Monday, March 22, 2010
10:30–11:20 am
(316) Loss of Communication and Sense of Self with ALS
Jennifer Ballard, BSN CCRN
Amyotrophic lateral sclerosis (ALS) is a progressive, degenerative neuromuscular disease involving upper and lower motor neurons. ALS includes muscle wasting throughout the body eventually leading to difficulty communicating with loved ones. Current management of ALS primarily focuses on symptomatic relief, and maintenance of maximum function and optimal quality of life (Brownlee, and Palovack 2007). Several techniques are available to help facilitate communication in patients with ALS. One method is augmentative and alternative communication (AAC). The rate of decline in ALS varies, making it difficult to predict a timeline of the need for alternative means of communication. Education concerning communication deficits shortly following diagnosis, allowing patients to make decisions regarding communication options before the disease becomes debilitating. Communication deficits leave patients feeling helpless, frustrated, isolated, fearful and depressed. Implementation of AAC devices can allow patients to communicate basic needs to caregivers, family and medical professionals to improve quality of life.
(317) Multisystem Impact of Severe TBI
Karen McQuillan, RN MS CCRN CNRN
Traumatic brain injury and resulting neurologic deficits can serve as a trigger for a multitude of harmful and potentially lethal systemic complications. These complications may include pulmonary dysfunction, fluid and electrolyte imbalance, coagulopathy, hemodynamic instability, gastrointestinal pathology, protein-calorie malnutrition, and problems associated with immobility. Often these problems threaten the possibility of increased secondary brain injury. Astute, comprehensive assessment skills are imperative to enable rapid recognition of these complications. Evidenced based therapeutic interventions which prevent and manage systemic complications are essential to reduce the mortality and morbidity associated with traumatic brain injury. The purpose of this lecture is to increase nurses' knowledge about these key concepts so that multisystem complications associated with brain injury can be prevented or readily recognized and appropriately managed.
(318) Creating Best Practice in a Level IV Epilepsy Monitoring Unit
Ann Reed, MSN RN
In a pediatric epilepsy monitoring unit (EMU), it is essential that nursing skills address the unique needs of the epilepsy patient in addition to the routine neurological assessment. Nurses who were traditionally rotated to the EMU from the neuroscience medical-surgical unit are now part of a dedicated nursing team. Care for this specialized pediatric population is optimized through this nursing care initiative. Current articles primarily discuss the proper layout, staffing, and equipment needed to establish an EMU. Published articles on nursing care specific to the EMU environment is limited. In the process of developing a Level IV EMU we created a dedicated team of nurses through specialized education, conference offerings, daily rounding with epileptologists and dedicated frontline leadership. The result of this implementation has enhanced best nursing practice as illustrated through a case presentation.
(319) Stroke Rehabilitation, from Inpatient Units to Community-based: Which Setting is Right for Your Patient?
Natacha Jean-Noel, MSN ARNP GNP-BC CCRN
1:10–2 pm
(320) Neurological Consequences of Eating Disorders and Dietary Supplements*
Cynthia Blank-Reid, RN MSN CEN
Eating disorders and the use of dietary supplements have become much more common. All healthcare workers should become savvier about who these two entities affect and what the short and long-term consequences are for patients. Frequently the patient will present with complaints that do not necessarily lead one to suspect there is an eating disorder. They are hard to detect and the subtle signs and symptoms are frequently not seen until a significant medical or injury event occurs. The use of dietary supplements is very common in all age groups but especially in the younger and geriatric populations. These supplements can cause significant neurological complications that the neuroscience nurse needs to understand and be on the lookout for. By utilizing case studies, participants will learn how the neuroscience nurse can decipher the subtle signs and symptoms their patients are displaying from eating disorders and the use of dietary supplements.
