CVA, Brain Tumor, Inflammatory Disease. Flashcards
Types of CVA:
embolic and hemorrhagic; most common cause is heart disease.
Embolic CVA:
most common, easier to recover from; sudden impairment of cerebral blood flow; s/s: slurred speech, might stagger.
Hemorrhagic CVA:
very devastating; blood outside vascular space = chemical damage to the brain tissue; will complain of horrific headache.
TIA:
mini stroke; onset: seconds to hours, clears in 12-24 hours; microemboli form = thrombosis = spasm; risks same as CVA - HTN, diabetes, smoking, obesity, stress, hyperlipidemia.
S/S of TIA:
vision problems - most common, speech problems, staggering, uncoordinated gait, unilateral weakness, falling.
Most cerebral events occur:
around the Circle of Willis.
CVA risk:
hx of TIA, atherosclerosis, HTN, arrhythmia, DM, rheumatic heart disease, cardiac enlargement, increased triglycerides, sedentary lifestyle, smoking, oral contraceptives, family hx.
Most common type of CVA:
thrombotic; usually occurs in extracerebal vessels.
TIA on a brain scan:
will look normal.
S/S of cerebral hemorrhage:
eye deviation, stertorous breathing, pinpoint pupils, decreased LOC, coma, headache, NV, delirium, focal to generalized seizure.
S/S after CVA:
headache, mental changes, aphasia (LCVA), resp problems, decreased cough/swallow reflex, agnosia, incontinence, seizures, hemiparesis/hemiplegia, hyperthermia, emotional lability, visual changes (homonymous hemianopsia, horner’s syndrome), vomiting, perceptual defects (RCVA), hypertension, apraxia (decreased learned movements).
Tx of embolic CVA:
clot busters - admin if no hx of head injury; ASA, anticoagulant, carotid endarterctomy.
Tx of hemorrhagic CVA:
hope; the more extensive the bleed, the greater the damage; damage is irreversible; must wait til bleed stops - maintain ABC’s; start looking at advanced directives.
Nursing considerations with CVA:
ABC’s, oxygenation, adequate nutrition, preserve function, rehab, protect from injury, education; will recover over years.
Brain tumor s/s:
headache, NV, increased ICP, visual changes, seizure, weakness/hemiparesis, speech changes, personality changes.
Frontal tumor s/s:
personality changes, inappropriate affect, motor dysfunction, aphasia, seizure.
Occipital tumor s/s:
headache, seizure, visual changes.
Temporal tumor s/s:
olfactory, vision, complex partial seizure, receptive aphasia.
Parietal tumor s/s:
inability to replicate pictures, less r-l discrimination, seizures, parasthesias, sensory.
Tx of tumor:
chemo, steroids (tx swelling), anti-seizure meds, surgery, radiation.
Encephalitis:
inflammation of the brain; common after brain abscess or after skull fracture.
Meningitis:
inflammation/infection of meninges; higher mortality in kids.
Meningitis is caused by:
bacteria, viruses, protoxoa, fungi, or 2nd to other infections; pneumonia, sinusitis, osteomyelitis, empyema, otitis media.
Viral meningitis:
headache, temp, change in LOC< stiff neck, recent illness, NV, abd pain, neg bacterial cultures; caused by enteroviruses, aboriviruses, herpes simplex, mumps; sudden onset; nuchal rigidity; fever 101-102.
CSF will show _____ with viral meningitis.
increased protein.
Tx of viral meningitis:
bed rest, f/e balance, analgesics for pain, exercise, no isolation, careful hand-washing.
Bacterial meningitis:
caused by haemophilis, pneumococcal, meningiococcal; ISOLATE; fever at 106, ice packs, cooling blankets.
Dx and Tx of meningitis:
lumbar puncture (culture CSF), + Kernig or Brudzinski; IV or intra-thecal antibiotics; steroids, anticonvulsants (usually on dilantin drip), resp isolation for meningiococcal only, antipyretics, ice packs.
Myasthenia gravis:
produces sporadic but progressive weakness and easy fatigue of skeletal muscle; includes respiratory system, difficulty swallowing, aspiration; will be on vent until out of exacerbation; usually muscles of cranial nerves or other muscle groups.
Causes of MG:
autoimmune disorder; antibodies produced by the thymus; stress, sinusitis, and common cold can cause exacerbation.
S/S of MG:
progressive muscle weakness, ptosis and diplopia, chewing/swallowing difficulties, rare report of leg weakness, milder in AM, sleepy expression, drooping jaw, hypoventilation.
do most care in the morning.
Dx of MG:
Tensilon test: temporary improvement in symptoms after IV injection of edrophonium or neostigmine; + results in 3-60 seconds.
Tx of MG:
relieve symptoms, anti-cholinesterase (neostigmine), steroids, plasmaphoresis, thymectomy, acute exacerbations, trach, ventilator – CPAP work very well.
Nursing interventions in MG:
psych support, establish neuro/resp baseline, be alert to s/s crisis, give meds on time - admin meds 20-30 min before eating, soft semi-solid food if problems w/ swallowing, teach pt. to avoid strenuous exercise, avoid alcohol.
Guillain-Barré syndrome:
paralysis starts at feet and comes up; myelin sheath degenerates = inflammation = swelling and demyelinization.
if dorsal root - sensory deficit.
if ventral root - motor deficit.
3 phases of GB:
acute: onset - 1-3 weeks when no further deterioration.
plateau: several days - 2 weeks.
recovery: coincides with remyelinization and axonal process regrowth; 4-6 months.
Complications of GB:
thrombophlebitis, pressure ulcers, contractures, muscle wasting, aspiration, respiratory infections, cardiac compromise.
S/S of GB:
symmetrical paralysis; causes problems with resp, talking, swallowing, bowel and bladder.
Assessment with GB:
hx of febrile illness - up to 4 weeks prior; tingling/numbess in legs moving upward; stiffness in calves, neuro weakness, sensory loss, cranial nerve deficit.
Dx and Tx of GB:
Dx: increase protein in CSF, EMG, electrophysiologic studies show slowing of nerve conduction velocities.
Tx: supportive, intubate, trach, ECG, plasmaphoresis.
Interventions with GB:
VS, LOC, resp status, breath sounds, vent support, skin care, ROM, assess gag, check for urinary retention, eyedrops/shield, relieve constipation, communication alternatives (pen and pad, etc.), diversion, family support.
Trigeminal neuralgia:
painful disorder of 1 or more tracts of the 5th CN; more in females; burning sensation for 1-15 minutes; may be precipitated by air, heat, cold, eating, smiling, drinking hot/cold beverages.
Tx of TN:
tegretol or dilantin; percutaneous radiofrequency tx - will cause partial numbness of face; microsurgery via craniotomy - advantage is no sensory loss in face.
Bell’s palsy:
unilateral facial weakness/paralysis; blocked impulses from 7th CN secondary to inflammatory rxn around the nerve.
S/S of Bell’s:
drooping mouth, difficulty eating, taste perception disorder, can’t puff cheeks, raise eyebrows, show teeth.
Tx of Bell’s:
prednisone, analgesics.
support, assist with nutrition, prevent corneal abrasion, emotional support.
