Exam 2 Flashcards by Krissa Thrift

B.E. F.A.S.T

Balance issues
Eye changes
Facial drooping
Arm weakness
Slurred speech
Time to call 911

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What do you need to teach family members if their loved one is having a stroke?

teach family member to take note of when the symptoms start

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What foods to avoid when on anticoag therapy

foods high in vitamin K

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What do thrombolytics do?

dissolve clots; they are clot busters

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GI Bleeding
GU Bleeding
Intracranial bleeding
Allergic RXN
BP
Arrhythmias
Ecchymosis
Flushing
N/V
Hemoptysis
Nose/Gums bleeds

are all S/E of what?

Thrombolytics

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S/E of thrombolytics

GI Bleeding
GU bleeding
Intracranial bleeding
Allergic RXN
BP
Arrhythmias
Ecchymosis
Flushing
N/V
Hemoptysis
Nose/gum bleeds

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What is the antidote for thrombolytics?

Amicar
or
Amnicaproic Acid

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Amicar or Amnicaproic Acid is the antidote for what?

thrombolytics

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What to check before administering thrombolytics

weight
PT/INR
PTT
HGB/HCT
plt
CT (what kind of stroke it is. Do not give if hemorrhagic)
order-have a 2 person witness
BP-do not give if BP is uncontrolled

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Interventions for Dysphagia and Aspiration

Implement aspiration precautions
Assess gag reflex, if present try sip of water
Order speech consult to do swallow study
Adhere to prescribe liquid consistency regimen
RN should provide initial feeding
Educate: sit upright, head forward when swallowing to decrease risk of choking

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Interventions for Unilateral neglect

observe affected side for injury
Apply arm sling of a client cannot remember to care for affected arm
ensure foot rest is on wheelchair
Education: dress affected side first, use unaffected hand to pull affected extremity to midline for protection

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Interventions for Constipation

Assess abdomen for bloating and tenderness
Implement bowel training program
Administer stool softeners PRN
Administer laxatives PRN
Education: increase fluid intake (if no swallowing deficits), fiber intake, and movement

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Interventions for Urinary Incontinence

Palpate bladder for distention
Anticipate foley catheterization
Implement bladder training program
Education: Teach kegel exercise, or pelvic muscle exercise

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____________ is the main nursing diagnosis for a stroke unless neurological deficits worsen. As patient weakens and LOC decreases ____________ becomes the main priority

Ineffective cerebral tissue perfusion
Airway patency

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Bladder training interval times

Gradually increase time between voiding by 15-min intervals. Start with every 2 hours while awake, then increase as tolerated. At night, go when you feel the need.

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modifiable

Risk factors for a stroke

HTN
Atherosclerosis
History of DVT
Diabetes Mellitus
Stress
Obesity
Cigarette smoking
Hypercholesterolemia
Oral Contraceptive use
Illicit drug use

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All of the following are risk factors for what?

HTN
Atherosclerosis
History of DVT
Diabetes Mellitus
Stress
Obesity
Cigarette smoking
Hypercholesterolemia
Oral Contraceptive use
Illicit drug use

modifiable

a stroke

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non-modifiable

risk factors of a stroke

Age > 55
Gender
Race: Mexican Americans, Latin Americans, African Americans, Japanese, and Chinese are at higher risk for hemorrhagic stroke

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All of the following are risk factors for what?

Age > 55
Gender
Race: Mexican Americans, Latin Americans, African Americans, Japanese, and Chinese

A stroke

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Left hemisphere stroke assessment findings

Aphasia; both expressive and receptive
Impaired L/R discrimination
Agnosia
Alexia
Agraphia
R-sided hemiplegia and hemiparesis
Depression, anxiety, quick to become angered or frustrated
Hemianopsia

Think Left = Language

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Assessment findings for right hemisphere stroke

Altered perception of deficits (they think they can do more than they can)
Unilateral neglect syndrome (ignore left side of the body – they cannot see, feel, or move that side so they are unaware it exists)
Loss of depth perception
Poor impulse control and judgement
Impaired time concepts
Left Hemiplegia or hemiparesis
Hemianopsia

Think Right = Reckless

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All of the following are assessment findings for what?

