2020 Australasian Neuroscience Nurses’ Association (ANNA) Annual Conference Abstracts

Ruby Crane and Ivy BensonWorkplace, location

DOI: 10.21307/ajon-2020-009a

The data in the literature indicates that between 1 in 5 adults in Australia are currently living with a Pituitary tumour, with the majority being small micro adenomas. Many people with a PT are not even aware they have a tumour. Diagnosis often only occurs as an incidental finding or when symptoms become problematic.

On average 900 to 950 patients are diagnosed with Pituitary Tumours (PT) each year in Australia. There are several different types of PT’s. The majority of tumours stem from abnormal cell growth within the pituitary gland. Symptoms vary depending on hormonal excretion within the pituitary gland.

The majority of PT’s do not require surgical intervention. At St Vincent’s Private we are fortunate to have several of the leading Neurosurgeons and Endocrinologist who specialise in Pituitary Tumour care and surgical management. On the Neurosurgical ward 32 patients have been admitted for surgical removal of PT’s in last two years.

Our case study involves a young man who presented with acromegaly. He underwent Pituitary surgery and was found to have a rare Ectopic Pituitary Tumour. We will discuss his clinical presentation and management in conjunction with a literature review of this very rare condition.

Dyan Fei Lariosa- Di Mattina

DOI: 10.21307/ajon-2020-009b

Neurosurgery is common place in Wellington Regional Hospital. The occurrence of a pressure injury to the head is uncommon. The organization and national health strategy may have various assessment tools for prevention and management of pressure injuries, but limited to other body parts and medical devices. I choose this topic based on the lack of literature focused on Pressure Ulcer avoidability in post brain surgery patients. I will explore on a case study of a young male who had traumatic brain injury and undergone double craniectomy and insertion of Ventriculo-Peritoneal Shunt/VP Shunt. It also share his long hospital stay in Wellington hospital and Acute Brain Injury (ABI) rehab unit. He became unwell with changes in Glasgow Coma Scale (GCS) and vital signs which showed signs of infection. As the team decide to operate for revision of Ventriculo-Peritoneal (VP) shunt, they found a pressure injury at the back of the ear. He had a number of contributing factors. Hence, he ended up also with a wound wash out surgery. As a result, an investigation with the wound clinical nurse specialist was done and contacted the medical device supplier. The future desired outcome is to prevent pressure injuries occuring through regular head assessments. As a result we are now trialling some new nasal prongs for oxygen in these complex patients.

Rebecca Lissiman

DOI: 10.21307/ajon-2020-009c

“Only 25% reported a complete recovery without psychosocial or neurological problems” (Jarvis and Tidy, 2019)

This is a case study of a 47year old female who was hospitalised, following an unwitnessed collapse at work which, we learn was a subarachnoid haemorrhage, secondary to a R) MCA aneurysm. During her admission to neurosurgery and multiple ICU admissions, she was intubated and acquired ventilator associated pneumonia. Her surgery was complicated. This case study will include a personal interview with the patient and her husband who will give their version of events from their perspective.

We will explore the journey of this lady and how short and long term complications impacted her life and how her recovery was far from linear.

Sharon Ker and Christine Holland

DOI: 10.21307/ajon-2020-009d

While there is a growing body of literature regarding the pathophysiology of Creutzfeldt-Jakob disease (CJD), there is a paucity of literature on how to care for patients with this disease, especially for those patients who have cerebellar signs and symptoms as the predominant feature. CJD is a rare disease and one of the transmissible and fatally progressive prion diseases affecting 1-2 persons per million, annually worldwide. Sporadic CJD (sCJD) is the most common form accounting for around 85% of all cases and this will be our predominant focus. Because CJD is transmissible, nurses can be fearful of caring for such a patient. Having knowledge of the disease will ensure the patient receives the compassionate care that is the heart and soul of nursing such patients. So begins our journey where we had the privilege to care for a young man admitted for investigation into our neuroscience unit. His clinical course was complicated, and his nursing care needs were uniquely specialised.

Sarah Smith and Christine Holland

DOI: 10.21307/ajon-2020-009e

Delirium is an acute disturbance to a person’s mental state, consciousness, attention and cognition that is associated with adverse clinical outcomes. There is also the potential of an increased risk of injury to staff associated with nursing patients who are delirious. Patients may develop psychotic symptoms such as hallucinations and paranoid thinking. Commonly seen among older patients, delirium is considered to be a serious condition with an associated increased mortality.

