13.3 Implement Nutritional Strategies to Impact Pulmonary Wellness
6 min read•june 18, 2024
Intracranial emergencies are critical situations that can quickly become life-threatening. These conditions, including strokes, traumatic brain injuries, and meningitis, require rapid assessment and intervention to prevent permanent brain damage or death.
Understanding the pathophysiology, causes, and treatments for intracranial emergencies is crucial for healthcare providers. From osmotic agents to thrombolytics, the medications used in these situations can have powerful effects on brain function and require careful monitoring and administration.
Intracranial Emergencies
Pathophysiology of intracranial emergencies
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- Ischemic stroke
- Blockage of blood vessels in the brain leads to decreased blood flow and oxygen supply causing damage to brain tissue (infarction)
- Sudden onset of focal neurological deficits occurs such as weakness, numbness, or speech difficulties depending on the area of the brain affected
- Hemorrhagic stroke
- Rupture of blood vessels in the brain causes bleeding and increased intracranial pressure compressing and damaging brain tissue
- Severe headache, nausea, vomiting, altered mental status, and focal neurological deficits develop due to the bleeding and increased pressure
- Traumatic brain injury (TBI)
- Direct or indirect force to the head causes damage to brain tissue and blood vessels leading to bruising (contusion), tearing (laceration), or bleeding (hemorrhage)
- Loss of consciousness, confusion, headache, nausea, vomiting, and focal neurological deficits occur depending on the severity and location of the injury
- Meningitis
- Inflammation of the meninges (protective membranes covering the brain and spinal cord) occurs due to bacterial, viral, or fungal infection
- Severe headache, fever, neck stiffness, photophobia, and altered mental status develop as the infection spreads and causes inflammation
Causes and diagnosis of intracranial emergencies
- Ischemic stroke
- Caused by atherosclerosis (plaque buildup), cardiac embolism (clot from the heart), small vessel occlusion, and other less common causes
- Diagnosed using CT scan, MRI, CT angiography, and MR angiography to visualize the blockage and affected brain tissue
- Hemorrhagic stroke
- Caused by hypertension (high blood pressure), aneurysms (weakened blood vessel walls), arteriovenous malformations (abnormal blood vessel connections), and bleeding disorders
- Diagnosed using CT scan, MRI, CT angiography, and lumbar puncture to identify the location and cause of the bleeding
- Traumatic brain injury (TBI)
- Caused by falls, motor vehicle accidents, sports-related injuries, and assaults
- Diagnosed using CT scan, MRI, and neurological examination to assess the extent and location of the injury
- Meningitis
- Caused by bacterial (Streptococcus pneumoniae, Neisseria meningitidis), viral (enteroviruses, herpes simplex virus), or fungal (Cryptococcus) infections
- Diagnosed using lumbar puncture (spinal tap), blood cultures, and PCR testing of cerebrospinal fluid to identify the causative organism
Brain physiology and regulation
- Blood-brain barrier: A selective semipermeable border that separates the circulating blood from the brain extracellular fluid, regulating the passage of substances into the brain
- Cerebral autoregulation: The brain's ability to maintain relatively constant blood flow despite changes in perfusion pressure, ensuring adequate oxygen and nutrient supply
- Neurotransmitters: Chemical messengers that transmit signals across synapses, playing crucial roles in brain function and communication between neurons
- Neuroplasticity: The brain's ability to reorganize itself by forming new neural connections, which is important for recovery and adaptation following injury or disease
- Cerebral : Swelling of brain tissue due to excess fluid accumulation, which can increase intracranial pressure and compromise brain function
Intracranial Emergency Drugs
Key features of intracranial emergency drugs
- Osmotic agents (mannitol, hypertonic saline)
- Reduce intracranial pressure by drawing water from the brain into the bloodstream through osmosis
- Used in patients with increased intracranial pressure due to stroke, TBI, or brain tumors to prevent further damage
- Anticonvulsants (phenytoin, levetiracetam)
- Prevent or control seizures by reducing neuronal excitability through various mechanisms (sodium channel blockade, synaptic vesicle protein binding)
- Used in patients with seizures due to intracranial emergencies or as prophylaxis in high-risk patients to prevent seizure-related complications
- Thrombolytics (alteplase)
- Break down blood clots to restore blood flow in ischemic stroke by converting plasminogen to plasmin, which degrades fibrin clots
- Used in selected patients with acute ischemic stroke within a specific time window (3-4.5 hours) to minimize brain damage
- Antibiotics (ceftriaxone, vancomycin)
- Treat or prevent bacterial infections in the brain or meninges by inhibiting bacterial cell wall synthesis or protein synthesis
