Qsen Evidence-Based Practice
Introduction
Evidence-Based PracticePractice integrates best current evidence with clinical expertise and patient or family likings and values for delivery of optimal health care (Pople, 2002). In my clinical shift, I explained the importance of monitoring a patient neuro status in regards to having a Ventriculoperitoneal shunt, the complications, and the countermeasures discussed below.
Background
My patient at SMUCLA was a 62-year-old female who was born with Spina Bifida, causing hydrocephalus. She recently had her VP shunt replaced due to blockage. She was experiencing recurring headaches, but just thought it might be allergies since she was spending a lot of time outdoors. Eventually, she presented to the hospital, and I realized that the VP shunt was blocked and needed an immediate replacement. Without careful investigation of the causal factor, the misdiagnosis has often led to patient worsening (Paff et al., 2018).
Noticing
Hydrocephalus presents with symptoms such as headaches and failing vision. These symptoms prompted the monitoring of her neuro system by doing focused neuro assessments using the PERRLA method (a type of eye exam). I noticed that the patient was able to participate in the concentrated neuro assessments fully and didn’t present any symptoms that indicated a neurological issue. I had to check shunts used for treatment carefully, and that’s why assessing the neurologic system was vital. Assessing the Neuro system accurately is done because the shunts come with lots of complications such as Papilloedema, enlarged blind spots on visual field analysis or reduced visual acuity, failure of upward gaze, general clumsiness, dyspraxic gait, large head (Pople, 2002)
Interpretation
The types of shunts used for the treatment of hydrocephalus are different. I established that there are CSF shunt valves, either fixed or programmable pressure settings (Bober, Rochlin, & Marneni, 2016). The programmable valves are the best since they regulate the opening and closing; hence pressures can be adjusted without a surgical procedure. With a transdermal magnetic device, forces changing according to the needs (Pople, 2002). I second the use of Neuro assessment since it helps detect the shunts if they are malfunctioning. The neuro system’s signs and symptoms are in cases where the shunts have malfunctioned—poor drainage of the cerebrospinal fluid by shunts results in poor neurologic outcomes. For instance, CSF overdrainage can result in the cerebral ventricles’ shrinking or collapsing, causing the meninges to pull away from the skull’s inner surface, leading to neurologic signs and symptoms. CSF under drainage causes the cerebral ventricles to enlarge in conjunction with signs and symptoms of hydrocephalus. In my case, the cases of headaches could be a neurologic system arising from the shunt malfunctioning hence the need to replace the shunt to alienate the problem. More so, the dysfunction of the shunts is examining through Computerized tomography, Magnetic resonance imaging, and ICP monitoring/CSF infusion studies.
Responding
As a nurse, caring for patients who have undergone shunt surgery is vital to ensure no complications. Assessing the neurological status and vital signs is the nurse’s responsibility to ensure there is appropriate cerebrospinal fluid drainage. Nurses can do this by monitoring the patient’s neurologic status, assessing for complications, and caring for the surgical sites. The nurses need to be keen on observing the signs of infection and, upon cerebrospinal fluid culture, should initiate a broad-spectrum antibiotic. They should optimize CSF drainage by elevating the head of the bed, typically to 30 degrees (Vacca Jr, 2018). For those patients with a shunt, the outpour is independent of the head of the bed elevation. Most importantly, I second that nurses should ensure there is discharge teaching. As nurses, it is our role to educate the patient, family, and caregivers about potential complications associated with the CSF shunt, signs, and symptoms of infection so that they don’t panic and advise them to seek referral support from near Hydrocephalus Association.
Reflection
As much as the shunts are for treatment, they come with complications such as infection, intracranial hemorrhage, mechanical complications (shunt malfunction), pain, seizures, and abdominal injury. Many people tend to rule out the underlying causal factors such as shunt complications or infections, such as in our case, they taught it was an allergy. I determined that careful assessment of neuro status can help arrest the difficulty early enough and help correct the situation to ensure patients outcome is improved (Pople, 2002). I observed most nurses forget the issue of discharge teachings, which is necessary to help patients be fully aware of the hydrocephalus condition. QSEN in place will ensure there are guidelines for nurses to restructure how they deliver nursing care providing high-quality, safe care.
References
Bober, J., Rochlin, J., & Marneni, S. (2016). Ventriculoperitoneal Shunt Complications in Children: An Evidence-Based Approach to Emergency Department Management. Pediatric emergency medicine practice, 13(2), 1-22.
Paff, M., Alexandru-Abrams, D., Muhonen, M., & Loudon, W. (2018). Ventriculoperitoneal shunt complications: A review. Interdisciplinary Neurosurgery, 13, 66-70.
Pople, I. K. (2002). Hydrocephalus and shunts: what the neurologist should know. Journal of Neurology, Neurosurgery & Psychiatry, 73(suppl 1), i17-i22.
Vacca Jr, V. M. (2018). Ventriculoperitoneal shunts: What nurses need to know. Nursing2019, 48(12), 20-26.