The Effect Of Intracranial Pressure On Adults With...

The Effect Of Intracranial Pressure On Adults With...
Title Use of mannitol versus hypertonic saline in the reduction of intracranial pressure in adults with
traumatic brain injury. Introduction: The use of mannitol (MTL) and hypertonic saline (HTS) are the
main medical management for elevated intracranial pressure (ICP) in traumatic brain injury (TBI)
(Marko, 2012). The use of hyperosmotic agents to reduce brain volumes has been known since 1919
(Ropper, 2012). HTS is gaining in popularity over the last few decades (Colton, et al., 2016), but
MTL remains the gold standard in the treatment of ICP in the setting of post traumatic events and
has been used since 1980s, it is used in most trauma protocols for emergency medicine (Marko,
2012). According to the new Evidence Based Medicine, HTS might be a good replacement to MTL
with less side effects and better outcome in the long term (Hays, et al., 2011) (Marko, 2012). The
two agents used the same mechanism of action by increasing the osmolality of the blood and both
required an intact blood brain barrier (BBB) (Sakellaridis, et al., 2011) (Ropper, 2012). HTS would
be in general more effective and superior to MTL for the treatment of ICP (Kamel, Navi, Nakagawa,
Hemphil, & Ko, 2011). Raised ICP is recognised as one of the major causes of mortality as well as
poor neurologic outcomes (Fink, 2012). It accounts for about half of all deaths associated with TBI
(Jagannatha, Sriganesh, Devi, & Rao, 2016). Increase ICP can be caused by TBI and multiple other
causes (Fink, 2012).
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Evaluation Of The Paediatric Neurosurgical Patient
Key Points
1. Approach to the paediatric neurosurgical patient is different because of age–related changes in
neurophysiology and cranial development.
2. The signs and symptoms of raised intracranial pressure in paediatric neurosurgical cases are age
specific.
3. Blood loss due to surgery or tumor bleed into the cavity constitutes a major fraction of total blood
volume in the paediatric population.
4. Capnography is the most feasible and safer method to monitor venous air embolism in children.
Introduction
The majority of tumors (60–70%) in pediatric age group occur in the posterior fossa. The reason
behind propensity to occur in the posterior fossa has not been elucidated till date. Lesion in the
posterior fossa may be neoplastic, developmental and vascular processes requiring surgical
intervention. By far, the most common posterior fossa tumors of childhood are medulloblastomas,
ependymomas and astrocytomas. Medulloblastomas are the most common malignant brain tumor in
children comprising 20% to 25% of all pediatric brain tumors. The median age at diagnosis is
approximately 6 to 9 years. Most of tumors occur in midline and frequently found associated with
hydrocephalus. Success with surgical intervention has become possible because of improved
understanding of physiology, advances in imaging and microsurgical techniques, excellent
anaesthetic techniques available, advances in perioperative care of the patient. These in turn have
improved the survival and quality of

Closed Head Injury Essay
Closed Head Injury Case Study Y.W. is a 23–year–old male student from Thailand studying
electrical engineering at the university. He was ejected from a moving vehicle, which was traveling
70 mph. His injuries included a severe closed head injury with an occipital hematoma, bilateral wrist
fractures, and a right pneumothorax. During his neurologic intensive care unit (NICU) stay, Y.W.
was intubated and placed on mechanical ventilation, had a feeding tube inserted and was placed on
tube feedings, had a Foley catheter to down drain (DD), and had multiple IVs inserted. He
developed pneumonia 1 month after admission. Closed Head Injuries: Closed head injuries result
from a blow to the head as occurs, for example, in a car accident when the ... Show more content on
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"Elevation of the head of the bed reduces sagittal sinus pressure, promotes drainage from the head
via the valveless venous system through the jugular veins, and decreases the vascular congestion
that can produce cerebral edema" (Lewis, et al, p. 1436) * Position the bed so that it lowers the ICP
while optimizing the CPP; not above 30 degrees. * Turn the patient with slow, gentle movements.
Rapid changes in position may increase ICP. * Avoid extreme hip flexion–this risks raising intra–
abdominal pressure which increases ICP. Turn pt every 2 hrs (minimum). * Protect the patient with
ICP from self–injury with adequate padding on the bed. Because of likelihood of decreased LOC,
confusion, agitation, and the possibility of seizures increase the risk for injury. * Be prepared to
explain situations to family and caregivers and the patient. With increased ICP, anxiety is likely and
the prognosis can be distressing. By providing short, simple explanations that are appropriate, it
allows the patient and the caregiver to acquire the amount of information they desire (Lewis, p.
1438). * Decorticate or decerebrate posturing is a reflex response in some patients with increased
ICP. The nurse can use turning, skin care, and even passive range of motion. * Monitor fluid and
electrolyte status. Disturbances can have an adverse effect on ICP. Closely monitor IV fluids with
the use of an accurate intravenous infusion

Managing Client with Cerebrovascular Disease
Name And Student Number (Bolded)Course, Semester, Year | SITI ROHAIDA BINTE
RAHMAT12B057ZADVANCE DIPLOMA IN NEUROSCIENCE, 2012 | Managing Client with
Cerebrovascular Disease Introduction Stroke is a part of a cardiovascular disease that occurs when
the supply of blood or oxygen to the brain is disrupted by a blockage in the artery or when there is
usually a trauma that causes spontaneous bleeding in the brain (Duncan, Zorowitz & Lambert,
2005). Bleeding in the brain, is referred to as a haemorrhagic stroke which results from either
ruptured blood vessels or due to an abnormal vascular structure such as arterio–venous
malformation. Although stroke can be classified into two different categories (ischemic and
haemorrhagic), one ... Show more content on Helpwriting.net ...
Pathophysiology – Subdural Haematoma A subdural haematoma is defined as a collection of blood
flow underneath the dura layer but outside of the brain and arachnoid membranes. Subdural
haematomas are commonly found around the top and sides of the head, also commonly associated
with contusions and intracranial haematomas (Barker, 2008). As discussed by Barker, an acute
subdural haematoma occurs within 48 hours after significant trauma to the brain and often risks
mortality due to injury to the brain tissue and mass effects caused by the bleed. As subdural
haematoma is the most common type of intracranial haemorrhage, it is usually caused by a
mechanism involving a high–speed impact. Based on the patient's social history, he had picked up
boxing as a hobby a year ago and been practising intensively for an upcoming competition in the
following month, thus leading to a possibility of the violent punches attained during training may
have led to the traumatic injury. Upon initial trauma, the patient complained of severe giddiness
before passing out and this can be attributed based on the initial bleed from the bridging vein at the
superior saggital sinus. Giddiness is a major symptom when a bleed occurs as it compromises the
brain capacity by compressing brain tissue. As we know, the brain is made up of 80% brain tissue,
10% blood and the remaining 10% cerebrospinal fluid. The principle of Monroe Kellie Doctrine
stated that the total intracranial

The Division Of Neurosurgery At The University Of Arizona
NEUROSURGERY
The Division of Neurosurgery at the University Of Arizona, Department of Surgery treats a full
range of surgical diseases that affect the central and peripheral nervous systems and conditions
affecting the skull, brain, spinal cord, spine, and peripheral nerves. In addition to providing the
highest level of neurosurgical care, the division' surgeons advance neurosurgery knowledge and
practice through research and innovation. Below is a synopsis of the Neurosurgery division's
research area of interest, activities, contributions and future goals/direction.
A) Research areas of interest The Research interests of the Division of Neurosurgery are in
translational, clinical trials, new technology and performance indicators as they pertain to spine,
spinal cord injury, epilepsy, cranial nerve monitoring, brain tumor markers, gait and balance in
patients with Parkinson disease, laser treatment for epilepsy and movement disorders and the use of
advancement technologies in neuromodulation, and surgical treatment of stroke.
B) Completed & current research studies since the last APR (funded)
Completed
STRATIS (Site PI: Dr. Dumont) study –national stroke registry to evaluate the safety and
effectiveness of a neuro–thrombectomy device.
Pilot study (Co–PI: Dr. Weinand) evaluated MR –guided laser ablation of epileptic foci.
Current studies
Neurosurgical Genomics (PI: Dr. Weinand)–investigating the genetic basis for epilepsy.