- Used in patients with suspected or confirmed bacterial meningitis or brain abscess to control the infection and prevent complications
Effects of intracranial emergency medications
- Osmotic agents
- Reduce intracranial pressure and improve cerebral perfusion by decreasing brain water content and increasing plasma osmolarity
- Side effects include electrolyte imbalances (hyponatremia, hyperkalemia), dehydration, and renal dysfunction (acute kidney injury)
- May enhance the effects of loop diuretics (furosemide) and increase the risk of electrolyte disturbances
- Anticonvulsants
- Control or prevent seizures by stabilizing neuronal membranes and reducing excitatory neurotransmission
- Side effects include dizziness, drowsiness, and allergic reactions (rash, Stevens-Johnson syndrome)
- May interact with other CNS depressants (benzodiazepines, opioids), increasing the risk of sedation and respiratory
- Thrombolytics
- Restore blood flow in ischemic stroke by dissolving blood clots, reducing infarct size, and improving neurological outcomes
- Side effects include bleeding complications, particularly intracranial hemorrhage, which can worsen neurological deficits
- Contraindicated with anticoagulants (heparin, warfarin) and antiplatelet agents (aspirin, clopidogrel) due to increased bleeding risk
- Antibiotics
- Treat or prevent bacterial infections in the brain or meninges, reducing inflammation, neurological damage, and mortality
- Side effects include gastrointestinal disturbances (nausea, diarrhea), allergic reactions, and nephrotoxicity (vancomycin)
- May interact with other medications, affecting their absorption (oral antibiotics), metabolism (CYP450 inducers or inhibitors), or elimination (probenecid)
Nursing considerations for intracranial emergencies
- Assessment
- Monitor vital signs (blood pressure, heart rate, respiratory rate, temperature), neurological status (Glasgow Coma Scale, pupillary response), and signs of drug toxicity or adverse reactions
- Assess for contraindications (active bleeding, recent surgery) and precautions (renal impairment, allergies) before administering medications
- Administration
- Ensure proper dose, route (IV, oral), and timing (loading dose, maintenance dose) of medication administration
- Follow institutional protocols and guidelines for medication preparation (reconstitution, dilution) and administration (infusion rates, compatibility)
- Monitoring
- Observe for therapeutic effects (improved neurological function, seizure control) and potential side effects (bleeding, hypotension, electrolyte imbalances) of medications
- Monitor laboratory values, such as electrolytes (sodium, potassium), renal function (creatinine, blood urea nitrogen), and coagulation studies (INR, aPTT), as appropriate
- Collaboration
- Work closely with the interdisciplinary team (physicians, pharmacists, therapists) to ensure optimal patient care and management
- Communicate any changes in patient status (neurological deterioration, adverse drug reactions) or response to medications to the healthcare team promptly
Patient education for intracranial medications
- Medication purpose and effects
- Explain the purpose of each medication (reduce intracranial pressure, control seizures, dissolve clots, treat infection) and its expected effects on the patient's condition
- Discuss the importance of adhering to the prescribed medication regimen (dose, frequency, duration) to achieve optimal therapeutic outcomes
- Side effects and precautions
- Inform patients and caregivers about potential side effects (bleeding, drowsiness, electrolyte imbalances) and how to manage them (report to healthcare provider, take with food, monitor intake and output)
- Provide instructions on precautions to take while taking the medications, such as avoiding alcohol (increased CNS depression), driving (impaired alertness), or sudden position changes (orthostatic hypotension)
- Administration and storage
- Teach patients or caregivers how to properly administer medications, especially if they will be taken at home (oral antibiotics, anticonvulsants), including techniques for measuring liquid doses or crushing tablets
- Provide guidance on proper storage conditions for the medications (room temperature, refrigeration, protection from light) and safe disposal of unused or expired medications
- Follow-up and communication
- Encourage patients to keep follow-up appointments (neurological assessments, imaging studies, laboratory tests) and communicate any concerns or changes in their condition to the healthcare team
- Provide contact information for the healthcare team (nurse, physician, pharmacist) and emphasize the importance of reporting any adverse reactions (allergic reactions, excessive bleeding) or worsening symptoms (seizures, altered mental status) promptly
Key Terms to Review (34)
Anti-Inflammatory Diet: An anti-inflammatory diet is a dietary approach that focuses on consuming foods with anti-inflammatory properties to help reduce inflammation in the body. This type of diet is often recommended to support various health conditions, including pulmonary, gastrointestinal, and musculoskeletal disorders, where inflammation plays a key role.
