409 Final 1 Flashcards
GBS is a ___ situation
acute
Overall description of GBS
Its an acute inflammatory syndrome, where the nerves lose their myelin sheath
GBS affects the peripheral nervous system which means it affects
sensory and motor stuff
GBS produces ____ motor weakness
progressive
GBS: where do the symptoms usually start
in the legs, and then work their way up
GBS: ascending paralysis means
the symptoms start in the legs and work their way up
How does healing occur in GBS
in the reverse order that symptoms progressed in
GBS: the general result of destruction of the myelin sheath is
it messes up nerve impulses
GBS is an acute disorder but it’s possible
to have permanent damage
GBS: the cause is unknown, but a clue can be that they had ___ or ___
epstein-barr or cytomega
GBS: Viruses like epstein-barr could cause the body’s
immune system to react in a messed up way and start attacking itself (which is GBS)
What do you teach PD patients about walking
do NOT look at your feet to prevent falls
PD: why might it be a bad idea to drive
they could have trouble sleeping at night, might fall asleep while driving
PD: they could have trouble communicating. What should you teach them
speak slowly, take deep breaths, exaggerate words if needed
PD: not all of them have dementia but
its common to have some kind of cognitive problem
PD: if they feel really embarrassed
dont FORCE them into social situations
Whats a good exercise for PD patients
light aerobic
PD: if drugs don’t help,
the last resort is surgery
Stereotactic Pallidotomy/Thalamotomy
Deep Brain Stim
Fetal Tissue Trans
Surgical tx for PD
A stroke happens when
there’s not enough blood to the brain
Stroke: There will be damage to the infarction area and maybe also
damage to the opposite side (contralateral) because of brain swelling
2 main types of stroke
Ischemic and Hemorrhagic
Types of ischemic stroke
Thrombotic and Embolic
Types of Hemorrhagic stroke
Aneurysm
HTN
Arteriovenous malformation
The most common type of stroke is
Ischemic (as opposed to hemorrhagic)
What kind of ischemic stroke develops slowly over minutes of hours
Thrombotic
In an embolic stroke, the emboli usually comes from
the heart
Stroke at night vs stroke in the day
Both kinds of ischemic strokes happen at night, the hemorrhagic strokes happen in the day
After the initial onset, hemorrhagic stroke signs
keep getting worse, because you keep bleedings (whereas with embolic stroke you might start to see some improvement after onset)
Stroke: if the symptoms come and go,
that might just be a TIA or reversible ischemic neuro deficit
Reversible ischemic neuro deficit last
longer than 24 hours
Compared to Reversible ischemic neuro deficits, TIAs are
are shorter, sometimes only an hour
Stroke: by the time they get to the ED its often resolved
TIA
Medication for a TIA
clopi (antiplatelet)
Stroke: if they suddenly say I have the worst headache of my life it could be
Aneurysm
When a stroke patient comes to the ED, the most important thing to assess is
LOC
To maintain perfusion during a stroke, you want the BP
to be a little high, 150/100
Stroke: assess for emotional swings if
the frontal lobe is involved
Stroke: the ECG might show
decreased T wave
ST depression
prolonged QT interval
For ischemic strokes, start 2 IV lines with
non-dextrose saline
Stroke: If the thrombus is in the carotid artery
they can do an endarterectomy, otherwise they need thrombolytics
You need to give TPA within
3 hours
Ischemic stroke: After you give TPA, if sys is greater than 180 or dys is greater than 105
they may need anti-hypertensives
Ischemic stroke: Don’t insert a urinary catheter until they’re stable because
you don’t want to cause bleeding
Ischemic stroke: If you detect ICP
escalate immediately
ICP: only suction if
they really need it because suctioning increases ICP
ICP: how should you handle various care tasks
do NOT cluster them because that’d increase ICP, you need to space them out
ICP: if sys is greater than 200
notify provider and recommend anti-HTN meds
Stroke: The goals of long term drug therapy are
Prevent future stroke
Prevent hypoxic damage to nerves
Stroke: aspirin consideration
an initial dose should be given, but not if they got TPA within 24 hours
Stroke: you may need a CCB to prevent
vasospasm
Vasospasm tends to happen ____ after stroke
a week
Stroke: What kind of environment do you want them to eat in
low stimulus (so they don’t get distracted and choke)
Stroke: for patients with receptive aphasia, speak
slowly but not loudly
Stroke: for patients with receptive aphasia, don’t communicate using
yes or no questions (because they might just give an automatic response)
Stroke: You should approach the patient on their ___ side
unaffected
Stroke: When getting dressed they should do their ___ side first
affected
GBS: ask about pins and needles aka
parasthesias
GBS: most people report a sudden
muscle weakness
GBS: you don’t have problems with ___ or ___
LOC or pupils
GBS: tx could include ___ or ___ but not both
PE or immunoglobulin
GBS: don’t give ___ unless you really have to
steroids
GBS: keep HOB
at least 45 degrees
GBS: keep them on a cardiac monitor because
they’re at risk for dysrhythmia
GBS: hypotn is treated with
fluids and place them in supine (unless they’re really having trouble breathing)
GBS: bradycardia is treated with
Atropine
GBS: pain is usually treated with opiates. We might use TCAs but don’t give them to
older adults