Craniosynostosis Cause And Effect Research Paper
Felicia M. Salgado
Mr. Belmont
College Composition 2
31 January 2017
Cause and Effect
Causes and Effects of Craniosynostosis Craniosynostosis, or simply synostosis, is a birth defect in
which one or more of the fibrous joints between the bones of the baby's skull [cranial sutures] close
prematurely [fuse], before the baby's brain is fully formed, and continues to grow giving the head a
misshapen appearance. Commonly, Craniosynostosis is present at birth, but it is not always
diagnosed when mild. Usually it is diagnosed as a cranial deformity in the first few months of life.
There are numerous types of Craniosynostosis, with the different names given to various types,
depending on the shape of the head and which suture, or sutures, are involved. ... Show more
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Asymmetry of the orbits leads to strabismus [crossed eye] (Craniosynostosis). Intracranial pressure
can develop if the baby has Complex Synostosis, and can affect the baby in various ways, like a full
or bulging fontanelle [soft spot located on the top of the head], sleepiness [or less alert than usual],
increased irritability, poor feeding, projectile vomiting, seizures, bulging eyes, development delays,
blindness, eye movement disorders, cognitive impairment [affects memory or thinking skills], or in
rare instances, death. The risk of intracranial pressure from simple synostosis is small, as long as the
suture and head shape are fixed surgically. Doctors cannot predict which children will develop this
pressure problem; however, with more than one suture fused, the likelihood of increased pressure is
higher. Surgery is typically the recommended treatment because the physician can reduce the
pressure in the head and correct the deformities of the face and skull bones, but some children may
not require surgery (Craniosynostosis). There are several types of Craniosynostosis, with the causes
and effects varying from one type to another. Genes and environmental factors are almost always the
cause of Synostosis, but other causes are still a mystery to doctors. The effects of Craniosynostosis
can ultimately harm the patient physically and mentally if it is left

Obstacles Makes The Person Not Define Them
Obstacles Makes the Person Not Define Them
"The greater the obstacle, the more glory in overcoming it."– Molière. We have all faced some kind
of obstacle in life. When the obstacle pushes us to are limit we tend to give up. But what I have
found is if do everything in your power to overcome the challenge you will fill better inside and out.
This is the story about the time I faced the biggest obstacle in my life. I will tell you about the
obstacle its self,the treatments I went through,and the skills I gained. I hope you enjoy.
I was sitting in my sixth grade class, on a beautiful Monday morning. When all of a sudden I started
having this major headache. I didn 't really think anything of it because I was use to having head
aches here and there. It was now three o 'clock and I was heading home from the bus stop. As I was
walking it felt like the headache was getting worse with each step. So when I stepped in the house I
told my mom immediately. She ended up giving me some medicine to reduce the pain. Days later, is
when I noticed my headache were happening more everyday. This is when my mom decided to take
me to the hospital to get checked out. When we arrived at San Jacinto Methodist Hospital,we had to
wait in the emergency room with all the other sick patients. We sat there for what felt like hours,
until One of the nurses called my name. As I was sitting in the room waiting for the doctor to come
see me. I prayed to God to help me get through this. The

The Separation Of Argon, A Uniform Dc Electric Field At...
Abstract– A home–made dc sputtering is characterized by cathode potential of 250–2000 V and
sputtering gas pressures of (3.5×10–2 – 1.5) mbar. This paper studies in experiment the breakdown
of argon, a uniform dc electric field at different discharge gaps and cathode potentials. Paschen
curves for Argon are obtained by measuring the breakdown voltage of gas within at different target
cu,Au,Ag, vacuum chamber . The Paschen curves in Ar gases show that the breakdown voltage
between two electrodes is a function of pd (The product of the pressure inside the chamber and
distance between the electrodes). Current–voltage characteristics visualization of the discharge
indicate that the discharge is operating in the abnormal glow region.
Keywords: gold target , gas discharge, glow discharge, plasma , dc sputtering.
I. INTRODUCTION
Dc glow discharges are widely applied for depositing thin films, etching, plasma polymerization,
oxidation, and pumping gas discharge lasers, etc. Therefore the research into the conditions of the dc
glow discharge is of considerable interest [1]–[6]. Plasmas are ionized gases; hence, they consist of
positive (and negative) ions and electrons, as well as neutral species. Therefore, the ignition of the
dc glow discharge is one of the oldest problems in the study of low–pressure gas discharges. The
mechanism of the gas discharge can be explained as follows: When a sufficiently high potential
difference is applied between two electrodes placed in a

Essay On Wisdom Continuum
The data, information, knowledge, wisdom continuum is applied in our practice daily. This
continuum guide our practice in providing safe and competent nursing care to the public. Now, the
continuum will be applied in my research on pain management in patients diagnosed with brain
tumors. With that said, the continuum will aid with identifying relevant data and information in this
research. While brainstorming ways that the knowledge can be utilized in my practice, the
continuum will help in the understanding of wisdom in the application of gained knowledge.
The researchable question, in patients with brain tumors, what is the effect of pain medications and
steroid drug therapy on the improvement of their symptoms? was formulated using the PICO
Framework. By working on a Neuro unit, I have provided care to patients that constantly complain
of headaches related to the diagnoses of brain tumor. Meanwhile, some of the patient's stated that
the pain medication was therapeutic, while others claimed no relief was granted. (Hess & et al,
2005), "Headache may rapidly become the most relevant clinical feature in patients with primary or
metastatic brain tumors. Although, the overall ... Show more content on Helpwriting.net ...
(American Nurses Association, 2015), "Wisdom is defined as the appropriate use of knowledge to
manage and solve human problems. It consist of knowing when and how to apply knowledge to deal
with complex problems and human needs" (P.3). Therefore, wisdom is essential in nursing and plays
a major role in our ability to think critically. Wisdom contributes to us being competent nurses,
because we must be able to able to apply the knowledge gain to various situations that we are faced
with. In nursing wisdom is an instrument that save lives, increase quality of care, promotes wellness,
and enhances health care as a

Essay on Outline of a Research Aticle
Small Group Discussion 3.2: Outline of a Research Article
The Use of Hypothermia as a Treatment for Traumatic Brain Injury
1. Introduction and core story elements
a. What is the overview of the purpose of the study and the problem discussed?
i. Research has shown that hypothermia has neuroprotective effects and might be an effective source
of treatment for patients with head injuries. When discussing the treatment of patients with traumatic
brain injuries, hypothermia is a controversial issue. The purpose of this study was to compare
existing research on the use of hypothermia with TBI patients to determine if it is an adequate form
of treatment.
b. Is the problem clearly stated? . Yes. Hypothermia has been shown to have ... Show more content
on Helpwriting.net ...
i. All studies found that ICP was decreased and CPP increased with the hypothermia groups. ii.
Hypothermia is not a widely used treatment due to risk for complications associated with
hypothermia such as pneumonia, seizures and infection. iii. Re–warming of the patient should be
performed cautiously
b. Was the literature relevant? . The literature is outdated; publishing dates ranged from 1997 to
2006. This article was published in 2009; only one of the articles used for research was within five
years, all others were older. The literature would be more relevant if it was more recent. The
literature that was used although it may have been outdated, did support the problem researched;
using hypothermia as a means of treatment for a traumatic brain injury.
c. What exactly did the literature state to support the problem statement and question? . Across all of
the studies, hypothermia is effective in that ICP was decreased and CPP increased.
i. Research from multiple meta–analyses found that hypothermia can be effective. The specific
studies reviewed by Clifton (2001) and Marion (1997) resulted in conflicting findings. ii. Clifton
(2001) and Shiozaki (2001) stopped their studies before completion due to high rate infection and
lack of benefit from hypothermia. It was found to be detrimental to the patients. iii. Marion (1997),
Jiang (2006), and Polderman (2002) make strong recommendations for hypothermia.

