Medical Surgical Nursing
Reflective Essay
Dalangin, Rexson
BSN III-1
Dr. Mario Marasigan
CLINICAL INSTRUCTOR
Asia’s FIRST IiP – Gold
Recognition for Commitment to Quality Management in 2012 Accredited University Granted INSTITUTIONAL ACCREDITATION Status Granted AUTONOMOUS Status
The video talks about different topics namely, cerebrovascular accident, neurologic
dysfunction, trauma, and autoimmune disease.
The first is a cerebrovascular accident (CVA) (stroke). A stroke occurs when blood flow
to a part of the brain is cut off, according to the video. A stroke occurs when oxygen-rich blood is unable
to reach brain cells (due to a blockage or bleeding), causing the cells to die. This can result in long-
term brain damage, disability, or even death. After watching the video, I learn the following; that
there are different types of stroke. The most common type is ischemic stroke, which is caused by a
blood clot within a blood vessel or stenosis of an artery feeding the brain tissue. This reduces the
amount of blood that reaches the brain cells. This can be caused by embolism, which occurs when a
clot leaves a part of the body and travels to the brain, stopping blood flow, or thrombosis, which occurs
when a clot forms within the artery wall of the neck or brain. This is seen in hyperlipidemia and
atherosclerosis patients. Hemorrhagic stroke is a type of stroke in which there is bleeding in the brain
due to a blood vessel break. There will be a reduction in blood flow to the brain cells, which can result
in excessive swelling in the brain due to blood leakage in the brain tissue. This can be caused by a
ruptured brain aneurysm or uncontrolled hypertension. This can be caused by a ruptured brain
aneurysm or uncontrolled hypertension. A patient may also have a TIA (transient ischemic attack), also
known as a mini stroke. The signs and symptoms of a stroke last only a few minutes to hours before
they fade away. It's a sign that a stroke is about to happen. The video also goes over the signs and
symptoms of a stroke, such as facial drooping, arm numbness or weakness, slurred speech or difficulty
speaking, and more. tPA an effective treatment for ischemic stroke (tissue plasminogen activator). This
drug works by dissolving the blood clot that is causing the reduced blood flow. tPA, on the other hand,
must be given within 3 hours of the onset of stroke symptoms. Monitoring vitals (especially blood
pressure and respiratory status), watching and educating the patient with neglect syndrome (which
most likely occurs with patients who have had a right brain injury), diet and swallowing techniques,
hemianopsia, and how to communicate with a patient with aphasia are all part of nursing care for stroke
patients.
One of the neurologic dysfunctions is the Increased intracranial pressure that occurs
when the inside of the skull experiences increased pressure and this is a medical emergency. After
watching the video, I learned the following; Intracranial pressure is the pressure created by the
cerebrospinal fluid and brain tissue/blood within the skull. It can be measured in the lateral ventricles
with an external ventricular drain. The normal intracranial pressure (ICP) is 5-15 mmHg, and greater
than 20 mmHg needs treatment. For its pathophysiology of increased intracranial pressure, the human
skull is very hard and is limited on how much it can expand when something inside the skull experiences
a change that leads to increased pressure exerted within the skull. Inside the skull are three structures
that can alter intracranial pressure: brain, cerebrospinal fluid (CSF), and blood. Intracranial pressure
fluctuates and this depends on many factors like the person’s body temperature, oxygenation status,
especially CO2 and O2 levels, body position, arterial and venous pressure, anything that increases
intra-abdominal or thoracic pressure (vomiting, bearing down). Also, cerebral perfusion pressure is
important when dealing with intracranial pressure. A normal CPP is 60-100 mmHg. When CPP
(pressure that pushes the blood to the brain) falls too low the brain is not perfused and brains tissue
dies. Symptoms of increased intracranial pressure are mental status changes it is the earliest
symptoms, vomiting, headache, decorticate or decerebrate posturing, optic and oculomotor nerve
damage, abnormal doll's eye, seizures etc. Nursing care for increased ICP includes monitoring and
preventing further increases in intracranial pressure, administering prescribe drugs such as Mannitol,
anticonvulsants, corticosteroids etc.
