WHAT IF YOUR PATIENT IS IN A COMA

It is important to be very careful what we say over the patient in a coma.
When some comatose patients(Sessions 3) finally awaken, they have been
known to repeat what they have been listening to.

For more helpful information on assessment and managemnt of the neurological patient,

just click on the link: STROKE SERIES -ASSESSMENT IN THE CLINICAL SETTING.

WHAT IF YOUR PATIENT IS IN A COMA

Hi all,

Hope you had a good week. Have you ever taken care of a patient in a coma ? Do you believe this patient has no idea what is going on? Think again. Patients can hear what you are saying.

I have had more than one experience where someone who has been in a coma has come back to relate all that has been said. So, CAREFUL WHAT YOU SAY AND WHERE YOU SAY IT.

Enjoy learning more about the Neurological Patient.

or watching the video :

http://www.dearnurses.com/clinical_nursing_videos_called_sessions

(Sessions 3)

WHAT IS A NEUROMUSCULAR BLOCKADE

A neuromuscular blockade includes such drugs as Pavulon, Vecuronium, Nimbex and Anectine.To learn more about the use of neuromuscular blockades, simply click on the link:
http://www.dearnurses.net/the_clinical_setting_step_by_step
and enjoy reading Adult Respiratory Distress syndrome, Chapter5.

WHAT IF YOUR PATIENT HAD AN NMB ORDER

Updated 7/25

Scenario: Nick is in the ICU, with a diagnosis of
ARDS (Adult Respiratory Distress Syndrome).

ARDS is a life threatening condition, brought on by
fluid buildup in the lungs. As the air sacs fill with fluid,

air exchange and oxygenation become difficult.

White patches on the lungs are seen on X-Ray. The
term"white out"is sometimes used to describe the
damaged lungs.

         

Mehanical ventilation becomes necessary, to assist
 with the workload of breathing. Breath sounds are
decreased as ventilation of lung tissue becomes difficult.

This complex illness, may be triggered by a number
of conditions.Causes include, but are not confined to: 
- pneumonia, near drowning
- massive blood transfusions
- pancreatitis, trauma and sepsis .

Management of the patient in ARDS is done in the ICU.

Neuroblockades are paralysing agents. They are sometimes
used in the Critical Care Setting or in the OR. Patients who
have traumatic injuries and require ventilatory support for
lung problems such as ARDS, may require NMB.

When patients are put to sleep in the OR, NMBs are also used.
They cause paralysis of all the muscles in the body.

Here are some helpful hints :
- Follow MD orders
- Patients should NEVER be given NMBs, without Ventilatory support.
- Patients need monitoring if Neuromuscular Blockades are being used.
- SEDATION should always accompany the use of NMB drugs.
Patients who are given NMBs without sedation have related
terrible experiences. Some felt like they were buried alive.

Learn more about : ARDS, DVT and PE

REST IS BEST FOR THE NEUROLOGICAL PATIENT

Updated 6/24

It has been suggested, after years of experience, that for the neurological patient, 
too much stimulation demands more oxygen and may result in secondary injury.

Pain medication and adequate rest make for better results. Enjoy watching the video:

Nursing communication

 

WHAT IS A BRAIN HEMORRHAGE?

Update 6/25

There are numerous reasons a brain hemorrhage may occur.
These include but are not confined to:
 - Stroke (hemorrhagic)
 - trauma

 and more.

Enjoy the video:

ICP monitoring

Learn more about: Care planning/ brain injuries

EPIDURAL BLEEDING

Updated 4/24

Dear nurses,

The Clinical Setting Step by Step is no longer available.

Please click on the link for more updated information:

Subarachnoid hemorrhage

Tim was on a ladder at work.He lost his balance and fell to the ground.

He has an EPIDURAL BLEED of the meningeal artery. He had a brief period

of consciousness, became lucid, then became lethargic.

For more updated and helpful information, click on the link:

STROKE SERIES ASSESSMENT IN THE CLINICAL SETTING OR

THE CLINICAL SETTING STEP BY STEP, CHAPTER 9.

WHAT IF PATIENT HAS A BLEED INTO THE BRAIN?

Updated 6 /25

Dear nurses,

Dearnurses.com is no longer available. 

Signs of meningitis         

                                                       

                  Learn more about: Repair of an aneurysm

                                                   

IF YOUR PATIENT HAS A BLEED, HERE ARE SOME HELPFUL HINTS:
- follow MD orders.
- closely monitor neuro status and document findings
- monitor for possible seizure activity.
- monitor vital signs and oxygen saturation. 
- medicate for pain and document results. Encourage patient to rest ,
  as this will decrease the need for lots of pain medication. Too much
  pain medication may mask any changes in neurological status.

It is important to educate family members about the need for rest ,
 as this will decrease the need for too much pain medication.
 A decrease in stimulation, helps.

Learn more about: Subarachnoid hemorrhage

EPIDURAL OR SUBDURAL BLEEDING

Updated 4/24

Dear nurses.

The Clinical Setting Step by Step is no longer available.

Please click on the link :
Subarachnoid hemorrhage

for more updated information.

Epidural bleeding occurs above the dura mater, which is the outermost covering of the brain. As blood collects, a hematoma forms. Subdural bleeding occurs under the dura mater and blood collects, forming a hematoma.

FOR ADDITIONAL INFORMATION ON BRAIN INJURY, CLICK ON THE

LINKS: STROKE SERIES ASSESSMENT IN THE CLINICAL SETTING.AND

http://www.dearnurses.com/clinical_nursing_videos_(sessions 7)

EPIDURAL VS. SUBDURAL BLEED

Updated 1/25

                           Epidural vs. subdural bleed

Scenario 1: Tim was on a ladder at work.
He lost his balance and fell to the ground.

He will later be diagnosed with an epidural bleed. 

Scenario 2 :Mrs. A has a history of alcohol
ingestion in excess. She has been falling
a lot. She is now unconscious.

Meningeal coverings and  Epidural vs. subdural bleed

An epidural bleed is an arterial bleed. The patient has a brief period of unconsciousness following injury. He then becomes lucid and quickly progresses to unconsciousness and possible coma. A common site for injury is the meningeal artery which runs close to the surface, behind the ear.

A subdural bleed is venous and progresses slowly. The patient may not experience any symptoms for a few days. It may even become chronic. Suspect a subdural bleed , if the patient had a fall / head injury and was initially okay, then later becomes unconscious. It is common in alcoholics.

E- COLI CASE

                                          E -Coli ( Eschereshia Coli )

Updated 7/24

Scenario: Mr. N ate at the local salad bar about 6 pm last evening.
Sad to say,he is awakened at 2 am, with severe abdominal cramps.
and a great desire to use the bathroom.

Mr. N had several bouts of diarrhea and is beginning to feel tired and
weak. He calls his doctor and is advised to go to the Emergeny Room. 
Mr. N would be diagnosed with E-Coli.

E-Coli is a strain of bacteria that lives in the bowel.
When it gets into food, gastrointestinal symptoms
like nausea, vomiting and diarrhea may develop.
Poor hygiene may cause this to happen. 

Also enjoy watching Sessions 38 and Sessions 61

WHAT IF YOUR PATIENT HAD E-COLI?

Updated 9/25

What is E-coli?

E-coli is a type of bacteria that normally
live in the intestines. If it gets into food,
it can cause gastrointestinal symptoms.

Signs and symptoms include :

- Vomiting, diarrhea, weakness, dehydration
from excessive fluid loss . 

Below are topics which will help in the healing
process. This should also be reflected in the plan 

of care.

Learn more about: Preventing the spread of infection

Learn more about: Electrolytes and Dehydration

HAPPY EASTER TO ALL NURSES - ENJOY LEARNING

Updated 9/25

Dear nurses,

New topics have been added, for your learning
pleasure.

It takes "all hands on deck" to complete the work.

It is important to recognize that classroom skills
are different from clinical skills. A nurse's
performance in the work place takes on a different 
challenge from the classroom.