(321) Electronic Consult Service to Facilitate TBI Care On the Battlefield
Kimberly Meyer, MSN ACNPBC CNRN
During times of war, medical specialists are often deployed as general medical officers, becoming responsible for the trauma care of wounded service members. As early as 2004, the Department of Defense has utilized various forms of electronic consultation to provide recommendations for care to providers caring for patients outside of their area of specialty. As a result of the increased recognition of mTBI/concussion and lack of provider experience dealing with this diagnosis, an electronic TBI consult service was established in 2007. Unlike stateside evaluation of TBI, in the austere environment, access to resources such as imaging, laboratory, and pharmacy are limited. Subsequently, decisions to evacuate an injured service member to a location with higher echelon medical services are often considered. Since evacuation carries inherent risk of transport as well as decreases the strength of the fighting force, prevention of unnecessary evacuations while allowing optimal medical care is critical.
(322) Pregnant Women with Epilepsy: What Neuroscience Nurses Need to Know
Alexandra McGrady, MSN FNP-BC CNRN MSCN CRRN
Pregnant women with epilepsy (WWE) present special, unique challenges. Although greater than ninety percent are expected to have good pregnancy outcomes, there is much anxiety not only in these women but also in those who care for this special dyad. In 2009 the American Academy of Neurology (AAN) published their updated evidence-based review of important issues related to the clinical management of WWE who are pregnant or plan pregnancy. This is summarized in three practice based parameters: 1) Vitamin K, folic acid, blood levels, and breastfeeding; 2) Teratogenesis and perinatal outcomes; 3) Obstetrical complications and change in seizure frequency. An overview of these guidelines will be presented. Neuroscience nurses are well-positioned to provide education, counseling, and support to WWE of childbearing age from preconception through postpartum. Special emphasis will be given to those recommendations that nurses can most impact.
(323) Utilizing Advanced Imaging to Determine Stroke Treatment
Debbie Summers, RN BSN MSN CNS-BC CCRN CNRN
(324)
NNF Research Workshop: Research Dissemination
2:10–4:20 pm
Importance of Dissemination
Dr. Jan Buelow
Preparing Abstracts
Dr. Jan Hinkle
Preparing Posters
Dr. Hilaire Thompson
Playing by the Rules
JD Meacham, NNF Executive Director
Writing Research Articles
Dr. Paula Sherwood; Dr. Jan Buelow; V. Susan Carroll, MS RN CNE, JNN Editor
2:10–3 pm
(325) Best Practices for Preventing Ventriculostomy Infection
Chris Stewart-Amidei, MSN FAAN RN CNRN CCRN
Ventricular catheter systems are commonly used in the neuro critical care setting for monitoring intracranial pressure and therapeutic drainage of cerebrospinal fluid. These invasive systems carry risks, the most common of which is infection. Ventricular infection may encompass ventriculitis, meningitis, and wound infection. A number of factors contribute to infection risk, including patient factors, such as age and type of illness; practitioner factors, such as insertion technique and location of device insertion; and management factors, such as cerebrospinal fluid sampling and tyoe of dressing used. Because of the risks, preventive measures are advocated. Impregnated catheters represent a recent advance that is changing the standard of care. This presentation will review factors identified in the literature that contribute to ventricular catheter infections. Best nursing practices for patients with this device will be explored, and areas for future research proposed.
(326) The Impact of Sudden Death in Epilepsy
Tess Sierzant, MS RN CNRN ACNS
Sudden death in epilepsy (SUDEP) is a poorly understood phenomenon that may account for 8-17% of deaths in people with epilepsy. For the health care provider, SUDEP presents significant challenges. Beyond the difficulty due to poor understanding of this tragedy, there is the ethical and practice dilemma of if, how and when to disclose risk of death to people with epilepsy and their families. While the United Kingdom leads the world in confronting the issue, including development of national guidelines, recent efforts in North America have led to the formation of a coalition of epilepsy care specialists and researchers dedicated to the advancement of our understanding of SUDEP and to the education of those affected by epilepsy. This presentation will provide an update on current knowledge of SUDEP and the work of the coalition followed by discussion of the dilemmas that face those working with families affected by epilepsy.
