Nursing Care of the Pediatric Neurosurgery Patient / Edition 1

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Nursing Care of the Pediatric Neurosurgery Patient serves as a detailed reference for all nurses caring for children with neurosurgical problems. Staff nurses (and student nurses) working in clinics, PICU, pediatrics, operating rooms, post-anesthesia care units, emergency departments and radiology will benefit from the information presented in this book. The explanations of pathophysiology, anatomy, radiodiagnostic testing and treatment options for each neurosurgical diagnosis will help them to understand the rationale behind the nursing care. Presenting symptoms and findings on neurological examination and history will enable nurses to identify normal signs. Each chapter includes information on patient and family education and will give helpful guidelines. Although there has been a need within the pediatric neurosurgery community for this type of information for years, there is no other reference available that provides this type of specific information.
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Editorial Reviews

From the Publisher
From the reviews:

"...The attributes of this text result in a much wider appeal than to just pediatric neurosurgical nurses. This book will prove useful to anyone remotely interested in pediatric neurosurgery. I have no hesitation in recommending a copy be in every neurosurgical residency library. Hospitals will find this a useful textbook reference to place on the pediatrics floors for nurses and pediatric house staff to be able to quickly and concisely review any of the various neurosurgical subjects along with appropriate surgical interventions. Libraries will find this book is a must addition if they have patrons interested in neurosurgery. My only caveat is that I suspect this book will have a high disappearance (ie, "borrowing") rate due to its value as a great educational tool." (J.T. Goodrich, JAMA, November 2007)

"This book provides a one-of-a-kind clinical resource for nursing staff who work with this challenging population of patients. In addition to the easy-to-read text, this book includes 119 figures and 61 tables of valuable information to enhance nursing practice. … is written for nurses who are for pediatric neurosurgery patients but is also a tremendous reference for students and others in the healthcare profession. … This book will be a tremendous resource for me, and for the patients and staff with whom I work." (Julie A Warren, Doody's Review Service, August, 2007)

"The architecture of the book, subdivided in 12 multi-authored chapters, is quite solid, each contribution offering the basic knowledge necessary to understand the pathophysiology of a given disease, the essential of the surgical management, and the nurses’ considerations. Each chapter is nicely illustrated and enriched by numerous tables aimed at illustrating specific points, as well as providing further sources of information when needed … . Although this book is written by nurses, also medical students and neurosurgeons in training will find its reading quite useful." (Concezio Di Rocco, Child’s Nervous System, Vol. 23, 2007)

Doody's Review Service
Reviewer: Elizabeth Haley Vance, MSN, CPNP-AC(Monroe Carell Jr. Children's Hospital at Vanderbilt)
Description: This second edition of a nursing guide to caring for pediatric neurosurgical patients provides up-to-date, evidence-based information on the treatment and management of common neurosurgical conditions.
Purpose: This book provides in-depth information related to the diagnosis, treatment, and management of neurosurgical conditions. The evidence-based information is presented well, making it easy to understand and valuable in the care of this patient population.
Audience: This was developed as a resource for all nurses who care for pediatric neurosurgical patients. Other healthcare professionals also may find it beneficial in providing a summary of key points of each disease process and an overview of treatment strategies.
Features: This is a comprehensive overview of neurosurgical patients from birth to adulthood. The first chapter is an outline of a normal neurological assessment, which is crucial to understand when attempting to identify the abnormal. There is lengthy, detailed information regarding hydrocephalus, which is appropriate since it is the most common diagnosis treated by pediatric neurosurgeons. The illustrations for each diagnosis are excellent visual resources for understanding anatomy and abnormalities.
Assessment: Overall, this book provides excellent information for nurses at all levels to help them gain a greater understanding of pediatric neurosurgical conditions. It is a must-have resource for any pediatric neurosurgical practice.
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Product Details

  • ISBN-13: 9783540297031
  • Publisher: Springer Berlin Heidelberg
  • Publication date: 5/3/2007
  • Edition description: 2007
  • Edition number: 1
  • Pages: 284
  • Product dimensions: 7.70 (w) x 10.70 (h) x 0.80 (d)

