Exam 3 Flashcards
Goal for aging family members with disability
Return home after learning to manage disability
What does managing disability in the elderly involve
ADLs/personal care
Meal prep
Physical therapy/exercise
Dr Appts
Each family is _
An illness in one member affects…
Unique
The other members
During time of illness provide… to PT
AND… to fam
Functional support
Emotional support
Antecedents of emotional support in a family
Trust
Safety/security
Boundary respect
Communication
When assisting elderly with goal or returning home, first…
Assess support system
When providing support to fam and patient give_ and be_
information
nonjudgmental
Info to give to PTs fam
As much as possible with PT consent
To build trust with PT and fam
Demonstrate use of equipment
Transfer and mobility skills
At home changes for disability may involve
Making a safe environment
Instructions on new diet or meds
Supportive info to provide elderly with disabilities
Where to get med supplies and DME (durable medical equipment)
Where to find support groups
Where to find recreation
What to evaluate for newborns with disabilities
Evaluate parents psych
Willingness to learn
What is the support system
Fantasy of family expansion
Real life is much more difficult and straining on family members
Adaptation to parenthood is
NOT easy
Have realistic expectation
Things to consider during family expansion
Partner struggles
Partner involvement
Sibling jealousy
Interventions for sibling rivalry
Expect and tolerate regression
Encourage discussion
Encourage participation in decisions
Make special time for siblings
First question when expanding fam
What is the support system
Teaching points for expanding family
Teach baby care
Teach breastfeeding
Provide info
Encourage mom/parents to
Provide interaction as much as possible
Praise efforts
Blended family
Significant other comes with baggage
Blended fam transition will take more
TIME
Children’s feelings in blended families
May feel jealous to stepparent
May feel disloyalty to biological parent
Competition/rivalry to other stepchildren
With blended families encourage
mutual respect
Blended families need _ and _ communication
Open
Honest
Parenting responsibilities in blended families
Must be shared
No good cop bad cop
What to assess for in blended families
Lack of support - overall or from partner to partner
Poor attachment - too much or too little
Negative behavior - retaliatory, attention seeking
In poor cases of blended families make
Referrals as needed
Major depressive disorder
2 or more weeks of sad mood or lack of interest in life
most clear up in about 6 months
20% of major depressive disorders have
psychotic features
To be considered major depressive disorder, sad mood must be accompanied by…
how many…
Anhedonia Weight change Sleep change Drop in energy Indecisiveness
Suicidal ideation
At least 4 must be present for diagnosis
Neurotransmitters involved in Major depressive disorders
Norepinephrine and serotonin
Drug classes for Major depressive disorder
SSRIs - most
MAOIs - sometimes
Tricyclic antidepressants - seldom
Therapies for MDD (major depressive disorder)
Psychotherapy
Electroconvulsive therapy
Tricyclic antidepressant MOA
How long to work
keep serotonin and norepinephrine available to the brain
6 weeks
TriCyclic Antidepressants Side
effects
TCA’S
Thrombocytopenia
Cardiac - arrhythmia, MI, stroke
Anticholinergic - tachycardia, urinary retention
Seizures
Contraindications for Tricyclic Antis
Liver problems
Heart problems
MOAIs + Tricyclic Antis =
SEROTONIN SYNDROME
Nursing for MDD
History
Safety
Be patient, dont rush client
