Neurosurgery nursing

Neurosurgery describes the surgical treatment and management of various disease processes that target the brain, spinal cord, and peripheral nervous system. The specialty is wide and varied as increasing numbers of neurological conditions can now be improved following neurosurgery; for example, some types of epilepsy respond to the insertion of a vagal nerve stimulator, Parkinson’s disease symptoms can be diminished with a deep brain stimulator, and intractable back pain may be improved following spinal surgery. Practitioners must be equipped with the knowledge and skills to care for these patients and meet their immediate and long-term needs.

Paediatric neuroscience care

Paediatric neurology services care for children aged 0–16 years. Many of these children suffer genetic and complex neurological problems and frequently require life-long support. Hydrocephalus and central nervous system tumours are commonly presenting disorders; however, craniofacial syndromes, spinal disorders, spinal neural tube defects, epilepsy, and trauma including non-accidental injuries are frequently managed. Paediatric nurses specialize in the care of these children and support of their families but as they grow up and transition into adult services, it is the responsibility of general nurses to have a basic understanding of some of their conditions so they can maintain and continue their care.

Common problems and symptoms

Any damage to the neurological system due to a disease process, infection, or injury frequently results in certain abnormal signs and symptoms. Depending on the degree of damage and the region of the brain or peripheral nervous system affected, neurological disorders can result in partial or complete paralysis, muscle weakness, pain and spasticity, seizures, and abnormal cognitive abilities. This chapter present some of the more commonly occurring problems with some management strategies.

Neurological investigations

Many neurological conditions are complex and can be difficult to diagnose, commonly occurring symptoms can be applicable to multiple disease processes and can mimic other non-neurological conditions. Delays in treatment can be attributed to the myriad of tests, examinations, and investigation necessitated to obtain an accurate diagnosis. A basic knowledge of the possible investigation, the pre- and post-procedure nursing care, and the psychological support required while undergoing investigations is important.

Long-term neurological conditions

There are several hundred neurological conditions, some more commonly occurring than others. NHS England categorizes them into sudden-onset conditions resulting from an acquired or traumatic brain or spinal cord injury; progressive deteriorating conditions such as Alzheimer’s disease, dementia, and motor neurone disease; and other conditions that might have a more fluctuating pathway such as epilepsy, Parkinson’s disease, or multiple sclerosis. Most of these conditions result in varying degrees of disability that demand considerable personal and NHS resources to improve independence and the quality of life for these people.

Legal and ethical issues

Legal and ethical decision-making is highly relevant to many patients suffering acute and chronic neurological illness and brain injury. The Mental Capacity Act 2005 has provided a robust framework on which to support difficult decision-making. Advance directives have enabled individuals to take control of their lives to some small degree; however, research, genetic testing, and disclosure continue to cause anxiety for people and healthcare professionals. Decision-making around end of life care, withdrawal of care, and palliative care is a particularly complex, emotive, and challenging area of nursing practice.

Complementary therapies

Complementary and alternative medicine therapies have been widely used for self-care for many years for the treatment of chronic back pain, headaches, and multiple other conditions. Traditional medical care has started to recognize its place in supplementing conventional treatments. It is important for nurses to develop their knowledge and skills in complementary therapies to be able to advise and support their patients and in some cases provide appropriate interventions.

Policy influences on neuroscience practice

This chapter provides the reader with access to a summary of many relevant UK health policies, research, charities, and third-sector organizations that research, campaign, and support patients with a neurological illness or injury. As policy and legislation is constantly changing, nurses are often approach to advise and signpost their patients to the most appropriate pathway or organization.

Neurological assessment

The neurological assessment incorporates the assessment of the patient’s level of consciousness, cognition, cranial nerve function, and motor, sensory, and cerebellar function. A comprehensive, good-quality neurological assessment is able to detect early changes and deterioration in neurological status. It enables to practitioner to establish a baseline for later comparison to judge the patient’s response to specific medical and nursing interventions.

Neurological emergencies

Neurological emergencies following any injury involving the central or peripheral nervous system can have a devastating outcome for the individual. Speedy diagnosis to enable early interventions is paramount to reducing morbidity and mortality. Acute management relies on practitioners understanding the importance of basic physiological principles of maintenance of normal brain function and the effects this can have on ensuring perfusion of the central nervous system and control of raised intracranial pressure.