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2.
Crit Care Nurse ; 39(3): 20-32, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154328

RESUMO

BACKGROUND: Brain injury with changes in clinical neurological signs and symptoms can develop while children are undergoing treatment in the intensive care unit. Critical care nurses routinely screen for neurological decline by using serial bedside neurological assessments. However, assessment components, frequency, and communication thresholds are not standardized. OBJECTIVES: To standardize neurological assessment procedures used by nurses, improve compliance with physicians' ordering and nurses' documentation of neurological assessments, and explore the frequency with which changes from preillness neurological status and previous assessments can be detected by using the assessment tool developed. METHODS: A quality improvement intervention was implemented during a 1-year period in a 55-bed pediatric intensive care unit with 274 nurses. Procedures for neurological assessment by nurses were standardized, a system for physicians to order neurological assessments by nurses at a frequency based on the patient's risk for brain injury was developed and implemented, and a system to compare patients' current neurological status with their preillness neurological status was developed and implemented. RESULTS: Process metrics that focused on compliance of ordering and documenting the standardized neurological assessments indicated improvement and sustained compliance greater than 80%. Exploratory analyses indicated that 29% of patients had an episode of neurological decline and that these episodes were more common in patients with developmental disabilities than in patients without such disabilities. CONCLUSIONS: Compliance with physicians' ordering and nurses' documentation of standardized neurological assessments significantly increased and had excellent sustainability. Further work is needed to determine the sensitivity of standardized nurses' neurological assessment tools for clinically meaningful neurological decline.


Assuntos
Lesões Encefálicas/enfermagem , Enfermagem de Cuidados Críticos/métodos , Unidades de Terapia Intensiva Pediátrica/organização & administração , Exame Neurológico/enfermagem , Avaliação em Enfermagem/normas , Melhoria de Qualidade , Lesões Encefálicas/diagnóstico , Criança , Pré-Escolar , Testes Diagnósticos de Rotina , Documentação/métodos , Feminino , Humanos , Lactente , Masculino , Monitorização Fisiológica/enfermagem , Exame Neurológico/normas
4.
Crit Care Nurs Clin North Am ; 28(1): 1-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26873755

RESUMO

Although technology over the past several decades has enabled improved neuroimaging and advanced noninvasive and invasive neuromonitoring, the role of the bedside nurse conducing ongoing neurologic examination is still a foundational element of neuromonitoring. Ongoing neurologic monitoring by the bedside nurse in the neuroscience intensive care unit is variable and guided by little evidence or data. When neurologic monitoring through clinical examination is possible, data obtained from multimodal monitoring should be interpreted in the context of the neurologic examination. The bedside nurse plays a crucial role in conducting ongoing neurologic examinations.


Assuntos
Exame Neurológico/enfermagem , Monitorização Neurofisiológica/enfermagem , Papel do Profissional de Enfermagem , Cuidados Críticos/métodos , Humanos , Unidades de Terapia Intensiva
5.
Crit Care Nurs Clin North Am ; 28(1): 101-7, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26873763

RESUMO

The neurologic examination (neuroexamination) is one of the most powerful tools available to nurses and physicians caring for patients with neurologic or neurosurgical illness. Assessing cranial nerve function is one of the most vital components of the neuroexamination. The pupillary light reflex helps to evaluate the status of the second and third cranial nerves and is one of the most well-known elements of the cranial nerve examination. Automated pupillometers have been developed that provide objective measures of size of the pupil and the responsiveness of the pupil to light (neuropupillary index).


