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Med Surg > Burns and Neurological Disorders > Flashcards

Burns and Neurological Disorders Flashcards

1
Q

When does cell death occur with stroke?

A

3-10 minutes

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2
Q

What are the two types of stroke?

A
  1. ischemic (caused by thrombosis or embolism (80%; most common)
  2. hemorrhagic (used by bleeding into the brain tissue or the subacrnoid space creating necrosis)
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3
Q

What is a TIA

A

warning sign that a stroke is imminent

~ transient decrease in blood supply to an area of the brain

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4
Q

S/s of a TIA

A
  • sharp pain
  • rapid onset of weakness
  • vertigo
  • aphasia
  • visual field cuts (diplopia)
  • ** symptoms usually last for about an hour
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5
Q

What is the single most important risk factor for stroke?

A

HTN (modifiable)

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6
Q

What are non-modifiable risk factors for stroke?

A
  • age >65
  • AA
  • Male
  • Family Hx
  • sickle-cell disease
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7
Q

What are the modifiable risk factors for stroke?

A
  • HTN
  • Smoking
  • obesity
  • contraceptives
  • inc cholesterol
  • uncontrolled diabetes
  • sleep apnea
  • metabolic syndrome
  • heart disease
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8
Q

Why does the condition of a stroke client improve after several days

A

d/t decrease in edema

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9
Q

What is the treatment for a TIA

A
  • aspirin

Surgical: carotid endarterectomy (remove the plaque or insert a stent)

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10
Q

post op care for a carotid endarterectomy

A
  • 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
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11
Q

Post carotid endarterectomy patent has a much lower BP than they had prior what do we expect

A

hemorrhage

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12
Q

What are the warning signs and symptoms of a stroke?

A 
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
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13
Q

What are the different types of strokes?

A
  • 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
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14
Q

What are the s/s of a stroke

A 
HA
N/v
HTN
mental status changes
dysphagia
flaccidiity/spasticity
seizures
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15
Q

How do they diagnose a stroke

A
  • 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
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16
Q

How soon after someone arrives to the ER and you suspect a stroke must they be taken into CT/MRI?

A

w/n 25 minutes of arrival

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17
Q

What do you do on arrival of a patient with suspected stroke?

A
  • 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
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18
Q

What to assess for stroke patient?

A
  • LOC, PERRLA, visual fields
  • FAST
  • what time did the onset occur (for TPA)
  • sensation and reflexes
  • VS
  • bladder/bowel incontinence
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19
Q

How do we reduce HTN for stroke puts?

A
  • we can ONLY give vasodilators if systolic BP is greater than 220
  • slowly with metoprolol or nicardipine
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20
Q

What do we use to reduce HTN for a pt with a hemorrhagic stroke

A

nimopidine

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21
Q

What must be done before we give TPA

A
  • 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
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22
Q

What are the contraindications of TPA

A
  • outside of 3 hour window
  • hx of GI bleed
  • previous stroke
  • head trauma w/n past 3 months
  • major surgery w/ 14 days
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23
Q

What are complications of a stroke?

A
  • intracranial hemorrhage and systemic bleeding
  • cerebral edema
  • in BG
  • stroke recurrence
    aspiration
  • coma
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24
Q

What orders are going to be placed with TPA

A
  • NG tube
  • foley
  • multiple IVs (min of 20G)
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25
Q

When must TPA be administered

A

within 3- 4.5 hours after a stroke

26
Q

When can you put someone on anti platelet therapy after the administration of TPA?

A
  • after 48 hours

- must first do a guac to determine if there is a GI bleed

27
Q

What are the nursing interventions for a hemorrhagic stroke?

A
  • 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
28
Q

What is the surgical management for hemorrhagic stroke?

A

clip and wrap the aneurysm or put a coil to prevent rupture

29
Q

Post- Stroke Nursing Management

A
  • 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
30
Q

What can we do to prevent contractures?

A
  • 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
31
Q

How long must post-stroke patients remain upright after eating

A

30 mins

32
Q

How can we ensure the best position to put the utensil in their mouth?

A
  • have them turn their head slightly to the affected side and slightly tuck their chin into their chest
33
Q

homonymous hemianopsia

A

blindness in the same half of each visual field

pt cannot see past the midline without turning their head to that side

34
Q

diplopia

A

double vision

- give them an eye patch and have them alternate it

35
Q

how do we test for coral reflex

A

wisp test

36
Q

ptosis

A

drooping eyelid

37
Q

hemiparesis

A

weakness to one side

38
Q

hemiplegia

A

paralysis of one side

39
Q

expressive aphasia

A

pt can understand the words that you are saying but cannot verbally respond

40
Q

aphasia

A

communication deficits

41
Q

dysarthria

A

articulation difficulty

have them stand in front of the mirror to practice

42
Q

agnosia

A

visual or auditory; cannot recognize familiar objects

43
Q

apraxia

A

loss of purposeful movement

44
Q

unilateral neglect

A

neglect the side of the body that is affected ; cannot purposely move that side of the body

45
Q

What are behavioral changes post-stroke

A
  • agression
  • passive or excessive crying
  • will not sensor speech
46
Q

What is the reason for a therapeutic pass?

A

to allow the pt to practice selfs-care skills
help the family adjust to pt’s presence
improve transition back into the community

47
Q

Munro-Kellie hypothesis (cranial vault)

A
  • brain tissue ( makes up 78%)
  • blood (12%)
  • CSF (10%)
48
Q

risk factors for inc ICP

A 
head injury
brain tumor
cerebral bleeding
hydrocephalus
edema from injury or surgery
49
Q

what is normal ICP

A

5-15 mmHg

50
Q

What ICP level indicates ischemia or brain death

A

> 20

51
Q

cerebral perfusion pressure (CPP)

A

amount of blood flow required to provide adequate oxygen and glucose for brain metabolism
60-100 mm Hg

52
Q

What CPP level indicates ischemia or brain death

A

<50

53
Q

Formula for CPP

A

MAP- ICP

54
Q

MAP

A

average pressure during cardiac cycle (SBP + (DBP x 2)) / 3

55
Q

If MAP and ICP are the same

A

they are dead

56
Q

What influences ICP?

A
  • arterial and venous pressure
  • intra-abdominal pressure
  • intra-thoracic pressure
  • posture
  • temperature
  • blood gasses (CO2 level)
57
Q

What are the 3 vitamin deficiencies that we need to rule out for dementia?

A
  • vit B12
  • vit B6
  • Vit D
58
Q

What do we need to r/o before diagnosing AD?

A
  • B12
  • B6
  • folic acid
59
Q

circumlocution

A

talking in circles

60
Q

paraphasia

A

using words in the wrong context

61
Q

palilalia

A

repeating the same word like a parrot

62
Q

echolalia

A

involuntary repeating words of others

Med Surg (7 decks)

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