Meet the Author

Cathy C. Cartwright, MSN, RN, PCNS, is a Pediatric Clinical Nurse Specialist in Neurosurgery at Children’s Mercy Hospital, Kansas City, Mo. Prior to this position, she had worked for over 20 years at the Children’s Hospital, University Hospitals and Clinics, Columbia, Mo. in a variety of positions, including Pediatric Clinical Nurse Specialist in Neurosurgery, Manager of Pediatric Services, Pediatric Outreach Coordinator, and Manager of the Pediatric Intensive Care Unit. She has received many awards, including an Excellence in Nursing Award (Advanced Practice), an Advanced Practice Research Award, an Excellence in Advanced Practice Award from the American Association of Neuroscience Nurses, the Sigma Theta Tau Excellence in Nursing Award (Alpha Iota Chapter), the Donna Pruzansky Award (Craniofacial), March of Dimes Future of Nursing Award (Pediatric) and a Circle of Excellence Award (Management). From 1990 to 2003 she was a member of Sigma Theta Tau, the National Honor Society of Nursing. She was President of the American Association of Neuroscience Nurses in 2009-10, having previously served as Secretary-Treasurer and Pediatric Focus Group Chair. She has an extensive publication record and has given numerous national and international presentations.

Donna C. Wallace is currently a Pediatric Nurse Practitioner at Children’s Mercy Hospital, in Kansas City, Mo. Prior to that, she was a Nurse Practitioner for 16 years at the Barrow Neurological Institute in Phoenix, Arizona. Ms Wallace has been a manager, and has also held several teaching positions. She has received several awards including the Mary Decker Mentorship Award, and the Excellence in Advanced Practice Award, from the American Association of Neuroscience Nursing (AANN). She is a current Director at Large on the Board of Directors for AANN, and past Special Focus Group Chair for Pediatrics. Her passion for writing has resulted in numerous articles and lectures.

