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Patient Centered Care 2 > Intracranial regulation > Flashcards

Intracranial regulation Flashcards

1
Q

Infant high pitch shrilling, bulging frontals, decrease deviation eyes

A

brain herniation

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2
Q

An adolescent who was having seizures discharge success seen by

A

no seizures for 1 month, playing basketball, and not driving

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3
Q

child seizures appropriate nurse action

A

stay with patient

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4
Q

CVA cognitive function assessment

A

patient orientation x4

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5
Q

Glasgow coma scale includes

A

verbal response

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6
Q

What are the three parts of the Monro Kelli Doctrine?

A
  1. 80% is the brain
  2. 10% is blood
  3. 10% is CFS (Cerebral spinal fluid)
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7
Q

What Diagnostic testing is used for intracranial regulation?

A
  1. neuroimaging (CT or MRI)
  2. Skull radiograph
  3. Electroencephalogram
  4. Brain biopsy
  5. lumbar puncture
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8
Q

What diagnostic test should be done first and what does it not have in it?

A

CT scan without contrast

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9
Q

Why would a CT scan without contrast be done first?

A

Helps determine if there is a bleed. If there is a bleed, then the whole area would be lit up with contrast.

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10
Q

What are MRI, CT, and CAT scans used for?

A

To identify edema, ischemia, and necrosis

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11
Q

What is Magnetic Resonance Angiography used for?

A

Used to identify the presence of cerebral hemorrhage, abnormal vessel structures, vessel ruptures, and regional perfusion of blood flow in the carotid arteries and brain

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12
Q

What are lumbar punctures used for?

A

To identify an infection or assess for blood in the cerebrospinal fluid. A positive finding is consistent with a cerebral hemorrhage or ruptured aneurysm

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13
Q

Why are very young and very old people at risk for intracranial issues?

A

They are more likely to fall

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14
Q

Why are adolescents at risk for intracranial issues?

A

They have risky behavior

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15
Q

What populations are more likely to have Parkinson’s

A
  1. 60 or above
  2. men
  3. rural areas
  4. inheritance
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16
Q

What populations are more likely to have seizures?

A
  1. children
  2. lower-income families
  3. small gestational age
  4. brain tumors
  5. cerebral palsy
  6. autism
  7. family history
  8. drug and alcohol abuse
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17
Q

What is the earliest sign of a change in intracranial regulation?

A

Change in LOC

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18
Q

What three things does the Glasgow coma scale evaluate?

A

Verbal, motor, and eye-opening

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19
Q

What are the two classifications of strokes?

A

Hemorrhagic and ischemic

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20
Q

What are some risk factors for strokes?

A
  1. cerebral aneurysm
  2. arteriovenous malformation
  3. DM
  4. Obesity
  5. HTN
  6. Atherosclerosis (Build-up)
  7. Hyperlipidemia
  8. Hypercoagulability
  9. A. Fib.
  10. Oral contraceptives
  11. Smoking
  12. Cocaine use
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21
Q

If a hemorrhagic stroke is caught early what can be done?

A

Evacuation of the clot with the cessation of the active bleed.

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22
Q

What do most people with a hemorrhagic stroke experience?

A

The worst headache they’ve ever had, nausea, projectile vomiting, a stiff neck, and droopy eyelids.

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23
Q

What are some assessment findings of ischemic strokes?

A

visual disturbances, dizziness, slurred speech, and a weak extremity

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24
Q

What treatments can be given for an ischemic stroke?

A
  1. hyperlipidemia meds
  2. surgery (carotid cleanout)
  3. Healthy lifestyle changes
  4. Smoking cessation
  5. Reduced sodium intake
  6. Get them to do more with their non-affected side
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25
Q

What is hemianopsia?

A

Loss of visual field in one or both eyes.

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26
Q

What is the acronym for identifying a stroke?

A 
FAST
Face
Arms
Speak
Time
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27
Q

What are the clinical manifestations of a stroke?

A
  1. hemiplegia
  2. Hemiparesis
  3. Faccidity
  4. paresthesia
  5. Weakness
  6. paralysis
  7. Aphasia
  8. Dysarthria
  9. Sensory-perceptual deficits
  10. Pain or strange cognitive and behavioral changes
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28
Q

What are the nursing priorities and plan of care for a stroke/CVA?

A
  1. Provide safety, reassurance, and support the family
  2. Meds
  3. BP control
  4. Maintaining fluid, O2, and nutritional status
  5. Maintain Cerebral perfusion
  6. Promote physical mobility
  7. Promote self-care
  8. Promote verbal communication
  9. Promote elimination
  10. Maintain safety
29
Q

What are the most important meds for a stroke/CVA?

