Evidence-Based Nursing Care for Stroke and Neurovascular Conditions

300 Pages·2013·3.17 MB·English

by  Sheila A. Alexander

Evidence-Based Nursing
Care for Stroke and
Neurovascular Conditions
Evidence-Based Nursing
Care for Stroke and
Neurovascular Conditions
Editor
Sheila A. Alexander, RN, PhD
AssistantProfessor
AcuteandTertiaryCare
SchoolofNursing
UniversityofPittsburgh
Pittsburgh,PA,USA
A John Wiley & Sons, Inc., Publication
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SheilaA.Alexander.
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Includesbibliographicalreferencesandindex.
ISBN978-0-470-95875-9(pbk.:alk.paper) 1.Cerebrovasculardisease–Treatment.
2.Evidence-basednursing. I.Alexander,SheilaA.
RC388.5.E9762013
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1 2013
“Nursing encompasses an art, a humanistic orientation, a feeling
forthevalueoftheindividual,andanintuitivesenseofethics,and
oftheappropriatenessofactiontaken.”
MyrtleAydelotte,PhD,RN,FAAN
Contents
Contributors ix
Preface xi
Acknowledgments xiii
1 Introduction 1
SheilaA.Alexander
2 TransientIschemicAttacks 25
LoriM.Massaro
3 IschemicStroke 35
LoriM.Massaro
4 IntracerebralHemorrhage 73
TarekDakakniandMichaelL.“Luke”James
5 SubarachnoidHemorrhage 95
SheilaA.Alexander
6 CerebralAmyloidAngiopathy 135
AliceE.Davis
7 VascularMalformations 163
SheilaA.Alexander
8 CerebralAutosomalDominantArteriopathywith
SubcorticalInfarctsandLeukoencephalopathy
(CADASIL) 185
SheilaA.Alexander
9 MigraineHeadache 195
SheilaA.Alexander
10 MoyamoyaDisease 213
SheilaA.Alexander
vii
Contents
11 Binswanger’sDisease 225
SheilaA.Alexander
12 AntiphospholipidSyndrome(APS) 233
AliceE.Davis
13 VasculitisoftheCentralNervousSystemandCranial
Vessel(Arteritis) 259
AliceE.Davis
Index 279
viii
Contributors
Tarek Dakakni, MD
TranslationalAcuteBrainInjuryResearchGroup
DepartmentofAnesthesiology
DepartmentofMedicine(Neurology)
DukeUniversity
Durham,NorthCarolina,USA
Alice E. Davis, PhD, APRN
AssistantProfessor
SchoolofNursing
UniversityofHawaii,Hilo
Hilo,Hawaii,USA
Michael L. “Luke” James, MD
AssistantProfessor
TranslationalAcuteBrainInjuryResearchGroup
DepartmentofAnesthesiology
DepartmentofMedicine(Neurology)
DukeUniversity
Durham,NorthCarolina,USA
Lori M. Massaro, MSN, CRNP
ClinicalSupervisor
UPMCStrokeInstitute
Pittsburgh,Pennsylvania,USA
ix
Preface
Nursingisaprofessionthatrequiressignificantdidacticandclini-
caltrainingforentryintopractice.Developmentintoanexpertin
thisfield,aswithanyother,requiresscholarlyinquiry,continuous
evaluation of current practices, and experience only gained over
time. There are limited resources available for the neuroscience
nurse, and even fewer specific to those who further specialize in
theneurovascularnursingspecialty.Anagingpopulationhasbeen
supported by advancements in care allowing individuals to sur-
vive who once would not, and an increase in population growth
haveledtoalargeragingpopulationwithsignificantneurovascu-
lardisease.Thesechangeshaveledtoanincreaseinbothquantity
and quality of life, but also an increase in workload for health
careprovidersandaneedforknowledgeabouttheevidencedriv-
ingcarepracticesincludingdiagnostictoolsandsurgical,medical,
andbehavioralinterventions.Nursing,neurosciencenursing,and
neurovascularnursinginparticularareadvancingatarapidpace.
Increasedknowledgeaboutpathologydrivingvariousdiseaseshas
ledtorapidadvancementsincareincludingnewlydevelopedinter-
ventions and challenges to existing treatment protocols that are
known to lack efficacy. It is difficult for the new bedside nurse