External Ventricular Device Analysis
At Keck Medical Center of USC, there are many patients that have experienced subarachnoid
hemorrhages (SAH) on the Neurology Intensive Care Unit. A subarachnoid hemorrhage occurs
"when there is intracranial bleeding into the cerebrospinal fluid–filled space between the arachnoid
and pia mater membranes" (Lewis 1392). This bleeding of the brain can be brought on by multiple
causes such as an aneurysm, illicit drug use, or trauma. More often than not, these patients will have
an External Ventricular Device (EVD), which is a device that drains cerebrospinal fluid (CSF), via a
ventricular catheter. This device drains CSF when the pressure within the cranial vault rises above a
specific level ordered by the physician, to which the EVD is zeroed ... Show more content on
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In addition, tracheostomy placement incidence was decreased to have of what it was within the
control group. As the research sought to implement, the day of first mobilization was also
significantly changed. Other than these two findings, other outcome changes were not remarkable.
The unchanged findings included length of stay, EVD device days, placement of a
ventriculoperitoneal shunt days, restraint days, urinary catheter days, and restraint days. As
demonstrated by the study, early mobility is not only safe, it is feasible for both the patient and
health care team. The patient can only benefit from the implementation of these measures during the
hospitalization.
The strategies used to implement early mobility in this patient population can definitely be used in
practice. However, not necessarily in its entirety as that would necessitate an entire multidisciplinary
team. However, these measures can be taken to evaluate patients and help assess their readiness for
early ambulation. Ensuring that nursing staff is educated on the conditions necessary to ensure safe,
effective ambulation can provide optimal functioning in the patient. In addition, nursing staff can
utilize these measures to help advocate for patients and expediting their

, Demographics And Characteristics Of Patient Demographics
RESULTS
Patient Demographics: Seventy three patients (81%) were males and the remaining 17 (19%) were
females. Sex distribution among the studied groups is shown in (Table 1). Road traffic accidents
were by far the most common cause of trauma 63%, followed by localized head trauma 20% and fall
from a height 10%. APOE ϵ4 allele was expressed in 18 patients (20%) and the remaining 72
patients (80%) were negative for this allele.
Initial CT brain Findings: Normal CT brain, small hematoma with no mid line shift and diffuse
axonal injury were seen in APOE ϵ4 positive and negative patients with no significant difference.
However, a large hematoma with midline shift was seen in 50% (n=9) of gene positive patients and
25% (n=18) of gene ... Show more content on Helpwriting.net ...
Sex influence on long term complication: Female patients were significantly less likely to develop
long term complications whether or not they possessed the APOE ϵ4 allele than our male
population, with a highly significant difference (P=0.004) in those who expressed the APOE ϵ4
allele (table 5).
Table (1): The Percentage of Sex distribution among the studied groups.
The studied groups sex male female
Mild, N=30 22 (73.3%) 8 (26.7%)
Moderate, N=30 25 (83.3%) 5 (16.7%)
Severe, N=30 26 (86.7%) 4 (13.3%)
Table (2): The Percentage the initial CT findings among all patients on presenting to the ER. APOE
e4 +ve APOE e4 –ve P N % N %
Normal CT 2 11.1 24 33.3 >0.05
Small hematoma with no midline shift 4 22.2 27 37.5 >0.05 large hematoma with midline shift 9 50
18 25 <0.05
DAI 3 16.7 3 4.2 >0.05
CT:computarised tomography
DAI:diffuse axonal injury
Table (3): The Percentage of Follow up CT findings.
Follow up CT Brain Group I (n=30) Group II (n=30) Group III (n=30) APOE ϵ4 –ve(n=24) APOE
ϵ4 +ve (n=6) APOE ϵ4 –ve (n=25) APOE ϵ4 +ve(n=5) APOE ϵ4 –ve (n=23) APOE ϵ4 +ve (n=7) n
% n % n % n % n % n %
Better 24 100 5 83.3 23 92 2 40 15 65.2 1 85.7

Worse 0 0 1 16.6 2 8 3 60 8 34.8 6 14.3
P 0.04 0.005 0.02
Table (4):Statistical Analysis of the Hospital stay in days among the 3 groups. Group I (n=30) Group
II (n=30) Group III (n=30) APOE ϵ4

Reflection on Mentorship
Nursing Management of a Patient with Raised Intracranial Pressure after Traumatic Brain Injury and
Dealing with Family Anxiety.
Introduction
The aim of this assignment is to explore, analyse and evaluate the nursing management of raised
intracranial pressure (ICP) and family anxiety after head injury. In order to obtain a wider
knowledge of the care of patients with raised ICP, a literature review was carried out. From this
information I hope to improve the standard of care and ultimately patient outcome. The anxiety felt
by family members are large and therefore I have decided to discuss this in my assignment. Consent
has been sought from the next of kin. Confidentiality will be maintained in accordance with Nursing
and ... Show more content on Helpwriting.net ...
The brain has an ability to tolerate increase intracranial volume without increasing the intracranial
pressure, known as compliance (Barker 2002). Some intracranial contents (blood and cerebro spinal
fluid) can be displaced into spinal cord(space) (Woodrow,2000). This displacement creates initial
compliance, but once compensation is exhausted, intracranial pressure rises sharply (Chitnavis &
Polkey 1998),squeezing brain tissue causing herniation and likely death.
Aldi's ICP was monitored by passing a catheter into his lateral ventricle connected to a transducer
and monitor known as ICP monitor. A normal ICP is 0–10mmhg ( Hickey 2002).ICP that is
persistent >15mmhg is termed as "intracranial hypertension and will impair cerebral perfusion and
cerebral blood flow (Garner,2007).Therefore early identification of increases in ICP using ICP
monitoring enables prompt treatment which could decrease morbidity and mortality rates
(Mestecky,2007). Aldi's ICP was 30 mmhg, ICP guided therapy commenced which would be
discuss. Due to word restrictions only 4 main strategies will be discuss in depth.
As there was an increased in Aldi's ICP concern would be the ability of his brain to be perfuse.
Normally, autoregulation which defines by Drummond (1990,p.118)) as "the intrinsic ability of the
cerebral blood vessel to dilate or constrict in response to

