury to the lips and tongue may result from such an action. If possible, place
the patient on one side with head flexed forward, which allows the tongue to fall forward
and facilitates drainage of saliva and mucus.
A patient who has been on longterm phenytoin (Dilantin) therapy is admitted to the unit.
In light of the adverse of effects of this medication, the nurse should prioritize which of
the following in the patient's plan of care?
- Monitoring of pulse oximetry
-Administration of a lowprotein diet
-Administration of thorough oral hygiene
-Fluid restriction as ordered - Answer Administration of thorough oral hygiene
Feedback: Gingival hyperplasia (swollen and tender gums) can be associated with
longterm phenytoin (Dilantin) use. Thorough oral hygiene should be provided
consistently and encouraged after discharge. Fluid and protein restriction are
contraindicated and there is no particular need for constant oxygen saturation
monitoring.
A nurse is admitting a patient with a severe migraine headache and a history of acute
coronary syndrome. What migraine medication would the nurse question for this
patient?
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