2.2 Nursing Management of Neurological Cerebrovascular Disorders Flashcards
1
Q
Cerebrovascular Disorder
A
- Umbrella term for functional abnormalities of CNS
- Stroke is the primary one and 5th leading cause of death.
Ischemic - 80-87% of strokes
Hemorrhagic - 13-20% of strokes
2
Q
Strokes
A
- Profound financial impact related to stroke/disability
- 7 million people alive today after stroke and costs about 33 billion in medical care and lost wages/caregiver burden
- Prevention is the key to strokes
3
Q
Non-Modifiable Risks
A
- Age, Gender, Race
- Ages 55+ are at higher risk
- Males are at higher risk
- African Americans are at higher risk
4
Q
Modifiable Risk
A
- Hypertension
- CVD
- Increased Cholesterol
- Obesity
- Diabetes
- Alcohol/Drugs/Smoking
- Woman at childbearing age who take oral contraceptives
5
Q
Categories of Ischemic Stroke
A
- 20% large artery thrombosis
- 25% small penetrating artery thrombosis
- Atrial defibrillation who develop clots in the atrium can travel to the brain
- Largest portion 30% are cryptogenic strokes (no known cause)
- 5% due to drug or cocaine use
6
Q
Origin of Stroke
A
- Plaque can develop in any large vessel
Brain, coronary arteries, vessels of legs
7
Q
Ischemic Cascade
A
- Ischemic strokes can cause a wide variety of neurological deficits depending on size, location, collateral blood flow (flow around occlusion area)
- NIHSS Scale is a stroke scale
1-4 = Mild stroke
5-15 = Moderate
15-20 = Moderate/Severe
21-42 = Severe
8
Q
Diagnostic Tests for Stroke
A
- First do a non-contrast CT scan
(25 minutes or less of patient arriving to ER) - Stroke alert code to alert everyone
- Monitor ABC’s
- Do they need to be intubated, what are their blood pressure and vital signs
- Keeping head of bed up will help with cerebral perfusion and airway
- Constantly monitor for changes in vital signs and neural status
9
Q
What to do during a stroke
A
- Change in level of consciousness or change in pupils
- These could be evidence of continued bleed or re-bleed or swelling of the brain
- Ischemic Stroke is treated with TA (Tissue Plasma Activator)
- Never give TA to Hemorrhagic Stroke
- If stroke onset was less than 3 hours treatment can be started (Beyond that TA may not be used)
10
Q
Assessment of Stroke
A
- First Step is assessment (Acute phase)
- Assess vital signs, level of consciousness, motor symptoms, speech, pupil changes, eyes, nose, intake and output.
- Blood pressure is important, elevation is not good, bleeding, oxygen saturation.
- Can they maintain airways
11
Q
Assessment of Stroke
A
Post Acute Phase Nursing Care
- Monitor Mental Status (motor control)
- Swallowing ability (gag reflex, aspirations, nutritional hydration, skin integrity)
- Check for numbness, mobility, paralysis, activity tolerance, bowel/bladder function.
- Make a NANDA nursing diagnoses
- Check for decreased cerebral blood flow, inadequate oxygen to the brain, risk of pneumonia, encourage patients to take deep breaths and cough every 2 hours.
12
Q
GOALS of Stroke
A
- Make sure it is measurable
- Ambulate length of hall or use walker 3 times a day
- Implement our goals by assisting patient out of bed, or teaching proper use of a cane or walker. Physical Therapy.
- Range of motion exercises every 4 hours
- Encourage patient to exercise with unaffected side with passive ROM on affected side
- Encourage person hygiene and do not neglect affected side
13
Q
GOALS of Stroke
A
- Encourage patient to turn head if there is peripheral vision loss
- Speech therapists teach swallowing and nutritional services.
- Patients should preferably sit up and out of bed to eat
- Bowel and bladder issues, we should assess schedule of voiding
- Measure fiber and fluid intake for patient and adding fiber/liquid if needed to prevent constipation.
14
Q
Evaluation of Stroke
A
- ## If goals were met we can close them out, if they were not met we should re-evaluate and change intervention
15
Q
Transient Ischemic Attack
A
- Same symptoms. Considered mini stroke or warning sign
- Temporary symptoms that last 1-2 hours.
- Sudden loss of motor/sensory/visual function
- Brain Imaging and CAT scan would still occur
- Does not show signs of ischemia or blockage
- ## These are usually warning signs and are referred to primary care doctor for plaque
16
Q
Transient Ischemic Attack
A
- They can get Ultrasound/MRI of their carotid
The main thing for TIA is prevention - Antihypertensive medications and ACE inhibitors.
- Frequent monitoring of neural and vital signs as well as ABC.
- Keep patients on bed rest with sedation and oxygen therapy
17
Q
Treatment of TIA
A
- Prevention include antihypertensive medications or ace inhibitors (captopril)
- Diuretics
- Antiplatelet therapy would be secondary treatment to decrease cholesterol levels
- Look for causes and risk factors and treat them to prevent future stroke.
18
Q
Hemorrhagic Stroke
A
- Rupture of blood vessel caused by uncontrolled hypertension.
- Primary injury results from bleed itself but secondary brain injury can occur related to reduced perfusion to brain
19
Q
Symptoms of Hemorrhagic Stroke
A
- Severe Headache, changes in level of consciousness or pupils, vomiting, cranial nerve deficits, speech difficulties, visual disturbances.
- Nursing diagnoses include risk of ineffective tissue perfusion, cerebral related bleeding or vasospasm, anxiety
- ## Issues of hemorrhagic strokes include re-bleeding or hematoma expansion. If hematoma expands it can exert pressure on the brain again
20
Q
Symptoms of Hemorrhagic Stroke
A
- Electrolyte imbalances such as natremia. Vasospasms are related to hyponatremia.
21
Q
Interventions of Hemorrhagic Stroke
A
- Allow brain to recover from initial insult
- Prevent and minimize risk of re-bleed
- Bed rest, sedation, antiseizure med (Dilantin) surgical treatment for aneurysm
- Seizure precautions, potential for discharge into rehab
- Can patient preform ADL’s, do they need assistive devices, education on whoever will be taking care of them.
- Shoulder pain is common with stroke patients so do not rotate shoulder. Teach caregiver about nutrition, speech therapy, swallow study.
- ## Dysphagia, thickened food
22
Q
Medical Management of Stroke
A
FAST - CT scan must be within 25 minutes of patient arriving to determine if it is ischemic or hemorrhagic.
23
Q
Nursing Mangement
A
- ABC’s, frequent neuro checks and keep head of bed up if no contraindications
24
Q
Ischemic Strokes Subtypes
A
Large Artery Thrombosis Small Penetrating artery thrombosis Cardiogenic Embolus (related to A-Fibrillation) Cryptogenic (unknown cause) Drug use related
25
TIA (Transient Ischemic Attack)
- Neurological symptoms similar to stroke
- Lasts 1-2 hours
- CT scan shows no evidence of stroke
- Warning signs (15% of strokes are preceded with TIA)
- Look at carotid, rule out a-fib, looking for plaque