Obstructive Sleep Apnea ( Osa )
Although obstructive sleep apnea (OSA) is known to be a common form of sleep–disordered
breathing and increase the overall risk of mortality by one and a half times in serious cases, many
patients with OSA remain undiagnosed and unrecognized by healthcare professionals (Stuart et al,
2013). Depending on the source, up to approximately 10% of women and 25% of men have OSA,
while the overall prevalence of OSA in the general population is between 3% and 7%. OSA is more
common in individuals who are obese, older, male, African American or of Pacific Island descent,
have a family history of OSA, or have a large neck size/small airway. Patients with OSA have been
shown to have a higher incidence of significant systemic conditions such as hypertension,
cerebrovascular accident, myocardial infarction, arrhythmias, diabetes, and dementia. Some of the
eye problems linked to OSA include glaucoma/other optic neuropathies, retinal vein occlusions,
central serous retinopathy (CSR), papilledema/idiopathic intracranial hypertension (IIH), floppy
eyelid syndrome (FES), and corneal disorders (i.e. keratoconus). This provides optometrists and
ophthalmologists with a tremendous opportunity to play an important role in diagnosing and
managing patients with OSA as well as improving their quality of life.
OSA is characterized by repeated episodes of either partial or complete obstruction of the upper
airways during sleep due to excessive relaxation of airway musculature, which leads to cessation

Essay on Ketamine
Ketamine
Description: Ketamine is a nonbarbiturate, sedative hypnotic used parenterally to provide anesthesia
for short diagnostic and surgical procedures. It is also used as an inducing agent, as an adjunct to
supplement low–potency anesthetics such as nitrous oxide, and as a supplement to local and
regional anesthesia. Ketamine can be used concomitantly with muscle relaxants without
complication because it does not provide muscle relaxation of its own. It is a fairly short–acting
agent that provides a profound, rapid, dissociative state and a short recovery time. Mechanism:
Although the exact mechanism of action is not known, ketamine appears to be an agonist at CNS
muscarinic acetylcholine–receptors and opiate–receptors. Ketamine ... Show more content on
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More rapid administration can result in respiratory depression, apnea, and an enhanced pressor
response. Usual induction doses are 1 – 2 mg/kg IV and will produce 5 – 10 minutes of surgical
anesthesia.
Intramuscular dosage is 3 – 7 mg/kg IM, which will produce 12 – 25 minutes of surgical anesthesia.
For intramuscular injection, no dilution is necessary and the standard procedures for IM injection
should be followed, such as injecting into a large muscle mass and aspiration prior to injection to
avoid injection into a blood vessel.
For general anesthesia maintenance: 50 – 100% of the full IV or IM induction dose can be repeated
as needed.
Ketamine can be used for sedation before minor procedures, although this use is not approved by the
FDA
The oral dosage would be 6 – 10 mg/kg PO (mixed in cola or other beverage) given 30 minutes
before procedure.
The intravenous dosage in this case is 0.5 – 1 mg/kg IV (range: 0.5 – 2 mg/kg).
In any usage, ketamine should be given on an empty stomach to help prevent possible vomiting and
aspiration.
Tolerance:
There is some evidence in the literature that repeated use can result in tolerance, requiring higher
doses with successive administrations to achieve the same levels of sedation and anesthesia.
Ketamine is contraindicated in patients with hypertension, cardiac disease, myocardial infarction,
congestive heart failure, stroke, head trauma or intracranial mass, or intracranial bleeding, or in
other patients

Dangers Of Peer Pressure On Girls
Dangers of Peer Pressure on Girls As a little girl I had much confidence about myself and felt I
looked the best from my school as well as many other girls from my school. Nowadays, many girls
are pressured into being perfect in a way they feel they will never accomplish. Little girls such as
ten year olds have started to show low self–esteem and hate to their body image because of the
models that are being constantly promoted. As 10TV stated, "When you were 10 or 11, you probably
didn't give much thought to body image. Today, kids that age are worried more about looking like
Barbie than playing Barbie." Girls are punishing themselves with cutting, going on extreme diets,
and often kill themselves because they hate themselves. Girls are also seen wearing makeup at a
young age to improve their facial features and think they will now finally be accepted in society as
being perfect. A recent Mintel survey showed that six out of ten seven–year–olds wear lipstick, and
two in five use eyeshadows. ("Pretty–Pressure: Girls–it pays to be pretty, but not too pretty.") So
even though social media is showing off beautiful women to give good advertisement, girls are
being affected by constantly feeling down and wanting to fit into society and be accepted and seen
as perfect, they hate themselves for not being pretty enough as celebrities that have gone through
many surgeries to get that "perfect" image, and some cases have led to issues such as depression,
cutting, eating problem, and

Description Of A Model Case
5. Cases: Model, Related, Contrary, Borderline & Invented
Model Case A model is a simple representation of something else. Avant and Walker 2011, define a
model case as an occurrence that defines the case or idea exactly. In many instances, a model is
something that the person can relate to and should come first in the study (Avant & Walker, 2011).
Example of a model case: "Jason" is a 31–year–old white male that has worked on the surgical
oncology floor for 5 years. He has a wife and a two–year–old son, drinks about three days a week
and often yells at his wife and son. He arrives to work every day on time and his coworkers know
him for his speed, organization and great time management. He is the charge nurse most nights and
is currently orientating a new nurse who also knows his wife. Most days, he is very short with the
new hired nurse; belittling and acting very pompous. One day, the new hire arrives to work and is
visibly upset and teary eyed, Jason does not care and proceeds to his teaching process as usual. The
new nurse gets fed up and proceeds to yell his faults to the entire night shift crew and even a few
members of upper management. The new nurse calls him "the worst nurse ever" and states that
"working together has been a nightmare". Further elaborating that he is "a monster and evil human
being because of his frequent verbal abuse directed toward his wife and son". Jason is immediately
taken back and is consumed by his guilt and shame causing him to completely

IIh Case Studies
IIH, previously referred to as pseudotumor cerebri or benign intracranial hypertension, is a diagnosis
of exclusion. IIH is typically found in women of childbearing age who are obese and it has a
worldwide incidence of 12 to 20 individuals per 100 000 people annually.2 The most common
symptom reported by IIH patients is headache, which increases in intensity overtime.3 Many IIH
patients have other coexisting headache disorders like migraines.4 The diagnosis and management
of IIH requires an extensive workup to rule out intracranial etiologies. Conventional treatment of
IIH includes weight loss, low–salt diet, and medical treatment. The pathogenic mechanisms of IIH
remain unclear. Several theories, including cerebral spinal fluid (CSF) hypersecretion, CSF outflow
... Show more content on Helpwriting.net ...
However, generalized edema is associated with reduced consciousness, which has not been reported
in IIH.14 In 1956, Joynt and Sahs reported cerebral edema in cerebral biopsies, but these findings
have not been replicated in the literature. Furthermore, the links between cerebral edema and IIH in
quantitative MRI studies have not been established.15 Obesity is noted in most cases of IIH,
suggesting a strong association between the two disorders. This notion is supported by clinical
observations of weight loss improving IIH symptoms.16 IIH mainly affects women, but according
to this notion, we should also expect to see IIH in men.17 Adipose tissue can produce cytokines, in
particular adipokines, which can cause inflammation in the body.18 Increased markers of
inflammation, specifically leptin, have been observed in the CSF of IIH patients, but these findings
remain inconclusive.19 The mechanism by which weight loss can improve IIH is complex and not
well understood. Hormonal factors are suggested to play a role in the pathogenesis of IIH. In a small