Find out if they are suicidal, ask DIRECTLY, ask if they have a plan
Nursing and MDD
Self care promotion with MDD
ADLs
Nutrition/hydration
Good sleep
Do activities and hobbies
Giving activities to MDD clients
One at a time
Do not overwhelm
Anticholinergic side effects of Tricyclic Antis
Urinary problems Eye problems - no if glaucoma Diabetes mellites Thyroid problems Heart problems Lung problems Kidney problems
Biggest problems with antidepressants
Suicide up to 2 weeks, because pt how has energy to act
Not taking pills - collecting for a suicide attempt
MDD and therapeutic communication
Encourage to verbalize and describe emotions
MDD teaching with fam
Depression is an illness not a lack of willpower or motivation
Best MDD treatment combo
Meds + Therapy
MDD maintenance teaching for pt
Support groups
Follow up on appts
Instruct on med side effects - ID S/S of relapse and get immediate treatment
Because of how long antidepressants take to have an effect pt may
feel discouraged by lack of progress but have more energy to attempt suicide
biggest problem during first 2 weeks
Electroconvulsive therapy 101
delivery of electrical impulses to brain = seizure
thought to reset neurotransmitters
When to electro therapy
If antidepressants don’t work
If actively suicidal
How much electro therapy before progress #
best results #
Normal routine #
Minimum of 6 treatments to see progress
Max benefits at 12-15 treatments
3xWeek
1st line med for mood disorders like suicide and depression
SSRIs
MAOIs
Monoamine oxidase inhibitors
101
MOA enzymes break down neurotransmitters
These meds stop that,
hence the inhibitors
MAOI dietary restrictions
Avoid tyramine
Will ^ BP to point of stroke or death
What foods have tyramine
Aged cheese
Fermented foods
Beer
Soy sauce
Normal side effect of MAOIs
dry mouth insomnia irritability high BP peeing problems
Serotonin syndrome S/S
MED EMERGENCY
Confusion
Restlessness
Sweating
Muscle jerk movements
How long does it take for antidepressants to work
but suicidal ideation happens at
3-4 weeks
2 weeks
Bipolar 101
episodes of depression and mania
Manic phase S/S
Euphoria
Sleeplessness
Poor judgement
Rapid thoughts/actions/speech
Depressive phase of mania S/S
2 or more weeks of sad mood
+
4 of the depression symptom changes in: anhedonia weight sleep energy concentration
suicidal ideation
Manic onset
duration
rapid over a few days
a few weeks to months
Bipolar pts at most risk of psychosis
Adolescents
At what age does mania onset
teens to 30s
Bipolar mixed 101
alternates between manic depressive and normal
Bipolar I 101
Mostly mania
some normal
few depressive episodes
Bipolar II 101
Mostly depression
some normal
few manic episodes
Diagnosing mania
1 week minimum of altered behavior
at least 3 of the following
sleeplessness
flight of ideas
exaggerated self-esteem
increased activity
Risky behaviors during mania
spending sprees
sex with strangers
impulsive investments
Go to med for bipolar
Antimanic - lithium
Anticonvulsant - mood stabilizer, and protection against cycles
Antipsychotics - if psychosis
Lithium 101
Partially or completely stops illness in 75% of pts
Heavy on renal system
Is lithium metabolized
NO
excreted in urine
hence the kidney problems
Maintenance lithium level
Treatment lithium level
Toxic lithium level
- 5-1.0
- 8-1.4
- 5 and up
Client and fam need to know S/S of _ with lithium
Toxicity
thyroid
renal
1.5-2 lithium toxicity S/S
nursing intervention
N/V/D
drowsiness
slurred speech
muscle weakness
hold next dose, call Dr.
2-3 lithium toxicity S/S
nursing interventions
Blurred vision Tinnitus Twitching Itching/rash Incontinence
Withhold all future doses, Call Dr.
