Neurosurgical Diagnoses and drugs

Diagnoses

The diagnosis name for traumatic brain injury (TBI) is intracranial injury or traumatic head injury. TBI’s disease process is chronic. TBI is usually as a result of an external mechanical force that results to brain dysfunction. The disease results from a jolt or violent blow to the body or head. In addition, an object that penetrates the skull including a shattered skull piece or bullet can bring about traumatic brain injury. As a result of mild TBI, a patient may suffer temporary brain cells’ dysfunction (Pacholczyk, Blakely & Amara, 2009). More critical TBI results to bleeding, torn tissues, bruising, and other brain physical damage, which mostly leads to death or long-term complications. TBI symptoms progress through 3 successive stages; coma, post-traumatic Amnesia, and recovery.

Critical TBI results to coma where the patient’s eyes remain closed and he shows no response to a pinch, touch, or speech (MacDonald & Wei, 2011). A coma can last for years, months, weeks, days, or hours and this depends on the severity of the injury. Prolonged coma mostly leads to permanent neurological damage. A concussion is similar to a coma but it lasts for minutes or seconds following a head blow. During the post-traumatic Amnesia stage, a patient reacts to purposeful movement or conversation by closing the eyes or gesturing. However, the patient is in a state of cognitive impairment, behavioral impairment, and acute confusion. In the recovery stage, a patient begins retaining information and it lasts depending on the area damaged and severity of damage (Pacholczyk, Blakely & Amara, 2009).

A majority of the severe TBI require surgery for repairing or removing contusions and hematomas. Disability associated with TBI depends on general health, age, and injury location and severity. There are many disabilities including vision problems, speech challenges, and behavioral issues.

There are a host of behavioral, emotional, social, cognitive, and physical impacts associated with TBI (MacDonald & Wei, 2011). Therefore, nursing interventions should consider all these impacts. The outcome of the disease ranges from death or permanent disability to complete recovery. Some present imaging techniques for treatment and diagnosis include computed tomography scans and magnetic resonance imaging. Interventions include emergency surgery and medications. Later, vision, occupational, recreation, speech, and physical therapies may be necessary (Wood, Lund & Beavan, 2010).

Craniosynostosis is also referred to as synostosis. This is a birth defect where joints between the skull’s bones in a baby close prematurely prior to full formation of the brain. A baby with the disease has a misshapen head and the brain does not grow in the natural shape. One or more skull joints can be affected. In some cases, the disease is as a result of an underlying brain abnormality, which hinders the brain from proper growth. The disease can be caused by biomechanical factors (fetal head constraint when a mother is pregnant), environmental factors (amine-containing drugs’ exposure during pregnancy and maternal smoking), hormonal factors (hyperthyroid), and genetic factors.

Usually, there is a change in the skull’s growth pattern. Since the skull cannot grow perpendicular to a fused suture, it compensates this by growing more towards the direction that is parallel to the bunged suture. Although this provides adequate space for brain growth, there is abnormal facial structures and head shape (Bernard et al., 2010). In case there is inadequate space for growth, the disease leads to increased intracranial pressure and consequently, eating difficulties, sleeping impairment, visual impairment, reduced IQ, and impaired mental development. The wellness of the baby depends on the overall health of the child and the number of sutures involved. The outcomes of surgery on children with the disease are terrific, particularly when the disease is not as a result of a genetic syndrome (MacDonald & Wei, 2011).

Fundosopy is one of the diagnosis procedures. Titanium plates should be avoided when fixing the skull. Surgery is one of the treatment processes used for Craniosynostosis and it aims at separating the fused bones. In case there is no basic brain abnormality, surgery allows the brain sufficient space for growth and development.

Brain tumor (post-operative): perioperative and surgery injuries are likely to lead to long-term or transient neurological deficits as a result of damage of the normal surrounding cerebral tissue. This leads to central neurological deficits. Some of the issues that arise after brain tumor surgery include venous air embolus, hyperventilation, hypothermia, hypotension, and neuroanaesthesia. Immediately after brain surgery, a patient can be cared for in the intensive care or neurosurgical stepdown unit where he is subjected to close monitoring and observation for a maximum of 24 hours. Vital sign monitoring and neurological assessment is given depending on routine post-operative practices and individual risks (Pacholczyk, Blakely & Amara, 2009).

During the first six hours after brain tumor surgery, the patient should be observed keenly for complications that may require surgical intervention. These complications can be detected through a novel onset of limb weakness, seizure, and other neurological changes that warrant further neurosurgical intervention. Cerebral edema may be masked or exacerbated by complications as well as their management. Some brain tumor postoperative neurological complications include wound infection, cranial nerve deficits, cerebrospinal fluid leak, seizures, hydrocephalus, pneumocephalus, cerebral infarction, peritumoural oedema, increased intracranial pressure and hemorrhage (Wood, Lund & Beavan, 2010).