Increased Intracranial Pressure Paper
Care for a Patient with Increased Intracranial Pressure
This paper explores research on nursing care for a patient at the hospital with an injury to the brain
that is being treated for increased pressure buildup in the skull. Two articles were evaluated in an
attempt to improve care for an individual suffering from a traumatic brain injury. The articles
discussed in this paper defined what diagnostic assessments and data are crucial in detecting
changes in the status of a patient with a brain injury who may be suffering from increasing
intracranial pressure, as well as defining nursing interventions and techniques which can be utilized
in practice to prevent complications. This paper identifies strategies for the nurse to use to prevent
the ... Show more content on Helpwriting.net ...
A Glasgow Coma Score of 8 or less also is an indication that the patient will need to be intubated
soon. Once the tube is placed the ventilation may be useful in controlling the intracranial pressure as
an intervention. Hyperventilation is a method used to reduce the carbon dioxide concentration in the
vessels causing vasoconstriction which lessens the amount of blood circulating in the brain resulting
in a decreased ICP (Zink and McQuillan, 2005). According to Zink and McQuillan, this intervention
should only be utilized 24 hours after the initial injury because cerebral blood flow is often reduced
at this point and constricting the vessels more may cause ischemia to occur. While using this
technique it is important to monitor oxygenation to the brain tissue to assure no irreparable damage
is

Intracranial Pressure (Icp
Intracranial Pressure (ICP): Overview: ❑ Intracranial pressure (ICP) is the hydrostatic force
measured in the brain cerebrospinal fluid (CSF) compartment. Intracranial Pressure (ICP) is the
combination of the pressure exerted by the brain tissue, blood, and cerebral spinal fluid (CSF). The
modified Monro– kellie doctrine states that these three components must remain at a relatively
constant volume within the closed skull structure. ❑ If the volume of any one of the three
components increases within the cranial vault and the volume from another component is displaced,
the total intracranial volume, and therefore, pressure, will not change. Factors that influence ICP
under normal circumstances are changes in arterial ... Show more content on Helpwriting.net ...
The upper limit of systemic arterial pressure at which autoregulation is effective is an MAP of 150
mmhg; once higher than this pressure the vessels are maximally constricted and further
vasoconstricto response is lost. ❑ The cerebral perfusion pressure (CPP) is the pressure needed to
ensure blood flow to the brain[ CPP = MAP minus ICP] or [CPP = Flow x Resistance]. As the CPP
decreases, auto regulation fails and CBF decreases, which can lead to ischemia and neuronal death.
Compliance is the expandability of the brain. With low compliance, small changes in volume result
in greater increases in pressure. When cerebral vascular resistance is high, blood flow to brain tissue
is impaired. Transcranial Doppler is a noninvasive technique used in ICUs to monitor changes in
cerebrovascular resistance. ❑ To maintain cerebral blood flow (CBF), it is necessary to keep
cerebral perfusion pressure (CPP) in the range of 60 – 100 mm Hg. When auto regulation is impair
red, the CBF fluctuates with changes in the systemic blood pressure. This may be seen in the patient
that is suctioned or who coughs, which causes a rise in blood pressure, resulting in elevated ICP.
MAP that is greater than 60 mmHg is enough to sustain the organs of the average person. MAP is
normally between 70 to 110 mmHg. If the falls below this number for an appreciable time, vital
organs will not get enough Oxygen perfusion, and will become ischemic. A CPP less than 50 mmhg
is

The Use Of Increased Intracranial Pressure As A Result Of...
Colton et al. (2014) research looked at 117 clients who experienced increase intracranial pressure as
a result of severe traumatic brain injury. Their research looked at client's respond to pharmacological
interventions and these pharmacological interventions include hypertonic saline, mannitol, propofol,
fentanyl, and barbiturate. In their research Colton et al., (2014) found "all treatment resulted in
significant intracranial pressure changes after 1 hour or 2 hours except for mannitol and barbiturate
administration" (Colton at el., 2014). This finding is significant given that mannitol is used as a first
line treatment for management of increased intracranial pressure. The chart below demonstrates how
each of these pharmacological interventions decreased intracranial pressure and it allows us to
compare each pharmacological intervention to each other. (Colton et al., 2014) As you can see in
table 3, a small dose of hypertonic saline was far more affective then mannitol in decreased
intracranial pressure. "Intracranial pressure fell after administration of a "small" dose of hypertonic
saline by 8.83 mm Hg in the first hours and 9.76 mm Hg in the second hour according to the manual
data" (Colton et al., 2014). When comparing hypertonic saline to mannitol as well as the other
pharmacological interventions, administration of hypertonic saline resulted in a significant amount
of reduction in clients with intracranial pressure. Their study also revealed, "mannitol resulted in

Chapter 57 Nursing Management Acute Intracranial Problems
Chapter 57: Nursing Management: Acute Intracranial Problems Test Bank MULTIPLE CHOICE 1.
Family members of a patient who has a traumatic brain injury ask the nurse about the purpose of the
ventriculostomy system being used for intracranial pressure monitoring. Which response by the
nurse is best? a. "This type of monitoring system is complex and it is managed by skilled staff." b.
"The monitoring system helps show whether blood flow to the brain is adequate." c. "The
ventriculostomy monitoring system helps check for alterations in cerebral perfusion pressure." d.
"This monitoring system has multiple benefits including facilitation of cerebrospinal fluid drainage."
ANS: B Short and simple explanations should be given initially to patients ... Show more content on
Helpwriting.net ...
What action is best for the nurse to take? a. Ask the family to stay in the waiting room until the
initial assessment is completed. b. Allow the family to stay with the patient and briefly explain all
procedures to them. c. Refer the family members to the hospital counseling service to deal with their
anxiety. d. Call the family's pastor or spiritual advisor to take them to the chapel while care is given.
ANS: B USTESTBANK.COM The need for information about the diagnosis and care is very high
in family members of acutely ill patients. The nurse should allow the family to observe care and
explain the procedures unless they interfere with emergent care needs. A pastor or counseling
service can offer some support, but research supports information as being more effective. Asking
the family to stay in the waiting room will increase their anxiety. DIF: Cognitive Level: Apply
(application) REF: 1375 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial
Integrity 7. A 41–year–old patient who is unconscious has a nursing diagnosis of ineffective cerebral
tissue perfusion related to cerebral tissue swelling. Which nursing intervention will be included in
the plan of care? a. Encourage coughing and deep breathing. b. Position the patient with knees and
hips flexed. c. Keep the head of the bed elevated to 30 degrees. d. Cluster nursing interventions to
provide rest periods. ANS: C The patient with increased intracranial

Case Study On Robotics
Situation Analysis The main focus of the study is all about the use of syringe plunger hydraulics to
take effect on manoeuvring a robotic arm. Robotic arms are used in industrial robotics nowadays.
They are used to pick up and manipulate any object at a distance. Wherein it is the biggest challenge
we will encounter in this study. Robotics only managed to carry through their precision by being
large, expensive, and most likely to consume or use lots of energy and are wasted. Nothing beats
hydraulic propulsion. Using hydraulics allows the robotic arm to do refined and precise motions.
With the syringe plunger, it allows to apply pressure to the water to make each part of the material to
function. Wherein ... Show more content on Helpwriting.net ...
It is becoming an increasingly important problem of the industry, and it affects the society at large.
In particular, it aims to answer the following questions:
Research Questions
1.) How do hydraulics affect the weight of robotics?
2.) How do hydraulics conserve energy?
3.) How do hydraulics optimise the robotic arm's approach?
4.) How do hydraulics make robotics cheaper?
5.) How do hydraulics function well than the other alternatives in robotics?
Paradigm of the Study
Hypothesis Hydraulics affects the weight of robotics and making it lighter. It conserves energy and
that water can be found anywhere rather than using any other energy without efficiency. It makes it
easier to optimise its trajectory and it has controlled speed to operate it, wherein electricity can't
much have the motion to operate it precisely. Its usage makes it cheaper and that it uses water to
produce energy which is easy to do. It functions well than other alternatives and nothing beats
hydraulic propulsion because this type of force is used in many applications we use every