Prepare for gastric lavage
Start IVs
3.0 and up lithium toxicity S/S
Nursing interventions
Cardiac arrhythmia Vascular collapse Hypotension Seizures Coma
Excretion meds
Hemodialysis
Monitor resp circ immune and thyroid system
Lithium excretion meds
Aminophylline
Mannitol
Urea
Anticonvulsants used for mood stabilization
Gabapentin
Carbamazepine
Lamotrigine
Side effects of anticonvulsants
Drowsiness
Sedation
Weakness
Fatigue
Nursing safety interventions for anticonvulsant meds
Get up slowly
Monitor for hypotension
Fall risk
Antipsychotics 101
block dopamine
used in psychotic mania, psychotic depression and drug induced psychosis
Generations of antipsychotics
1st - haloperidol
2nd - quetiapine
3rd - aripiprazole
3rd has least side effects
side effects of antipsychotics
Dystonia - involuntary contractions
Pseudoparkinsonism
Dyskinesia - involuntary jerking
Akathisia - can’t be still
Psychotherapy is not useful for what bipolar cycle
mania
Nursing when bipolar pt is depressed
Get History
Safety (suicide/harm prevention) ask the question
Promote ADLs
Hydration/nutrition
Do activities
Have good sleep
Manic comms interventions
Hist from fam or use short sessions
Distance respect
Use short sentences
Manic physical needs interventions
Finger foods high in calories and protein
Rest and sleep
Chanel movement into productive tasks
Manic psych interventions
Protect dignity
Promote appropriate behavior
Decrease stimuli
Fluid consumption when on lithium
2 Liters qd
Teach pt and fam that lithium therapy needs
have them know
periodic blood work
side effects and toxicity
Manic teaching to pt and fam
avoid risk taking behavior
recognize S/S or relapse
Risk factors for Postpartum depression
Poverty Lack of support Unplanned pregnancy Depression history Decrease in self esteem
Domestic violence
Post partum depression onset
6 weeks and up to 1 year
KEY , feelings last longer than 2 WEEKS
Post partum Depression S/S
no appetite poor sleep emotional lability mood swings panic attacks
Depressed feelings
Rejection of infant
Postpartum depression if untreated
becomes chronic depression
Father and Postpartum depression
increased depression risk in father
children of post partum depression moms have an increased risk for
emotional and behavioral problems
sleep problems
eating problems
delays in development
Postpartum psychosis onset
2-3 week average
48h to 6months after birth
Post partum psychosis S/S
Major depression
Disorientation
Paranoia
Hallucinations
Thoughts of self harm or harming the baby
Postpartum psychosis is a medical _
needs
emergency
immediate hospitalization
postpartum depression prevention during pregnancy
Monitor for S/S
Do screening questionnaire
Support groups
Therapy
Antidepressants if severe
Postpartum depression prevention after birth
Screenings
Counseling
Therapy
Meds
Reluctance to do newborn care
Big sign of postpartum depression
Questions to ask for PostPartDep
Emotional state?
Bonding?
Hist of depression?
Emotional self care post partum
communicate feelings
rest/ask for help
take time for self
see friends
Physical self care post partum
Exercise
Eat well
Bathe
Dress
Breastfeeding and antidepressants
meds will go through milk
not a big deal
Drugs of choice for post partum depression
SSRIs
Sertraline
Paroxetine
Fluoxetine
Citalopram
SSRIs 101
Serotonin helps in
behavior appetite sleep sex function
SSRIs keep more available
SSRI side effects
Sex problems N/V/D Insomnia Joint/muscle pain Headaches
Serotonin syndrome S/S
Agitation/restlessness ^HR ^BP ^Sweating Dilated pupils Muscle twitching Shivers, fever
Life threatening serotonin syndrome S/S
High fever seizures
Irregular heartbeat
Coma
St Johns’ wort and serotonin
Increases level = serotonin syndrome
How long does it take for SSRIs to work
4-6 weeks
Discontinue SSRIs
DO NOT stop suddenly
SSRI withdrawal
Flu symptoms
NVD
Dizziness
Fatigue
Suicide
Killing self
Risks for suicide
Psych disorders Chronic health issues PT hist Fam hist Environmental factors
If you suspect suicide
ASK THE QUESTION
Determine lethality of suicidal pt
Is there a plan?
Are there means to execute?
Where?
Time/date? Anniversary?
