Burns and Neurological Disorders Flashcards
When does cell death occur with stroke?
3-10 minutes
What are the two types of stroke?
- ischemic (caused by thrombosis or embolism (80%; most common)
- hemorrhagic (used by bleeding into the brain tissue or the subacrnoid space creating necrosis)
What is a TIA
warning sign that a stroke is imminent
~ transient decrease in blood supply to an area of the brain
S/s of a TIA
- sharp pain
- rapid onset of weakness
- vertigo
- aphasia
- visual field cuts (diplopia)
- ** symptoms usually last for about an hour
What is the single most important risk factor for stroke?
HTN (modifiable)
What are non-modifiable risk factors for stroke?
- age >65
- AA
- Male
- Family Hx
- sickle-cell disease
What are the modifiable risk factors for stroke?
- HTN
- Smoking
- obesity
- contraceptives
- inc cholesterol
- uncontrolled diabetes
- sleep apnea
- metabolic syndrome
- heart disease
Why does the condition of a stroke client improve after several days
d/t decrease in edema
What is the treatment for a TIA
- aspirin
Surgical: carotid endarterectomy (remove the plaque or insert a stent)
post op care for a carotid endarterectomy
- check q 1-2 hours
- keep head in a straight alignment to maintain latency of breathing and to minimize stress to the operative site
- HOB elevated per dr orders
- maintain BP w/n 20 mmHg
Post carotid endarterectomy patent has a much lower BP than they had prior what do we expect
hemorrhage
What are the warning signs and symptoms of a stroke?
FAST - face- ask to smile and look for droop - arms- elevate with palms up - speech- ask them to repeat a simple phase and observe for slurring - time- call 911
What are the different types of strokes?
- thrombolitic: develops over minutes to hours (partial or complete occlusion)
- embolitic: occurs suddenly without warning (pt might remain conscious but have a headache
- hemorrhagic: occurs rapidly “worst headache of my life” then drop dead
What are the s/s of a stroke
HA N/v HTN mental status changes dysphagia flaccidiity/spasticity seizures
How do they diagnose a stroke
- CT: to discriminate btw hemrrhage or ischemic and determine size and location
- MRI: to see if it will leak into other areas
- EKG
- Cerebral angiography: helps visualize blood vessels in the brain and determine where the plaques are located
- lumbar puncture
- carotid duplex
How soon after someone arrives to the ER and you suspect a stroke must they be taken into CT/MRI?
w/n 25 minutes of arrival
What do you do on arrival of a patient with suspected stroke?
- CT scan immediately
- maintain airway (remove dentures)
- pulse Ox
- admin O2 (>95)
- IV assess with NS
- maintain BP
- baseline labs
- keep head midline and elevate HOB 15-20 degrees
- seizure precautions
- anticipate thrombolytic TPA therapy for ischemic stroke
What to assess for stroke patient?
- LOC, PERRLA, visual fields
- FAST
- what time did the onset occur (for TPA)
- sensation and reflexes
- VS
- bladder/bowel incontinence
How do we reduce HTN for stroke puts?
- we can ONLY give vasodilators if systolic BP is greater than 220
- slowly with metoprolol or nicardipine
What do we use to reduce HTN for a pt with a hemorrhagic stroke
nimopidine
What must be done before we give TPA
- must have a MRI or non-contrast CT to r/o hemorrhagic stroke
- must stop TPA infusion if there are signs and symptoms of HA, n/v, or changes in LOC
What are the contraindications of TPA
- outside of 3 hour window
- hx of GI bleed
- previous stroke
- head trauma w/n past 3 months
- major surgery w/ 14 days
What are complications of a stroke?
- intracranial hemorrhage and systemic bleeding
- cerebral edema
- in BG
- stroke recurrence
aspiration - coma
What orders are going to be placed with TPA
- NG tube
- foley
- multiple IVs (min of 20G)
When must TPA be administered
within 3- 4.5 hours after a stroke
When can you put someone on anti platelet therapy after the administration of TPA?
- after 48 hours
- must first do a guac to determine if there is a GI bleed
What are the nursing interventions for a hemorrhagic stroke?
- gather PMH
- figure out if they are on anticoagulants
- send to OR
- place intermittent pneumatic compression stocking if pt has a stroke from a ruptured aneurysm
What is the surgical management for hemorrhagic stroke?
clip and wrap the aneurysm or put a coil to prevent rupture
Post- Stroke Nursing Management
- prevent atelectasis, aspiration pneumonia, and airway obstruction
- keep pt NPO until we can r/o dysphagia
- monitor neurologic condition
- assess for retention, DVD, BP variations
- prevent dehydration/over-hydration
- position pt for a MAX OF 30 MIN on the weak or paralyzed side
- ST, OT, PT
- prevent joint contractors and muscular atrophy
- posterior leg splints or footboards to prevent foot drop
What can we do to prevent contractures?
- perfomr passive ROM to affected limbs at least 2x a day after the first 24 hours
- support flaccid arm with pillow when in bed or chair
place pt in the prone position for 15-30 mins - use hightop tennis shoes when in bed to prevent foot drop
How long must post-stroke patients remain upright after eating
30 mins
How can we ensure the best position to put the utensil in their mouth?
- have them turn their head slightly to the affected side and slightly tuck their chin into their chest
homonymous hemianopsia
blindness in the same half of each visual field
pt cannot see past the midline without turning their head to that side
diplopia
double vision
- give them an eye patch and have them alternate it
how do we test for coral reflex
wisp test
ptosis
drooping eyelid
hemiparesis
weakness to one side
hemiplegia
paralysis of one side
expressive aphasia
pt can understand the words that you are saying but cannot verbally respond
aphasia
communication deficits
dysarthria
articulation difficulty
have them stand in front of the mirror to practice
agnosia
visual or auditory; cannot recognize familiar objects
apraxia
loss of purposeful movement
unilateral neglect
neglect the side of the body that is affected ; cannot purposely move that side of the body
What are behavioral changes post-stroke
- agression
- passive or excessive crying
- will not sensor speech
What is the reason for a therapeutic pass?
to allow the pt to practice selfs-care skills
help the family adjust to pt’s presence
improve transition back into the community
Munro-Kellie hypothesis (cranial vault)
- brain tissue ( makes up 78%)
- blood (12%)
- CSF (10%)
risk factors for inc ICP
head injury brain tumor cerebral bleeding hydrocephalus edema from injury or surgery
what is normal ICP
5-15 mmHg
What ICP level indicates ischemia or brain death
> 20
cerebral perfusion pressure (CPP)
amount of blood flow required to provide adequate oxygen and glucose for brain metabolism
60-100 mm Hg
What CPP level indicates ischemia or brain death
<50
Formula for CPP
MAP- ICP
MAP
average pressure during cardiac cycle (SBP + (DBP x 2)) / 3
If MAP and ICP are the same
they are dead
What influences ICP?
- arterial and venous pressure
- intra-abdominal pressure
- intra-thoracic pressure
- posture
- temperature
- blood gasses (CO2 level)
What are the 3 vitamin deficiencies that we need to rule out for dementia?
- vit B12
- vit B6
- Vit D
What do we need to r/o before diagnosing AD?
- B12
- B6
- folic acid
circumlocution
talking in circles
paraphasia
using words in the wrong context
palilalia
repeating the same word like a parrot
echolalia
involuntary repeating words of others