A
  1. anticoagulants
  2. Thrombolytics
  3. Corticosteroids
30
Q

What is the time frame that thrombolytics can be given with a stroke?

A

3-4 hours of symptoms

31
Q

What are some other meds for a stroke/CVA?

A
  1. Platelets
  2. diazepam
  3. calcium channel blockers
  4. Stool softeners
  5. analgesics
  6. antianxiety
32
Q

Why are neonates at risk for strokes?

A

Their greatest risk time is from birth-30 days after birth. They have an increased ability to form clots. Stress to veins and arteries on their head because of labor and delivery.

33
Q

What are the lifespan considerations for adolescents regarding strokes/CVA?

A
  1. develop from congenital heart defects or sickle cell disease
  2. severe headache, vomiting, seizure, loss of balance and coordination
  3. Thrombolytics is controversial
  4. Control the seizures
  5. Supportive care
34
Q

What are the lifespan considerations for pregnant women?

A
  1. Increase of hormone levels on vascular walls
  2. increase BP with pregnancy
  3. Highest risk= third trimester through 6 weeks after delivery
  4. Treated the same as any other adult with a stroke
35
Q

What are the clinical manifestations of Parkinson’s disease?

A
  1. Tremors
  2. Postural instability
  3. rigidity
  4. bradykinesia
36
Q

How do tremors in people usually present in people with Parkinson’s?

A
  1. start unilaterally and then go bilaterally
  2. usually starts in hand or jaw or foot
  3. seen at rest
  4. Interfere with ADLs
  5. usual.ly the reason they seek assistance
37
Q

What are the non-motor symptoms of Parkinson’s?

A
  1. fatigue
  2. irritability
  3. Loss of sense of smell
  4. Dementia
  5. cognitive deficit
  6. affects speech and language
38
Q

What are the three types of rigidity in Parkinson’s and describe them?

A
  1. cogwheel- rhythmic interruption movement
  2. plastic- mildly restrictive movement
  3. Leadpipe- total resistance to movement
39
Q

What are some nursing considerations for women with Parkinson’s ambulating? what diagnosis would be a priority?

A

A bigger chest can make women tend to fall forward. The priority would be safety

40
Q

What are some difficulties in your nursing care that the pt may experience?

A
  1. difficulty with ADLs (Assistive devices; promote independence)
  2. difficulty walking (remind them to pick up their feet)
41
Q

When doing an assessment of someone who you suspect might have Parkinson’s what should you ask them about?

A
  1. family history
  2. exposure to toxins
  3. brain disorders
42
Q

What are the important meds for Parkinson’s Disease?

A
  1. levodopa
  2. dopamine agonist
  3. Mao-b inhibitors
  4. Comtinhibitors
  5. Anticholinergics
43
Q

What is important to remember about Levodopa?

A
  1. it is a metabolic precursor
  2. titrate to avoid side effects
  3. high protein diets can interfere with absorption
  4. sweat and urine can be a darker color
  5. can cause dyskinesias
44
Q

What is important to remember about Dopamine agonists?

A

They mimic the role of dopamine in the brain. They can cause compulsive behaviors, hallucinations, or orthostatic hypotension

45
Q

What is epilepsy?

A

Chronic recurring abnormal brain electrical activity resulting in two or more seizures. Seizures resulting from identifiable causes of substance withdrawal or fever are not considered epilepsy.

46
Q

If a pt having a seizure has their jaw clenched shut what should the nurse do?

A

stay with the pt and watch for any complications

47
Q

What are the risk factors for seizures?

A
  1. genetics
  2. acute febrile state (children under 2)
  3. Head trauma
  4. cerebral edema
  5. Abrupt cessation of antiepileptic drugs
  6. Infection
  7. Metabolic disorder
  8. Exposure to toxins
  9. Stroke
  10. heart disease
  11. brain tumor
  12. hypoxia
  13. acute substance withdrawal
  14. fluid and electrolyte imbalances
48
Q

What are environmental factors that can put someone at risk for seizures?

A

Exposure to toxins like pesticides, carbon monoxide, and lead poisoning

49
Q

What are some triggers for seizures?

A
  1. increased physical activity
  2. excessive stress
  3. hyperventilation
  4. overwhelming fatigue
  5. acute alcohol ingestion
  6. excessive caffeine intake
  7. exposure to flashing lights
  8. substances such as cocaine, aerosols, and inhaled glue products
50
Q

What are the signs of a tonic seizure?