Altered perception of deficits (they think they can do more than they can)
Unilateral neglect syndrome (ignore left side of the body – they cannot see, feel, or move that side so they are unaware it exists)
Loss of depth perception
Poor impulse control and judgement
Impaired time concepts
Left Hemiplegia or hemiparesis
Hemianopsia

Right hemisphere stroke

Think right = reckless

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All of the following are assessment findings for what?

Aphasia; both expressive and receptive
Impaired L/R discrimination
Agnosia
Alexia
Agraphia
R-sided hemiplegia and hemiparesis
Depression, anxiety, quick to become angered or frustrated
Hemianopsia

Left hemisphere stroke

Think Left = language

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If a patient with a hemorrhagic stroke is is experiencing hypotension what needs to be done?

HCP needs to be notified ASAP

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ACE Inhibitors | Suffix, Example, Action, S/E, NI

* -Pril * Enalapril * Prevents vasoconstriction * S/E: Angioedema, cough, increased K, hypotension * NI: Monitor for S/E, K, BP, Pulse

Beta Blockers | Suffix, Example, Action, S/E, NI

* -lol/-olol * atenolol * Blocks the effect of epinephrine at the receptor site * S/E: Bradycardia, dizziness, hypotension, hyperglycemia * NI: Do not give to pt with asthma. Monitor glucose, BP, pulse

Calcium Channel Blockers | Suffix, Example, Action, S/E, NI

* -pine, -amil, -zem * Amlodipine, cardiazem, verapamil * prevents calcium ion movement across cell membranes * S/E: orthostatic hypotension, dizziness, bradycardia * NI: Monitor BP and pulse, educate pt to change positions slowly

Diuretics | Suffix, Example, Action, S/E, NI

* -semide or -thiazide * furosemide, HCTZ * Promotes diuresis which in turn promotes NA and fluid loss * S/E: Decreased K, NA, and BP * NI: Monitor BP, pulse, ECG, electrolytes

# What type of medication is this? * -lol/-olol * atenolol * Blocks the effect of epinephrine at the receptor site * S/E: Bradycardia, dizziness, hypotension, hyperglycemia * NI: Do not give to pt with asthma. Monitor glucose, BP, pulse

Beta Blockers

# What type of medication is this? * -Pril * Enalapril * Prevents vasoconstriction * S/E: Angioedema, cough, increased K, hypotension * NI: Monitor for S/E, K, BP, Pulse

ACE Inhibitors

# What type of medication is this? * pine, -amil, -zem * Amlodipine, cardiazem, verapamil * prevents calcium ion movement across cell membranes * S/E: orthostatic hypotension, dizziness, bradycardia * NI: Monitor BP and pulse, educate pt to change positions slowly

Calcium Channel Blockers

# What type of medication is this? * -semide or -thiazide * furosemide, HCTZ * Promotes diuresis which in turn promotes NA and fluid loss * S/E: Decreased K, NA, and BP * NI: Monitor BP, pulse, ECG, electrolytes

Diuretics

Purpose of a CT for stroke patients

Used to detect intracranial hemorrhage, space occupying masses, cerebral edema, infarctions, hydrocephalus, cerebral atrophy, and shifts in the brain structures. Should be initial diagnostic test to determine if tPA is needed. Door to CT time is 25 mins, Door to CT results time is 45 mins

Door to CT time

25 mins

Door to CT results

45 mins

# What type of stroke is this? Occurs d/t plaque build up in the vessel walls, and eventually the blood can not get through. Onset is gradual

Ischemic Stroke

# What type of stroke is this? Symptoms gradually worsen as occlusion worsens, usually over a period of several hours to days

Thrombolic | type of ischemic stroke

# What type of stroke is this? Instant onset of S/S or instant loss of consciousness

Embolic | type of ischemic stroke

# What type of stroke is this? think clot causes vessel to ruptured cerebral aneurysm. Poor prognosis d/t ischemia and increasing ICP; ICP is increasing d/t accumulating blood in the brain. Prognosis can improve by surgery to remove the clot and stop the bleed. Do not use Thrombolytics or Anticoags

Hemorrhagic

# What Lobe is this? Smell, speech, concentration, planning, problem solving, motor control. Contains Broca’s area.

Frontal Lobe

# What lobe is this? Touch, pressure, taste, body awareness, language, and reading.

Parietal lobe

# What lobe is this? Hearing, facial recognition, language, and reading. Also contains Wernicke’s area. Contains Hippocampus which is responsible for learning and memory.

Temporal lobe

# What lobe is this? Vision, language, and reading

Occipital lobe

# What lobe of the brain controls this? Coordination

Cerebellum

either the right or the left side of the brain. Remember it is the clients right or left.

Hemisphere

pt can understand what is being said but is unable to communicate verbally. Damage occurs in the Broca’s area of the frontal lobe

expressive aphasia

pt is unable to understand the spoken and often written word. Damage occurs in the Wernicke’s area in the temporal lobe.

Receptive aphasia

Dysfunction occurs in expression and reception

Global Aphasia

# A stroke symptom unable to recognize familiar objects

Agnosia

# A stroke symptom difficulty reading

Alexia

# A stroke symptom difficulty writing

Agraphia

# A stroke symptom paralysis

Plegia

# A symptom of a stroke one-sided paralysis

Hemiplegia

# A stroke symptom Weakness

Paresis

# A stroke symptom one-sided weakness

Hemiparesis

# A stroke symptom loss of half of the field of vision in one eye or both eyes

Hemianopsia

# A stroke symptom loss of vision in the same half of the visual field of each eye

Homonymous Hemianopsia

# A stroke symptom The bodys ability to sense it's location, movements, and actions

Propriception

# A stroke symptoms Impaired balance or coordination

ataxia

# A stroke symptom Difficulty swallowing

dysphagia

# A stroke symptom difficulty or inclear articulation (garbled speech)

Dysarthria

# A stroke symptom inability to execute skilled movement or gestures despite having the ability and desire to preform them

Apraxia

What do you need to teach patients who have hemianopsia

Turn head from side to side to compensate for the loss of vision

# LOC awake with appropriate speech and behavior

Conscious

# LOC Disorientation, bewilderment, difficulty following commands

Confusion

# LOC Sleepiness; slow and delayed response to stimulus

Lethargic

# LOC somnolence with drowsiness between sleep states, lessened interest in the environment, slowed responses to stimulation.

Obtundation

# LOC minimal movement without stimulus; requires strong vigorous stimulus and then drifts back to unresponsiveness.

Stupor

# LOC Not arousable

Coma

# What mode of conlifct resolution is this? * Unassertive * Uncooperative * Do not pursue their own needs, goals or concerns * Do not assist other to pursue theirs * Postpone dealing with issues

Avoidance

# What mode of conflict resolution is this? * Neglect their own needs, goals or concerns while trying to satisfy those of others * Obeys and serves others * Feels resentment and disappointment because they “get nothing in return”

Accommodation

# What mode of conflict resolution is this? * Pursue their own needs and goals at the expense of others * Stands up for right * Defends important principles

Competition

# What mode of conflict resolution is this? * Assertive * Cooperative * Works creatively and openly to find solutions that satisfies most all-important objectives and goals

Compromise

Action: affects serotonin, norepinephrine and dopamine Classification: SNRI & DNRI / Antidepressant S/e: * Headache * Dizziness * Vertigo * Photosensitivity * Agitation/tremors * Insomnia * Dry mouth/ thirst * Dehydration * Constipation

Cymbalta (Duloxetine)

Nursing interventions for cymbalta | Duloxetine

 Monitor BP , appetite and nutritional intake  Assess sexual dysfunction before taking medication  Asses for Serotonin syndrome  Educate family/patient on importance of adherence to medication  Advise patient to change position slowly d/t orthostatic Hypotension.  Notify pcp of any attacks , insomnia or worsening depression

Action: binds to calcium channel in CNS tissue which regulate neurotransmitter release: does not bind to opioid receptors Classification: Anticonvulsant, Analgesics S/E: * Vertigo * PR interval prolongation * Peripheral edema * Dry mouth * Abd pain * Constipation * N/v/D * Thrombocytopenia * Increase appetite * Increased creatine kinase * Sucidal ideation * Angioedema * Dizziness/drowsiness/headache * Resp depression

Lyrica or Pregablin

Side effects of Cymbalta or Duloxetine

* Headache * Dizziness * Vertigo * Photosensitivity * Agitation/tremors * Insomnia * Dry mouth/ thirst * Dehydration * Constipation * Nausea/diarrhea

Side effects of Pregabalin

* Vertigo * PR interval prolongation * Peripheral edema * Dry mouth * Abd pain * Constipation * N/v/D * Thrombocytopenia * Increase appetite * Increased creatine kinase * Sucidal ideation * Angioedema * Dizziness/drowsiness/headache * Resp depression

Nursing interventions of Lyrica or Pregabalin

 Monitor closely for note able changes in behavior  Assess pain location, characteristics, and intensity of pain during therapy  For seizures assess location , duration and characteristics  Instruct family to take medication as directed  Inform pt to report unexplained muscle pain, tenderness weakness.  Inform pt of weight gain and edema  Advise patient and family to notify HCP if thoughts of suicide or dying.

Action: inhibits mycobacteria’s cell wall synthesis and interferes with metabolism Classification: Antituberculars S/e: * DRESS * Toxic Epidermal Necrolysis * Visual disturbances * Gynecomastia * Hepatoxicity * N/V * Peripheral neuropathy * Psychosis/ seizures * Fever * Bloody dycrasias

isoniazid or Isotamine

Side effects of Isotamine or Isoniazid

* DRESS * Toxic Epidermal Necrolysis * Visual disturbances * Gynecomastia * Hepatoxicity * N/V * Peripheral neuropathy * Psychosis/ seizures * Fever * Bloody dycrasias

Nursing interventions for Isoniazid or isotamine

 Importance of medication adherence medication can be continued for 6 mo- 2 yr  Notify HCP of signs of Hepatitis (yellowing skin or eyes)  Caution pt to avoid alcohol.  Hepatic function should be evaluated prior to medication therapy (monthly)  Importance of regular follow up with pcp and ophthalmologist to monitor for s/e.  Monitor for symptoms of DRESS  If Isoniazid overdose occurs, antidote with pyridoxine( Vitamin B)

# All of the following are S/E of what medication * Vertigo * PR interval prolongation * Peripheral edema * Dry mouth * Abd pain * Constipation * N/v/D * Thrombocytopenia * Increase appetite * Increased creatine kinase * Sucidal ideation * Angioedema * Dizziness/drowsiness/headache * Resp depression

Lyrica or pregabalin

# All of the following are side effects of what medication * Headache * Dizziness * Vertigo * Photosensitivity * Agitation/tremors * Insomnia * Dry mouth/ thirst * Dehydration * Constipation * Nausea/diarrhea

Cymbalta of Duloxetine

# All of the following are s/e of what medication * DRESS * Toxic Epidermal Necrolysis * Visual disturbances * Gynecomastia * Hepatoxicity * N/V * Peripheral neuropathy * Psychosis/ seizures * Fever * Bloody dycrasias

Isoniazid or isotamine

Action: binds to cell receptors enhancing the effects of GABA. Classification: Benzodiazepine S/e: * Drowsiness/sedation * Lightheadedness/ Dizziness/ Ataxia * Visual disturbances * Anger, restlessness * N/D/ constipation * Lethargy, Apathy, fatigue * Dry mouth * Weight gain * Physical dependence/psychological dependence/ tolerance

Xanax or alprazolam

# All of the following are side effects of what medication * Drowsiness/sedation * Lightheadedness/ Dizziness/ Ataxia * Visual disturbances * Anger, restlessness * N/D/ constipation * Lethargy, Apathy, fatigue * Dry mouth * Weight gain * Physical dependence/psychological dependence/ tolerance

Xanax or alprazolam

Nursing interventions for xanax or alprazolam

 Inform importance of medication adherence and do not stop abruptly  Advise pt to avoid grapefruit  Inform pt the use of other CNS and alcohol can cause resp depression  Inform pt medication is only for short term use  May cause drowsiness/dizziness, for older adults inform family how to reduce the risk of falls at home  May be administer with food if GI is upset  Assess degree of anxiety and mental status  Assess for risk of addiction  Monitor cbc and liver/renal function during therapy  FLUMAZENIL is antidote if toxicity is noticed

Antidote for xanax

Flumazenil

Flumazenil is the antidote for what?

xanax

How long can Isoniazid therapy last?

6 months to 2 yrs

Isoniazid or isotamine antidote

Pyridoxine or Vitamin B

Pyridoxine or Vitamin B is the antidote for what?

Isoniazid or Isotamine

7 levels of cognitive ability

Knowledge Understanding Applying Analyzing Synthesizing Evaluating Creating

# 7 Levels of cognitive ability Know You're Almost Always Saying Everything Correct | KUAASEC

K-knowledge U-understanding A-applying A-analyzing S-synthesizing E-evaluating C-creating