Nursing Diagnosis : Pain related to cerebral edema and headache or other sign of discomfort.

Outcome : Patient states pain level is acceptable or demonstrates a decrease in painful behavior. Nursing Intervention: Assess pain using a scale of 0 to 10. If patient is unable to participate. Observe for pain behavior such as restlessness , grimacing or moaning and monitor vital sign. The patients self report is the best measure of the patients pain. Pulse and blood pressure may be elevated in acute pain. Administer appropriate pain medication as order. Nonnarcotic medication are preferred because they do not alter the level consciousness. If these are not effective , codeine preparation, which have a minimal effect on LOC, may be prescribed . Keep head bed elevated at least 30 degrees. Elevating the head of the bed helps prevent increased intracranial pressure , which can increase pain. Provide alternative comfort measures such as as dim lights, a quiet environment , and positioning for comfort . Decrease stimuli in the room by dimming light and decreasing noise can have a calming effect. Evaluation : patient more comfortable.

Nursing diagnosis : Impaired physical mobility related to motor deficits. Outcome: Patient will maintain maximum mobility and be free from complication of immobility. Nursing Intervention : Assess degree of mobility limitation . A good assessment can help determine how much the patient can actively participate in a plan for mobilization. Turn patient every 1 to 2 hours. If postoperative , avoid positioning on the operative site unless specifically permitted by the surgeon. Turning helps prevent skin and respiratory complication. Position patient in correct body alignment. High top tennis shoes, trochanter rolls and slings can be used to keep the body alignment. This keeps the patient in functional position in case function is regained in the future. Perform range of motion exercise consult physical therapy as order. ROM helps prevent contractures . Consult occupational therapist to assist the patient in learning to perform ADLs. The patient may be able to participate in self care with assistive devices. Evaluation : Patient more comfortable.

Nursing diagnosis : Risk for injury related to seizures. Outcome: Patient will remain free of injury during a seizure. Nursing intervention : Observe the patients behavior and time the length of the seizure. When patient is alert following seizure , determine if an aura occurred and what it was. Observing the seizure can provide clues for teaching the patient to recognize the warning signs of a future seizure and how to maintain safety. If patient should lose consciousness during the seizure , lay patient on his or her side or turn head to the side. This helps prevent oral secretions from being aspirated. Remove objects from patients surroundings to prevent injury during a seizure. If the patient must have side rails , pad them with blankets or foam. During a tonic clonic seizures the patient may be harmed by hitting furniture or other objects. Evaluation : Patient more comfortable .

Nursing Diagnosis : Anxiety related to uncertain future and prognosis Outcome : The client have decreased anxiety and express fears and concerns openly. Nursing Interventions: Repeat information provide information in different forms , encourage the client and or significant other to write down question and or concerns . Depending on the type of tumor , the location of the tumor , and or motor or sensory deficits , the client may be faced with loss of specific functions and the possibility of having a malignancy. Appropriate interventions may help the client better understand the prescribed plan of care. Encourage open communication between the client , significant others , and members of the health care team. Having a diagnosis of brain cancer may immobilize all of the normal coping mechanisms of the client and significant others. Involve the clients clergy or hospital chaplain if desired. Spiritual support is crucial at times of serious illness for the client , family members , and significant others. The client need not be religious to gain support from clergy. Evaluation : Anxiety should be controllable in a short time. However , changes in response to therapy or other outcomes will increase anxiety.

Nursing diagnosis : Decrease intracranial adaptive capacity related to neurologic changes from edema of surgical excision. Outcome: The client will have intracranial adaptive as evidence by controlled intracranial pressure. Nursing intervention : Perform Glasgow Coma Scale and other neurologic assessment q 1 hr. Compare findings to baseline , and report changes. Hourly observation allow early intervention when changes occur. Maintain patent airway with p0 values greater than 85 mm Hg and pC0 between 25 and 30 mm Hg. Prevent cerebral hypoxia , hypercapnia increase cerebral blood flow. Maintain sterile and patent CSF drain , keeping stopcock at level of tragus (or as specified ). Monitor CSF color. CSF drainage is normally sterile. A plugged CSF drain would increase ICP. The tragus is level with the

ventricles and allows normal intracranial pressures when maintained at that level. Evaluation : Stabilizing the brain in order to reach normal levels of adaptation to changes in intracranial volume and pressures will require at least 72 hours depending upon the initial amount of odema and tissue injury..

DEFINITON OF INFECTED CRANIOTOMY A craniotomy is a surgery done on the head. The surgeon cuts through the skull to reach the brain. There are different types of craniotomies, including: Burr holeA small hole is made in the skull. Traditional craniotomyA piece of skull is cut out and then put back after the surgery. StereotaxyA computer is used to help find where things are in the brain during the surgery. Awake craniotomyThe patient is awake during part of the surgery.

DEFINATION OF SUBDURAL EMPYEMA.. Subdural empyema (ie, abscess) is an intracranial focal collection of purulent material located between the dura mater and the arachnoid mater. About 95% of subdural empyemas are located within the cranium; most involve the frontal lobe, and 5% involve the spinal neuraxis. This chapter focuses on the intracranial type, which causes clinical problems through extrinsic compression of the brain by an inflammatory mass and inflammation of the brain and meninges. Subdural empyema is a life-threatening infection that was first reported in the literature about 100 years ago. It accounts for about 15-22% of focal intracranial infections. The mortality rate approached 100% before the introduction of penicillin in 1944 and has declined since that time. Because the symptoms might be very mild initially, rapid recognition and treatment are important; the early institution of appropriate treatment gives the patient a good chance of recovery with little or no neurological deficit.

