Role of the nurse in managing patients with hepatic cerebral oedema

Acute liver failure occurs abruptly often without pre-existing liver disease being present. Management comprises support of the patient and treatment of symptoms until recovery or transplantation can occur. Cerebral oedema is one of the recognized complications of acute liver failure with a mortality rate of 30-50% when it occurs. Effective supportive nursing management includes use of sedative agents, positioning and thermoregulation if the patient is to recover or be optimized for transplantation.

Management of intracranial hemodynamics in the adult: a research analysis of head positioning and recommendations for clinical practice and future research

Head elevation is a conventional nursing intervention used to control raised intracranial pressure and avoid complications in patients with neurotrauma or other conditions requiring management of intracranial hemodynamics. This therapy, however, provides a particular dilemma for health care providers. While elevating the head of the bed does decrease intracranial pressure, it may put some patients at risk for intracranial hypertension and cerebral ischemia due to decreases in cerebral perfusion pressure. This article analyzes research on head positioning that provides individual outcome measurements versus group means in adult patients with various conditions. The risk/benefit method of analysis used in this review revealed that in addition to only monitoring and controlling for ICP, we must also monitor and control CPP with a greater emphasis on this particular measurement. This analysis also revealed that optimal head positioning to manage intracranial hemodynamics should be decided upon on an individual basis using both ICP and CPP measurements.

Continuous midazolam/atracurium infusions for the management of increased intracranial pressure

Maintaining the pressure/volume balance in the brain is a challenging goal for the neuroscience team caring for patients with traumatic brain insults. Often, standard therapies are not effective in controlling increased intracranial pressure (ICP). Four severe traumatic brain injury patients given continuous infusions of midazolam and atracurium showed control of otherwise unstable ICPs. Midazolam and atracurium infusions are now considered an acceptable form of therapeutic intervention for our patients requiring such treatment. Intensive nursing care considerations for patients using the combined pharmacologic therapy are essential.

Understanding cerebral edema: implications for oncology nurses

The nonspecific disorder cerebral edema is potentially a life-threatening complication of cancer and its treatment. Oncology nurses proficient in neurologic assessment can detect subtle changes and identify early stages of cerebral edema. When cerebral edema is suspected, oncology nurses must administer medications, manage side effects associated with these medications, institute safety and seizure precautions, and prevent complications of immobility. This paper reviews the pathogenesis and medical treatment of cerebral edema, describes a practical neurological assessment tool, and identifies implications for oncology nurses.

Selected postoperative complications of cranial surgery

Selected postoperative complications following a craniotomy are discussed in relation to assessment and nursing care. Clinical differentiation between structural and metabolic postoperative complications is emphasized. The signs, symptoms, diagnostic aids and nursing implications related to each of these two major classifications of complications are presented. The specific postoperative complications discussed include: cerebral edema, intracranial bleeding, hydrocephalus, cerebral infarction, tension pneumocephalus, hypoxia, water and electrolyte imbalances, hypoglycemia, endocrine disturbances, hyperthermia, and seizures.