Suicide preparations
Giving things away
Being unnaturally happy - pt has a plan
Talking to folks one last time
Suicide notes
Safety and suicide nursing interventions
If lethality is low observe q10min
If high = one on one supervision
Contracts
Assess support system
Good attitude
Suicide contract
Have pt make a no-suicide or no-self harm contract
Nursing attitude toward suicidal pts
Be positive and non judgmental
Monitor your body language and facial expressions
Treatment for suicide
Psych Therapy
Meds- SSRIs, MAOIs, Tryc
Electrotherapy
Seizure 101
imbalance of electrical impulses rapidly firing without inhibition
Generalized vs partial seizure
Both hemispheres
1 hemisphere
Seizure causes
Fever
CNS infection
Hypoxia
Hypoglycemia
ETOH withdrawal
Acid/base imbalance
Tumor
Epilepsy
2 or more seizures more than 24h apart
Epilepsy can be caused by
Chronic condition
TBI
Stroke
Meningitis
Seizures from fever or ETOH withdrawal are not considered _
epilepsy
4 stages of a seizure
Prodromal
Aura
Ictus
Post ictus
Prodromal 101
S/S
occurs before event
mood problems - depression, anxiety, anger
Aura 101
S/S
Seconds or minutes before event
Altered vision, spots, dizziness, weird tastes, deja vu feeling
Ictus 101
S/S
Actual seizure - lasts 1-3 min
As soon as seizure starts start
Timing
Seizures lasting longer than 5 min
Status epilepticus
Med emergency
Post ictus 101
S/S
Recovery - can be immediate or up to days
Tiredness, confusion, headaches
Cant remember
Injury to tongue/cheek
Tonic/Clonic (Gran mal) seizure 101
Most common \+ aura 1-3 min LOC High injury risk
Tonic phase
Body stiffens May groan or cry Bite mouth Foam at mouth Apnea
Clonic phase
Recurrent jerking
Spasms
Incontinence
Tonic seizure 101
only body stiffens
LOC w/incrased muscle tone
30sec to minutes
Clonic seizure 101
Recurrent jerking
Contraction and relaxation of muscle
lasts severe minutes
Atonic seizure 101
Simply go limp and fall
Followed by confusin
Seizure types recap
Tonic/clonic aka gran mal
Tonic
Clonic
Atonic
Focal seizures (partial seizures) 2 types
Simple partial
Complex partial
Simple partial seizure 101
S/S
Aware during seizure
less than 2 min
HR change
Flushing
Pain
Offensive smell
Can lead to Complex partial seizure
Complex partial seizure 101
S/S
Unaware of seizure
Unusual movements - lip smacking, rubbing hands, picking at clothes
Cant remember afterwards
Can pt recover from status epilepticus on their own
Status epilepticus consequences
NO
life threatening
Hypoxia to brain \+ Venous congestion = Irreversible fatal brain damage
Meds for Status epilepticus
Diazepam Valium
Lorazepam Ativan
GIVE IV
will stop seizure immediately
Medications to stop convulsions with seizures
Barbiturate’s
Anticonvulsants
Benzodiazepines
Barbituates to stop convulsions
Side effects
Phenobarbital
lowers BP and respirations, need blood levels
causes fetal malformations
Anticonvulsants for seizure convulsions
Side effects
2 of em
Phenytoin - bone marrow suppression, birth defects
Valproic acid - liver heavy, WBC and platelets need monitoring
Benzodiazepines for convulsions
Side effects
Diazepam/lorazepam
FAST acting
Drowsiness, build tolerance
2 Invasive treatments and diet for seizures
Surgery - remove area causing seizures
Vagus nerve stimulator - stimulation prevents seizures
Keto diet - 5% carbs, 30 % protein, 65% fat
First thing to assess for seizure risk factors
Hx of seizures
Last med dose
Last drug level
Seizure precaution
Padding of railing
Fall precaution
O2 and suction at bedside
IV access
Bed position and clothing with seizures
Lowest position
Clothing should be non restrictive
Priority care during a seizure
Over 5 min =
Prevent aspiration and trauma
Don’t put fingers in mouth
Emergency
After seizure, to prevent aspiration with seizures
Keep pt on side
Make sure airway is patent
On awakening from seizure
If confused
