Colleen M. Counsell

Coordinated care for the neuroscience patient: future directions.

&NA; A coordinated care model was developed on a neuroscience unit to achieve positive outcomes in a cost‐effective environment. This included the development of a patient care coordinator (PCC) role, critical paths and a system for variance tracking. The PCC was responsible for coordinating care of patients and ensuring that patients progressed toward expected outcomes. Multidisciplinary critical paths were developed for four medical diagnoses. To evaluate the effectiveness of the program, an analysis of length of stay data, cost comparison, patient and staff satisfaction, and variance reports of one critical path, the microvascular decompression for trigeminal neuralgia were completed. Results from the pilot project were positive and provided valuable information for the use of coordinated care as a hospital‐wide patient care delivery model.

VAGUS NERVE STIMULATOR AS A TREATMENT FOR INTRACTABLE EPILEPSY

&NA; Vagus nerve stimulation was recently approved for control of medically intractable seizures. This therapy provides some relief of seizures for selective patients, however seizure freedom using this device is uncommon. Vagus nerve stimulation appears to work by calming “hyperexcited” nerve cells and reverting brain activity to its normal patterns. Many people do have significant relief in the intensity and duration of their seizures and report improved quality of life using this device.

Round out your department.

Clinical teaching rounds extend the staff orientation process without extending the budget.

Pallidotomy: a surgical intervention for control of Parkinson's disease.

&NA; Parkinsons disease, a chronic incurable disorder, has a significant impact on quality of life. Parkinsons disease results from chronic degeneration of cells in the basal ganglia that produce dopamine. It typically affects elderly individuals producing muscle rigidity and akinesia. Traditionally, Parkinsons disease has been controlled by medications. However, for some patients, medications may no longer be effective, or may produce drug‐related complications. For this group of patients, pallidotomy is gaining support as an intervention to control the debilitating symptoms of Parkinsons disease, thus enabling a person to perform everyday tasks. Although the procedure was developed in the 1950s, contemporary technology has allowed a resurgence of the intervention. With the focus on relief of two of the major symptoms of Parkinsons disease, the pallidotomy procedure is gaining support as a surgical intervention for this disease. Therefore, it is important for the health care team to have an understanding of the disease process, surgical intervention and postoperative care to enhance quality outcomes for this patient population.

Management of the Patient with a Pituitary Tumor Resection

The resection of a pituitary tumor represents a challenging diagnosis for the critical care nurse. There are important nursing assessments that can assist in identifying postsurgical complications. Detailed teaching instructions by the critical care nurses will also assist in minimizing the patients postoperative complications.

Nimodipine: a drug therapy for treatment of vasospasm.

Cerebral vasospasm presents a challenge for the nursing staff. To date, no effective prevention methods have been identified. The key to decreasing the mortality rates is in discovering a method of preventing or reversing the arterial narrowing caused by vasospasm. The nurse needs to be aware of the theories of vasospasm and the rationale for treatment. Neurologic assessment skills are important for the nurse to detect minimal changes that may indicate vasospasm. Nurses who are informed will be able to provide optimal care to patients with cerebral vasospasm and provide the necessary support for family members. Drug therapy continues to be the first-line defense in treating vasospasm. Nimodipine is a very promising drug with demonstrated effectiveness to reduce the neurologic deficits caused by vasospasm. Further research on the treatment of vasospasm following SAH is currently in progress.