Postoperative brain tumor surgeries cause severe to moderate pain. Effective pain management is hindered by concerns regarding opioids effects and absence of consensus guidelines. Postoperative MRI scans should be obtained from 24 to 72 hours following brain tumor surgery so as to assess the disease extent after surgery intervention.

A neurosurgeon should be contacted in cases of CSF leak, focal neurological deficit, and wound infection. The wound can be managed through no hair washing until suture or clip removal, dry dressing, or exposing the wound. Support from friends and family is very vital as it makes the patient feel good. In addition, there should be provision of good nutrition.

A tumor is also referred to as a neoplasm or mass and it refers to abnormal body tissue growth. A tumor can be benign or malignant (MacDonald & Wei, 2011). Tumors occur as a result of excessive growth and division of body cells. Usually, cell division and growth is controlled strictly. New cells perform new functions or replace older ones. Cells that are not needed anymore or damages die and are replaced by healthy ones. If the cell death and growth balance is distorted, a tumor forms. Problems associated with the immune system can also result to tumors. Tobacco leads to many deaths as a result of cancer compared to other environmental substances. Other causes of tumor include viruses, radiation, obesity, genetic problems, excessive exposure to sunlight, environmental toxins (aflatoxins and poisonous mushrooms), taking too much alcohol, toxins, and benzene (Bernard et al., 2010).

The outlook differs greatly depending on the type of tumor. In benign tumors, the outlook is extremely good. However, a benign tumor in the brain can result to significant problems. In malignant tumors, the outcomes vary depending on the stage and type of tumor during diagnosis. Some tumors can be cured. While some are rapidly life-threatening, others that are uncurable can be managed and the patient is able to live a longer and healthier life.

There are potent complications if a tumor is located in a place where it influences the normal function of the organ (Wood, Lund & Beavan, 2010). Malignant cancers can cause complications if they metastasize. The risk of malignant cancer can be reduced through regular exercise, healthy diet, limiting alcohol, healthy weight, limiting exposure to toxic and radiation chemicals, avoiding smoking, and reducing exposure to the sun. Treatment varies depending on the location, type of tumor, and if it is malignant or benign (MacDonald & Wei, 2011).

Medications

Ibuprofen is marketed as Brufen. Other common trademarks include Nuprin, Nurofen, and Motrin. Iboprufen is used for treating and relieving dysmenorrhea, pain, and fever as well as inflammatory diseases such as rheumatoid arthritis and osteoarthritis. It can also be used for patent ductus arteriosus and pericarditis (Wood, Lund & Beavan, 2010). The drug shop not be taken if the following serious but rare side effects are noticed; vomit that is similar to coffee grounds, persistent abdominal or stomach pains, tarry or black stools, pain in the left arm, jaw, or chest, unusual sweating, shortness of breath, weakness on one body side, confusion, sudden vision changes, and slurred speech. Children with hives, asthma, or those who experience allergic-type reactions following consumptions of aspirin and other NSAIDS should avoid taking ibuprofen Wood, Lund & Beavan, 2010).

The chewable table should be chewed before swallowing. It should be taken with milk or food to lessen stomach upsets. An adult can take a maximum of 4 doses in a day and each is 800 milligrams. Some of the critical and rare side effects include bleeding from the intestines or stomach particularly in older adults (Wood, Lund & Beavan, 2010). The following are the major nursing considerations; a person should not take ibuprofen if taking aspirin for heart attack or stroke; and it should not be taken if taking another allergy, cold, or pain medicine to avoid too much ibuprofen in the body.

Cefotaxime Sodium’s trade name is Claforan. It is used to treat lower respiratory infections including joints and bones, skin structures and the skin, urinary tract, and pneumonia; treating septicemia or bacteremia, infections in the central nervous system, intra-adbominal infections such as peritonitis, gynecological infections such as endometritis, pelvic inflammatory disease, and pelvic cellulitis; and perioperative prophylaxis. The drug should not be used in case a person is hypersensitive to cephalosporins.

The drug can be administered through intramuscular injection or intravenously. An adult can take 12g/ day in separate doses (from every twelve hours for uncomplicated infections to 4 hours for septicemia). This should be taken for 7-10 days. Children less than 50 kilograms (1-12 years) should take 50- 180 mg/kg/day in four to six separate doses (Cohn & Fulton, 2009). The side effects include vomiting, stomach upsets, stomach pain, diarrhea, skin rash, difficult breathing, bruising, unusual breathing, itching, hives, and sore mouth. Some of the nursing considerations include; the drug should only be administered through IV or IM, the IV route is most preferable in cases of life-threatening or severe infections, and it should be shaken before use so that it dissolves.

