Volume 26, Issue 1 ,2004
How the brain recognizes and responds to shock
Copyright © 1976, The American Association of Neurosurgical Nurses, reprinted with permission.
The rat that wishes to reach the goal of his learning and attain the reward, his very own mountain of cheese, must be able to navigate through the maze (Figure One).
So the nurse, to reach the goal of understanding why the outward manifestations of shock occur, must learn to navigate through the physiological maze of the body. After considering some general information on shock, we will embark on a tour through the maze created by the shock syndrome.
Analysis of nursing assessments in a cohort of patients with ruptured cerebral aneurysms
Patients admitted with subarachnoid hemorrhage are monitored for symptoms of vasospasm. A prospective study was designed to compare two monitoring instruments: a standard neurological tool (SNR) and the National Institutes of Health Stroke Scale (NIHSS). The two assessment tools were compared to evaluate their concordance and to identify areas where efficiency in recording assessments might be improved. We found no statistical difference between the two tools in detecting symptomatic cerebral vasospasm. Substantial discrepancies in the documentation of observations were noted, particularly in the assessment of limb drift. Avoidance of these discrepancies may require further definition in the SNR tool.
A qualitative component consisting of a review of the nurses’ notes regarding neurological status in the patients’ charts was conducted. It was demonstrated that nurses commonly document information in the progress notes that is already captured in the SNR. Further education of nurses in the use of assessment tools is therefore recommended to avoid redundancies and increase efficiency in recording clinical observations.