Editor Sukhpal Kaur PhD
Lecturer National Institute of Nursing Education PGIMER,
Chandigarh India
Associate Editor Manjeet Singh MD (Medicine)
Medical Officer Government Multi Specialty Hospital,
Sector 16, Chandigarh India
Foreword Yogesh Chawla
Sandhya Ghai
4Contributors
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Clinical Neurosciences and Critical Care Nursing
First Edition: 2014
9789351522003
Printed at
3Dedicated to
My parents who have inspirited the spirit of hard work, honesty and truthfulness in my life
- Amarjeet Singh md (community medicine)
- Professor
- School of Public Health, PGIMER, Chandigarh
- Angela Gnanadurai phd
- Professor and Vice Principal, CSI College of Nursing, TVM, Kerala
- Ashish Bhalla md (medicine)
- Additional Professor, Department of Internal Medicine, PGIMER,
- Chandigarh
- Ashok Kumar msc (neurosciences nursing)
- Nursing Sister Gr II (Stroke Nurse), Department of Neurology, PGIMER,
- Chandigarh
- Bidisha Basu msc (cardiovascular and thoracic nursing)
- National Institute of Nursing Education (NINE), PGIMER, Chandigarh
- Deepak Kumar md (physical medicine & rehabilitation)
- Senior Resident, Department of Physical Medicine and
- Rehabilitation, PGIMER, Chandigarh
- Dheeraj Khurana dm (neurology)
- Additional Professor, Department of Neurology, PGIMER, Chandigarh
- Dinesh Kumar mds
- Senior Resident, Department of Oral Health Sciences PGIMER,
- Chandigarh
- Monika Dutta phd
- Clinical Instructor, NINE, PGIMER, Chandigarh
- Hemant Bhagat md (anesthesia)
- Additional Professor, Department of Anesthesia, PGIMER, Chandigarh
- Jaspreet Kaur Minhas bsc nursing
- Nursing Sister Gr II, Neurosurgery ICU, Nehru Hospital,
- PGIMER, Chandigarh
- Kanchan Kumar Mukherjee mch (neurosurgery)
- Professor, Department of Neurosurgery, PGIMER, Chandigarh
- Latika Bajaj msc (neurosciences nursing)
- Clinical Instructor, NINE, PGIMER, Chandigarh
- Manisha Negi msc (neurosciences nursing)
- Clinical Instructor, NINE, PGIMER, Chandigarh
- Manjeet Singh md (medicine)
- Medical Officer, GMSH Sector 16, Chandigarh
- Manju Dhandapani msc (neurosciences nursing)
- Lecturer, NINE, PGIMER, Chandigarh
- Monaliza msc (neurosciences nursing)
- Lecturer, NINE, PGIMER, Chandigarh
- Nadiya Krishnan msc (crtical care nursing)
- Clinical Instructor, NINE, PGIMER, Chandigarh
- Neena Vir Singh msc (medial surgical nursing)
- Leturer, NINE, PGIMER, Chandigarh
- Nitasha Sharma msc (psychiatric nursing)
- Clinical Instructor, NINE, PGIMER, Chandigarh
- Prabhjot Kaur msc (critical care nursing)
- Clinical Instructor, NINE, PGIMER, Chandigarh
- Prabhjyot Kaur bpt mph
- State Training and Monitoring Coordinator
- NRHM HQ (Panchkula), Haryana
- Pragya Pathak phd
- Principal, Himalayan CON, Kala Amb, District Ambala
- Raj Kumari Kaushal msc (neurosciences nursing)
- Nursing Sister Gr II, PGIMER, Chandigarh
- Rajesh Kumar Singla mbbs
- Medical officer, Dhakoli, Zirakpur, Punjab
- Ramandeep Kaur bsc nursing mph
- Ruchi Saini msc (critical care nursing)
- Nursing Sister Gr II, (ICU), PGIMER, Chandigarh
- SS Dhandapani mch (neurosurgery)
- Assistant professor, Department of Neurosurgery,
- PGIMER, Chandigarh
- S Shantanam Mahalingam ms (neurosurgery)
- Senior Resident, Department of Neurosurgery,
- PGIMER, Chandigarh
- Sandhya Ghai phd
- Principal, NINE, PGIMER, Chandigarh
- Seema Chetri bsc (chemistry-hons), bot
- (Occupational Therapy)
- Senior Occupational Therapist
- Department of Physical and Rehabilitation Medicine, PGIMER,
- Chandigarh
- Shine Stephen msc (cardiovascular and thoracic nursing)
- Staff Nurse, ESIC, Kerala
- Shruti msc (medical surgical nursing)
- Lecturer, NINE, PGIMER, Chandigarh
- Smriti bds
- Dental Surgeon, BSS Government Hospital, Panipat, Haryana
- Sukhpal Kaur phd
- Lecturer, NINE, PGIMER, Chandigarh
- Sunita Bhagat msc (critical care nursing)
- Nursing Sister Gr II, Nehru Hospital, PGIMER, Chandigarh
- Sunita Malhotra msc (foods and nutrition), Postgraduate Diploma in Public Health Nutrition and Dietetics
- RD, Senior Dietician, Department of Dietetics,
- PGIMER, Chandigarh
- Suresh Kumar Sharma phd