The Efficacy Of Neurologic Deficits From Cerebral In...
The efficacy of nimodipine in the reduction of neurologic deficits from cerebral vasospasm in
patients with aneurysmal subarachnoid haemorrhage (aSAH)
Introduction
Subarachnoid Haemorrhage (SAH) is the presence of blood in the subarachnoid space. It is
characterised by sudden onset of severe headache, often described as "thunderclap headache".[1]
Eighty–five percent of the cases are caused by an aneurysm and 50% of patients diagnosed with
SAH die.[2] The estimated incidence of SAH was at 10 to 15 per 100 000 person–years, but recent
studies showed 6 to 8 per 100 000 person–years.[3] A New Zealand study in 1985 showed higher
incidence rate of SAH in women than men.[4] Same findings were noted in one Australasian study
conducted in 2000, wherein among the four neurosurgical units tested within Australia and New
Zealand, results showed highest incidence of SAH in Auckland, attributing mainly to the high
incidence of SAH among Maori and Pacific Islanders.[9] Cigarette smoking, uncontrolled
hypertension, and excessive intake of alcohol remain to constitute the biggest threat [17]. Ten
percent of the cases were also linked to a positive family history.[2] The risk is also increased during
vigorous activities like physical exercise, Valsalva manoeuvre during defecation, micturition and
sexual intercourse[19] relatively due to increased intracranial pressure associated with these
mechanisms.
Despite recent advancements of SAH management, neurologic deficits secondary to cerebral

Monitoring At Risk For Elevated Icp Monitoring
ICP Monitoring Indications. Of monitoring of ICP : ICP monitoring is generally indicated in patients
who meet all three of the following criteria:
1. The patient is suspected to be at risk for elevated ICP.
2. The patient is comatose (Glasgow coma scale score ≤ 8).
3. The prognosis is such that aggressive ICU treatment is indicated. Suspicion of increased ICP is
usually based on clinical signs (Tables 2 and 3) and the results of a computed tomography (CT) scan
showing significant intracranial mass effect with midline shift or effacement of the basal cisterns.
However, in comatose patients with TBI, intracranial hypertension occurs in approximately 10% of
patients with normal CT scans; this risk is even higher in patients more than 40 years old, with
motor posturing, or with hypotension (systolic blood pressure < 90 mmHg) . If a patient is awake
and can follow commands, it is unlikely that ICP is dangerously elevated (11), and the benefits of
ventricular drainage or ICP monitoring probably do not outweigh the risks. Careful monitoring of
mental status in an ICU will usually suffice in these cases.
1. INTRAVENTRICULAR CATHETERS. These devices directly connect the intracranial space to
an external pressure transducer via saline–filled tubing. The bedside pressure transducer must be
positioned at the level of the foramen of Monroe (external auditory meatus) to accurately reflect
ICP. The catheter is usually connected to both a

Idiopathic Intracranial Hypertension (IIH)
oduction Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology that primarily
affects young, obese women (1,5). In idiopathic intracranial hypertension (IIH) there is raised
pressure within the skull (raised intracranial pressure), which puts pressure on the brain. Idiopathic
means that the cause of this raised pressure is unknown. The main symptoms are headache and loss
of sight (visual loss). It mostly affects women of childbearing age who are overweight or obese.
Treatment is aimed at preventing permanent visual loss and includes treatment with medicines.
Brain surgery (neurosurgery) may also be used. For many people, a combination of medical and
surgical treatment can help to control their symptoms well. This disorder ... Show more content on
Helpwriting.net ...
Along with this new designation, the authors outline their proposed criteria for a definitive diagnosis
of PTCS: the presence of papilledema, normal results (other than cranial nerve abnormalities) from
a neurological examination, normal cerebrospinal (CSF) composition, normal neuroimaging and the
presence of elevated lumbar puncture (LP) opening pressure. The authors further define a
"probable" diagnosis of PTCS to be when the previously mentioned criteria are met in the presence
of an opening pressure that is lower than specified for a "definite" diagnosis OR in the absence of
papilledema the patient demonstrates all other criteria specified for a "definite" diagnosis including
unilateral or bilateral abducens nerve palsy. Finally, PTCS is "suggested" when papilledema and
cranial nerve (C.N.) VI palsy are absent but all other criteria specified for a "definite" diagnosis are
met AND the patient has at least 3 of the following key findings on neuroimaging: empty sella,
flattening of the posterior aspect of the globe, distention of the perioptic subarachnoid space with or
without a tortuous optic nerve and/or transverse venous sinus stenosis (12). Another study reports
that those with IIH may also demonstrate fully unfolded optic nerve sheaths

Graduation Speech : College Students
According to the 2015 National College Health Assessment, over 85% of college students have felt
stressed or overwhelmed in the last year. As an undergraduate, I am fully aware of the pressure we,
as students, feel. We are a machines, constantly trying to balance studying, our classes, working,
having a social life, and preparing for our future. And we are still expected to get eight hours of
sleep every night? I know first hand how this feels. I wake up early every morning, go to class,
spend countless hours studying and doing homework between classes, attend more classes, come
home, clean, go to work, and study some more. Every day is a work in progress of what I will
become in the future. What will be my occupation? How much money will I make per year? How
am I going to pay off my student loans? These are all questions college students ask themselves
everyday. William Zinsser reflects on his own college experience in his article "College Pressures"
and discusses why college students feel such an intense load of pressure these days. In "College
Pressures" William Zinsser reminisces on his days as an undergraduate, and focuses on how he can
turn it into a learning experience for students in college now. He wants us to take a step back from
focusing so heavily on the future, and to enjoy every minute of the present, and more specifically to
relish the education experience we are receiving. In fact, Zinsser says, "What I wish for all students
is some release from the clammy

Idiopathic Intracranial Hypertension
Discussion
History
In 1890, a German physician named Quicke described a neurological condition in which patients
had signs and symptoms of increased intracranial pressure without a brain tumor being present [1].
Between 1927 and 1937, Dr. Dandy, a pioneer of neurosurgery was able to gather the most common
signs and symptoms of 22 patients with pseudotumor cerebri [2]. These symptoms included
headache, nausea, vomiting, diplopia, dizziness, and loss of vision. It is important to note that the
patient seen in our clinic was not experiencing any of the mentioned symptoms except for vision
loss. According to Dr. Dandy, the most common ocular signs were bilateral papilledema and some
patients had retinal hemorrhages, which indicated long–standing severe intracranial hypertension. In
each case intracranial pressure was measured by ventricular or lumbar puncture and measured to be
anywhere from 250 to 550 mm of water and in every instance the ventricles were smaller than
normal and symmetrical. The treatment for most of these patients was a right sub–temporal
decompression. This was done if the signs and symptoms indicated a need for intervention. In most
patients there was a complete, spontaneous cure [2]. A more recent prospective study of 50 patients
showed the breakdown of the most common symptoms of idiopathic intracranial hypertension [3]:
●Headache (92 percent)
●Transient visual obscurations (72 percent)
●Intracranial noises (pulsatile tinnitus) (60 percent)