If agitated
Reorient patient
Gently guide to bed or chair
Maintain distance but be close enough to prevent injury
Post seizure assessment and lab
VS
Neuro check
EEG
Blood levels
Post seizure, document
Meds given
Characteristics noted
Status epilepticus nursing actions
Emergency
Activate Rapid Response Team IV - diazepam or lorazepam Airway - O2 or ET tube Labs - lytes, glucose, meds V/S and neuro checks
Education for seizure patients
Decrease stress
Increase fluids
Maintain normal glucose
Ged blood work regularly
NOs of recreational activities for seizure patients
strobe lights
loud noises
alcohol
recreational drugs
Brain tumor 101
Growth in brain
Brain tumor classification
Cell type
Location
Primary brain tumor
originates from cell within brain
Secondary brain turmo
Develops from outside brain
Brain tumors apply pressure resulting in
ICP
ICP S/S
Headache N/V Swelling of optic nerves Cerebral Edema Personality changes
Frontal lobe tumor changes
emotions/apathy
inappropriate behaviors
impulsiveness
Parietal lobe tumor changes
Decreased sensation or seizure on opposite side of body
Temporal lobe tumor changes
seizure on other side of body
Psych changes
Occipital lobe tumor changes
Loss of half the visual field on opposite side of tumor
Visual hallucinations
Cerebral lobe tumor changes
ataxia
gait problems
falling toward side of lesion
incoordination
Cerebellopontine angle tumor changes
tinnitus
vertigo
deafness
numbness and tingling in face
face paralysis
motor problems
Incidents of brain tumors increase with
AGE
Early S/S of intracranial tumor with age
are often overlooked or misdiagnosed as normal cognitive decline
Most common brain tumor S/S in elderly
Personality
Confusion
Speech
Gait
Diagnosing brain tumore
CT w/contrast
MRI
PET
Lumbar puncture
EEG
Biopsy
Brain tumor meds
pain
edema
Analgesics
Corticosteroids
Brain tumor meds
seizures
vomiting
Anticonvulsants
Antiemetics
Decreasing ICP with brain tumors
Diuretic Mannitol
Surgery for brain tumore
craniotomy
Radiation and chemo for brain tumors
Radiation - external and brachytherapy available
Chemo - with or without radiation available
Nursing care for brain tumors
Seizure precaution
Headaches and nausea
Neuro deficit - poor swallowing, semisoft diet
Normal ICP monitoring pressure
5-15mmHg
S/S of ICP
NV Headache LOC Pinpoint pupils Altered breathing Abnormal posture - decerebrate or decorticate or flaccid
Preventing ICP
Elevate HOB Maintain head and neck neutral DONT Valsalva Maintain body temp Maintain fluid balance Avoid noxious stimuli
Corticosteroids for ICP
hyperglycemia and lyte imbalance
monitor blood sugar
push fluids
Assist patient with brain tumors in
Self care
Walking
Injury prevention
Assess brain tumor pts
Muscle strength
Eye problems
Glasgow coma scale
Neuro assessment
Magic number on Glasgow coma scale
8
below 70% mortality
above 90% survival
what interferes with doing glasgow scale
intubation
Glasgow coma scale
8=
9-12=
above 13=
severe head injury
moderate head injury
minor head injury
Hydrocephalus 101
Abnormal accumulation of cerebrospinal fluid in ventricles
water on the brain
Types of hydrocephalus
Communicating (non-obstructive)
Non communicationg (obstructive)
Normal pressure hydrocephalus
communicating non obstructive
most common in elderly
Infant and hydrocephaly S/S
High pitched cry
Poor feeding
Vomiting
LOC
Infants and hydrocephaly head alterations
Increased circumference of head
Wide open bulging fontanels without pulse
Head will feel tense and full
Children with hydrocephaly S/S
same as infants plus
Headache complaints
Visual problems
Physical and cognitive changes
Adult hydrocephaly manifestations
Eye problems Gait problems Mild dementia Personality changes Seizures
Diagnostics for hydrocephaly
Skull xray
CT
MRI
EVD
External ventricular device
pulls liquid out of brain via machine
ETV