Anxiety: Anxiety is a psychological and physiological state characterized by feelings of worry, nervousness, or fear. It can significantly impact overall health and is influenced by various factors including nutrition.
Aspiration: Aspiration refers to the unintentional entry of foreign material, such as food, liquid, or secretions, into the lungs. This can occur during swallowing or when the body's protective mechanisms fail, leading to respiratory complications and potential health issues.
Asthma: Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to recurrent episodes of wheezing, coughing, chest tightness, and shortness of breath. It is a complex condition that can be influenced by various environmental, genetic, and lifestyle factors, including nutrition.
Bronchitis: Bronchitis is a respiratory condition characterized by inflammation and irritation of the bronchial tubes, the airways that connect the trachea to the lungs. This condition can lead to excessive mucus production, coughing, and breathing difficulties, impacting pulmonary wellness.
Bronchodilators: Bronchodilators are medications that work by relaxing and widening the airways, making it easier to breathe. They are commonly used to manage and treat various respiratory conditions, including asthma and chronic obstructive pulmonary disease (COPD).
Corticosteroids: Corticosteroids are a class of steroid hormones that are produced naturally in the body by the adrenal glands. They are also available as synthetic medications used to treat a wide range of medical conditions, including neurological disorders, pulmonary diseases, and inflammatory conditions.
Cystic Fibrosis: Cystic fibrosis is a genetic disorder that primarily affects the respiratory and digestive systems. It is caused by a mutation in the CFTR gene, which regulates the movement of salt and water in and out of cells, leading to the production of thick, sticky mucus that can clog the lungs, pancreas, and other organs.
Depression: Depression is a mental health disorder characterized by persistently low mood, loss of interest in activities, and impaired daily functioning. It can significantly impact physical health, including nutritional status and neurological wellness.
Dysphagia: Dysphagia is a medical term that refers to difficulty or discomfort with swallowing. It can range from a mild annoyance to a serious condition that interferes with a person's ability to consume adequate nutrition and hydration. Dysphagia is an important consideration in various nursing practice areas, including interdisciplinary teams, physical assessment, digestive function, pulmonary wellness, and gastrointestinal health.
Edema: Edema is the abnormal accumulation of fluid in the body's tissues, resulting in swelling. This condition can occur in various parts of the body and is often associated with underlying medical conditions or factors that affect fluid balance and circulation.
Enteral Nutrition: Enteral nutrition refers to the delivery of nutrients directly into the gastrointestinal tract, typically through a feeding tube. It is a method of providing nourishment to individuals who are unable to meet their nutritional needs through oral intake alone.
Fatigue: Fatigue is a state of extreme tiredness and reduced functional capacity that can be physical, mental, or a combination of both. It is often a symptom of underlying health issues and can significantly impact daily activities.
Gluconeogenesis: Gluconeogenesis is the metabolic process by which the body synthesizes glucose from non-carbohydrate precursors, such as amino acids, lactate, and glycerol. This process is essential for maintaining blood glucose levels, especially during periods of fasting or starvation, when the body needs to generate glucose from alternative sources to meet its energy demands.
High-Protein Diet: A high-protein diet is a dietary pattern that emphasizes the consumption of foods rich in protein, such as meat, eggs, dairy, and legumes, while limiting the intake of carbohydrates and fats. This dietary approach is often used to support various health goals, including weight management, muscle building, and improved athletic performance.
Honey-Thick: Honey-thick refers to a viscous, slow-flowing, and dense consistency, similar to the texture of honey. This term is particularly relevant in the context of implementing nutritional strategies to impact pulmonary wellness, as it can describe the desired consistency of certain dietary interventions aimed at improving respiratory function.
Hypercapnia: Hypercapnia is a condition characterized by an abnormally high level of carbon dioxide (CO2) in the blood. It is a direct result of the pulmonary system's inability to effectively remove CO2 from the body, which can have significant implications for overall health and wellness.
Low-Carb Diet: A low-carb diet is a dietary approach that focuses on reducing the intake of carbohydrates, such as sugars and starches, in favor of increased consumption of proteins, healthy fats, and non-starchy vegetables. This dietary strategy can have a significant impact on pulmonary wellness by influencing various aspects of respiratory health.
Magnesium Deficiency: Magnesium deficiency is a condition characterized by an abnormally low level of magnesium in the body, which can lead to various health issues, including those related to pulmonary wellness. Magnesium is an essential mineral that plays a crucial role in many bodily functions, and its deficiency can have significant impacts on respiratory health.
Malnutrition: Malnutrition is a condition resulting from an unbalanced intake of nutrients, either through deficiency or excess. It adversely affects bodily functions and overall health.