Assuntos
Cuidados Críticos , Monitorização Fisiológica/instrumentação , Exame Neurológico/enfermagem , Reflexo Pupilar/fisiologia , Lesões Encefálicas/diagnóstico , Humanos , Monitorização Fisiológica/métodos , Pupila
6.
J Neurosci Nurs ; 47(5): 256-62, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26236950

RESUMO

A unique extant database to explain heterogeneity in peripheral immune response (PIR) over time in response to stroke/transient ischemic attack (TIA) was used to compare changes in PIR between first-time and recurrent stroke/TIA and to identify distinct and common trajectories of change in the PIR in stroke/TIA. Associations between risk factors for stroke (hypertension, smoking, diabetes, hypercholesterolemia, infection) and PIR trajectory were quantified using multivariate random effects modeling. With comparable admission values, patients with recurrent stroke/TIA had a persistent elevation in lymphocyte percentage as opposed to the significant decline in lymphocyte percentages over time observed in those with first-time stroke/TIA. Two naturally occurring trajectories of the PIR to stroke/TIA were observed, one indicative of a primed PIR and one indicative of an unprimed PIR. A large proportion of the sample, 80%, was classified as having persistently higher lymphocyte percentages and lower neutrophil percentages over time compared with the remainder of the sample. When controlling for risk factors for stroke, adults admitted with recurrent stroke/TIA without infection were more than three times as likely to have a primed PIR (i.e., the high lymphocyte-low neutrophil trajectory) than those with first-time stroke with infection. Interventions for reduction of neurological deficits require tight implementation windows early after stroke occurs. The outlined classification of cases in these primed and unprimed trajectories of the PIR adds to the knowledge of optimal clinical timing for de novo immune-based interventions.


Assuntos
Ataque Isquêmico Transitório/imunologia , Ataque Isquêmico Transitório/enfermagem , Contagem de Leucócitos , Contagem de Linfócitos , Neutrófilos/imunologia , Acidente Vascular Cerebral/imunologia , Acidente Vascular Cerebral/enfermagem , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Exame Neurológico/enfermagem , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco
7.
Rev Infirm ; (199): 31-3, 2014 Mar.
Artigo em Francês | MEDLINE | ID: mdl-24754125

RESUMO

The clinical examination of the neurological system provides valuable information regarding a person's health status. The nurse, in her daily practice, must be able to identify certain signs which may reveal situations requiring urgent treatment. Others are regularly assessed to monitor the evolution of the patient's condition.


Assuntos
Técnicas de Diagnóstico Neurológico/enfermagem , Doenças do Sistema Nervoso/diagnóstico , Exame Neurológico/enfermagem , Enfermeiras e Enfermeiros , Estado de Consciência/fisiologia , Humanos , Monitorização Fisiológica/enfermagem , Doenças do Sistema Nervoso/enfermagem , Exame Neurológico/métodos , Prática Profissional/normas , Sinais Vitais
8.
J Neurosci Nurs ; 46(2): 125-32, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24556660

RESUMO

Evaluation of neurological status is imperative to patient assessment. Multiple assessment tools are readily available for clinicians to diagnose and report changes in neurological condition. Some of these tools include the Glasgow Coma Scale, the National Institutes of Health Stroke Scale, the Canadian Neurological Scale, and the Four Score. Although assessment tools are beneficial to help standardize the assessment and communication of findings, they are at times cumbersome, leaving bedside clinicians with questions concerning which tool is appropriate for a given patient population. This initiative began as a means to standardize assessments and communication for neuroscience patients. As success was met, the project was moved forward locally at our hospital campus and later extended to the entire health system. With the support of the chief of neurology, the neuroscience patient care services director, the stroke coordinator, and the neuroscience clinical educator, three different neurological examinations were developed. They were defined as the Basic Neurological Check, the Coma Neurological Check, and the National Institutes of Health Stroke Scale/Stroke Neurological Check. The neurological examinations would address the assessment needs of patients with acute stroke, general neurosurgery/neurology patients, and patients in coma.


Assuntos
Coma/diagnóstico , Coma/enfermagem , Especialidades de Enfermagem/normas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/enfermagem , Hospitais Universitários , Humanos , Exame Neurológico/enfermagem , Exame Neurológico/normas , Equipe de Assistência ao Paciente , Índice de Gravidade de Doença , Especialidades de Enfermagem/métodos
12.
J Obstet Gynecol Neonatal Nurs ; 41(1): 17-23, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22834719

RESUMO

Nurses caring for high-risk infants use advanced assessment skills to identify the nature of infant instability and to assure timely intervention. The NICU Network Neurobehavioral Scale (NNNS) is a comprehensive assessment of neurological integrity and behavioral function of infants at risk. Research evidence supports its validity and reliability for clinical and research use. The NNNS offers nurses a neurobehavioral assessment especially suited to high-risk and premature infants.


Assuntos
Transtornos do Comportamento Infantil/diagnóstico , Deficiências do Desenvolvimento/diagnóstico , Doenças do Prematuro/diagnóstico , Terapia Intensiva Neonatal/métodos , Exame Neurológico , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Transtornos Psicomotores/diagnóstico , Transtornos do Comportamento Infantil/enfermagem , Desenvolvimento Infantil , Deficiências do Desenvolvimento/enfermagem , Feminino , Humanos , Comportamento do Lactente/fisiologia , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/enfermagem , Unidades de Terapia Intensiva Neonatal , Masculino , Exame Neurológico/métodos , Exame Neurológico/enfermagem , Valor Preditivo dos Testes , Gravidez , Efeitos Tardios da Exposição Pré-Natal/enfermagem , Transtornos Psicomotores/enfermagem , Reprodutibilidade dos Testes , Fatores de Risco , Pesos e Medidas
13.
Int Emerg Nurs ; 19(4): 199-205, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21968413

RESUMO

Although emergency nurses receive education and training in performing comprehensive and rapid assessment, pediatric patients may prove to be challenging due to dynamic growth, development and maturation. If the emergency department (ED) has limited exposure to pediatric patients, performing assessments and prompt interventions may be daunting. Neonates, infants and young children with illness or trauma have unique and often times subtle signs and symptoms that can change rapidly. Although the neurological exam for older children may be similar to that of an adult, there are significant differences based on maturation. The neurologic exam for neonates and infants provides the nurse with even more opportunity to be familiar with developmental differences. Therefore, it is important for ED nurses to become familiar with typical development and early recognition of neurologic insult.


Assuntos
Exame Neurológico/métodos , Pediatria , Fatores Etários , Criança , Pré-Escolar , Doenças dos Nervos Cranianos/diagnóstico , Emergências , Escala de Coma de Glasgow , Humanos , Lactente , Recém-Nascido , Exame Neurológico/enfermagem , Desempenho Psicomotor , Reflexo
16.
Emerg Nurse ; 17(10): 28-31, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20364782

RESUMO

The aim of this article is to inform staff who are new to emergency care settings how to use the Glasgow Coma Scale (GCS) when managing patients with head injuries. It may also be useful as a refresher for experienced staff and a helpful teaching tool. It emphasises the need for continual, standardised assessment of neurological status and emphasises how the GCS is seen as best practice nationally and internationally.


Assuntos
Traumatismos Craniocerebrais/diagnóstico , Enfermagem em Emergência/métodos , Escala de Coma de Glasgow , Exame Neurológico/métodos , Avaliação em Enfermagem/métodos , Traumatismos Craniocerebrais/classificação , Serviço Hospitalar de Emergência , Humanos , Destreza Motora , Exame Neurológico/enfermagem , Registros de Enfermagem , Reflexo Pupilar , Comportamento Verbal
17.
Cancer Nurs ; 33(3): 173-83, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20357656

RESUMO

BACKGROUND: Assessment of chemotherapy-induced peripheral neuropathy signs and symptoms has been hampered because of the lack of simple, reliable, and valid measures. OBJECTIVE: The study objective was to examine the internal consistency and interrater reliability as well as the structural validity of a 5-component total neuropathy score-reduced (TNSr) variant and a chemotherapy-induced neuropathy-specific Neuropathic Pain Scale. METHODS: One hundred seventeen outpatients receiving taxanes or platinums were assessed by a consistent nurse practitioner using the 2 instruments. Ten subjects participated in interrater reliability testing. RESULTS: Mean scores and SDs for individual items were low. The strength item was deleted because of low interitem correlations and a floor effect. The reflex item was deleted because of low interitem correlations and its negative influence on Cronbach alpha. Pin sensibility was deleted because of low factor loadings. The TNSr-short form and the chemotherapy-induced neuropathy-specific Neuropathic Pain Scale formed 2 distinct factors, providing evidence of structural validity. Cronbach alpha's for the 2 instruments were .80 and .96, respectively. The TNSr interrater reliability results suggested acceptable rater concordance, but minor revisions could further improve scoring precision. CONCLUSION: Clinimetric evidence supports the use of 2 new instruments when monitoring taxane- and platinum-related neuropathy and pain. Further instrument modifications are recommended, followed by additional testing in diverse populations. IMPLICATIONS FOR PRACTICE: With these new instruments, nurses can more easily incorporate prospective neuropathy assessment into daily clinical practice. The outcome will be improved symptom awareness by oncology clinicians and patients, leading to fewer chemotherapy-induced peripheral neuropathy-related devastating effects on functionality and quality of life.