Endoscopic third Ventriculostomy
pulls liquid out of brain via device
VP shunt
Ventriculoperitoneal shunt
Shunt from ventricle to peritoneal space
need to be changed over time to accommodate growth
Hydrocephaly head assessment
Inspect
Palpate
Percuss
Infection S/S with VP shunt
elevated vitals
decreased responsiveness
seizures
vomit
local inflammation along shunt
Malfunction S/S with VP shunt
Vomit
Drowsiness
Headache
Unequal pupils
Basically ICP
Early Signs of ICP
Headache
Projectile vomit
Blurred vision, delayed pupils, double vision, setting sun
Seizures
Vitals and ICP
ON test
Decrease in pulse and resp
Increase in BP or pulse pressure
Infants and ICP
physical changes
Bulging fontanels
Wide sutures
Increased circumference
Dilated veins
Late signs of ICP
LOC Decreased motor/sensory response Bradycardia Chain-stokes resp Dilated fixed pupils
Body posturing and late signs of ICP
Decerebrate or decorticate posturing
Teaching parent about hydrocephalus and kids
Recognize complications early Developmental disabilities will be present Have realistic goal Financial strain Therapeutic listening
TBI 101
Traumatic brain injury
skull or brain injury serious enough to interfere with normal function
Primary vs secondary TBI
immediate damage due to impact
delayed damage due to lack of nutrition of perfusion
Mild
Mod
Severe
TBI
Mild - LOC less than 15 min, disoriented and confused
Mod - LOC greater than 15 min, days or weeks confused
Severe - LOC greater than 6H
Brain injury types
Contusion
Diffuse axonal injury
Intracranial hemorrhage
Concussion - mild TBI
Contusion TBI 101
Damage in specific area
LOC stupor confusion
edema and hemorrhage risk peaks at 18-36h
possible ICP
Diffuse axonal injury TBI 101
widespread injury
tearing, shearing or axon fibers
Immediate coma longer than 6H
Decorticate posture
feet/arms toward body
cerebral damage
Decerebrate
feet and arms away from body
brain stem damage
Hemorrhage location terms
Extra axial -
Epidural -
Subdural -
Subarachnoid -
outside brain tissue
above dura
below dura
below arachnoid space
Hemorrhage location terms
Intra axial -
Intracerebral -
Intraventricular -
Inside brain tissue
Within brain
Within ventricles
Expanding TBI hematoma S/S
Brief LOC
Lucid intervals
ICP
Restless
Confused
Then Coma
TBI hematoma Treatment
Craniotomy - remove clot or bleeding
Elderly TBI injuries are most likely in what area
subdural
Mild vs classic concussion
mild - no loc, brief confusion
classic - loc less than 5 min, amnesia, mind problems (NV, HA, memory etc.)
What to monitor for TBIs
LOC HA NV Abnormal pupils Slurred speech Arm/leg numbness or weakness
red flags indicating further action
Chronic traumatic encephalopathy
CTE
Happens due to multiple concussions
brain degeneration
CTE S/S
impulsiveness
poor judgement
memory loss
emotional lability
substance abuse
suicidal thoughts
Post concussion syndrome 101
duration
S/S
10 days to 3 months
Cognitive issues
Behavioral issues
NVH
visual and hearing sensitivity
Post concussion patient teaching
Problems will start with going back to work or school
Avoid activities that can result in another concussion
Rest brain
Skull fracture 101
S/S
persistent localized pain indicates
most common is basal
racoon eyes, battel signs, CSF leakage from ears and nose
Diagnostics for TBIs
CT scan without contrast
Xray of head and neck
MRI
Angiography
Glasgow coma scale categories
Eye opening - 4 point max
Verbal response - 5 point max
Motor response - 6 point max
Coma on Glasgow scale
Severe head injury on scale
moderate injury on scale
mild injury on scale
3
8 or less
9-12
13-15
TBI interventions
HOB at 30 degrees Patent airway O2 Ventilation Suction
Monitoring for TBI
neuro function cerebral perfusion lytes nutrition temp
skin integrity
Late ICP finding, cushings triad
Hypertension
Bradycardia
Bradypnea
Cushings triad leads to
Seizures
