Nr 341 final paper - rua for nr 341

Sample 1

RUA: Interdisciplinary Management of Healthcare Technology

Introduction

In the United States, traumatic brain injury (TBI) affects approximately 1.7 million individuals annually, with adolescents aged 15-19 and adults over 65 being the most susceptible groups (Georges & Booker, 2020). Mild traumatic brain injury (mTBI), also known as brain concussion, was initially considered a benign condition. However, it has gained significant attention due to the adverse neuropsychological outcomes observed in contact-sport athletes and military personnel. A crucial tool in managing TBI is intracranial pressure (ICP) monitoring, which helps assess and manage the hydrostatic force within the brain’s cerebrospinal fluid (CSF) compartment (Harding et al., 2020).

Case Study: Intracranial Pressure Monitoring

Consider the case of a 41-year-old female who sustained severe injuries in a motor vehicle accident. She suffered a traumatic brain injury, including a left-sided frontal parietal contusion, a subarachnoid hemorrhage, and a basilar skull fracture. Upon arrival at the emergency room, her Glasgow Coma Scale (GCS) score was three, indicating a deep coma, and she required intubation. Her left pupil was 7mm and nonreactive. The patient received mannitol before undergoing a left hemicraniectomy, a surgical procedure to relieve pressure. An ICP monitor was inserted post-operatively, showing a reduction in intracranial pressure from 45 mmHg to 18 mmHg. The normal range for ICP is 5-15 mmHg.

Understanding Intracranial Pressure Monitoring

ICP monitoring involves inserting a device into the skull to measure the pressure inside the cranium. This procedure is essential for patients who have experienced traumatic brain injuries, blunt or penetrating trauma, ischemic and hemorrhagic strokes, or other neurological injuries. According to the Guidelines for the Management of Severe TBI, an ICP monitor is recommended for TBI patients at risk of intracranial hypertension, particularly those in a coma (GCS <8) with an abnormal head CT scan (Leroux, 2016).

Initial pharmacologic management of elevated ICP may include analgesics and sedatives like fentanyl and remifentanil to manage pain and agitation. Osmotic diuretics like mannitol and hypertonic saline are used to reduce cerebral edema by pulling water out of the brain tissue, thus decreasing ICP (Munakomi & Das, 2020).

Risks and Benefits

The primary benefit of ICP monitoring is maintaining normal intracranial pressure, thereby preventing secondary brain injury. Elevated ICP, if left untreated, can lead to cerebral hypoperfusion, hypoxia, tissue ischemia, cerebral herniation, and potentially brain death. Studies have shown a proportional relationship between elevated ICP and mortality, with a sixfold increase in the risk of death when ICP exceeds 40 mmHg (Le Roux, 2016). Continuous dynamic ICP monitoring improves the accuracy of outcome predictions, although the association between ICP and morbidity remains less clear.

Interdisciplinary Team Roles and Responsibilities

Effective management of ICP requires a coordinated interdisciplinary team, including physicians (MDs, DOs, NPs, PAs), specialists, and specialty-trained nurses. The medical team prescribes and adjusts medications, communicates care plans, and ensures continuous monitoring. Critical care nurses play a vital role in hourly neurological and hemodynamic evaluations, ensuring prompt treatment of any changes (Haskell, 2020). The collaboration between these professionals is crucial for optimizing patient outcomes.

Nursing Scope of Practice

Critical care nurses managing patients with ICP monitoring must possess extensive knowledge of brain physiology and the mechanisms of neurological deterioration and recovery. Their responsibilities include monitoring ventilator settings, administering medications, managing fluids and nutrition, and utilizing therapeutic devices to stabilize patients during recovery (Haskell, 2020).

Patient and Family Education

Educating patients and their families about ICP monitoring is essential. Nurses should provide clear, concise explanations of the procedure, the reasons for monitoring, and the expected outcomes. It’s also important to address the emotional and psychological needs of the patient and their family, offering support and reassurance throughout the treatment process.

Conclusion

Caring for patients with ICP monitoring requires a comprehensive understanding of brain physiology, meticulous monitoring, and coordinated interdisciplinary care. By maintaining proper ICP levels and preventing secondary brain injuries, healthcare providers can significantly improve outcomes for patients with traumatic brain injuries.

References

Georges, A., & Booker, R. (2020). [Insert further reference details].
Harding, M., Bowman Woodall, C., & Kwong, J. (2020). Study Guide for Lewis’s Medical-Surgical Nursing (11th ed.). Elsevier Health Sciences (US).
Haskell, R. (2020). Increased Intracranial Pressure (ICP): What Nurses Need to Know. Nursingcenter.com.
Leroux, P. (2016). Intracranial Pressure Monitoring and Management. PubMed; CRC Press/Taylor and Francis Group.
Munakomi, S., & Das, J. (2020). Intracranial Pressure Monitoring. PubMed; Stat Pearls Publishing.
Sacco, T. L., & Delibert, S. A. (2018). Management of Intracranial Pressure: Part I: Pharmacologic Interventions. Dimensions of Critical Care Nursing, 37(3), 120-129. DOI: 10.1097/DCC.0000000000000293

Sample 2

Running head: RUA1 Critical Care

RUA NR341 Complex Adult Health

Chamberlain College of Nursing

Kayla R. Lewis

April 2, 2017

RUA2 Background Information

Patient Demographics

Patient’s Initials: K.B.
Date of Admission: 3/2/17
Age: 75
Sex: Female
Marital Status: Widow
Code Status (with date): FULL (3/2/2017)
Reason for Admission: Change in mental status reported by family along with decreased responsiveness; patient has UTI, possible sepsis.
Occupation: NONE
Admitted From: Emergency Room
Allergies: Augmentin

Situation

A 75-year-old female was brought to the emergency room by her family, who reported a recent change in mental status and decreased responsiveness. According to the family, the patient has no history of dementia but has been somewhat confused throughout the day. For example, she believed a TV show was real and that “Bobby Flay was coming to make her fresh.” Upon arrival, EMS reported no signs of confusion. The emergency department noted that the patient could carry on a conversation and reported no complaints other than burning during urination. The ER admitted the patient for UTI, possible sepsis, with a white blood count of 17,000. She is hyperglycemic and shows evidence of UTI with over 38,000 bacteria. Her chest x-ray was normal, and her head CT showed no acute hemorrhage. She is receiving an IV sepsis bolus and broad-spectrum antibiotics.

Background (including Co-morbidities/past medical or surgical history)

Noninsulin-dependent diabetes mellitus (diagnosed several years ago). The patient has not seen her physician in over a year and has been on no medications.
Past medical history includes gout, colitis, hypertension, osteoporosis, and rheumatoid arthritis. She experiences severe pain in her legs and feet when walking.
Past surgical history includes a lumpectomy and coronary artery bypass graft.

Physical Assessment

Assessment time: 6am
VS: Temp: 98°F, HR: 125, RR: 18, BP: 208/97, O2: 98% on room air, Wt: n/a
Environment: Patient appeared more alert according to family. She was oriented to person and place (x2) and was smiling. Her daughter was at the bedside.

Skin: Skin was warm and dry. The patient has a large stage IV sacral decubitus ulcer with no erythema or drainage, mycotic toenails, and a possible small pressure ulcer on the third toe of the right foot.

Neurological: Patient was alert but disoriented. No cranial nerve or sensory deficits noted.

HEENT:

Head: Normocephalic and atraumatic.
Eyes: Conjunctivae are pink.
Ears: No hearing impairment observed; the patient does not wear hearing aids.
Neck: Supple and benign.
Throat: Patent airway, gag reflex intact, no deviations or masses noted.