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  • 1. Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 40: Caring for Clients with Neurologic Deficits Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. Neurologic Deficit • One or more functions of CNS or PNS are decreased, impaired, absent • Often affects more than one body system • Examples: Paralysis; Muscle weakness; Inability to recognize objects; Impaired speech, memory, swallowing; Abnormal gait, difficulty walking; Abnormal bowel, bladder elimination • Divided into three phases: Acute; Recovery; Chronic – All phases not necessarily experienced by all clients Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. Healthcare Team Management • Temporary or Permanent Neurologic Deficit Care – Complex • Team Members – Physician; Nurse – Nursing assistant; Social worker – Physical therapist; Occupational therapist – Speech therapist; Prosthetist; Dietician – Psychotherapist; Pharmacist – Vocational counselor Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 4. Acute Phase • Sudden Neurologic Event: Client critically ill • Medical, Surgical Management : Stabilization; Prevent further neurologic damage – Drug therapy; Mechanical ventilation; Surgical intervention • Nursing Management: Frequent neurologic, physical assessments • Glasgow coma scale; Mini-Mental Status Examination – Basic rehabilitation interventions – Prevent complications Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. Recovery Phase • Begins upon stabilization of client condition; Lasts weeks to months • Medical, Surgical Management: Keeping the client stable – Prevention, Treatment: Complications; Neurologic impairment • Nursing Management – Continual assessment of client abilities, potential • Assessment tools – Planning rehabilitation program Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Chronic Phase • Client exhibits little, no improvement; Progressively worsens • Medical, Surgical Management – Rehabilitation rationale: Prevent complications – Surgery rationale: Correct resulting problems • Nursing Management – Prevent physical, psychological complications – Rehabilitation center therapy • Retraining in skills Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 7. Psychosocial Issues, Home Management • Return to Home Issues – Fear – Increased need for support – Caregiver burden – Financial strain – Home adaptation – Relearning of employment skills Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 8. Psychosocial Issues, Home Management • Nursing Management – Identification of problems, needs – Evaluation of client abilities – Assessment of assistance – Individual coping • Reassurance; Emotional support • Empathy; Support groups • Solutions, possible alternatives Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 9. Psychosocial Issues, Home Management • Nursing Management (Cont’d) – Socialization: Health team; Family; Occupational, recreational therapies – Family processes • Changes: Acceptance; Processing • Communication; Venting • Rehabilitation participation – Client and family teaching Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 10. Nursing Process • Assessment – Thorough history; General neurologic assessment – Specific systems; Emotional, mental status • Diagnosis, Planning, and Interventions – Impaired: Physical mobility, etc. – Risk: Impaired skin, tissue integrity; disuse syndrome, etc. – Elimination issues • Evaluation of expected outcomes Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Nursing Process: Risks Figure 40-1 Pressure ulcer of the elbow Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. End of Presentation Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins