CVA, Brain Tumor, Inflammatory Disease.

Question 1

Types of CVA:

Answer 1

embolic and hemorrhagic; most common cause is heart disease.

Question 2

Embolic CVA:

Answer 2

most common, easier to recover from; sudden impairment of cerebral blood flow; s/s: slurred speech, might stagger.

Question 3

Hemorrhagic CVA:

Answer 3

very devastating; blood outside vascular space = chemical damage to the brain tissue; will complain of horrific headache.

Question 4

TIA:

Answer 4

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.

Question 5

S/S of TIA:

Answer 5

vision problems - most common, speech problems, staggering, uncoordinated gait, unilateral weakness, falling.

Question 6

Most cerebral events occur:

Answer 6

around the Circle of Willis.

Question 7

CVA risk:

Answer 7

hx of TIA, atherosclerosis, HTN, arrhythmia, DM, rheumatic heart disease, cardiac enlargement, increased triglycerides, sedentary lifestyle, smoking, oral contraceptives, family hx.

Question 8

Most common type of CVA:

Answer 8

thrombotic; usually occurs in extracerebal vessels.

Question 9

TIA on a brain scan:

Answer 9

will look normal.

Question 10

S/S of cerebral hemorrhage:

Answer 10

eye deviation, stertorous breathing, pinpoint pupils, decreased LOC, coma, headache, NV, delirium, focal to generalized seizure.

Question 11

S/S after CVA:

Answer 11

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).

Question 12

Tx of embolic CVA:

Answer 12

clot busters - admin if no hx of head injury; ASA, anticoagulant, carotid endarterctomy.

Question 13

Tx of hemorrhagic CVA:

Answer 13

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.

Question 14

Nursing considerations with CVA:

Answer 14

ABC’s, oxygenation, adequate nutrition, preserve function, rehab, protect from injury, education; will recover over years.

Question 15

Brain tumor s/s:

Answer 15

headache, NV, increased ICP, visual changes, seizure, weakness/hemiparesis, speech changes, personality changes.

Question 16

Frontal tumor s/s:

Answer 16

personality changes, inappropriate affect, motor dysfunction, aphasia, seizure.

Question 17

Occipital tumor s/s:

Answer 17

headache, seizure, visual changes.

Question 18

Temporal tumor s/s:

Answer 18

olfactory, vision, complex partial seizure, receptive aphasia.

Question 19

Parietal tumor s/s:

Answer 19

inability to replicate pictures, less r-l discrimination, seizures, parasthesias, sensory.

Question 20

Tx of tumor:

Answer 20

chemo, steroids (tx swelling), anti-seizure meds, surgery, radiation.

Question 21

Encephalitis:

Answer 21

inflammation of the brain; common after brain abscess or after skull fracture.

Question 22

Meningitis:

Answer 22

inflammation/infection of meninges; higher mortality in kids.

Question 23

Meningitis is caused by:

Answer 23

bacteria, viruses, protoxoa, fungi, or 2nd to other infections; pneumonia, sinusitis, osteomyelitis, empyema, otitis media.

Question 24

Viral meningitis:

Answer 24

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.

Question 25

CSF will show _____ with viral meningitis.

Answer 25

increased protein.

Question 26

Tx of viral meningitis:

Answer 26

bed rest, f/e balance, analgesics for pain, exercise, no isolation, careful hand-washing.

Question 27

Bacterial meningitis:

Answer 27

caused by haemophilis, pneumococcal, meningiococcal; ISOLATE; fever at 106, ice packs, cooling blankets.

Question 28

Dx and Tx of meningitis:

Answer 28

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.

Question 29

Myasthenia gravis:

Answer 29

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.

Question 30

Causes of MG:

Answer 30

autoimmune disorder; antibodies produced by the thymus; stress, sinusitis, and common cold can cause exacerbation.

Question 31

S/S of MG:

Answer 31

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.

Question 32

Dx of MG:

Answer 32

Tensilon test: temporary improvement in symptoms after IV injection of edrophonium or neostigmine; + results in 3-60 seconds.

Question 33

Tx of MG:

Answer 33

relieve symptoms, anti-cholinesterase (neostigmine), steroids, plasmaphoresis, thymectomy, acute exacerbations, trach, ventilator – CPAP work very well.

Question 34

Nursing interventions in MG:

Answer 34

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.

Question 35

Guillain-Barré syndrome:

Answer 35

paralysis starts at feet and comes up; myelin sheath degenerates = inflammation = swelling and demyelinization.
if dorsal root - sensory deficit.
if ventral root - motor deficit.

Question 36

3 phases of GB:

Answer 36

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.

Question 37

Complications of GB:

Answer 37

thrombophlebitis, pressure ulcers, contractures, muscle wasting, aspiration, respiratory infections, cardiac compromise.

Question 38

S/S of GB:

Answer 38

symmetrical paralysis; causes problems with resp, talking, swallowing, bowel and bladder.

Question 39

Assessment with GB:

Answer 39

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.

Question 40

Dx and Tx of GB:

Answer 40

Dx: increase protein in CSF, EMG, electrophysiologic studies show slowing of nerve conduction velocities.
Tx: supportive, intubate, trach, ECG, plasmaphoresis.

Question 41

Interventions with GB:

Answer 41

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.

Question 42

Trigeminal neuralgia:

Answer 42

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.

Question 43

Tx of TN:

Answer 43

tegretol or dilantin; percutaneous radiofrequency tx - will cause partial numbness of face; microsurgery via craniotomy - advantage is no sensory loss in face.

Question 44

Bell’s palsy:

Answer 44

unilateral facial weakness/paralysis; blocked impulses from 7th CN secondary to inflammatory rxn around the nerve.

Question 45

S/S of Bell’s:

Answer 45

drooping mouth, difficulty eating, taste perception disorder, can’t puff cheeks, raise eyebrows, show teeth.

Question 46

Tx of Bell’s:

Answer 46

prednisone, analgesics.

support, assist with nutrition, prevent corneal abrasion, emotional support.