Neuroscience Assignment Rubric
N260 Pediatric Clinical
A. Identify four neurology/ neurosurgical diagnoses listed and for each one chosen
document: (45 Points)
� Diagnosis Name
� Disease Process (onset, etiology, progression)
� Main nursing interventions/ priorities
� Main teaching points/ priorities for patient/ family
� Prognosis/ Outcomes
B. Identify six common medications used on neuroscience patients and for each one chosen:
(50 Points)
� Drug name (generic/ trade)
� Drug Indications/ Contraindications (as appropriate for pediatric population)
� Drug Dosing/ Administration
� Major &/or Common Side Effects
� Main nursing/ teaching considerations
Pick up one of the diseases below
Neurology Neuro-surgery
New onset seizure EVD
Ketogenic Diet Lumbar Drain
Encephalitis Tethered Cord Release.
New Dx-Infantile Spasms Chiari Malformation
(ACTH) Shunt Revision
Brain tumor (Post-Op)
Traumatic Brain Injury
Craniosynostosis
Newly Diagnosed Brain
Tumor.
Acetaminophen IVIG
Fentanyl (Intavenous Immune Globuin)
Lorazepam (Acthar gel)
Morphine Sulfate DHE 45 INJ
Midazolam HCL Ketamine
Heparin Flush (PCA only)
(30units/3ml)
Cefotaxime Sodium
Potassium Chloride
Dexamethasone INJ/oral
Phenytoin INJ/oral
Fosphenytoin Sodium INJ
Ranitidine HCL INJ/oral
Vancomycin INJ
Oxacillin INJ
Phenobarbital INJ/oral
NEUROSURGICAL DIAGNOSES 2
Prednisone oral
LMAX w/onsite
Codeine oral
Ondasetron INJ/oral
Bisacodyl supp.
Ibuprofen
Assignment should include references in APA format (5 points)
Full credit will be based upon complete coverage of all aspects indicated in the rubric for
the assigned number of diagnoses/ medications.
Neurosurgical Diagnoses and drugs
Diagnoses
Traumatic brain injury (TBI)
The diagnosis name for traumatic brain injury (TBI) is intracranial injury or traumatic
head injury. TBI’s disease process is chronic.
Disease process
TBI is usually as a result of an external mechanical force that results to brain dysfunction.
The disease results from a jolt or violent blow to the body or head. In addition, an object that
penetrates the skull including a shattered skull piece or bullet can bring about traumatic brain
injury. As a result of mild TBI, a patient may suffer temporary brain cells’ dysfunction
(Pacholczyk, Blakely & Amara, 2009). More critical TBI results to bleeding, torn tissues,
bruising, and other brain physical damage, which mostly leads to death or long-term
complications. TBI symptoms progress through 3 successive stages; coma, post-traumatic
Amnesia, and recovery.
Teaching points
Critical TBI results to coma where the patient’s eyes remain closed and he shows no
response to a pinch, touch, or speech (MacDonald & Wei, 2011). A coma can last for years,
NEUROSURGICAL DIAGNOSES 3
months, weeks, days, or hours and this depends on the severity of the injury. Prolonged coma
mostly leads to permanent neurological damage. A concussion is similar to a coma but it lasts for
minutes or seconds following a head blow. During the post-traumatic Amnesia stage, a patient
reacts to purposeful movement or conversation by closing the eyes or gesturing. However, the
patient is in a state of cognitive impairment, behavioral impairment, and acute confusion. In the
recovery stage, a patient begins retaining information and it lasts depending on the area damaged
and severity of damage (Pacholczyk, Blakely & Amara, 2009).
Nursing interventions
There are a host of behavioral, emotional, social, cognitive, and physical impacts
associated with TBI (MacDonald & Wei, 2011). Therefore, nursing interventions should
consider all these impacts. The outcome of the disease ranges from death or permanent disability
to complete recovery. Some present imaging techniques for treatment and diagnosis include
computed tomography scans and magnetic resonance imaging. Interventions include emergency
surgery and medications. Later, vision, occupational, recreation, speech, and physical therapies
may be necessary (Wood, Lund & Beavan, 2010).
Prognosis
A majority of the severe TBI require surgery for repairing or removing contusions and
hematomas. Disability associated with TBI depends on general health, age, and injury location
and severity. There are many disabilities including vision problems, speech challenges, and
behavioral issues.
Craniosynostosis
Craniosynostosis is also referred to as synostosis.