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Table of Contents

Neurological Assessment of the Neonate, Infant, Child and Adolescent   Jennifer A. Disabato   Karen W. Burkett
Introduction     1
Importance of Neurological Assessment     1
Nursing Approach to Neurological Assessment     1
Diagnostic Imaging and Testing in Neurological Assessment     2
Developmental Assessment: Growth and Developmental Tasks by Age     2
Neonate     4
Infant     7
Toddler     10
Preschooler     11
School-Age Child     11
Adolescent     12
Developmental Assessment Tools     13
Hands-On Neurological Assessment     13
Appearance and Observation     14
Level of Consciousness     14
Cranial Nerve Assessment - Brainstem Function     16
Assessment of Vital Signs     19
Assessment of Motor Function     19
Assessment of Sensory Function     20
Assessment of Reflexes     20
Assessment of Gait and Balance     21
Assessment of Brain Death: Herniation Syndromes and Brainstem Reflexes     22
Assessment of External Monitoring Apparatus     23
Pain Assessment in the Child with a Neurological Diagnosis     23
Conclusion     24
References     27
Hydrocephalus   Nadine Nielsen   Katherine Pearce   Elizabeth Limbacher   Donna C. Wallace
Introduction     29
History of Hydrocephalus     29
Incidence of Hydrocephalus     30
Prognosis     30
Classifications of Types of Hydrocephalus     30
Communicating Hydrocephalus     31
Noncommunicating Hydrocephalus     31
Congenital Hydrocephalus     31
Acquired Hydrocephalus     31
Internal Hydrocephalus     32
External Hydrocephalus     32
Ex Vacuo Hydrocephalus     32
Normal Pressure Hydrocephalus     32
Pathophysiology of Hydrocephalus     32
Overview of CSF Production and Flow Dynamics     32
CSF Pathways     32
Intracranial Pressure     32
Structural Changes     34
Vascular Changes     34
Metabolic Changes     34
CSF Changes     34
Brain Tissue Changes     34
Etiologies of Hydrocephalus     35
Aqueductal Stenosis     35
Myelomeningocele and Chiari II Malformation      35
Chiari I Malformation     36
Dandy-Walker Malformation     36
Vein of Galen Malformation     36
Arachnoid Cysts     37
Posthemorrhagic Hydrocephalus of Prematurity     37
Postinfectious Hydrocephalus     38
CNS Tumors     39
Head Trauma     39
Signs and Symptoms of Hydrocephalus     39
Diagnosis of Hydrocephalus by Imaging Studies     41
Ultrasonography     41
Computed Tomography     42
Magnetic Resonance Imaging     43
Treatment of Hydrocephalus     43
Medical Therapy     43
Surgical Intervention     44
Treatment of Hydrocephalus in Specific Malformations/Diseases     48
Complications of Shunts and Treatment     50
Shunt Malfunction     50
Shunt Infection     52
Complications Related to Distal Catheter Location     53
Lumboperitoneal Catheter Complications     54
Overdrainage Causing Extra-axial Fluid Collection     54
Special Diagnostic and Treatment Challenge: Slit Ventricle Syndrome     54
Pseudotumor Cerebri in the Pediatric Population     56
Pathophysiology      56
Nursing Care of the Hydrocephalus Patient After Surgery     57
Neurological Assessment     58
Wound and Dressing Care     58
Medications     58
Other Nursing Care     59
Extraventricular Drainage     60
Discharge     61
Family Support     61
Living with Hydrocephalus     62
Cognitive Abnormalities     63
Motor Disabilities     64
Ocular Abnormalities     64
Seizures     64
Precocious Puberty     65
Conclusion     65
References     65
Craniosynostosis   Cathy C. Cartwright   Patricia Chibbaro
Introduction     67
Nonsyndromic Craniosynostosis     68
Pathophysiology     68
Syndromic Craniosynostosis     76
Pathophysiology     76
Treatment for Craniosynostosis     81
Surgical Intervention     81
Preoperative Preparation for Intracranial Surgery     82
Surgical Experience     83
Surgical Technique     84
Conclusion     87
References     88
Neural Tube Defects   Shona S. Lenss
Introduction     91
Etiology     91
Epidemiology     92
Pathophysiology     92
Myelomeningocele (Open Defect)     93
Comorbidities of Myelomeningocele     95
Prenatal Screening for Myelomeningocele     96
Management     98
Nursing Considerations     98
Spina Bifida Occulta (Closed Defect)     101
Clinical Presentation     102
Cutaneous Anomalies of OSD     103
Orthopedic Findings of OSD     104
Urologic Dysfunction of OSD     105
Management     105
Nursing Considerations     105
Diagnostic Studies for Neural Tube Defects     106
Radiographic Imaging     106
Conclusion     106