Learn more about: Avoiding medication errors
and Medication errors

THE NURSE"S ROLE / A CODE BLUE

Updated 6/25

Please click on the link:

The role of the nurse who is assigned

 to the Code Blue

Learn more about : Hemodynamics

Learn more about: Triage

MR. O HAS A BOUT OF V-TACH

Scenario: Mr. O was admitted to the ICU. Shortly after
arrival, his monitor pattern changes from Sinus Rhythm
to Ventricular Tachycardia.

Learn more about : Ventricular Tachycardia

What is Ventricular Tachycardia ?

Ventricular Tachycardia is an EKG arrhythmia 
which is life threatening. An assessment may
or may not reveal a pulse. If there is no pulse,
it is treated the same as ventricular fibrillation.

Causes include: 

Coronary artery disease, myocardial infarction, 
electrolytes imbalances and more.

Treatment and intervention is directed at the cause. 
AHA has guidelines in place, for treating Ventricular tachycardia.

WHAT IF THERE IS CHEST PAIN?

Updated 8/25

                      Dearnurses.net is no longer available.

Learn more about: Myocardial infarction

Poor circulation may occur for a number of reasons.
The patient in heart failure, is at risk for stroke.

Myocardial infarction

A MI (myocardial infarction ) is also known as a heart
attack. It results from obstruction to blood flow. Fatty
deposits may cause this. 

Death of the heart muscle surrounding the obstructed
blood vessel will result. Symptoms such as lack of oxygen,
shortness of breath and chest pain will occur.

Reperfusion Therapy is a form of treatment used
for patients who have a myocardial infarction with 
STEMI ( ST segment elevation myocardial infarction).
See above image for an example of STEMI.

STEMI 

Typically, the patient with a completely blocked
coronary artery, would demonstrate STEMI on 
the EKG. Death of the heart muscle caused by a
blood clot, would obstruct blood flow and cause
lack of oxygen. 

Severe chest pain, shortness of breath and possible
fainting may occur. Quick intervention would be
necessary to prevent further damage. 

TPA

TPA ( Thrombolytic Plasminogen Activator) is
a " clot buster" that is used in the treatment of 
embolic stroke and myocardial infarction with
STEMI. 

TPA  is not without its side effects. Bleeding, 

particularly into the brain and at injection sites,
 seizures and possible anaphylaxis may occur.

Labetolol , an antihypertensive may be ordered.
ICP monitoring may also be ordered by the doctor.

WHAT IF IT IS V-TACH OR V-FIB

Ventricular Tachycardia is a lethal rhythm.Quick action is necessary. To learn more about this topic and how to intervene, simply click on the link:
http://www.dearnurses.com/ekg_series_-_what_is_wrong_with_this_ekg
and enjoy learning.

UNDERSTANDING V-TACH

If the patient in your care develops Ventricular Tachycardia would you know what to do? To learn more about this and many more rhythms, simply click on the link:
http://www.dearnurses.com/ekg_series_-_what_is_wrong_with_this_ekg
and enjoy learning.

RECOGNIZING VENTRICULAR TACHYCARDIA - A LETHAL RHYTHM

Updated 8/25

Dearnurses.com is no longer available.

Scenario: A young man, possibly in his 30 s ,
was found near the lake. Someone calls 911.
Paramedics arrive shortly afterwards. 

Rescue efforts are begun. The cardiac monitor
shows Ventricular Tachycardia. AHA guidelines
will be followed.

                                                                                 

Below are some EKG rhythms that are considered 

to be lethal. Immediate intervention is necessary
for good outcomes. 

Ventricular Tachycardia - There may or may not be a pulse
present. The ventricles are beating rapidly and there is no atrial
activity. Blood flow to the vital organs is compromised.

Ventricular Fibrillation -  There is a chaotic rhythm and no
atrial activity. The ventricles are quivering , so there is no 
cardiac output. There is no pulse and the patient may become
unresponsive. Immediate action to defibrillate is usually done.

PEA - the patient in PEA will have a heart rhythm, but is 
unresponsive. This may be caused by hypovolemia, cardiac
 tamponade, pneumothorax, drug overdose, thrombosis,

 and trauma.

Learn more about : Third degree AV Block

Chest pain and the EKG.