(327) EVD Infection: a Description of Risk Factors for Infection
Joni Herrington, RN CNRN
External ventricular drains (EVD's) are used to monitor and treat critically ill neuroscience patients. As an invasive device, the EVD pose a risk for infection. Identification of risk factors that influence the development of nosocomial infection can help to improve practice and promotes excellence in practice. Other researchers have used a similar method of study to identify risk factors such as catheter dwell time (Hoefnagel et al., 2008) or to change practice and decrease the incidence of infection (Dasic et al., 2006). A retrospective chart review will be used to collect data as defined by Horan, Adrus and Dudeck (2008), including: positive CSF culture, clinical signs and CSF lab values. The purpose of this study is to describe patterns of infection among patients with EVD's related to: specific patient characteristics, clinical factors and co-existing non-CNS infection.
3:30–4:20 pm
(328) Multimodal Oral Pain Management Following Spinal Fusion Surgery
Andrea Strayer, NP MS CNRN
Multimodal postoperative pain management regimens were developed to improve pain relief while reducing the total opioid requirement and associated side effects. Multimodal regimens utilize combinations of different classes of analgesics to block different types of pain responses so that patients experience quicker advancement of postoperative goals such as mobility. Searching for better postoperative spinal fusion pain control, a multimodal oral pain management protocol was investigated. Prospective data was collected using long acting oxycodone, gabapentin, acetaminophen, and short acting oxycodone for the protocol medications. The oral pain management protocol group used statistically significant less morphine equivalents, had lower ratings of least pain, less nausea, less drowsiness, less interference with walking, and less interference with coughing/deep breathing than the initial 100 patients who used intravenous patient controlled analgesia. Neuroscience nurses will learn about multimodal pain management principles, and an alternative postoperative spinal surgery pain management protocol that has demonstrated positive outcomes.
(329) Reducing Incidence of Pressure Ulcers in Spinal Cord Injury Surgical Intensive Care Unit Patients
Cynthia Blank-Reid, RN MSN CEN
Preventing pressure ulcers (PU) in spinal cord injury (SCI) patients has historically been a challenging nursing responsibility. The cost of PU has drastically increased over the years. In addition to the cost increase, new regulations regarding reimbursement from Centers for Medicare/Medicaid Services (CMS) for PU has changed resulting in a higher emphasis on skin breakdown prevention. A trial was done at a 500-bed Level 1 Urban Trauma Center in the Surgical Intensive Care Unit. Data analyzed in June of 2008 revealed an incidence of skin breakdown at 42.9%. The trial was nurse driven and conducted from September to November 2008. All data was collected and analyzed by bedside staff nurses. The trial consisted of applying a silicone foam dressing to the SCI patient's sacral area from SICU admission until discharge. The results concluded that the incidence rate for PU during the trial dropped significantly to 0%.
Survey of RN Learning Needs Related to Mild TBI Patients
Dorraine Watts, PhD RN
Background The CDC estimates over 1.1 million suffer mild traumatic brain injury (mTBI) each year. While moderate and severe TBI is easily diagnosed, mTBI is harder to detect and is often missed. Purpose The purpose of this study was to survey non-advanced practice RN's who may potentially care for patient with mTBI to determine their educational needs. Methodology A convenience sample of RNs completed an anonymous web-based survey assessing current knowledge and learning needs in relation to mTBI. Results 1,186 nurses responded. Many indicated high level knowledge of the causes of mTBI (40.6%); fewer indicated such knowledge of patient assessment (19.9%), screening (13.7%), symptoms (12.6%), treatment (10.4%) or education (10.1%). Significance Nurses related significant knowledge deficits in the care of mTBI patients. Given the prevalence of mTBI, it is critical that nurses receive education to address their identified needs.