Treatments for Neurologic Disorders

The most common treatments for neurologic disorders are drug therapy and surgery.

Treatments for Neurologic Disorders: Drug therapy

Drug therapy is a common and important treatment for neurologic disorders. When caring for a patient undergoing drug therapy, you’ll need to be alert for severe adverse reactions and for interactions with other drugs. Some drugs, such as barbiturates, also carry a high risk of toxicity.

Keep in mind that drug therapy’s success hinges on the patient’s strict adherence to his medication schedule. Compliance is especially critical for drugs that require steady-state blood levels for therapeutic effectiveness, such as anticonvulsants, or for drugs used prophylactically such as beta-adrenergic blockers. (See Drugs used to treat neurologic disorders.)

Treatments for Neurologic Disorders: Surgery

Surgical procedures typically used to treat neurologic disorders include cerebral aneurysm repair, craniotomy, and intracranial hematoma aspiration. As a medical-surgical nurse, you should prepare to handle the patient’s preoperative assessment and preparation and postoperative care.

 

Questions, concerns, fears

Focus Topic: Treatments for Neurologic Disorders

When confronted with surgery, the patient and his family usually have questions, concerns, and fears that require compassionate attention. Keep in mind that a patient requiring surgery to address a neurologic disorder may be left with deficits that can be frustrating for him and his family. A positive, caring attitude and support can help them cope with their ordeal.

 

Treatments for Neurologic Disorders

 

Cerebral aneurysm repair

Surgical intervention is the standard method for preventing rupture or rebleeding of a cerebral aneurysm. First, a craniotomy is performed to expose the aneurysm. Then, there are several corrective techniques the surgeon may use, depending on the shape and location of the aneurysm. He can clamp the affected artery, wrap the aneurysm wall with a biological or synthetic material, or clip or ligate the aneurysm. (See Clipping a cerebral aneurysm.)

Newer surgical approaches use a combination of therapies to repair an aneurysm. For instance, interventional radiology may be used in conjunction with endovascular balloon therapy to occlude the aneurysm or vessel and treat arterial vasospasm with cerebral angiography.

 

Treatments for Neurologic Disorders

 

Don’t flip your lid yet

Focus Topic: Treatments for Neurologic Disorders

Another less invasive technique that has been successful for some patients is electrothrombosis, or coiling. This endovascular technique doesn’t require open surgery; instead, the surgeon uses a catheter to thread a platinum coil into the aneurysm sac and, through electrolysis, seal off the aneurysm to prevent further bleeding. (See Electrothrombosis.)

Patient preparation

Before the procedure, take these steps:

  • Tell the patient and his family that he’ll be monitored in the intensive care unit (ICU) after surgery, where he’ll be observed for signs of vasospasm, bleeding, and elevated intracranial pressure.
  • Explain that he’ll return to the medical-surgical unit for further care when his condition is stable.

Monitoring and aftercare

After the procedure, take these steps:

  • Gradually increase the patient’s level of activity, as ordered.
  • Monitor the incision for signs of infection or drainage.
  • Monitor the patient’s neurologic status and vital signs, and report acute changes immediately. Watch for increased ICP: pupil changes, weakness in extremities, headache, and a change in LOC.
  • Provide the patient and his family with emotional support as they cope with residual neurologic deficits.

Treatments for Neurologic Disorders

 

Home care instructions

Before discharge, give the patient these instructions:

  • Teach the patient or family member proper dressing change and wound care techniques and how to evaluate the incision regularly for redness, warmth, or tenderness, and to report any occurrence to the practitioner immediately.
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Dazed and confused

  • Remind the patient to continue taking prescribed anticonvulsant medications to minimize the risk of seizures. Depending on the type of surgery performed, he may need to continue anticonvulsant therapy for up to 12 months after surgery. Also, tell him to notify his practitioner of any adverse drug reactions such as excessive drowsiness or confusion.
  • Emphasize the importance of returning for scheduled follow-up examinations and tests.
  • Refer the patient and his family for appropriate home care or support groups.

Craniotomy

Craniotomy involves creation of a surgical incision into the skull to expose the brain for various treatments, such as ventricular shunting, excision of a tumor or abscess, hematoma aspiration, and aneurysm clipping. Craniotomy has many potential complications, including infection, hemorrhage, respiratory compromise, and increased ICP. The degree of risk depends on the patient’s condition and the surgery’s complexity.

Patient preparation

Before the procedure, take these steps:

  • Answer questions the family may have about the procedure to help reduce confusion and anxiety and help them cope.
  • Explain to the patient that his hair will be clipped or shaved.
  • Discuss the recovery period so the patient understands what to expect. Explain that he’ll awaken with a dressing on his head to protect the incision and may have a surgical drain as well.
  • Tell him to expect a headache and facial swelling for 2 to 3 days after surgery, and reassure him that he’ll receive pain medication.
  • Perform and document a baseline neurologic assessment.
  • Explain that the patient will go to the ICU after surgery for close monitoring.

Monitoring and aftercare

After the procedure, take these steps:

  • Gradually increase the patient’s level of activity, as ordered.
  • Monitor the incision site for signs of infection or drainage.
  • Monitor the patient’s neurologic status and vital signs, and report any acute change immediately. Watch for signs of increased ICP, such as pupil changes, weakness in extremities, headache, and change in LOC.
  • Provide the patient and his family with emotional support as they cope with residual neurologic deficits.

Home care instructions

Before discharge, take these steps:

  • Teach the patient or family member proper wound care techniques and how to evaluate the incision regularly for redness, warmth, or tenderness and report occurrences to the practitioner.
  • Remind the patient to continue taking prescribed anticonvulsant medications to minimize the risk of seizures. Depending on the type of surgery performed, he may need to continue anticonvulsant therapy for up to 12 months after surgery. Also, remind him to report any adverse drug reactions, such as excessive drowsiness or confusion.
  • Emphasize the importance of returning for scheduled follow-up examinations and tests.
  • Refer the patient and his family for home care or support groups as appropriate.
  • Provide written copies of home care instructions and a list of medications for the patient and family members.

Intracranial hematoma aspiration

In intracranial hematoma aspiration, an epidural, subdural, or intracerebral hematoma is aspirated with a small suction tip. This suction tip is inserted through burr holes in the skull (for a fluid hematoma) or through a craniotomy (for a solid clot or a liquid one that can’t be aspirated through burr holes).

It’s complicated

Focus Topic: Treatments for Neurologic Disorders

Patients undergoing hematoma aspiration risk severe infection and seizures as well as physiologic problems associated with immobility during the prolonged recovery period. Even if hematoma removal proves successful, associated head injuries and other complications, such as cerebral edema, can produce permanent neurologic deficits, coma, or even death. (See Emergency intracranial hematoma aspiration.)

Emergency intracranial hematoma aspiration

Treatments for Neurologic Disorders

 

What you can do

Focus Topic: Treatments for Neurologic Disorders

Patient preparation, monitoring and aftercare, and home care instructions are the same as those for cerebral aneurysm repair.

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