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OBJECTIVES

1. Describe management of the neuroscience patient in an ICU setting.
   
2. Review complications of the neuroscience patient and explain risk management.
   
3. Explain methods of patient monitoring in the NCCU.
   
4. Identify signs and symptoms of increased intracranial pressure (ICP).
   
5. Review the key concepts of ICP, and assessment guidelines.
   
6. Describe management of the patient with ICP Monitor.

OUTLINE

A. NEUROSCIENCE CRITICAL CARE NURSING

1. Prerequisites for Neuroscience Cratical Care Nursing
2. Multidisciplinary Team Management
3. Standards and Policies for Neuroscience Critical Care

B. NEUROSCIENCE CRITICAL CARE ADMISSION AND DISCHARGE CRITERIA

1. Admission Criteria
2. Discharge Criteria

C. PATIENT MONITORING

1. Hemodynamic Monitoring
2. Hemodynamic Drug Therapy

D. PULMONARY CONSIDERATIONS

1. Respiratory Management
2. Oxygen Requirements and Tolerance to Hypoxemia
3. Indications / Criteria for Oxygen Therapy
4. Indications / Criteria for Mechanical Ventilation
5. Indications / Criteria for Tracheotomy
6. Secretion Clearance
7. Management of PCO2 and PO2
8. Complications of Ventilatory Support

E. SECONDARY BRAIN INJURY

1. Hypotension / Hypoxemia
2. Intracranial Pressure and Cerebral Perfusion Relationships

F. ADDITIONAL THERAPIES

1. Analgesia, Sedation, Paralysis, "Train of Four," and Bispectral Index Monitoring
2. Pharmacologically Diminished Metabolic Rate
3. Hypothermia Therapy

G. POSTOPERATIVE MANAGEMENT

H. METABOLISM MANAGEMENT

I. COAGULOPATHY MANAGEMENT

J. INFECTION MANAGEMENT

1. Blood-Brain Barrier Properties and Impact on Antibiotic Usage
2. Resistant Pathogens

K. THERAPIES COMMON TO THE NEUROSCIENCE PATIENT IN THE INTENSIVE CARE UNIT

1. Nutritional Considerations
2. Stress Ulcer Prophylaxis
3. Deep Vein Thrombosis (DVT)
4. Pressure Ulceration Prophylaxis
5. Coagulation Issues and Disseminated Intravascular Coagulation

L. CRITICAL NEUROLOGIC DISORDERS REQUIRING NCCU MANAGEMENT

1. Myasthenia Gravis
2. Guillan-Barré Syndrome
3. Brain Attack / Stroke
4. Seizures

M. OTHER CRITICAL CARE CONSIDERATIONS

1. Rehabilitation
2. Case Management
3. End-of-Life Issues

N. CONCLUSION

OUTLINE

A. DYNAMICS AND CONCEPTS OF INTRACRANIAL PRESSURE

1. Intracranial Compliance
2. Intracranial Volume
3. Modified Monro-Kellie Hypothesis
4. Intracranial Volume-Pressure Curve
5. Cerebral Blood Flow
6. Cerebral Perfusion Pressure
7. Cerebral Autoregulation
8. Blood-Brain Barrier
9. Conductance Of Cerebrospinal Fluid Outflow

B. INCREASED INTRACRANIAL PRESSURE

1. Etiology / Pathophysiology
2. Continual / Serial Assessment
3. Treatment

C. COMPREHENSIVE PATIENT MANAGEMENT: INCREASED INTRACRANIAL PRESSURE

1. Neurologic Interventions
2. Cardiovascular Interventions
3. Pulmonary Interventions
4. Renal Interventions
5. Gastrointestinal Interventions
6. Musculoskeletal / Skin Interventions
7. Pain Interventions
8. Acute / Nonacute Rehabilitation
9. Nutritional Considerations
10. Psychosocial Considerations
11. Health Teaching
12. Postacute / Nonacute Care

D. CONTINUUM OF CARE

1. Case Management Considerations

E. CONCLUSION