A

unconscious, hypoxia, cyanosis, increased basal metabolic rate, continuous muscle contraction, hypoglycemia

51
Q

What are the signs of a clonic seizure?

A

Alternating muscle contraction and relaxation

52
Q

What is the postictal period of a seizure?

A

The period right after the seizure ends. The patient is usually sleepy but arousable. They can also have snoring type respirations.

53
Q

What is an “aura” for someone that has seizures?

A
  1. an early warning sign that only they an experience

2. If they give that aura, they may have time to lay down on the floor to protect themselves.

54
Q

What are automatisms and what type of seizures are they more common with?

A 
Unconscious movements (lip-smacking or repetitive movements)
They are more common with focal seizures
55
Q

What happens during a tonic-clonic seizure?

A
  1. begins for only a few seconds with a tonic episode (stiffening of muscles and loss of consciousness)
  2. A 1-2 minute clonic episode (rhythmic jerking of the extremities) following the tonic episode
  3. breathing can stop during the tonic phase
  4. Cyanosis can accompany breathing irregularities
  5. Biting of the cheek or tongue can occur during the clinic phase
  6. Incontinence can also accompany a tonic-clonic seizure
  7. During the postictal phase, a period of confusion and sleepiness follows the seizures
56
Q

What happens during a tonic seizure?

A
  1. Only the tonic phase is experienced.
  2. Sudden loss of consciousness and experience sudden increased muscle tone, loss of consciousness, and autonomic manifestations (arrhythmia, apnea, vomiting, incontinence, and salivation)
  3. The seizure usually lasts 30 seconds to several minutes
57
Q

What happens during a myoclonic seizure?

A
  1. consist of brief jerking or stiffening of the extremities, which can be symmetrical or asymmetrical
  2. lasts only for seconds
58
Q

what happens during an atonic or akinetic seizure?

A
  1. characterized by a few seconds in which muscle tone is lost
  2. the seizure is followed by a period of confusion
  3. the loss of muscle tone frequently results in falling
59
Q

What happens during partial or focal/local seizures?

A
  1. automatisms (lip-smacking or picking at clothes)
  2. the seizure can cause a loss of consciousness or blackout for several minutes
  3. amnesia can occur immediately prior to and after the seizure
60
Q

What happens during an absence seizure?

A
  1. far off look in their eyes, sit still with blank stair, unresponsive for up to 1-2 minutes
  2. usually noted in school-aged children
61
Q

What is status epilepticus?

A
  1. A seizure that lasts greater than 30 minutes or a series of seizures where consciousness is not regained. This is a life-threatening emergency.
  2. keep airway patent
  3. Slowly give lorazepam or diazepam.
62
Q

What are febrile seizures?

A

Occur in children as a result of a rapid increase in temperature. Associated with acute illness. can also occur when the temperature is on the decline.

63
Q

What does HARM(M) stand for?

A 
Harm protection
Airway patency
restraining (Inappropriate)
Mouth should never have anything in it
Monitor compliance with taking anticonvulsant meds
64
Q

What equipment should be readily available for someone who has frequent seizures?

A
  1. oxygen, standby
  2. suction equipment, standby
  3. Airway equipment, standby
  4. IV access
  5. side rails up and padded
65
Q

What the acronym PROTECTS stand for?

A
  1. Protect the privacy and from injury, never restrain
  2. Review respiratory status
  3. Oral airway maintain, never put anything in the mouth
  4. Turn to side decrease aspiration
  5. Equipment available
  6. Check VS, injuries, reorient post seizure
  7. T- Time of onset and duration, observe and document
  8. Suction oral secretion
66
Q

What meds are used for seizure management?

A
  1. lorazepam
  2. Diazepam
  3. Diastat- can be given rectally
  4. IV Phenytoin (Dilantin) or Fosphenytoin (Celebrex)
67
Q

What does the acronym COUGH stand for?

A
  1. Control temperature
  2. Oral tracheal/endotracheal suctioning (don’t do it too often)
  3. use force when blowing nose (don’t)
  4. Get neck/hip to an extreme flexion/extension position
  5. Hyperventilation creates vasodilation- HOB elevated at 30 degrees
68
Q

What is the difference between decorticate and decerebrate posturing?

A

In decorticate posturing, everything is flexed to the middle. In decerebrate posturing, everything is extended (BAD)

Patient Centered Care 2 (26 decks)

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