Evaluation Of An Increased Intracranial Pressure New...
Simulation Reflection
My charge nurse informed me that my assignment was to care for an increased intracranial pressure
new admission patient. The gentleman was in his early thirties and he came in thought the hospital
emergency department after wrecking his motorcycle. This patient was immediately transferred up
to my intensive care unit and had family present. I went into the room to get report and my patient's
father constantly interrupted the day shift nurse. He frantically asked what was happening, if there
was any hope of survival, and if he should have his son's care transferred to another hospital. This
was all the overwhelming information that happened in the first five minutes of the first portion of
my simulation. The second portion of my simulation was on advanced cardiac life support. Though
completing the critical care simulation, I learned a major strength and weakness I have as a senior
nursing student.
When I was caring for my patient with increased intracranial pressure, I was highly stressed and
distracted by the concerns of the family. The report seemed rushed and confusing to follow. During
report a medical error was mentioned and the father overheard that Mannitol was not started on
time. He was taking over other nurses and myself to ask question our competency. The family did
not trust anyone providing care for the patient and I felt a tight knot in my stomach. I felt myself
sweating as I attempted to explain the situation to the father left my

School Registration and Fees Payment System
Development and Assessment of Well Control Procedures for Extended Reach and Multilateral
Wells Utilizing Computer Simulation by Dr. Jerome J. Schubert, Texas A&M University Dr.
Jonggeun Choe, Seoul National University, Korea Mr. Bjorn Gjorv, Texas A&M University Mr. Max
Long, Texas A&M University Final Project Report Prepared for the Minerals Management Service
Under the MMS/OTRC Cooperative Research Agreement 1435–01–99–CA–31003 Task Order
85222 Project Number 440 December 2004 OTRC Library Number: 12/04–A146 "The views and
conclusions contained in this document are those of the authors and should not be interpreted as
representing the opinions or policies of the U.S. Government. Mention of trade names or
commercial ... Show more content on Helpwriting.net ...
"Olga", a well known multiphase simulator, was used to study the effects of varied hole and pipe
size combinations, and hole angles from 80 degree from vertical to 100 degrees from vertical on the
efficient removal of gas kicks. Results show that annular velocities of up to 3.4 ft/sec may be
required to efficiently remove gas from near horizontal wellbores with relatively large annular
spaces. Task 4 – Work on Task 4 has begun, but has not been completed at this date. Dr. Jonggeun
Choe is scheduled to arrive in College Station in early January, 2005, where he and Dr. Schubert
will complete this task. This work will be reported in a supplemental report that will be provided to
the MMS in mid February, 2005. Conclusions Results from this study can be useful in planning well
kill operations. The planning process can be summarized as follows: 1. Determine the capacities of
the mud/gas separation equipment to determine the maximum circulation rate that this equipment
can tolerate. 2. Compare this rate to the optimum circulation rate to remove gas from the horizontal
portion of the hole. a. If the minimum rate to remove gas from the horizontal section exceeds the
maximum rate that can be handled by the surface equipment, the kill operation should begin at the
higher kill rate to remove gas

Behavior of Gases and Absolute Zero Determination Essay
Pre Lab Report Behavior of Gases and Absolute Zero Determination
Lab 4
Summary of Concepts:
Through this experiment we will be investigating the differences between the gas laws. We will
investigate the relationships between pressure, volume, and temperature. By the end of the
experiment we will have data to prove the gas laws.
The Gas Laws we will be investigating are as follows:
Boyle's Law:
PV=C
Charles' Law:
V/T=C
Gay–Lussac's Law:
P/T=C
Avogadro's Law
V/n=C
Ideal Gas law:
PV=nRT
http://chemistry.bd.psu.edu/jircitano/gases.html
Materials:
Lab Quest
Lab Quest App
Vernier Gas Pressure Sensor
Temperature Probe
20 mL Gas Syringe
125 mL Erlenmeyer Flask
Three 600 mL Beakers
Rubber Stopper assembly with two way ... Show more content on Helpwriting.net ...
b. Stop data collection when you have finished collecting data to view a graph of pressure vs.
volume. Save data under file save. Print a copy of the data and a graph of pressure vs. volume.
PART 2:
1. In this experiment, you will study the relationship between temperature of a gas sample and the
pressure it exerts. Using the apparatus shown in Figure 2, you will place an Erlenmeyer flask
containing an air sample in a water bath and you will vary the temperature of the water bath.

Connect the Temperature Probe to Channel 2 of LabQuest. Choose New from the File menu.
2. Assemble the apparatus shown in Figure 2. Be sure all fittings are airtight. Make sure the rubber
stopper and flask neck are dry, then twist and push hard on the rubber stopper to ensure a tight fit.
3. Set up water baths in large–volume containers as you need them, ranging from ice water to hot
water.
4. Change the graph settings to display a graph of pressure vs. temperature.
5. 30 – 2 Advanced Chemistry with Vernier
6. Exploring the Properties of Gases
a. Change the data–collection mode to Selected Events. Leave everything else the same and Select
OK.
b. Choose Change Units ► K (Kelvin temperature) from the Sensors menu. Tap Graph.
c. In Part II it is best to see one graph of pressure vs. temperature. Choose Show Graph ►Graph 1
from the Graph menu.
d. Tap the

A Case Study : Traumatic Brain Injury
A Case Study: Traumatic Brain Injury
Jennifer Buechler
University of San Diego
Traumatic Brain Injury
Introduction
Traumatic brain injury, or TBI, occurs when there is a sudden, direct injury to the head. This type of
wound can result from a bump, blow, or jolt to the cranium. It may even result from the penetration
of a foreign object into the brain tissue. Most TBI's result from car accidents, sports injuries, blunt
trauma, unintentional injuries and falls, with falls accounting for about 40% of all TBI injuries.
Much like stroke patients, individuals suffering from traumatic brain injuries may have to live with a
variety of detriments based on the location and extent of their injury. For example, patients can
experience impaired sensation, vision, hearing, memory, processing skills or even emotional and
behavioral functioning ("Injury Prevention & Control: Traumatic Brain Injury.") The purpose of this
paper is to provide information regarding the pathophysiology, treatment and medical management
of traumatic brain injuries, as well as to educate health care providers of the additional ways in
which support can be provided to both patients suffering from these types of injuries and their
families. A case study will be supplied to facilitate discussion of the topic.
Pathophysiology
The pathophysiology of traumatic brain injuries can be slightly different depending on the type of
injury that has occurred. For example, injuries can result from

Symptoms And Treatment Of Cystic Retrochiasmatic...
Abstract:
Cystic retrochiasmatic craniopharyngiomas may reach enormous size by expanding into the
posterior fossa along the retroclival area, which is very unusual finding. A 5–year–old boy presented
with headache for 2 month. On the neurological examination, it was normal. Initial magnetic
resonance (MR) images revealed a huge, thin–capsuled multi–cystic mass, which extended around
brain stem & extending bilaterally along the base of the middle and posterior cranial fossa. Subtotal
excision of the cystic wall was done followed by applying of a catheter within the cyst attached to a
reservoir with a favorable outcome.
KEY WORDS: Endoscopic drainage, Cystic, Craniopharyngioma,
Introduction
Craniopharyngiomas usually emerge in the infundibulo–hypophyseal axis of the sella and
suprasellar region occupies the suprasellar cisterns, however may extend in any direction. The
horizontal extension of the tumor may be anteriorly into the pre–chiasmatic cistern and sub–frontal
space, may extend laterally into the sub–temporal space, or may extend posteriorly into the
prepontine and interpeduncular cisterns, cerebellopontine angle and then to the foramen magnum. 7
However, rarely extensive tumors may extend anteriorly in the pre–chiasmatic cistern and
posteriorly into the 3rd ventricle and down along the clivus. Approximately 4 % of the cases have
posterior fossa extension. 2,6
Case Report
A 5–year–old boy was admitted to our department with severe headache, which aggravated over 3

