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The Clinical Practice of
Neurological and
Neurosurgical Nursing
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The Clinical Practice of
Neurological and
Neurosurgical Nursing
S I X T H E D I T I O N
Joanne V. Hickey
PhD, RN, ACNP-BC, CNRN, FAAN, FCCM
Professor
The University of Texas Health Science Center
at Houston
School of Nursing
Houston, Texas
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6th Edition
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Copyright © 2003, 1997 by Lippincott Williams & Wilkins. Copyright © 1992 by J. B. Lippincott Company. All
rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted
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9 8 7 6 5 4 3 2 1
Printed in the United States of America
Library of Congress Cataloging-in-Publication Data
Hickey, Joanne V.
The clinical practice of neurological and neurosurgical nursing / Joanne V. Hickey. —6th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7817-9529-6
ISBN-10: 0-7817-9529-X
1. Neurological nursing. I. Title. II. Title: Neurological and neurosurgical nursing.
[DNLM: 1. Nervous System Diseases—nursing. 2. Neurosurgery—nursing. WY160.5 H628c 2009]
RC350.5.C55 2009
616.8(cid:2)04231—dc22
2008039275
Care has been taken to confirm the accuracy of the information presented and to describe
generally accepted practices. However, the authors, editors, and publisher are not responsible for
errors or omissions or for any consequences from application of the information in this book and
make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy
of the contents of the publication. Application of this information in a particular situation remains
the professional responsibility of the practitioner; the clinical treatments described and recom-
mended may not be considered absolute and universal recommendations.
The authors, editors, and publisher have exerted every effort to ensure that drug selection
and dosage set forth in this text are in accordance with the current recommendations and practice
at the time of publication. However, in view of ongoing research, changes in government regula-
tions, and the constant flow of information relating to drug therapy and drug reactions, the reader
is urged to check the package insert for each drug for any change in indications and dosage and
for added warnings and precautions. This is particularly important when the recommended
agent is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Admin-
istration (FDA) clearance for limited use in restricted research settings. It is the responsibility of
the health care provider to ascertain the FDAstatus of each drug or device planned for use in his
or her clinical practice.
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To neuroscience patients and their families who have lived the
experience of neurological illness.
To the many nurses who compassionately and competently care
for neuroscience patients, making a difference in the lives of
patients and families, and serving communities locally,
nationally, and internationally.
And as always . . . to my husband, Jim; daughter, Kathan; son,
Christopher; and their families—who have given and continue
to give my life meaning, direction, and purpose through their
continued love and support. It is family that is the most
precious of gifts and the substantive denominator of life. And
to my grandchildren, Jenna, Matthew, Max, and Joanna, who
are the wonderful and perfect gifts and links from the past to
the future, and the joy of the present.
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About the Author
Currently, Dr. Hickey is Pro- mended books in nursing. The text has been translated into
fessor and the Director of Japanese. Dr. Hickey serves on a number of editorial and
the Doctor of Nursing Prac- advisory boards.
tice Program at the Univer- Dr. Hickey received her diploma in nursing from Roger
sity of Texas Health Science Williams General Hospital School of Nursing in Providence,
Center at Houston School Rhode Island; her BSN from Boston College in Boston, Mass-
of Nursing. Dr. Hickey achusetts; her MSN from the University of Rhode Island in
holds the Patricia L. Starck/ Kingston, Rhode Island; her MAin counseling from Rhode
PARTNERS Endowed Pro- Island College in Providence, Rhode Island; her PhD from
fessorship in Nursing. She the University of Texas in Austin, Texas; and her post-mas-
has focused her career on ter’s certificate as an acute care nurse practitioner from Duke
education, practice, research, University in Durham, North Carolina. She is certified in
and publications in the neu- neuroscience nursing (CNRN) by the American Board of
rosciences and neuroscience Neuroscience Nursing, and is board certified as an acute care
patient populations. Dr. nurse practitioner (APRN, BC) by the American Nurses Cre-
Hickey has been a faculty dentialing Center. She is a fellow in the American Academy
member in a number of of Nursing (FAAN) and a fellow in the American Academy
schools of nursing. At Duke of Critical Care Medicine (FCCM).