Increased ICP-herniation-death
Devoices to monitor ICP
normal range
Intraventricular cath
Subarachnoid screw
Epidural sensor
5-15mmHg
Managing ICP
Oxygenation HOB 30 degrees Head and neck in neutral alignment Prevent valsalva Body temp Fluid balance
Normal cerebral perfusion pressure
50-70mmHg
TBI Meds
Diuretic - mannitol - decrease pressure
Steroid - decrease inflammation
Anticonvulsant - prevent seizure
Benzo - sedation, (makes it hard to do Glasgow)
NS - isotonic fluid
TBI supportive measures
Ventilator for O2
F/E balance
Nutrition support
Manage pain/anxiety
Brain death
3 cardinal signs
complete loss of function
Coma
Absence of brainstem reflex
Apnea
Confirming brain death tests
EEG
CBF - cerebral brain flow
Organ donation and fam
Fam can overturn decision if no documentation is complete
fam needs to be informed
OPO/TOSA
what they do
Oran Procurement Organization
They will talk with family
Keeping body viable for organ donation rule of 100s
ON TEST
PaO2 100mmHg
Urine output 100ml per hour
Systolic BP at 110mmHg
Temp at about 100
2 types of stroke
Ischemic - occlusion by thrombus or emboli
Hemorrhagic - bleeding into brain
FAST stroke S/S
Face - uneven
Arms - hanging, uncontrolled
Speech - slurred
Time - call 911 now
Stroke is associated with what heart condition
Afib
tPA treats what stroke
Ischemic
tPA time frames
given within 3h of stroke
given within 60min of getting to hospital
Ischemic stroke motor body problems S/S
numbness weakness on one side
balance and walking problems
hemiparesis, hemiplegia
apraxia
Ischemic stroke motor face problems S/S
Dysarthria - speech problems
Dysphasia - swallowing problems
Aphasia - understanding speech x2
Ischemic stroke cognitive problems S/S
Mental status changes
Headaches
Agnosia - perception problems
Memory loss
Left hemisphere stoke will present as S/S
right side problems
Aphasia - speech and understanding
Intellectual disability
Slow cautious behavior
Right hemisphere stroke will present as S/S
Left side problems
Spatial perception problems
Distractibility
Poor judgement, impulsivity
TIA
Transient ischemic attack
temporary attack
lasts 1-2h less than 24
Warning of an impending stroke
Healthy lifestyle and stroke prevention
No smoking
Physical activity
Healthy weight and diet
Modest alcohol consumption
Modifiable risk factors to prevent stroke
Hypertension AFIB, stenosis Cholesterol Obesity Sleep apnea Oral contraceptive use
smoking and drinking
Treatment of stroke
CT scan within 25min - determines ischemic or hemorrhagic
12 lead EKG and carotid ultrasound
MRI or brain and neck
tPA
What does tPA do
dissolve clots
regulations for admining tPA
2 IV sites
10% push 90% pump
V/S q15m for 2h, 30min for 6h, 1h for 24h
BP maintained ABOVE 180/105
Side effects of tPA
BLEEDING
what to monitor with tPA patients
Airway
Circulation
Neuro
Stroke and carotid endartherectomy
surgery to remove plaque from artery
To prevent stroke, Afib is managed by
Anticoagulant therapy
A fib makes pumping slow, so clotting risk goes up
PREVENTION
Managing cholesterol with stroke
Managing clotting with stroke
Managing BP with stroke
Statins
Antiplatelet
Antihypertensive
Hemorrhagic stroke 101
brain metabolism disrupted by blood
ICP
Secondary Ischemia from vasoconstriction due to pressure
Hemorrhagic stroke S/S
Same as Ischemic plus
HA
sudden LOC
Vomiting
BACK AND NECK PAIN
Diagnosing hemorrhagic stroke
CT, MRI
Cerebral angiography
Toxicology if pt under 40
Stroke can lead to what complications
Cerebral hypoxia
Vasospasms
ICP
Seizures
Hydrocephalus
Hypertension
Rebleeding
Managing hemorrhagic stroke
sedation and rest
surg-relieve bleeding
prothrombin to stop bleeding
dilantin - stroke prevention
Analgesics/antipyretics
promote circulation with strokes via what device
Pneumatic compression devices
Monitoring during acute phase of stroke
vitals O2 neuro motor pupils BP I&O/bleeding