I also learned the other neurologic dysfunctions include altered level of consciousness,
which occurs when a patient is disoriented and refuses to obey commands, or when the patient requires
constant stimulation to achieve a state of alertness. LOC is measured on a scale of one to ten, with
normal alertness and full cognition at one end and coma at the other. Coma is a clinical state of
unresponsiveness in which no purposeful responses are made. Seizures are periods of abnormal
motor, sensory, autonomic, or psychic activity caused by an overabundance of cerebral neuron
discharge. An electrical disturbance in the nerve cells of one section of the brain is the underlying
cause. These cells produce electrical discharges that are abnormal, recurrent, and uncontrollable.
Epilepsy refers to a group of disorders marked by unprovoked, recurrent seizures.
Asia’s FIRST IiP – Gold
Recognition for Commitment to Quality Management in 2012 Accredited University Granted INSTITUTIONAL ACCREDITATION Status Granted AUTONOMOUS Status
A brain, spine, or nerve injury is known as neurological trauma. These injuries are
commonly caused by car accidents, bike accidents, sports injuries, or falls. Many parts of the body,
including the organs, blood vessels, muscles, and bones, can be affected by neurological trauma.
Normal brain function is disrupted because of trauma-related injury, resulting in compromised
neurologic function and focal or diffuse symptoms. The most common cause of injury is motor vehicle
accidents. After watching the video, I learn the following; that there are several types of neurologic
trauma, first is concussion, it is the transient interruption in brain activity next is the cerebral contusion,
where bruising of brain with associated swelling, another one is the intracerebral hematoma where
bleeding into the brain tissue commonly associated with edema, epidural hematoma where blood
between the inner table of the skull and dura, subdural hematoma, where blood between the dura and
arachnoid caused by bleeding commonly associated with additional brain injury and lastly the diffuse
axonal injury where axonal tears within the white matter of the brain.
A condition in which your immune system mistakenly attacks your body is known as
autoimmune disease. Normally, the immune system protects us from germs such as bacteria and
viruses. It sends out an army of fighter cells to attack these foreign invaders when it detects them. After
watching the video, I learn the following; that the inflammation of the meninges, which cover and
protect the brain and spinal cord, is known as meningitis. The immune system attacks the joints in
rheumatoid arthritis (RA). The joints become red, warm, sore, and stiff because of this attack. Multiple
sclerosis (MS) causes damage to the protective coating that surrounds nerve cells in the central
nervous system, known as the myelin sheath. The transmission speed of messages between your brain
and spinal cord to and from the rest of your body is slowed when the myelin sheath is damaged.
Numbness, weakness, balance issues, and difficulty walking are all symptoms of nerve damage. Nerve
impulses that help the brain control the muscles are affected by myasthenia gravis. Signals from the
nerves to the muscles are unable to direct the muscles to contract when communication between them
is disrupted. Muscle weakness is the most common symptom, which worsens with activity and improves
with rest. Often muscles that control eye movements, eyelid opening, swallowing, and facial movements
are involved.
As a nursing student, it is important to know such disorder or disease condition as it is the
preparation for my future profession. Even though I am just a student nurse for now, it can be helpful
in a sense that I can now share my knowledge and educate people about the stuff that I know. It is also
for my personal growth. Learning means having many opportunities in a variety of practice settings
such as hospitals, rehabilitation facilities, and patients’ homes. I can also work as part of a care team
that includes physicians, social workers, nursing aides, physical and occupational therapists, and other
caring professionals.
Asia’s FIRST IiP – Gold
Recognition for Commitment to Quality Management in 2012 Accredited University Granted INSTITUTIONAL ACCREDITATION Status Granted AUTONOMOUS Status