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Disease process
This is a birth defect where joints between the skull’s bones in a baby close prematurely
prior to full formation of the brain. A baby with the disease has a misshapen head and the brain
does not grow in the natural shape. One or more skull joints can be affected. In some cases, the
disease is as a result of an underlying brain abnormality, which hinders the brain from proper
growth. The disease can be caused by biomechanical factors (fetal head constraint when a
mother is pregnant), environmental factors (amine-containing drugs’ exposure during pregnancy
and maternal smoking), hormonal factors (hyperthyroid), and genetic factors.
Usually, there is a change in the skull’s growth pattern. Since the skull cannot grow
perpendicular to a fused suture, it compensates this by growing more towards the direction that is
parallel to the bunged suture. Although this provides adequate space for brain growth, there is
abnormal facial structures and head shape (Bernard et al., 2010).
Teaching points
In case there is inadequate space for growth, the disease leads to increased intracranial
pressure and consequently, eating difficulties, sleeping impairment, visual impairment, reduced
IQ, and impaired mental development.
Prognosis
The wellness of the baby depends on the overall health of the child and the number of
sutures involved. The outcomes of surgery on children with the disease are terrific, particularly
when the disease is not as a result of a genetic syndrome (MacDonald & Wei, 2011).
Nursing interventions
Fundosopy is one of the diagnosis procedures. Titanium plates should be avoided when
fixing the skull. Surgery is one of the treatment processes used for Craniosynostosis and it aims
NEUROSURGICAL DIAGNOSES 5
at separating the fused bones. In case there is no basic brain abnormality, surgery allows the
brain sufficient space for growth and development.
Brain tumor (post-operative)
Disease process
Brain tumor (post-operative): perioperative and surgery injuries are likely to lead to long-
term or transient neurological deficits as a result of damage of the normal surrounding cerebral
tissue. This leads to central neurological deficits. Some of the issues that arise after brain tumor
surgery include venous air embolus, hyperventilation, hypothermia, hypotension, and
neuroanaesthesia. Immediately after brain surgery, a patient can be cared for in the intensive care
or neurosurgical stepdown unit where he is subjected to close monitoring and observation for a
maximum of 24 hours.
Prognosis
Vital sign monitoring and neurological assessment is given depending on routine post-
operative practices and individual risks (Pacholczyk, Blakely & Amara, 2009).
Teaching points
During the first six hours after brain tumor surgery, the patient should be observed keenly
for complications that may require surgical intervention. These complications can be detected
through a novel onset of limb weakness, seizure, and other neurological changes that warrant
further neurosurgical intervention. Cerebral edema may be masked or exacerbated by
complications as well as their management. Some brain tumor postoperative neurological
complications include wound infection, cranial nerve deficits, cerebrospinal fluid leak, seizures,
hydrocephalus, pneumocephalus, cerebral infarction, peritumoural oedema, increased
intracranial pressure and hemorrhage (Wood, Lund & Beavan, 2010).
NEUROSURGICAL DIAGNOSES 6
Nursing interventions
Postoperative brain tumor surgeries cause severe to moderate pain. Effective pain
management is hindered by concerns regarding opioids effects and absence of consensus
guidelines. Postoperative MRI scans should be obtained from 24 to 72 hours following brain
tumor surgery so as to assess the disease extent after surgery intervention.
A neurosurgeon should be contacted in cases of CSF leak, focal neurological deficit, and
wound infection. The wound can be managed through no hair washing until suture or clip
removal, dry dressing, or exposing the wound. Support from friends and family is very vital as it
makes the patient feel good. In addition, there should be provision of good nutrition.
Tumor
A tumor is also referred to as a neoplasm or mass and it refers to abnormal body tissue
growth. A tumor can be benign or malignant (MacDonald & Wei, 2011).
Disease process
Tumors occur as a result of excessive growth and division of body cells. Usually, cell
division and growth is controlled strictly. New cells perform new functions or replace older ones.
Cells that are not needed anymore or damages die and are replaced by healthy ones. If the cell
death and growth balance is distorted, a tumor forms. Problems associated with the immune
system can also result to tumors. Tobacco leads to many deaths as a result of cancer compared to
other environmental substances. Other causes of tumor include viruses, radiation, obesity,
genetic problems, excessive exposure to sunlight, environmental toxins (aflatoxins and
poisonous mushrooms), taking too much alcohol, toxins, and benzene (Bernard et al., 2010).
Prognosis
NEUROSURGICAL DIAGNOSES 7
The outlook differs greatly depending on the type of tumor. In benign tumors, the outlook
is extremely good. However, a benign tumor in the brain can result to significant problems. In
malignant tumors, the outcomes vary depending on the stage and type of tumor during diagnosis.
Some tumors can be cured. While some are rapidly life-threatening, others that are uncurable can
be managed and the patient is able to live a longer and healthier life.