References     107
Chiari Malformation and Syringomyelia   Susan McGee   Diane Baudendistel
Introduction     109
Chiari Type I     109
Chiari Type II     110
Chiari Type III     111
Syringomyelia     111
Presentation     111
Chiari Type I     111
Chiari Type II     112
Chiari Type III      113
Syringomyelia     113
Diagnostic Tests     113
Treatment Options for CIM     114
Medical     114
Surgical     114
Nursing Care     114
Treatment Options for CIIM     115
Medical     115
Surgical     115
Nursing Care     115
Treatment Options for Syringomyelia     115
Nursing Care     116
Patient and Family Education     116
Outcomes: Short and Long Term     116
Conclusions     117
References     117
Tumors of the Central Nervous System   Tania Shiminski-Maher
Introduction     119
Etiology     119
Nervous System Anatomy     120
Diagnosis     121
Treatment     125
Types of Tumors     130
Infant Tumors     138
Nursing Care: Overview     139
Developmental Considerations     139
Diagnosis     139
Surgery     140
Observation     141
Radiation Therapy     142
Chemotherapy     142
The Multidisciplinary Team     143
Late Effects of CNS Tumors and Treatment     143
School Re-Entry: Physical and Neurocognitive Sequelae     144
Ototoxicity     144
Neuroendocrine Late Effects     144
Psychological/Social     145
Secondary Cancers     145
Reccurrence, Death and Dying, and Hospice     145
Conclusion     145
References     146
Traumatic Brain Injury   Angela Enix   Jodi Mullen   Carol Green   Sherry Kahn
Epidemiology     149
Pediatric Anatomy and Physiology in Head Trauma     149
Skull     150
Brain     150
Initial Evaluation and Resuscitation     150
Primary Versus Secondary Mechanism of Injury     150
Neurologic Assessment and Deterioration in Pediatric Head Trauma     151
General Assessment     151
Vital Functions     152
Level of Consciousness     152
Glasgow Coma Scale     152
Cranial Nerve Evaluation     153
Visual Acuity     153
Pupillary Response     153
Extraocular Eye Movements     154
Brainstem Reflex Exam     154
Motor Exam     155
Reflexes      156
Supratentorial Versus Infratentorial Injury     156
Radiographic Imaging in Pediatric Head Trauma     158
Types of TBI     158
Birth-related TBI     158
Neonatal Skull Fracture     159
Intracranial Hemorrhage     161
Epidural Hemorrhage     161
Subarachnoid Hemorrhage     161
Subdural Hemorrhage     161
Intracerebellar Hemorrhage     162
Pediatric TBI     163
Diffuse Axonal Injury     169
Penetrating Craniocerebral Injury     170
Inflicted TBI     171
Concepts of Cerebral Physiology     174
Intracranial Dynamics     174
Compensatory Mechanisms     174
Intracranial Compliance     174
Cerebral Blood Flow     175
Cerebral Metabolism     175
Pathophysiology of Intracranial Hypertension     175
Cerebral Edema     176
Intracranial Hypertension     176
Cerebral Perfusion Pressure     175
Cerebral Herniation Syndromes     176
Collaborative Management of Intracranial Hypertension     178
Initial Resuscitation     178
Intensive Care Management     178
ICP Monitoring     179
Jugular Venous Oxygenation Saturation Monitoring     180
Monitoring Partial Pressure of Oxygen     180
CSF Drainage     180
Analgesia, Sedation, and Neuromuscular Blockade     180
Hyperosmolar Therapy     181
Hyperventilation     181
Temperature Regulation     182
Barbiturate Therapy     182
Hydration and Nutrition     182
Additional Nursing Care     183
Endocrine Complications     183
Diabetes Insipidus     183
Syndrome of Inappropriate Secretion of Antidiuretic Hormone     184
Cerebral Salt Wasting     184
Postoperative Nursing Care and Complications     184
Preoperative Baseline     185
Assuming Postoperative Nursing Care     185
Vital Functions     185
Neurologic Function     185
General Postoperative Nursing Care     185
Postoperative Complications     186
Outcomes     187
Prevention Efforts     187
References     188
Spine   Laurie Baker   Suzan R. Miller-Hoover   Donna C. Wallace    Sherry Kahn
The Pediatric Spinal Column     191
Traumatic Spinal Cord Injuries     192
Etiology     192
Injury Classifications     192
Assessment     199
Treatment     199
Nursing Care     200
Developmental Considerations     200
Secondary Medical Conditions     200
Summary     202
Congenital Spinal Cord Disorders     202
Spinal Manifestations of Achondroplasia     202
Klippel-Feil Syndrome     205
Outcomes     206
Mucopolysaccharide Disorders     206
Summary     208
References     208
