Final Project paper NURS 6052

PICOT and Evidence Based Practice Question

What is the Practice Issue?

The following is the Practice Issue For The Study. “Does brain hemispherectomy have more detrimental effects on an adult’s cognitive abilities than in children due to their brain’s plasticity over a period of six months?”

The chances of one developing postoperative Aphasia are higher in adults than in children. Researchers define Aphasia as a condition that develops due to a person’s anatomical cognitive abilities getting impaired. This can be through the lesions. The condition can be classified as either: Broca’s or Wernicke’s Aphasia. Aphasics have been shown to be poor in their communication skills, but have fairly commendable intellectual abilities. Brain hemispherectomy has in the past been performed on epileptic patients that failed to show positive improvement while under medication. This then necessitates the removal of one of the brain’s hemispheres to help reduce the occurrence of seizures and improvement of the patient’s overall quality of life.

Whilst, most patients actually recorded a positive reduction or complete elimination of their seizures, some lost most of their language cognitive abilities. Most of them also had a much harder time identifying and naming objects/tools that were placed in their right hands than when the same objects were placed in their left hands, a few months after the surgery. This has raised questions among health professionals as to what approach should be considered when dealing with an adult epileptic patient. There has been consideration of the suggestions on the abandonment of hemispherectomy and embracing of the alternative Corpus Callostomy to regulate electrical activity in the brain. It is because studies have shown that children had a quicker recovery time from seizures and did not have to grapple with the detrimental effects after removal of one their brain hemisphere. It has been accredited to their brain’s plasticity; where, their language and cognitive abilities are allocated to the brain’s right hemisphere.

What is the practice area?

Clinical

I work as a nurse at the Angels Health Centre in California. It is a 500 licensed bed capacity hospital with 450 physicians. It is a revered medical Centre having pioneered numerous researches on global medicine. It acts as a research hub for practicing physicians and medical students. The institution has various departments, namely: Nutrition and dietetics, oncology, gynecology, ophthalmology, dermatology, pediatrics and dentistry departments. The institution has, to date, been able to carry out 500 children hemispherectomy surgeries and about 300 adults on the same. It has also performed 259 corpus callostomy surgeries with an 87% success rate on all the performed surgeries.

How was the practice issue identified?

Contrasting end results between young and mature adult patients before and after surgery;

· Most of the adult and children patients had gotten relief from their seizures after surgery.

· Most of the adult cognitive abilities deteriorated most of which include: their linguistic abilities and their quick identification of things.

· There had been coverage of successful treatment of epilepsy in children than in their adult counterparts.

Wide Variation in Practice.

There had been evidence of successful hemispherectomy in children and adults leading to the complete elimination of seizures. However, there had been challenges of adults acquiring Aphasia after the surgery. The research was conducted using the following healthcare sites; http://ncbi.nlm.gov http://jnnp.bmj.com, http://surgeryencyclopedia.com , http://researchgate, http://clevelandclinic.org. There had been close selection of articles that contained scientific detail backing, documented cases of real life patients who underwent the procedure and their outcomes thereafter.