Nursing priorities
There are potent complications if a tumor is located in a place where it influences the
normal function of the organ (Wood, Lund & Beavan, 2010). Malignant cancers can cause
complications if they metastasize.
Teaching pints
The risk of malignant cancer can be reduced through regular exercise, healthy diet,
limiting alcohol, healthy weight, limiting exposure to toxic and radiation chemicals, avoiding
smoking, and reducing exposure to the sun. Treatment varies depending on the location, type of
tumor, and if it is malignant or benign (MacDonald & Wei, 2011).
Medications
Ibuprofen
Ibuprofen is marketed as Brufen. Other common trademarks include Nuprin, Nurofen,
and Motrin.
Indications and contraindications
Iboprufen is used for treating and relieving dysmenorrhea, pain, and fever as well as
inflammatory diseases such as rheumatoid arthritis and osteoarthritis. It can also be used for
patent ductus arteriosus and pericarditis (Wood, Lund & Beavan, 2010). The drug shop not be
NEUROSURGICAL DIAGNOSES 8
taken if the following serious but rare side effects are noticed; vomit that is similar to coffee
grounds, persistent abdominal or stomach pains, tarry or black stools, pain in the left arm, jaw, or
chest, unusual sweating, shortness of breath, weakness on one body side, confusion, sudden
vision changes, and slurred speech. Children with hives, asthma, or those who experience
allergic-type reactions following consumptions of aspirin and other NSAIDS should avoid taking
ibuprofen Wood, Lund & Beavan, 2010).
Administration and dosing
The chewable table should be chewed before swallowing. It should be taken with milk or
food to lessen stomach upsets. An adult can take a maximum of 4 doses in a day and each is 800
milligrams.
Side effects
Some of the critical and rare side effects include bleeding from the intestines or stomach
particularly in older adults (Wood, Lund & Beavan, 2010).
Major nursing considerations
A person should not take ibuprofen if taking aspirin for heart attack or stroke; and it
should not be taken if taking another allergy, cold, or pain medicine to avoid too much ibuprofen
in the body.
Cefotaxime Sodium’s
Cefotaxime Sodium’s trade name is Claforan.
Indications and contraindications
It is used to treat lower respiratory infections including joints and bones, skin structures
and the skin, urinary tract, and pneumonia; treating septicemia or bacteremia, infections in the
central nervous system, intra-adbominal infections such as peritonitis, gynecological infections
NEUROSURGICAL DIAGNOSES 9
such as endometritis, pelvic inflammatory disease, and pelvic cellulitis; and perioperative
prophylaxis. The drug should not be used in case a person is hypersensitive to cephalosporins.
Administration and dosing
The drug can be administered through intramuscular injection or intravenously. An adult
can take 12g/ day in separate doses (from every twelve hours for uncomplicated infections to 4
hours for septicemia). This should be taken for 7-10 days. Children less than 50 kilograms (1-12
years) should take 50- 180 mg/kg/day in four to six separate doses (Cohn & Fulton, 2009).
Side effects
The side effects include vomiting, stomach upsets, stomach pain, diarrhea, skin rash,
difficult breathing, bruising, unusual breathing, itching, hives, and sore mouth.
Major nursing considerations
Some of the nursing considerations include; the drug should only be administered
through IV or IM, the IV route is most preferable in cases of life-threatening or severe infections,
and it should be shaken before use so that it dissolves.
Ranitidine HCL INJ/oral’s
Ranitidine HCL INJ/oral’s trade name is ZANTAC.
Indications and contraindications
The drug is used in some hospitalized patients who have intractable duodenal ulcers or
pathological hypersecretory conditions. It can also be used on a short-term basis in patients who
are not in a position of taking oral medications (Wood, Lund & Beavan, 2010). If a person is
hypersensitive to this drug, it should not be used on him.
Administration and dosing
NEUROSURGICAL DIAGNOSES 10
The drug is administered though intramuscular (IM) injection, intravenously, or orally.
For intramuscular injections, intermittent bolus, and intermittent infusion, 50mg should be
administered every 6-8 hours.
Side effects
Following administration of the drug through the intramuscular, transient pain is
experienced at the site (MacDonald & Wei, 2011). With intravenous administration, there is
itching or transient local burning. Patients mostly experience headache after taking the drug and
there may be mild side effects on the musculoskeletal, hepatic, gastrointestinal, cardiovascular,
and central nervous system.
Major nursing considerations
Since the drug is primarily excreted through the kidneys, patients having impaired renal
function should receive an adjusted dosage. In addition, there should be cautious administration
in patients having hepatic dysfunction as the liver metabolizes the drug. The drug should not be
used in patients with acute porphyria’s history.
Codeine oral
Codeine oral is also referred to as Vopac or APAP wCodeine.