- Principal, CON, AIIMS, Rishikesh
- Tissamol Sebastian msc (critical care nursing)
- Nursing Sister Gr II, AIIMS, New Delhi
- Tynrai Bashisha RN Dohling msc (critical care nursing)
- NINE, PGIMER, Chandigarh
- Upasana Sharma bams mph phd scholar
- ICMR- JRF, NIMHANS, Bengaluru
- Virinder Singh Gogia mbbs dorth dipnb
- (Physical Medicine & Rehabilitation), MNAMS
- Assistant professor, Department of Physical and Rehabilitation
- Medicine, PGIMER, Chandigarh
It gives me immense pleasure to pen the foreword for this book ‘Clinical Neurosciences and Critical Care Nursing’ edited by Dr Sukhpal Kaur. When your student authors a useful book, the happiness you enjoy cannot be expressed in words. It is just a few years back when Dr Sukhpal had come to me for her MSc thesis. Her interest in publishing was evident from the fact, that the moment her research work was over, she was ready with her paper for publication. Since then, she has never looked back, and has to her credit more than seventy publications in various reputed journals. She has already brought out seven books, a few of which have been given state awards. Her keen interest in research work in nursing is obvious from the fact that she has a large number of research projects funded from ICMR, DST, and DBT.
As medical field has now progressed from a number of specialities to super specialities and further subspecialities, a parallel growth of nursing professionals is the need of the hour. For any super specialized set-up, a matching level of nursing care is mandatory. With the advancement in medical sciences in particular, it becomes very important for the nurses to keep themselves updated with recent advances. Neurosciences becomes all the more important as during acute emergencies, a vigilant and updated nurse can help save many lives in ICU settings as well as go a long way in reducing morbidity and mortality.
I am sure the book ‘Clinical Neurosciences and Critical Care Nursing’ will help nurses and other paramedicals working in various ICUs and particularly in neurology and neurosurgery ICUs. It will help the readers to update their information in neurology and critical care nursing. As a large number of neurology patients remain on long-term follow-up, they can be helped to a large extent by nurse practitioners. This understanding will help in offloading the already overburdened neurologists and neurosurgeons, which are so few in number in our country. In fact, on the same lines, nurse practitioners are required as part of various specialized teams in our country like diabetes, arthritis, palliative care, oncology, organ donation, etc. to name a few.
This book ‘Clinical Neurosciences and Critical Care Nursing’ will be of immense help to nurses, undergraduate and postgraduate nursing students to help them manage critical neurology and neurosurgery patients in a more effective and professional manner. This book will also be a stimulus to others working in nursing academics and research to bring more updated literature in their respective areas of work. The chapter on organ donation would help in improving the concept and understanding of organ donation in society and particularly so amongst nursing, paramedical as well as medical fraternity. I wish the readers a pleasure and knowledgeable experience.
Yogesh Chawla dm (gastroenterology)
Director
PGIMER, Chandigarh, India
7Foreword
Along with the growth of medical sciences, equal advancements and matching expectations from nurses are obvious. In all specialized and super-specialized medical set-ups, it is the need of the hour, that all the nurses must get latest knowledge updates to excel in their chosen disciplines. No nurse can do justice to her work without thorough theoretical knowledge and evidence-based practical skills related to the domains of her work. Therefore, every nurse in practice needs to learn more and more to widen her/his horizon. There is a huge demand for specialized nurses in all super specialized areas like obstetrics, psychiatry, cardiology, neurology, and critical care, etc. to name a few.