Malnutrition: Malnutrition refers to a state of nutritional imbalance, where an individual's intake of nutrients is either insufficient, excessive, or imbalanced, leading to adverse effects on their health, growth, and overall well-being. This term is particularly relevant in the context of nursing practice, population health, and the care of vulnerable populations.
Malnutrition Screening Tool: The malnutrition screening tool is a simple and quick assessment used to identify individuals who may be at risk of malnutrition or have existing malnutrition. It is an essential component in implementing effective nutritional strategies to impact pulmonary wellness, as malnutrition can significantly compromise respiratory function and overall health.
Mediterranean Diet: The Mediterranean diet is a plant-based eating pattern that emphasizes the consumption of whole, minimally processed foods commonly found in the countries surrounding the Mediterranean Sea. This diet is characterized by a high intake of fruits, vegetables, whole grains, legumes, nuts, and olive oil, along with moderate consumption of fish, poultry, and red wine. The Mediterranean diet has been extensively studied for its numerous health benefits, including its positive impact on evidence-based practice and nutrition, gut health, neurological wellness, endocrine wellness, hematological wellness, cardiovascular wellness, pulmonary wellness, and musculoskeletal and integumentary wellness.
MUST: MUST is a term that denotes a requirement or an obligation that must be fulfilled. It indicates a necessary or essential action or condition that cannot be overlooked or disregarded. In the context of nutrition and wellness, MUST highlights the critical importance of certain strategies, interventions, or considerations that are essential for achieving optimal outcomes.
Nectar-Thick: Nectar-thick refers to the consistency or viscosity of a liquid, specifically in the context of nutritional strategies to impact pulmonary wellness. It describes a thick, syrup-like texture that is often recommended for individuals with swallowing difficulties or certain respiratory conditions to help facilitate safe and effective swallowing.
Omega-3 Fatty Acids: Omega-3 fatty acids are a type of polyunsaturated fatty acid that are essential for human health. They play a crucial role in various bodily functions, including the maintenance of the neurological, endocrine, cardiovascular, and pulmonary systems. Omega-3s are considered 'essential' because the body cannot produce them on its own, and they must be obtained through diet or supplementation.
Oral Nutritional Supplements: Oral nutritional supplements are nutrient-dense liquid or powdered products that are consumed by mouth to provide additional calories, protein, vitamins, and minerals to individuals who may not be meeting their nutritional needs through diet alone. They are often used to support pulmonary wellness and address nutritional deficiencies.
Oxidative Stress: Oxidative stress refers to an imbalance between the production of free radicals and the body's ability to neutralize them, leading to cellular damage and dysfunction. This term is particularly relevant in the context of understanding the impact of nutrition on the neurologic system, endocrine system, and pulmonary wellness across the lifespan, as well as in the management of chronic neurological and pulmonary illnesses.
Proteolysis: Proteolysis is the breakdown of proteins into smaller peptides or amino acids through the action of proteolytic enzymes. This process is essential for various physiological functions, including digestion, tissue repair, and immune response.
Pulmonary Rehabilitation: Pulmonary rehabilitation is a comprehensive, multidisciplinary program designed to improve the physical and psychological well-being of individuals with chronic respiratory conditions. It focuses on optimizing respiratory function, enhancing exercise capacity, and promoting self-management strategies to manage the symptoms and improve the quality of life for those with pulmonary diseases.
Respiratory Muscle Strength: Respiratory muscle strength refers to the force-generating capacity of the muscles involved in breathing, including the diaphragm, intercostal muscles, and accessory respiratory muscles. This term is particularly relevant in the context of pulmonary wellness, as the strength of these muscles directly impacts respiratory function and overall respiratory health.
Spiritual and cultural practices: Spiritual and cultural practices encompass the beliefs, rituals, and traditions that individuals or groups follow to maintain spiritual well-being and cultural identity. These practices can significantly influence dietary choices and nutritional strategies, especially in clinical settings.
Vitamin D: Vitamin D is a fat-soluble vitamin that plays a crucial role in maintaining overall health and wellness. It is often referred to as the 'sunshine vitamin' because the body can synthesize it when the skin is exposed to sunlight. Vitamin D is essential for the regulation of calcium and phosphorus levels in the body, supporting strong bones and teeth, and it also has important functions in various other physiological processes.
Vitamin D Deficiency: Vitamin D deficiency refers to a state in which the body does not have adequate levels of vitamin D, an essential nutrient that plays a crucial role in various physiological processes, including pulmonary wellness and gastrointestinal function.