Total Intravenous Anesthesia And Spine / Neurosurgery
Total Intravenous Anesthesia in Spine/Neurosurgery
La Donna Brown
University of New England
Total Intravenous Anesthesia in Neurosurgery
Trends in anesthesia practice have evolved over the past 20 years. In 2007, the most frequent types
of neurosurgical procedures were spinal fusion, endovascular spinal procedures, craniotomies for
tumor pathology; craniotomies not associated with tumor pathology, and intracranial endovascular
procedures (Alacon, Larios, & Bergese, 2015). Like other areas of medicine, neurosurgery is also
moving towards minimally invasive procedures, and there is current evidence of a 32% growth in
intracranial endovascular procedures in 2013 (Alacon et al., 2015).
Everyday, anesthetists provide anesthesia to neurosurgical patients because, in order to maintain
neurological functions, it is vital to assess the effect of intravenous anesthetics during neurosurgical
procedures, as well as the speed of recovery. This has led to an ongoing to debate of which
anesthetic technique is best for these surgeries. Total intravenous anesthesia (TIVA) is arguably the
best anesthetic technique for neurosurgical procedures because propfol does not affect cerebral
auto–regulation and only mildly effects intracranial pressure. Opiolds are shown to have minimal
effects on cerebral blood flow.
Cerebral Hemodynamics The anesthetic goal in neuro/spine surgery is to maintain hemodynamic
stability in order to safeguard cerebral auto–regulation. One of the

Evaluation Of A Nursing For An Increased Intracranial...
Simulation Reflection My charge nurse informed me that my assignment was to care for an
increased intracranial pressure new admission. The gentleman was in his early thirties and he came
in thought the hospital emergency department after wrecking his motorcycle. This patient was
immediately transferred up to my intensive care unit and had family present. I went into the room to
get report and my patient's father constantly interrupted the dayshift nurse. He frantically asked what
was happening, if there was any hope of survival, and if he should have his son's care transferred to
another hospital. This was all the overwhelming information that happened in the first five minutes
of the first portion of my simulation. The second portion of my simulation was on advanced cardiac
life support. Though completing the critical care simulation, I learned a major strength and
weakness I have as a senior nursing student. When I was caring for my patient with increased
intracranial pressure, I was highly stressed and distracted by the concerns of the family. The report
seemed rushed and confusing to follow. During report a medical error was mentioned and the father
overheard that Mannitol was not started on time. He was taking over myself and the other nurses to
question our competency. The family was not trusting anyone providing care for the patient and I
felt a tight knot in my stomach. I felt myself sweating as I attempted to explain the situation to the
father left my

The Efficacy Of The Decompressive Craniectomy
Scott Sorge
OMS 1
Advanced Dissection
Decrompressive Craniectomy
The efficacy of the decompressive craniectomy is a topic of debate in today's healthcare setting.
While initial studies showed no significance in the procedure's ability to save lives when compared
to conservative treatment, more recent studies that take into account time after onset of injury and
age of patient make a strong case for the necessity of the craniectomy. As research continues to
develop, the decompressive craniectomy continues to gain more support as the gold standard
treatment for a sudden, uncontrolled increase in intracranial pressure.
Various forms of acute trauma can lead to swelling of the brain within the cranium. Infection,
ruptured blood vessels, or inflammation due to stroke can cause the brain to expand, potentially
forcing the brainstem through the foramen magnum. During this expansion blood vessels may
become compressed, leading to further accumulation of inflammatory molecules and stasis of blood
flow to cerebral tissue. Lack of oxygen along with physical trauma due to expansion may cause
irreversible damage and death. In extreme cases of intracranial swelling, a decompressive
craniectomy may be necessary to alleviate pressure. Additionally, the procedure provides the
surgeon with an access point to physically remove hematomas and repair damaged vasculature.
The first steps of the procedure include identifying the presence, nature, location, and severity of the
trauma.

Gas Laws And Equilibrium : Extended Response Task Scuba...
Gas Laws and Equilibrium: Extended Response Task Scuba Diving
Good Morning/Evening Ladies and gentleman, Scuba diving is a method of underwater diving in
which a diver utilises a Self–Contained Underwater Breathing apparatus (Scuba) to breathe under
water. There are three main gas laws that are pertinent to scuba diving. These are Boyle's Law,
Dalton's Law and Henry's Law. Throughout this presentation we will examine how gas laws relate to
the diving industry and how innovative technology could transform the future of diving. The
pressure on a submerged diver:
Hydrostatic and Atmospheric pressure are the two major components which act upon a diver at
depth. Hydrostatic pressure refers to the weight of the water above the diver, whereas Atmospheric
Pressure is equal to the total weight of the atmosphere above the water.
Atmospheric Pressure:
Although air is very light, the atmosphere above the earth is approximately 150km high. This
amount of air has extensive weight and exerts significant pressure on the earth surface. Atmospheric
pressure at sea level can be referred to as, 1 ATA or one bar.
A diver descending to a depth of 10 meters, is equivalent to the entire 150km of atmospheric air (1
ATA). This is due to water being much denser than air. If the diver were to descend another 10
meters, the water will exert a further pressure, equal to another atmosphere, 2 ATA.
Absolute pressure:
The absolute pressure

Professional Self Into The Health Care System Essay
Introduction The purpose of this paper is to reflect on a specific clinical experience, in hope to
increase personal and professional agency to meet the College of Nurses of Ontario standards.
Reflecting on this clinical situation will aid in the theme of integration of the professional self into
the health care system. I will start off with looking back at the situation, and then elaborate in more
detail objectively and subjectively. After identifying the relevant factors of the event, I will go into
more depth by analyzing the entire event using scholarly literature. Following the analysis, I will
revise on how the informational gathered will affect my practice in assisting in building my
professional self into the healthcare system. I will then determine which practices should be
preserved and which should be changed. The goal is to reflect on a situation that occurred and to
gain insight how to approach future similar situations. Look Back December 18, 2015 was my
second shift at Sunny brook hospital on the trauma unit. It was my first night shift as a nursing
student. This situation that occurred was extremely meaningful to me as a student nurse because the
events made me fell very overwhelmed, stressed, and unable to make appropriate decisions.
Reflecting back on that night, it made me realize that I did not exemplify best practice. I personally
believe my personal emotions clouded my judgment, which interfered with my performance and my
lack of knowledge on how to

Symptoms And Diagnosis Of Chronic Post Traumatic Headaches...
his is a 55–year–old female with a 2/10/2015 date of injury, who sustained a concussion when she
slipped and fell into a doorframe at work.
DIAGNOSIS: Chronic Post Traumatic Headaches
12/19/15 Brain MRI report showed no acute intracranial abnormality. No acute infarct, hemorrhage,
midline shift, mass–effect, or abnormal extra–axial collection was seen.
12/19/15 MRA Report demonstrated no focal stenosis or aneurysm in the intracranial vasculature.
12/16/15 Progress Report indicated that the patient wakes up with headaches. She mentioned
headache in the frontal vertex or temporal occipital areas. She also feels imbalance. She denies
bruxism and has no significant neck symptoms. She reported having some minor neck tightness. She
was being treated with acupuncture 2 X per week and craniosacral therapy 2 X per week. She noted
that she was able to read better in the past two weeks. She had difficulty scanning a written page in
the past. She also mentioned that her insomnia has slightly improved since initiating these 2
therapies. Physical exam showed no palpable spasms in her cervical region over her muscles of
mastication. Cervical range of motion: backward flexion 70 degrees and forward flexion 60 degrees.
She was able to turn 60 degrees to each side. She is able to tilt 40 degrees to other side. Comments:
Based on the absence of objective findings, she has reached a medical end result with no need for
any further treatment. No additional treatment or diagnostic testing is

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