Assuntos
Antineoplásicos/efeitos adversos , Medição da Dor/métodos , Doenças do Sistema Nervoso Periférico , Compostos de Platina/efeitos adversos , Índice de Gravidade de Doença , Taxoides/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Neurológico/métodos , Exame Neurológico/enfermagem , Exame Neurológico/normas , New Hampshire , New Jersey , Profissionais de Enfermagem , Avaliação em Enfermagem/métodos , Avaliação em Enfermagem/normas , Pesquisa em Avaliação de Enfermagem , Variações Dependentes do Observador , Enfermagem Oncológica , Medição da Dor/normas , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/diagnóstico , Psicometria , Método Simples-Cego , Estatísticas não Paramétricas , Inquéritos e Questionários/normas
19.
Can J Neurosci Nurs ; 31(2): 6-12, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19522456

RESUMO

Head injuries are the leading cause of trauma mortality and account for nearly half of all deaths related to trauma injuries. Patients who present with subdural hematomas are at risk for initial damage to the brain, as well as for subsequent brain damage related to re-bleed, ischemia or cerebral edema. These injuries can be acute or chronic in nature, and may be manifested in the patient as an altered level of consciousness. Skilled nursing assessment of altered level of consciousness leads to early nursing and medical intervention, which, in turn, can improve patient outcomes. In this paper, a critical review of the literature will focus on altered level of consciousness in patients presenting with a subdural hematoma. The Human Response to Illness Model will be utilized as a framework for this review. Accordingly, the physiological, pathophysiological, behavioural, and experiential perspectives of altered level of consciousness will be examined. Thus, a comprehensive understanding of this human response and rationale for evidence-based interventions will be established.


Assuntos
Transtornos da Consciência/diagnóstico , Hematoma Subdural/complicações , Modelos de Enfermagem , Exame Neurológico/enfermagem , Avaliação em Enfermagem/métodos , Transtornos da Consciência/etiologia , Transtornos da Consciência/fisiopatologia , Transtornos da Consciência/psicologia , Educação em Enfermagem , Saúde Holística , Homeostase , Humanos , Exame Neurológico/métodos , Papel do Profissional de Enfermagem , Diagnóstico de Enfermagem , Pesquisa em Enfermagem , Fatores de Risco
20.
J Neurosci Nurs ; 41(1): 2-5, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19368066

RESUMO

The National Institutes of Health Stroke Scale (NIHSS) is commonly used in the assessment of stroke severity. Nurses, who use the tool infrequently, find it difficult to use due to the neurologic terminology embedded in the scale. For this project, we modified the NIHSS by replacing the neurologic terminology for each component of the original scale with plain English. No components were deleted or changed; the language was merely simplified. Testing showed the modified tool to be reliable (0.96) and valid (0.977) when compared with the NIHSS.


Assuntos
Exame Neurológico/métodos , Avaliação em Enfermagem/métodos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Terminologia como Assunto , Competência Clínica , Disartria/etiologia , Educação Continuada em Enfermagem , Paralisia Facial/etiologia , Humanos , National Institutes of Health (U.S.) , Exame Neurológico/enfermagem , Exame Neurológico/normas , Avaliação em Enfermagem/normas , Pesquisa em Avaliação de Enfermagem , Recursos Humanos de Enfermagem no Hospital/educação , Variações Dependentes do Observador , Oregon , Análise de Componente Principal , Análise de Regressão , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/complicações , Estados Unidos
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