At Clinical review, the incidence of acute delirium on the Neuroscience Ward was analysed over time. Neuroscience nursing requires a complex and concise understanding of the brain as a whole including both the disease process and psychological aspects.

Neuroscience nursing of the delirious patient is complex, multifaceted and one that involves nurses that are highly skilled at patient assessment. It also involves implementation of Non-pharmacological and environmental support strategies to help minimise the complications associated with delirium. Early identification and appropriate management of delirium is at the heart of Neuroscience nursing. Our journey begins.

Posters

Zyra Manlunas

DOI: 10.21307/ajon-2020-009f

In Australia, one of the main causes of death and disability is stroke. Internationally, it is considered as the second most common cause of mortality and disability. Ischemic strokes (IS) account for 80% of all strokes. Hypertension has been identified as one of the most common modifiable risk factors in the prevention and management of IS mortality and morbidity rates. Treatment for IS is time and escalation essential. Patients queried as suffering from an IS need to have radiology diagnostic testing immediately to be able to determine whether the patient is a candidate for administration of tissue plasminogen factor (t-PA). The post administration management of patients that have received t-PA includes several clinical nursing interventions. Blood pressure management and treatment is one of the essential responsibilities a nurse performs when caring for a patient who has had an IS.

This poster will critically analyse a metropolitan public hospital’s stroke protocol in conjunction with the current Australian guidelines as well as international guidelines highlighted from the American Heart Association (AHA) and American Stroke Association (ASA). The analysis will discuss current literature and clinical practice in the management of blood pressure after administration of t-PA including blood pressure parameters and medication treatment used.

Simeon Dale

DOI: 10.21307/ajon-2020-009g

Background: Oral care is an essential aspect of optimal oral health, yet internationally little is known about current oral care practices for patients with stroke in hospitals.

Aim: To explore oral care practices for inpatients with stroke in the UK and Australia.

Method: Surveys questionnaires were mailed to stroke specialist nurse or lead stroke clinician in hospitals known to provide inpatient care for patients with stroke. Descriptive analyses are presented.

Results: Response rates were high [UK: 86% (150/174)]; [Australia: 74% (120/162)]. Oral care protocols existed in 52% of UK and 30% of Australian hospitals. However, only 17% (n=26) of UK and 6% (n=7) of Australian units had stroke specific protocols. Oral care training was given to 55% (n=83) of UK and 30% (n=36) of Australian staff. Oral care assessment tools were used in 53% (n=80) of UK and 13% (n=16) of Australian hospitals, however, half, 50% (n=40) UK units and 38% (n=6) Australian units used generic tools. Oral care assessments were undertaken on admission in 73% (n=109) of UK and 57% (n=68) of Australian hospitals. When patients were unable to provide their own oral care, staff were only expected to undertake cleaning of natural teeth twice a day in 62% [n=93] of UK and 56% (n=67) Australian hospitals. It was an expectation in only half (UK: 54% [n=81]; AUS: 55% [n=66]) of the hospitals that patients ‘nil by mouth’ were to receive oral care three times a day.

Conclusion: Unacceptable variability exists in oral care practices for stroke in both regions with Australia having poorer practices than the UK. Oral care is a neglected area of stroke clinical practice. Some results reflect an expectation only, the actual practice is likely to be even lower.

Kristine Gutierrez

DOI: 10.21307/ajon-2020-009h

Stroke is the second leading cause of mortality after ischemic heart disease and it is predicted to greatly increase internationally by 2030. It is a medical emergency whereby the abrupt death of several brain cells caused by oxygen insufficiency and absent blood flow to the brain due to obstruction or rupture of a cerebral artery. Acute ischemic stroke is a type of stroke that occurs as a result of an obstructive blood clot to the brain. In the current clinical practice, early intervention and nursing management of acute ischemic stroke is vital to reduce irreversible brain damage. Blood glucose monitoring and management is a critical assessment regardless of the diabetic status of the patient. Hypoglycaemia and hyperglycaemia have both detrimental effects in patients with acute ischemic stroke if left untreated, and greater morbidity and mortality rates when not clinically managed appropriately. Current protocols and guidelines are used by hospitals to monitor and manage blood glucose level that are supported based on current clinical literature.