and for the practicing nurse to develop and maintain expertise
withinthecontextofrapidlychangingstandardofcareprotocols.
Patientsarebetterservedbyclinicianswithspecializedknowledge
andexperienceinsimilarpopulations.Aswecontinuetofocuson
more specialized areas of care and populations, it becomes more
andmoredifficultfortheclinicianatanypointinthespectrumto
keepuponbestpracticestomaximizepatientoutcomes.Thereare
fewtextresourcesfortheneurosciencenurse,andwhilethereare
someveryexcellenttextsavailable,therearenonespecifictoneu-
rovascularnursing.Thecomplexityofneurovasculardiseaseand
thebody’sresponsetocriticaleventsinthecontextofpre-existing
xi
Preface
co-morbiditiesrequiresnursestoprovidecarebasedonevidence,
butalsoperformcriticalthinkingthatrequiresastrongknowledge
baseandfoundationforcare.Thespecialneedsofthesepatients’
demandsthatnurseshavedetailedknowledgeofthepathophys-
iologic underpinnings driving disease development, progression,
symptoms,andthecareweprovide.Thisbookwaswrittenoutof
theneedforbedsidenursesfromnovicetoexpertinallrolesfora
singlesourcetobeginthelearningprocessaroundtheareaofneu-
rovascularnursing.Itismeanttoservethenovicenurseasasingle
sourcetoinitiatetheprocessofdevelopmentintoexpert,butalso
toservetheexpertnurseasasourceofreferenceforexistingcare
andfoundationalunderstandingtoaidinthedevelopmentofstan-
dard protocols. It brings together the knowledge gained through
personalexperiencesofthevariouscontributors,alifetimeofmen-
tors,andanexhaustivesearchoftheliteraturetofindrationalefor
currentpractices.
This book is the first effort to bring together knowledge from
themanydisciplinesonwhichnursingdrawstodevelopaframe-
workforcareofsomecommonandnotsocommonneurovascular
diseases. Each chapter includes a clear description of the known
pathophysiologyofthediseaseprocessandtheimpactthatpatho-
physiologyhasonindividualpatients.Currentevidence-basedcare
isdescribedwithrationaleforeachinterventionprovided.Incases
wherethereisnoproven,efficacioustreatmentregimenavailable,a
currentstateoftheknowledgeofexistingtreatmentswithappropri-
aterationalehasbeenprovided.Thishasbeenprovidedtopromote
theunderstandingofdiseaseandinterventionsandcriticalthink-
ing.Itisnotmeanttobethefinaldecisionforpatientcare,butrather
astartingpointuponwhichnursescangainmeaningfulcommand
of the knowledge and build on that understanding to offer indi-
vidual patients the best care. It has also been written so that the
reader may better understand the impact of as yet unidentified
interventionsandtheirpotentialimpactonpatientrecovery.
xii
Acknowledgments
Therehasbeenconsiderableeffortonthepartofmanyindividu-
alsresultinginthisfinalbook.Iwouldliketoextendappreciation
and thanks to each of those people because without their input
thisfinalproductwouldneverhavebeencompleted.Mycolleague
andfriend,GretchenZewe,workedwithmetoidentifythemost
clinically necessary topics for this book and identify others with
appropriateexpertisetoassistinthewriting.Theothercontribut-
ing authors of this book, Lori M. Massaro, Alice E. Davis, Tarek
Dakakni, and (Michael) Luke James have my eternal gratitude
for thankless sharing of their time, energy, experience, expertise,
andbrainpowertoproducethiswork.Additionalrecognitionand
thanksgoouttoMelissaWahl,SeniorEditorialAssistant,andCar-
rieHorn,SeniorProductionEditor,atWileyfortheirpleasantand
persistent tolerance of my untraditional working style. Finally to
mycolleagues,friends,family,andmydearhusbandwhowereso
supportiveasIworkedonthispiece.Itisthroughtheeffortsofall
oftheseindividualsthatthisfinalproducthascometofruition.
xiii