The book ‘Clinical Neurosciences and Critical Care Nursing’ is an endeavor by Dr Sukhpal to help medical-surgical nurses to upgrade themselves as ICU-nurses, Neuro-ICU nurses and Neurosurgey-ICU nurses. I appreciate the efforts by Dr Sukhpal and her team of esteemed co-authors for bringing out this excellent, readable and precious piece of literature. This book and similar efforts by todays’ nursing experts will go a long way to fulfill the dream of conceiving the concept of nurse practitioner and super-specialized nursing into the Indian medical and nursing mind set.
This book will prove to be a blessing not only for undergraduate and postgraduate students but also will be of immense help for the nurses and the technical staff working in various ICUs. This will help all the practicing nurses of the related specializations to update themselves and further polish their skills. I congratulate Dr Sukhpal and her team who have authored a state-of-the-art presentation and have scientifically dissected the best practices. They also deserve appreciation and best wishes so that they bring out more and more of such literature and work to the best of their capability to serve humanity through efficient nursing. Myself and our institute ‘National Institute of Nursing Education’ join to wish them success in their present and all the coming future endeavors.
Sandhya Ghai PhD
Principal
National Institute of Nursing Education
PGIMER, Chandigarh, India
9Preface
In today's era of super specializations in nursing and the concept of nurse practitioners, a nurse no longer continues to be just an assistant, but is actually following up, monitoring, and treating the patients at her own. With the exponential growth of science in general and nursing sciences in particular, it becomes very important for present day nurses to keep themselves updated in recent advances. As the medical sciences have become vast, we all now need to select and then excel in the fields of our chosen nursing specializations, super specializations, and sub specializations.
Neurosciences and Critical Care Nursing becomes all the more important for nurses as during acute emergencies a vigilant and updated nurse can help save many lives in ICU settings as well as can go a long way to reduce morbidity and mortality. The role of a nurse expert acquires more importance in our society in view of limited availability of specialists and super specialists where patients are left with no choices except to go to unqualified and self-styled doctors. Our updated approach and proactive attitude can reduce this gap. The onus of uplifting the healthcare status of our society lies on our shoulders and we have to break the inertia of many of our professional colleagues and have to achieve new heights in the present day nursing arenas.
With this understanding, this book ‘Clinical Neurosciences and Critical Care Nursing’ has been brought out with a humble and sincere effort where nurses in our country will no longer limit themselves just to distributing tablets and capsules, giving injections, and doing beddings. In fact, they now qualify themselves for establishing and maintaining central lines, endotracheal tubes, ventilators, and much more.
Critical care nurses work in a variety of areas, with a diverse patient population. In order to meet the challenges of the complex healthcare system, today's nurses are expected to be knowledgeable and skilled in order to provide efficient and compassionate nursing care to the critically ill patients.
The ‘Clinical Neurosciences and Critical Care Nursing’ is an excellent overview of the care and management of critically ill patients. The contributors to the book are the eminent nursing and medical faculty from all over India. The contents are elaborated in 31 chapters. The target population for this book includes the nursing faculty, the postgraduate and undergraduate nursing students, and the nurses working in various intensive care units of the hospitals as well as other bedside nursing colleagues.
Research is an integral part of the scientific enterprise for improving the nation's health. The growing body of nursing research provides a scientific basis for patient care and this evidence-based information should be practiced by the nurses. Research is conducted to improve patient outcomes and promote the health and well-being of the patients. A unique feature of this book is that in majority of the chapters the evidences from research have been incorporated. Authors’ own professional experience and the addition of evidences from the other research studies regarding the topics under discussion, make the current book different. The topics covered in the book may not be exhaustive. Feedbacks from the readers are sincerely solicited by the undersigned.
We wish to sincerely thank all the contributors to the book without whose help this endeavor would not have been possible.
Sukhpal Kaur
Manjeet Singh
10Acknowledgments
It is with a sense of immense relief and satisfaction at the conclusion of this book that I turned to the pleasant task of acknowledging the help of all those who made this work possible. No endeavor can be successful without the blessings of one and only God Almighty. I am grateful to divine Lord for the inspiration, motivation, encouragement and for providing me with the right tool to make and complete this onerous task. My sincere thanks to all the contributors for this book without whose efforts this project would have not been completed. I cannot refrain from thanking the office staff of Jaypee Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India especially Mr Bhupesh Arora (General Manager-Publishing) and Mrs Preeti Parashar (Author coordinator) for the help they offered me throughout.