摘要:

The treatment options and management of ischemic and hemorrhagic stroke are expanding. Neuroradiologic interventions are being used in acute care settings to change the course of these devastating processes. These interventions include the injection of intra-arterial urokinase for ischemic stroke, use of coils to secure aneurysms, and balloon angioplasty for increasing the lumen of spastic cerebral arteries in patients with cerebral vasospasm. Using a case study approach, these three options for managing stroke patients will be integrated, and nursing strategies for delivering care to the stroke patient will be profiled.

ISSN:0889-4655    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Recent scientific data suggest that there is a "window of opportunity" between the onset of brain ischemia and irreversible neuronal death. Although neurons can withstand complete absence of blood flow for only minutes, collateral circulation typically surrounds the "core" of the stroke. In these brain regions known as theischemic penumbra, brain tissue can survive for several hours following stroke onset. Recent studies suggest that neuroprotective agents would give these viable neurons the chance for recovery. This article reviews the mechanisms of ischemic neuronal injury, mechanism of action of neuroprotective agents, current neuroprotective clinical trials, and guidelines for patient care management.

ISSN:0889-4655    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Although outcomes from coronary artery bypass grafting (CABG) surgery have improved in general, there has been little or no improvement in the incidence of postoperative stroke or neurologic dysfunction. Several studies have identified factors that increase the CABG patient's risk for developing a stroke and neurologic complications. It is important to identify those patients at increased risk and differentiate among stroke, delirium, and seizures. Post-CABG patients need to be monitored for neurological dysfunction with appropriate assessments. Neurologic complications must be appropriately managed to optimize patient recovery.

ISSN:0889-4655    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The role of excitotoxins in the ischemic cascade that results in ischemic neuronal death has been clearly defined and has brought about attempts to halt the progression of neurologic damage. Improved understanding of this process has allowed for the development of interventions to optimize neurologic outcome following periods of ischemia. Deep hypothermia (15-22°C) has long been recognized as one method of achieving neuroprotection, but is not without serious implications and risks to the patient. Mild hypothermia (32-34°C) is evolving as an alternative neuroprotective measure that has been shown to improve neurologic outcome in experimental models of ischemia and head injury, as well as in recent head injury clinical trials. It has been safely used intraoperatively in a large series of patients undergoing craniotomy. Mild hypothermia is a technique that may soon be commonly employed alone or in conjunction with other methods of neuroprotection. Nurses caring for patients undergoing this technique must be aware of the practice implications associated with this procedure and adapt their care accordingly.

ISSN:0889-4655    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A constant challenge for health care providers caring for the neurologically injured patient is to restore function and/or prevent permanent disability. Advances in technology have led to the development of diagnostic studies that assist in determining potential and actual neuronal injury. Xenon-enhanced computed tomography (CT) provides reproducible quantitative information coupled with anatomic CT imaging. Not only does it provide accurate estimation of cerebral blood flow, but it also reflects regional alterations in flow. This technique is useful for identifying those patients who have, or are at risk for, ischemic compromise. Xenon-enhanced computed tomography is useful when assessing the patient with an acute neurologic change who is being considered for thrombolytic therapy and for patients with carotid artery stenosis to evaluate cerebrovascular reserve. This article will focus on the clinical applications of xenon-enhanced CT.

ISSN:0889-4655    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Cerebrovascular events are known to produce changes in the electrocardiogram (ECG). Whether or not these changes are actually reflective of myocardial damage has been the topic of much research. There are indications that these ECG changes result from an imbalance in the autonomic nervous system, resulting in a relative excess of sympathetic activity. This article provides an overview of the ECG and physiologic changes noted in patients with acute ischemic stroke and identifies subgroups that may be at high risk for developing these changes. Implications for nursing care are discussed.

ISSN:0889-4655    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Saint Luke's Hospital is a 642-bed urban, tertiary, teaching hospital in metropolitan Kansas City, Missouri. In 1992, Saint Luke's developed a "Collaborative Care" program supported by tools such as clinical paths as a means to assure quality stroke care and to continually improve outcomes. This article describes the development of a comprehensive Collaborative Care Program for stroke patients, highlights the development of a dedicated stroke unit, and stroke clinical path, and describes the clinical and fiscal outcomes from these efforts.

ISSN:0889-4655    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The recent focus on stroke treatment has revealed that stroke survivors are not reaching emergency care early enough to benefit from available treatment modalities. As a result, the authors designed a study to determine the factors that influence the timing of seeking health care for stroke symptoms. Encouraged and supported by peers across the country, it became a collaborative national multicenter research study. This article describes the process used to develop the research study, as well as the challenges encountered along the way.

ISSN:0889-4655    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Synergism is an apt description for the powerful results that can occur when multidisciplinary approaches are used. Studies have documented that multidisciplinary teams produce improved patient outcomes in selected patient groups, including recent studies of patients with strokes. Multidisciplinary teams in patient care are still far from being the normative model of care delivery. In the interest of better patient care and outcomes, it is time for health care professionals to actively engage in multidisciplinary approaches because the sum of our collaborative efforts is greater than our individual disciplinary parts.

ISSN:0889-4655    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0889-4655    

出版商:OVID    

年代:1998

数据来源: OVID