This poster will discuss the aspects of blood glucose monitoring and management in patients with acute ischemic stroke. It will be supported by the local guidelines and through critical analysis from both national and international evidence-based literature. It will also explore blood glucose management and treatment impacts upon future nursing practice and the benefit on patient care.

Rebecca Green

DOI: 10.21307/ajon-2020-009i

Aneurysmal Subarachnoid Haemorrhage (ASAH) is a type of intracranial haemorrhage in which bleeding occurs in the subarachnoid space. ASAH is classed as a non-traumatic subarachnoid haemorrhage which is commonly caused by a ruptured cerebral aneurysm. A cerebral aneurysm is a ballooning like swelling of a cerebral artery. Aneurysms rupture due to a weakness in the wall of the artery caused by high blood pressure. The treatment of a ruptured aneurysm is determined by the type and location of the aneurysm involved. Clipping of the aneurysm and endovascular coiling prevent rebleeding and enable safe management of vasospasm. Vasospasm is the most common complication of ASAH. Vasospasm is the spontaneous contraction of the cerebral arteries and it occurs in up to 70% of patients between 7 to 10 days post rupture of the aneurysm. Cerebral vasospasm post haemorrhage is a major cause of death and permanent disability in patients with ASAH.

This poster will inquire into the local practice for medication and fluid management in the prevention of vasospasm in ASAH patients post coiling/clipping, in a metropolitan private hospital neurosurgical ward. The local practice of medication and fluid management in ASAH’s will be critically analysed looking at national and international evidence-based literature, comparing local practice guidelines; discussing the impact of the local practice on the nursing management and interventions implemented when caring for a patients with an ASAH.

Differentiating electrolyte and fluid disorders. Let’s talk sodium imbalance.......Na Leigh Bruce and Diane Lear

Vasopressin or anti diuretic hormone (ADH) is a hormone made in the hypothalamus; it acts to maintain blood pressure, blood volume and tissue water content. Osmolality and volume status are the two greatest factors that affect ADH secretion. There are three pathologic states related to ADH

Diabetes Insipidus (DI) - It is a deficiency in ADH. It is most commonly seen in Patients post pituitary surgery, Subarachnoid Haemorrhage and head injured patients. Indications are high serum osmolality and high serum sodium levels, greater than 145mmol/l. Patients complain of increase in thirst, polyuria and nocturia. Central DI should respond to corrected fluid balance by drinking to thirst or in some cases short to long periods using synthetic ADH compounds such as Desmopressin

Cerebral salt wasting (CSW) - Is seen in Patients post subarachnoid haemorrhage. It presents with hyponatremia, both serum sodium and serum osmolality are decreased. Serum sodium levels are less than 135mmol/ l. Patients have an increase in thirst and urine output. The recommended treatment is fluid and salt replacement.

Syndrome inappropriate Antidiuretic Hormone (SiADH) - Is considered dilutional hyponatremia is caused by continuous secretion of ADH. Serum sodium and serum osmolality are both decreased and serum sodium is less than 135mmol/l. Patients with brain tumours are often at risk of developing SiADH. Treatment is to fluid restrict the patient.

Ruby Crane

DOI: 10.21307/ajon-2020-009j

Diabetes Insipidus (DI) is one of the most common post-surgical complications associated with the removal of a Pituitary Tumour. Up to 70% of patients post Pituitary surgery will develop DI.

Generally this complication is of short duration and rarely becomes permanent.

The post-operative nursing management of DI at St Vincent’s Private Hospital Melbourne includes strict measurement of all oral and IV fluid input and fluid output. This information is then documented on the Pituitary Fluid Balance Chart (PFBC). The fluid balance results are reported to the Endocrinologist who will then recommend management.

Unfortunately, there was a reported incident on the neuroscience ward where a PFBC had been calculated incorrectly. This error in documentation resulted in a delay in recognition of the patient’s diagnosis of DI. As a result the clinical team undertook a root cause analysis which identified there where discrepancies in how to correctly complete documentation of a patients PFBC.

In response, the clinical team conducted a retrospective audit of 189 PFBC’s which identified common themes that lead to documentation errors. Feedback was sort from both medical practitioners and nursing staff. Benchmarking was also undertaken with 4 major metropolitan hospitals who also specialise in pituitary surgery. The PFBC was updated and a trial was completed on the neuroscience ward. The results were analysed, and a consensus agreement reached on the correct documentation of the PFBC. The outcome has improved understanding on how to complete the PFBC correctly, minimising patient risk.