Best hospital environment for stroke patients
Nonstimulating Restrict fam HOB at 30 No valsalva Compression stockings
Decrease anxiety
Post acute phase nursing for stroke patients
Mental status
Motor status
Skin integrity
Activity tolerance
Most brain patients will be bed ridden, be sure to check
skin integrity
Encouraging self care post stroke
Realistic goals
Personal hygiene
Dont neglect affected side
Use assistive devices
Diet and nutrition interventions after stoke
speech therapy
Sit upright
Chin tuck swallow method
THICKENED LIQUIDS or PUREE
Bowel and bladder interventions post stroke
Voiding schedule
Fiber + Fluids
Bowel and bladder retraining
Education post stroke
Med education
Safety measures
Exercise
Recreation
Meningitis 101
Inflammation of brain
2 major bacteria that cause meningitis
Nisseria meningitides
Streptococcus pneumoniae
Primary prevention of meningitis
Meningococcal Vaccine
initial at 11-12y
booster at 16
given to individual living closely together
Meningitis vaccine for kids
HIB b
4 shots
2m4m6m 12-15m
Meningitis vaccine for immunocompromised adults or over 65
Pneumococcal polysaccharide vaccine
PPSV23
given q5years
Meningitis S/S
SEVERE HA
fever/chills
N/V
disorientation
restlessness
photophobia
rash
Nuchal rigidity
Stiff neck
Indicates meningitis
Kernig’s sign
Brudzinski’s sign
Pain with extension from flexed position
Pain with knee/hip flexion + neck flexion
Infant S/S of meningitis
poor feeding
weak cry
vomiting
rash
Meningitis babies will be more consolable when
lying still as opposed to being held
Opisthotonic position
Baby arches back
Meningitis
Diagnosing Meningitis
MRI/CT
Lumbar puncture - CSF
CBC - W^
cultures
Parkinsons 101
Progressive
debilitates motor function
destruction of dopamine cells in brain
Carginal signs of Parkinsons
ON test
Tremors
Rigidity
Bradykinesia
Postural changes
tremors with parkinsons
Shaking
pill rolling
starts with fingers and moves to hands
may disappear with purposeful movement or sleep
muscle rigidity with parkinsons
cogwheel movement - jerking
kinda like a clock tick
as it progresses, pt wont be able to move face
bradykinesia with parkinsons
slowing of movement
muscles issue, messages come but movement is delayed
Freezing - pt will literally stop in place because they can’t move
Postural instability with parkinsons
Late sign
stooped posture
shuffling gate
Diagnosing parkinsons
Based on presence 2 of the 4 cardinal symptoms
Positive response to levodopa trial
Cure for parkinsons
none
Antiparkinsonian meds
Levodopa - converted to dopamine by body, symptom relief
Carbidopa - added to levodopa, keeps it available for longer
Levodopa therapy is most effective at
after that
1-2y
effectiveness drops
adverse effects become severe
Dyskinesia
Biggest side effect to levodopa
Dyskinesia
Uncontrolled involuntary movement of head body and extremities
chewing and smacking movements
head bobbing
Perkinsons and deep brain stimulation
implant of electrode into brain
pulse increases dopamine release
criteria for getting deep brain stimulation surgery with parinsons
having disease for 5 years
disability due to tremors
levodopa causes dyskinesia
Parkinsons nursing care for motion
Mobility - daily exercise, massages
Walking training
Physical therapy
Parkinsons nursing for self care
assistive devices
bedside rails at home
bowel training
fiber+fluids
Nutrition and diet with parkinsons
CHOKING is common
Sit up right
THICK LIQUID diet
monitor weight weekly
Communication from nurse to parkinsons
speak slowly
face listener
annunciate
Communication from parkinsons pt
Encourage deep breaths before speech
Use tool or images
Home education for parkinsons patients
Plan activities for pt
DONT just do things for them
pt and fam need to know stages and severity
Postpartum depression scales
Edinburgh scale
and
PDSS self screen