DEFINATION OF VENTRICULITIS..

Ventriculitis is the inflammation of the ventricles in the brain. The ventricles are responsible for containing and circulating cerebrospinal fluid throughout the brain. Ventriculitits is caused by andinfection in the ventricles, leading to an immune response in the cells lining them, followed by swelling and inflammation. This is especially prevalent in patients with external ventricular drainsand intraventricular stints.[1] Ventriculitis can cause a wide variety of short-term symptoms and longterm side effects ranging from headaches and dizziness to unconsciousness and death if not treated early. Ventriculitis is the inflammation of the brain ventricles. It commonly accompanies the bacterial meningitis. Ventriculitis may accompany or complicate an intracranial infection such as pyogenic meningitis. It may be a source of persistent infection and treatment failure. It also increases morbidity and mortality amongst infants with meningitis.

DEFINITION OF DECOMPRESSIVE CRANIOTOMY WOUND.. Decompressive craniectomy is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury and stroke. Use of the surgery is controversial. The procedure evolved from a primitive form of surgery known as trephining or trepanning. The older procedure, while common in prehistoric times, was deprecated in favor of other, less invasive treatments as they were developed; although it was still performed with some frequency prior to the twentieth century, its resurgence in modern form became possible only upon the development of precision cutting tools and sophisticated post-operative care such as antibiotics.

Nursing diagnosis : Ineffective coping related to fear of changes in body image , role performance , or life expectancy. Outcome: The client will have improved individual coping as evidenced by statement indicating feeling of self worth behavior demonstrating self worth , and less use of dependent behaviors. Nursing intervention : Encourage family members / significant others to assist in meeting need for close contact. Family members may also fear they will injure the client. Anticipate needs. Anxiety increases feelings of loneliness. Offer praise and encouragement during ongoing assessment of clients readiness to move toward more competent coping. Positive reinforcement helps to guide future steps toward independence. Provide opportunities for expression and ventilation of feelings and issue. Problem solving coping styles are initiated by talking about feelings. Utilize consistent personnel. A therapeutic relationship is easier to maintain than to build. Establish trust relationship , follow through on promises. Feeling of fear and anxiety are reduced. Evaluation : coping skills will wax and wane over time . expect periods of coping and period of failure to cope with changes in prognosis.

MEDICATION

SC MORPHINE.. ACTION: Poor oral availability because it undergoes extensive first pass metabolism Multiple active metabolism. Effective within 15 30 minutes (sc or im) duration 4 hours. Use:

Relief of moderated to severe pain , especially that associated with neoplastic , disease and post operative pain. Supplementary analgesia during general anesthesia. Relief of anxiety and apprehension.

Nursing responsibility: Assess patient for any known allergy to opiods. ( It is important to have patient described the allergy because some will described the adverse effect especially nausea and vomiting as allergy) Withhold the drug and report to the doctor if the respiratory rate show marked decline and especially if 8 breaths / min or less. Even if initial dose causes vomiting , subsequent doses depress the vomiting centre. Antiemetic should be given at the same time if vomiting is a problem. Advise patient to deep breathe , cough and move frequently . T. BACLOFEN ACTION: Antispasticity agent that acts at the spinal end of the upper motor neuron Does not affect neuromascular transmission Stimulates gastric acid secretion. USE:

Skeletal muscle spams in multiple sclerosis and spinal lesions.

NURSING RESPONSIBILITY: Monitor respiratory and cardiovascular function closely (especially in those with cardiopulmonary disease or respiratory muscle weakness) Tablets should be protected from light and moisture.

With chronic therapy , there is usually an increase dose requirement with time and some patients develop tolerance. Patient with intrathecal implant should be very carefully monitored monitored whenever dosage in increase, Liver enzymes should be monitored in those with liver impairment.

GENTAMICIN. ACTION: First line treatment for gram negative sepsis. Not active against anaerobic organisms. Eye infections. NURSING RESPONSIBILITY: The doctor and all relevant staff must be informed of the allergy and the history , medication chart and patient labeled suitably. Renal function should be monitored closely in those with known or suspected renal impairment. Careful routine history is taken to excluded allergy to aminoglycosider in order to avoid anaphylaxis. Patient should also be asked about other allergies they may have. Blood urea nitrogen , serum creatinine, calcium , magnesium and sodium and cretinine clearance should be monitored regularly and report oliguria. Once daily administration has proven to be as efficacious , safe and less costly than divided dose administration. Fortum. ACTION: Not active against streptococcus faecalits , may other enterococci , methicillin resistant staphylococci , listeria monocytogenes , campylobacter spp. NURSING RESPONSIBILITY: All the doctor and all the staff be inform of the allergy and the history medication chart and patient labelled suitably. Advise the patient to inform any other medical or nursing personnel of the allergy. White blood cell monitoring is recommended if therapy > 7 days. Vials should be protected from light and heat. Food or gastric acid has no effect on absorption of oral preparation.