Cerebrovascular Disease   Patti Batchelder   Tina Popov   Arbelle Manicat-Emo   Patricia Rowe   Maria Zak   Amy Kolwaite
Introduction     211
Cerebral Blood Supply     211
Arterial Supply     212
Venous Supply     213
Vein of Galen Aneurysmal Malformations     214
Pathophysiology     214
Presenting Symptoms     214
Diagnostic Tests     215
Treatment Options     216
Nursing Care      216
Family Education     217
Outcomes     217
Cerebral Arteriovenous Malformation in Children     217
Etiology     217
Pathophysiology     218
Presenting Symptoms     218
Diagnostic Imaging     218
Treatment     219
Outcomes     221
Cerebral Arteriovenous Fistulas (AVFs) in Children     221
Etiology     221
Pathophysiology     221
Presenting Symptoms     222
Diagnostic Imaging     222
Treatment     223
Outcomes     223
Intracranial Aneurysms     223
Incidence     223
Aneurysm Subtypes     223
Etiology     224
Pathophysiology     224
Presenting Symptoms     225
Diagnostic Tests     225
Treatment Options     225
Assessment of Intracranial Aneurysms     226
Outcomes     226
Venous Angiomas (Developmental Venous Anomaly)     227
Etiology     227
Pathophysiology     227
Presenting Symptoms     227
Diagnostic Tests     227
Treatment Options     227
Capillary Angiomas and Telangiectasia     228
Capillary Angiomas     228
Telangiectasias     228
Cavernous Malformations     228
Etiology     228
Pathophysiology     228
Presenting Symptoms     229
Diagnostic Imaging     229
Treatment     229
Outcomes     230
Moyamoya Syndrome     231
Etiology     231
Pathophysiology     231
Presenting Symptoms     231
Diagnostic Test     231
Treatment Options     231
Outcomes     232
Nursing Care     232
Patient and Family Education     232
Nursing Care for Vascular Brain Lesions     233
Monitoring of Neurological Status     233
Cerebral Perfusion - Monitoring and Maintenance     233
Monitoring for Seizures     233
Management of Environmental Stress     233
Management of Pain and Anxiety     233
Management of Nausea and Vomiting     234
Monitoring for Signs of Infection     234
General Postoperative Care     234
Patient and Family Education      234
Spinal Arteriovenous Malformations     235
Etiology     235
Pathophysiology     235
Presenting Signs and Symptoms     236
Cavernous Malformations and Arteriovenous Fistulas of the Spine     237
Diagnostic Tests     237
Treatment Options     237
Nursing Care     238
Outcomes     239
Conclusion     239
Neurovascular Websites for Parents     239
References     240
Surgical Management of Epilepsy   Mary Smellie-Decker   Jennifer Berlin   Trisha Leonard   Cheri Salazar   Kristin Wall Strother
Introduction     243
Preoperative Preparation     244
Invasive Monitoring     245
Seizure Surgery     247
Temporal Lobectomy     248
Frontal Lobectomy     248
Lesionectomy     248
Hemispherectomy     248
Subpial Resection and Corpus Callostomy     249
Complications     249
Nursing Care     249
Vagal Nerve Stimulator     250
History     250
Surgical Procedure     250
Complications      251
Function     251
Nursing Care     251
Conclusion     251
References     252
Surgical Management of Spasticity   Herta Yu   Mary Szatkowski
Pathophysiology of Spasticity     253
Baclofen     254
Oral Baclofen     255
Intrathecal Baclofen     255
Intrathecal Baclofen Therapy     256
Rhizotomy     260
History     260
Patient Selection     260
Procedure     260
Postoperative Nursing Care     261
References     261
Infections of the Central Nervous System   George Marcus Galvan
Brain Abscess, Epidural Abscess, Subdural Empyema     263
Etiology     263
Pathophysiology     264
Presenting Symptoms     264
Diagnostic Tests     265
Treatment Options     265
Nursing Care     266
Patient and Family Education     266
Outcome     266
Neurocysticercosis     267
Etiology     267
Pathophysiology     267
Presenting Symptoms     267
Diagnostic Tests      267
Treatment Options     268
Nursing Care     268
Patient and Family Education     268
Outcome     269
Shunt Infections     269
Etiology     269
Pathophysiology     269
Presenting Symptoms     269
Diagnostic Tests     270
Treatment Options     270
Nursing Care     270
Patient and Family Education     271
Outcome     271
Postoperative Infections     271
Etiology     271
Pathophysiology     271
Diagnostic Tests     272
Treatment Options     272
Nursing Care     272
Patient and Family Education     272
Outcome     272
References     273
Subject Index     275
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