Ranitidine HCL INJ/oral’s trade name is ZANTAC. The drug is used in some hospitalized patients who have intractable duodenal ulcers or pathological hypersecretory conditions. It can also be used on a short-term basis in patients who are not in a position of taking oral medications (Wood, Lund & Beavan, 2010). If a person is hypersensitive to this drug, it should not be used on him. The drug is administered though intramuscular (IM) injection, intravenously, or orally. For intramuscular injections, intermittent bolus, and intermittent infusion, 50mg should be administered every 6-8 hours. Following administration of the drug through the intramuscular, transient pain is experienced at the site (MacDonald & Wei, 2011). With intravenous administration, there is itching or transient local burning. Patients mostly experience headache after taking the drug and there may be mild side effects on the musculoskeletal, hepatic, gastrointestinal, cardiovascular, and central nervous system. Since the drug is primarily excreted through the kidneys, patients having impaired renal function should receive an adjusted dosage. In addition, there should be cautious administration in patients having hepatic dysfunction as the liver metabolizes the drug. The drug should not be used in patients with acute porphyria’s history.

Codeine oral is also referred to as Vopac or APAP wCodeine. The drug relieves moderateto mild pain and reduce coughing and cold. Codeine is inappropriate for relieving pain in children after a surgery aimed at removing adenoids and tonsils. The drug is taken orally as a solution, suspension, elixir, capsule, or tablet. The drug can be taken every 4-6 hours as required. In 24 hours, a person should not take more than six doses. For adults, taking more than 4 grams in a day is very dangerous (Bernard et al., 2010). Taking codeine is associated with side effects such as mood changes, vomiting, constipation, nausea, drowsiness, headache, lightheadedness, dizziness, stomach pain, difficulty urinating, confusion, sleepiness, rash, itching, noisy breathing, hives, changes in vision, and seizures. Taking too much codeine leads to fatal liver disease and therefore, patients with liver disease should consults the doctor so as to ensure a safe dose. Taking alcohol should be avoided when taking this drug. A patient should consult a doctor immediately if there a liver damage symptoms such as yellowing of the eyes and skin, dark urine, persistent vomiting, extreme tiredness, and abdominal pain.

Potassium Chloride use Klor-Con as the trade name. This medication is used as a mineral supplement for preventing or treating low blood potassium amounts. A normal level of potassium in the blood is essential for the proper functioning of the nerves, muscles, heart, kidneys, and cells. Potassium Chloride is recommended in patients with severe prolonged vomiting and diarrhea, as well as hormone problems (hyperaldosteronism), or diuretics treatment. Potassium Chloride should not be used with drugs that slow food transit through the intestine such as loperamide and atropine since potassium tablets’ passage in the digestive system is delayed and this leads to narrowing or ulceration of small intestines (Pacholczyk, Blakely & Amara, 2009).

Potassium chloride is consumed orally as capsules or tablets. To treat hypokalemia, an adult can take a dose of 40 to 100 mEq daily and to prevent it, a dose of 16- 24 mEq is sufficient. The medication should be taken with fluids and meals to avoid intestinal problems. Some of the side effects of the drug include abdominal discomfort, flatulence, diarrhea, vomiting, and nausea. Damage and irritation to the stomach such as ulceration may be managed through reducing the dose, taking the supplement with meals, and using juice to dilute liquid preparations. The medication should be avoided in people who are allergic to it and in those suffering from severe kidney disease, adrenal gland problems, and high potassium levels in the blood.

Vancomycin INJ’s brand name is Vancocin. This is an antibiotic that is used for treating bacterial infections and Clostridium difficile-linked diarrhea. The drug should be used with caution in the elderly, people with reduced kidney function, and hearing problems. It should not be used in people who are allergic to vancomycin. The drug can be administered intravenously or orally. Adults should receive 2 grams in a day in divided doses while children should be given 10 mg/ kg per dose in every sox hours (Pacholczyk, Blakely & Amara, 2009). Some of the side effects include spinning sensation, shivering, tinnitus, kidney failure, rashes, and hearing problems. There may be increase kidney side effects or hearing problems if Vancomycin INJ is taken with medications that cause these problems such as colistin, bacitracin, tacrolimus, or cisplatin.

References

Bernard, G. R., Wheeler, A. P., Russell, J. A., Schein, R., Summer, W. R., Steinberg, K. P. & Swindell, B. B. (2010). The effects of ibuprofen on the physiology and survival of patients with sepsis. New England Journal of Medicine, 336(13), 912-918.

Cohn, J. L., & Fulton, J. S. (2009). Nursing staff perspectives on oral care for neuroscience patients. Journal of Neuroscience Nursing, 38(1), 22-30.

MacDonald, T. M., & Wei, L. (2011). Effect of ibuprofen on cardioprotective effect of aspirin. the LANCET, 361(9357), 573-574.

Pacholczyk, T., Blakely, R. D., & Amara, S. G. (2009). Basic Neurosciences. depression, 26, 429-427.

Wood, M. J., Lund, R., & Beavan, M. (2010). Stability of vancomycin in plastic syringes measured by high–performance liquid chromatography. Journal of clinical pharmacy and therapeutics, 20(6), 319-325.