Indications and contraindications
The drug relieves moderate to mild pain and reduce coughing and cold. Codeine is
inappropriate for relieving pain in children after a surgery aimed at removing adenoids and
tonsils.
Administration and dosing
NEUROSURGICAL DIAGNOSES 11
The drug is taken orally as a solution, suspension, elixir, capsule, or tablet. The drug can
be taken every 4-6 hours as required. In 24 hours, a person should not take more than six doses.
For adults, taking more than 4 grams in a day is very dangerous (Bernard et al., 2010).
Side effects
Taking codeine is associated with side effects such as mood changes, vomiting,
constipation, nausea, drowsiness, headache, lightheadedness, dizziness, stomach pain, difficulty
urinating, confusion, sleepiness, rash, itching, noisy breathing, hives, changes in vision, and
seizures.
Major nursing considerations
Taking too much codeine leads to fatal liver disease and, therefore, patients with liver
disease should consults the doctor so as to ensure a safe dose. Taking alcohol should be avoided
when taking this drug. A patient should consult a doctor immediately if there a liver damage
symptoms such as yellowing of the eyes and skin, dark urine, persistent vomiting, extreme
tiredness, and abdominal pain.
Potassium Chloride
Potassium Chloride use Klor-Con as the trade name.
Indications and contraindications
This medication is used as a mineral supplement for preventing or treating low blood
potassium amounts. A normal level of potassium in the blood is essential for the proper
functioning of the nerves, muscles, heart, kidneys, and cells. Potassium Chloride is
recommended in patients with severe prolonged vomiting and diarrhea, as well as hormone
problems (hyperaldosteronism), or diuretics treatment. Potassium Chloride should not be used
NEUROSURGICAL DIAGNOSES 12
with drugs that slow food transit through the intestine such as loperamide and atropine since
potassium tablets’ passage in the digestive system is delayed and this leads to narrowing or
ulceration of small intestines (Pacholczyk, Blakely & Amara, 2009).
Administration and dosing
Potassium chloride is consumed orally as capsules or tablets. To treat hypokalemia, an
adult can take a dose of 40 to 100 mEq daily and to prevent it, a dose of 16- 24 mEq is sufficient.
The medication should be taken with fluids and meals to avoid intestinal problems.
Side effects
Some of the side effects of the drug include abdominal discomfort, flatulence, diarrhea,
vomiting, and nausea.
Major nursing considerations
Damage and irritation to the stomach such as ulceration may be managed through
reducing the dose, taking the supplement with meals, and using juice to dilute liquid
preparations. The medication should be avoided in people who are allergic to it and in those
suffering from severe kidney disease, adrenal gland problems, and high potassium levels in the
blood.
Vancomycin INJ
Vancomycin INJ’s brand name is Vancocin.
Indications and contraindications
This is an antibiotic that is used for treating bacterial infections and Clostridium difficile-
linked diarrhea. The drug should be used with caution in the elderly, people with reduced kidney
function, and hearing problems. It should not be used in people who are allergic to vancomycin.
NEUROSURGICAL DIAGNOSES 13
Administration and dosing
The drug can be administered intravenously or orally. Adults should receive 2 grams in a
day in divided doses while children should be given 10 mg/ kg per dose in every six hours
(Pacholczyk, Blakely & Amara, 2009).
Side effects
Some of the side effects include spinning sensation, shivering, tinnitus, kidney failure,
rashes, and hearing problems.
Major nursing considerations??
There may be increase kidney side effects or hearing problems if Vancomycin INJ is
taken with medications that cause these problems such as colistin, bacitracin, tacrolimus, or
cisplatin.
NEUROSURGICAL DIAGNOSES 14
References
Bernard, G. R., Wheeler, A. P., Russell, J. A., Schein, R., Summer, W. R., Steinberg, K. P. &
Swindell, B. B. (2010). The effects of ibuprofen on the physiology and survival of
patients with sepsis. New England Journal of Medicine, 336(13), 912-918.
Cohn, J. L., & Fulton, J. S. (2009). Nursing staff perspectives on oral care for neuroscience
patients. Journal of Neuroscience Nursing, 38(1), 22-30.
MacDonald, T. M., & Wei, L. (2011). Effect of ibuprofen on cardioprotective effect of aspirin.
the LANCET, 361(9357), 573-574.
Pacholczyk, T., Blakely, R. D., & Amara, S. G. (2009). Basic Neurosciences. depression, 26,
429-427.
Wood, M. J., Lund, R., & Beavan, M. (2010). Stability of vancomycin in plastic syringes
measured by high–performance liquid chromatography. Journal of clinical pharmacy and
therapeutics, 20(6), 319-325.