Neurosurgery and the Implications for Patient Care

Course Description:

Neurosurgery has long been a mystery for some health care providers. Today, secondary to the aging population and improved diagnostics, we are increasingly seeing more neurosurgical patients in hospitals, skilled and rehabilitation facilities, and the outpatient settings. It is paramount that all providers: nurses, advanced practice professionals and therapists have a firm understanding of the world that is neuroscience.

This seminar is designed to give individuals, either with or without a neuroscience background, a solid foundation of knowledge to build upon through their clinical practice. Through a discussion of neuroanatomy and neurophysiology, you will achieve a better understanding of the proper neurological assessment and what your findings mean for your patient. A case-based approach will be used to explore neurosurgical diseases, treatments, implications and care from brain tumors to hemorrhagic stroke.

Objectives:
Upon completion of this self-study package, you should be able to:

1. Identify the eloquent areas of the brain.
2. Explain a proper neurological assessment based upon patient presentation.
3. Classify tumor types.
4. Anticipate treatment-related complications of brain cancer patients.
5. Correlate the different types of traumatic brain injuries to their prognosis.
6. Explain the management of aneurysmal stroke.
7. Identify red flags of the neurosurgical patient.

Program Outline:

1. Neuroanatomy
   1. Monro-Kelley Hypothesis
   2. Cerebral Hemispheres
   3. Cerebellum
   4. Brain stem
   5. Ventricular system
   6. Eloquent areas of brain
   7. Cranial Nerve location
   8. Pituitary Gland
   9. Spinal Cord
   10. Cerebral Blood Circulation
2. Neuroassessment
   1. Purpose of Assessment
   2. Types of Assessment
   3. The Neurological Assessment
   4. Motor Function Assessment
   5. Sensory Function Assessment
   6. Reflex Assessment
   7. Brainstem Reflexes/Brainstem Assessment
   8. Cerebellar Function Assessment
   9. Vital Sign Assessment
3. Brain Tumors
   1. Classification
   2. Tumor Type
      1. Glioma
      2. Gliomatosis Cerebri
      3. Medulloblastoma
      4. Primary CNS Lymphoma
      5. Pituitary Adenoma
      6. Meningioma
      7. Schwannomas/Acoustic Neuromas
      8. Metastases
      9. Spinal Cord Tumors
   3. Pathophysiology
   4. Signs and Symptoms
   5. Treatment
      1. Surgical
      2. Radiotherapy
      3. Chemotherapy
      4. Side Effects of Treatment
   6. Nursing Care
      1. Of the Surgical Patient
      2. Of the patient receiving radiotherapy/chemotherapy
      3. Post operative Care
4. Neurotrauma
   1. Primary and SecondaryInjuries
   2. Initial Assessment
   3. Initial Labs/Studies
   4. Management of TBI
      1. Sedation and Pain Control
      2. Avoidance of Hypoxia
      3. Hypotension Dangers
      4. Elevated ICP
      5. Hyperglycemia
      6. Seizures
      7. Hypothermia
      8. Infection
      9. DVT and PE
      10. Nutrition
   5. Use of Serial CT Imaging
   6. Concussion
      1. Seizure Management of CHI (Closed Head Injury)
      2. Prophylaxis
      3. Headache Management
   7. Cerebral Contusions
   8. Hematomas
   9. Fractures
   10. Diffuse Axonal Injury/Shear
   11. Coma
       1. Assessment
       2. Brain Death Exam
   12. TBI Prognosis
5. Hemorragic Stroke
   1. Intracerebral Hemorrhage
   2. Presentation
   3. Diagnosis/Evaluation/Treatment
   4. Subarachnoid Hemorrhage/
   5. Aneurysmal Stroke
   6. Presentation
   7. SAH Classifications/Diagnosis
   8. Management
      1. Medications used
      2. Rebleed
      3. Vasospasm
      4. Triple H Therapy
      5. Hypertonic Saline
   9. Long Term Treatment
6. Care of the Neurosurgical Patient
   1. Hospital Setting
      1. Intensive Care Unit
      2. Nursing
      3. HOB
      4. Identifying Trends
      5. Therapy with the Bed Bound patient
      6. Airway
      7. Swallow
      8. Individuals appropriate for acute inpatient rehab
      9. Individuals appropriate for long term acute care
      10. Acute Care
   2. Rehab Setting
      1. Primary goals
      2. Traumatic Brian Injury
      3. SAH
   3. Long Term Care
      1. Deconditioning concerns
      2. Long term medication management (AED, steroids)
   4. Outpatient
      1. Neuropsychology testing
      2. Reacclimating the TBI patient to the home
   5. Family Discussions
      1. Neuro-oncology
      2. Traumatic Brain Injury: Good v. poor outcome
7. Neurosurgical Red Flags

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