Catherine Harris

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Purpose— The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. Methods— Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Results— Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.

Return to Work After Stroke: A Nursing State of the Science

There is a lack of research related to return to work (RTW) after acute ischemic stroke. Historically considered a disease of the elderly, acute ischemic stroke studies have not routinely used RTW as an outcome. Major stroke trials have not routinely collected these data as an end point. However, the mean age for acute ischemic stroke (AIS) has declined to 69 years of age, whereas the incidence in patients aged <55 years has increased to 19%.1–3 Changes in retirement age have also affected RTW as a consideration in patients with stroke. Failure to RTW after recovery from AIS has been associated with negative health outcomes such as increased cardiac disease, depression, and higher rates of mortality and social consequences such as isolation and poor coping ability.4 RTW has not been extensively studied in the AIS population. However, with an aging, yet active population and an increased awareness of AIS in younger patients, the relevance of RTW is becoming increasingly important. According to current research, ≤50% of stroke survivors are likely to RTW if they can walk, their cognition is relatively intact, they were previously used, are younger than the mean age, and have a white-collar position.5–9 The physical, psychological, social, financial, and economic consequences associated with loss of productivity for patients with AIS and their caregivers are reported to cost billions of dollars each year.10 With an increasing prevalence of survivors, the ability to RTW has gained significant importance as an area for further research. The purpose of this review was to provide …

Factors influencing return to work after aneurysmal subarachnoid hemorrhage.

ABSTRACT Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a type of stroke that affects women and men with a mean age of 50 years. Return to work (RTW) has been cited as a strategic goal of patients after injury; however, success rates are low in multiple studies. Therefore, the purpose of this study was to investigate factors influencing RTW after aSAH. The study design was a cross-sectional design at 1–2 years after injury to assess work status in 134 patients who were treated for aSAH. Participants were recruited at one hospital setting via mailed invitations. They were interviewed over the telephone after consent was obtained for chart review and to participate in the study. Eligible participants were asked to complete the Brief Illness Perception Questionnaire and the Functional Status Questionnaire. Data analysis was performed using univariate analysis and logistic regression with Statistical Package for the Social Sciences software. Results: There was a moderate negative correlation between illness perception and RTW. Illness perception was found to significantly predict failure to RTW, whereas marital status improved the prediction model to significantly predict successful RTW. Conclusions: This study addressed a gap in the literature regarding work status after aSAH and has provided direction for further investigation. Addressing issues surrounding patients’ perception of illness may serve as an important conduit to remove barriers to RTW. Recognition of these barriers to RTW in assessing a person’s illness perception may be the key to the development of interventions in the recovery process.

Neuromonitoring Indications and Utility in the Intensive Care Unit

Information on the use of neuromonitoring in intensive care units is scattered but significant. Nurses who do not care for neurologically impaired patients on a daily basis may not have a strong understanding of the utility of various neuromonitoring techniques, why they are used, or how they are interpreted. Two main types of neuromonitoring that are frequently seen but poorly understood are reviewed here: transcranial Doppler sonography and electrophysiology. Information on these 2 techniques tends to be either superficial with limited applicability to the critical care setting or very technical. This review provides information about neuromonitoring to help guide critical care nurses providing care to neurologically impaired patients.

Recognizing thyroid storm in the neurologically impaired patient.

&NA; Thyroid storm is a life‐threatening complication of thyroid dysfunction that is manifested by signs of cardiac arrhythmias, fever, and neurological impairment. These symptoms can easily be attributed to a multitude of factors commonly seen in neurological intensive care units, making the recognition and diagnosis of this event difficult. In this case study, a patient presents with a complicated course of hospitalization exacerbated by thyroid storm. Early nursing care and medical collaboration offset a potentially fatal condition.

Neurofibromatosis Type 2-Living with the Complications: A Case Study

Neurofibromatosis is a disease caused by a chromosomal defect that can occur spontaneously or be inherited. The disease is grossly disfiguring and carries with it significant psychological sequelae. It is characterized by tumors on nerve sheaths that can arise anywhere in the body. The rate and frequency of occurrence is unpredictable. More than nine different types of neurofibromatosis have been identified, but other than types 1 and 2, they are quite rare. All types of neurofibromatosis persist for a lifetime, so nurses from different backgrounds may encounter such a patient for various reasons. Nursing care should focus not only on the medical issues the patient presents with, but also on the psychosocial needs that may arise.

Seizures and Status Epilepticus

Seizures are a common phenomenon in the intensive care unit. This chapter provides an organized synopsis of seizure evaluation and management for the advanced practice provider to use in daily practice. The chapter starts with a common-case scenario followed by a comprehensive overview of the essentials in managing a patient with this condition. The easy-to-read format will help the advanced practice provider to identify what steps to take first and to develop a plan of action.

Neuromonitoring in the Intensive Care Unit.

This issue of Critical Care Nursing Clinics of North America is focused on neuromonitoring in the intensive care unit (ICU). Neuromonitoring is a broad umbrella term that elicits different concepts depending on a person’s role in the ICU. For instance, a trauma nurse may associate neuromonitoring with intracranial bolts, whereas an ultrasound technician may immediately think of transcranial Dopplers. A neuro ICU nurse may have visions of going to multiple scans or working with external ventricular drains. The term neuromonitoring includes all these concepts as well as more, which are discussed within this dedicated issue of Critical Care Nursing Clinics of North America. In designing this issue, we created three overriding themes of neuromonitoring that remained fairly broad. First, we thought of traditional methods of neuromonitoring that a nurse would expect to see in this issue. Robinson goes into depth on treating refractory increased intracranial pressures, while Heck discusses different modalities that are available for using invasive neuromonitoring for patients. Irick and Feil provide an extremely helpful overview of neuromonitoring in the operating room. Many ICU nurses are not familiar with neuromonitoring in the operating room, and the literature is resource-poor in this area. Therefore, the collaborative approach from Irick and Feil not only provides a better understanding of neuromonitoring but also gives nurses a glimpse into the role of the nurse anesthetist. The second approach we took on neuromonitoring was to explore novel concepts and products. Hylkema provides a look at one of the newest concepts of using optic sheath ultrasound as a method for assessing intracranial pressures noninvasively. The use of ultrasound has grown exponentially over the years due to its ease of use, low cost, and accessibility. Hylkema provides an overview of how it is being used for neurologic patients. Few centers have microdialysis, but the road on how to use it is being mapped by Kumar and Young in this issue. Even if your hospital setting does not use microdialysis, there is tremendous value in understanding brain metabolism. Wilson and Della Penna present evidenced-based research on the value of