University, she developed and directed its first acute care Dr. Hickey is a member of the American Nurses Associa-
nurse practitioner program. She has had clinical appoint- tion, the American Association of Neuroscience Nurses, and
ments at Massachusetts General Hospital in Boston, Massa- the Society of Critical Care Medicine. She serves or has served
chusetts, and Duke University Medical Center in Durham, on a number of national boards and commissions, including
North Carolina, where she was Attending Nurse, Neuro- the American Nurses Credentialing Center (ANCC) Board on
science Nursing. Her neuroscience research interests include Certification for Acute Care Nurse Practitioners (Chairperson
cerebrovascular problems and increased intracranial pres- 1995–1999), ANCC Commission on Certification (Chairper-
sure, and she was an American Foundation of Nursing son 1999–2004), ANCC Board of Directors, and ANCC Insti-
Research Scholar in 1992 for research on preparing family tute of Credentialing Research (Chairperson 2004–present).
caregivers for recovery from stroke. She was the Scurlock Nurse Scholar at The Methodist Hospi-
The Clinical Practice of Neurological and Neurosurgical Nurs- tal in Houston, Texas. Dr. Hickey is a frequent national and
ing,now in its sixth edition, has received the American Journal international speaker and consultant on topics in neuro-
of Nursing (AJN) Book of the Year Award and has been science patient management, neuroscience nursing practice,
repeatedly cited by the Brandon and Hill listing of recom- and advanced practice nursing.
vii
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Contributors
The following individuals contributed to chapters in the sixth edition:
Kathryn Montgomery, MSN, RN, NP Jamie Zoellner, MSN, RN, ACNP, BC
Palliative Care Nurse Practitioner Nurse Practitioner
St. Luke’s Episcopal Hospital Duke University Medical Center,
Houston, TX Durham, NC
Chapter 3 • Ethical Perspectives and End-of-Life Care Chapter 14 • Management of Patients Undergoing
Neurosurgical Procedures
Joseph Kanusky, MSN, RN, CRNA
Sugar Land, TX Mary Bray Powers, BSN, RN, CNRN
Chapter 4 • Overview of Neuroanatomy and Staff Nurse, Neuro Intensive Care Unit
Neurophysiology The Methodist Hospital
Houston, TX
Theresa Dildy, RD, MS, LD, CNSD Chapter 15 • Nursing Management of Patients With a
Clinical Nutrition Manager Depressed State of Consciousness
St. Luke’s Episcopal Hospital
Houston, TX Susan Chioffi, MSN, RN, ACNP, BC
Chapter 8 • Nutritional Support for Neuroscience Neuroscience Nurse Practitioner
Patients Duke University Medical Center
Durham, NC
Timothy F. Lassiter, PharmD, MBA Chapter 16 • Neuroscience Critical Care
Clinical Pharmacist
Neuroscience Intensive Care Unit Bettina C. Prator, MSN, RN, ACNP, BC
Duke University Medical Center Nurse Practitioner
Durham, NC Tampa General Hospital
Chapter 12 • Pharmacologic Management of Neuroscience Tampa, FL
Patients Chapter 17 • Craniocerebral Injuries
Amy I. Henkel, PharmD Andrea L. Strayer, MSN, RN, NP
Clinical Pharmacist Neuroscience Nurse Practitioner
Duke University Medical Center University of Wisconsin, Department of Neurosurgery
Durham, NC Madison, WI
Chapter 12 • Pharmacologic Management of Neuroscience Chapter 19 • Back Pain and Spinal Disorders
Patients
Terri S. Armstrong, DSN, RN, APN
DaiWai M. Olson, PhD, RN
Associate Professor
Neuro Intensive Care
MD Anderson Cancer Center and The University of
Duke University Medical Center, Texas Health Science Center at Houston
Durham, NC School of Nursing
Chapter 13 • Intracranial Hypertension: Theory and Houston, TX
Management of Increased Intracranial Pressure Chapter 21 • Brain Tumors
Chapter 22 • Spinal Cord Tumors
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x CONTRIBUTORS
Deidre A. Buckley, MS, RN, ANP-C Ann Quinn Todd, RN, MSN, CNRN, FAHA
Nurse Practitioner, MGH Brain Aneurysm/AVM Center Director, Eddy Scurlock Stroke Center
Massachusetts General Hospital The Methodist Hospital
Boston, MA Houston, TX
Chapter 23 • Cerebral Aneurysms Chapter 25 • Stroke
Chapter 24 • Arteriovenous Malformations and Other
Cerebrovascular Anomalies
