Mobility Flashcards
What is a Hemorrhagic stroke
Bleeding into the brain that results in brain cell death
What is a ischemic stroke
Inadequate blood flow (blockage) to part of the brain
Can be complete or partial
Most effective way to decrease burden of stroke is..
Prevention and teaching
NON-modifiable risk factor of stroke
50 and up
Men more likely
African American
Modifiable risk factor of stroke
- HTN most modifiable risk factor (Sbp less than 140)
A-Fib !! Leads to Blood clots
Obesity Diet Smoking Drinking Sleep apnea Diabetic
Hemorrhagic stroke results from bleeding into
1) subarachnoid space
2) brain tissue itself
Subarachnoid hemorrhagic stroke
Area between the brain and skull; bleeding into the cerebrospinal fluid
Often caused by rupture of super broad aneurysms, trauma or illicit drug use 
Intracerebral hemorrhagic stroke (ICH)
-  bleeding within the brain tissue caused by rupture of a vessel
- most common cause is HTN
- sudden onset of symptoms
- progression over minutes to hours
- hemorrhage can occur during activity
Symptoms varies and depends on amount, location and duration of bleeding
Headache, decrease consciousness, n/v
2 types of ischemic stroke
1) thrombotic
2) embolic
Thrombotic stroke (ischemic)
Extent of stroke depends on:
- rapidity of onset
- size of damaged area
- presence of collateral circulation ( is it a main vessel or a small one that doesn’t supply a lot of blood)
Embolic stroke
Traveling clot
*A-FIB ➡️ traveling clot ➡️ occluded a cerebral artery
Sudden onset with severe clinical manifestations
Warning signs less common
Pt usually CONSCIOUS
Prognosis related to amount of brain tissue deprived of blood supply
Recurring is common bc of a-fib
Transient ischemic attack (TIA)
“ mini stroke”
Puts at risk for actual stroke
Medical emergency that can lead to an ischemic stroke
Clinical manifestations of STROKE are related to
- related to location
- important to know where stroke happened ( Intercranial, subarachnoid) because this will determine deficits 
- TIMR OF ONSET OF SYMPTOMS/ LENGTH OF PERIOD of ischemic is important
Most COMMON clinical manifestations of STROKE
- numbness or weakness of the face, arm, leg ( especially on one side)
- confusion or change in mental status
- trouble speaking or understanding speech
- Visual disturbances
- complaint of dizziness
- difficult walking, loss of balance or coordination
- sudden severe headache
What to do for a stoke
Act FAST
Face: ask person to smile, does one side droop?
Arms: ask to raise both arms, does one arm drift down
Speech: ask to repeat simple phrase, is speech slurred or strange
Time: if you observe any of these signs call 911
Note time if first symptom- can affects treatment decisions
Goal of act FAST
Preserving life
Preventing further Brian damage
Reducing disability
Motor functions affects by stroke
Mobility- stumble Respiratory function Swallowing and speech Gag reflex Changes in muscle tone Altered reflexes( hyporeflexia to hyperreflexia) Self care abilities * Akinesia= loss of skilled voluntary muscle movement
Initial period of flaccidity for stroke
Hangin lose/ poor muscle tone
- maybe ask from days to several weeks
Then spasticity of muscles follow ( tight, increase muscle tone) 
Communication manifestations of stroke
Aphasia-inability to comprehend or formulate language bc of damage to brain
- receptive: understanding
- expressive: can’t find words
- global: loss of total ability to communicate 
DysphaSia- inability to communicate
1) nonfluent: minimal speech activity with slow speech
2) fluent: speech is present but has little meaningful communication
Stroke affect on emotions
- may have hard time controlling emotions
- emotional responses may be exaggerated or unpredictable
Magnified by:
- depression
- changed in body image
- loss of function
Stroke affect on intellectual function
Memory and judgment may be impaired
Homonymous hemianopsia
Blindness in one half of visual field
Reminders and arranging things in visual field important
Stroke affect on eliminating
Most problems with urinary and bowel elimination occur initially and are temporary
Diagnostic study for stroke
- CT, MRI ( do ASAP from first symptoms)
- angiography can be done to look at vessel
Done to:
- confirm it’s a stroke
- identify cause of stroke
- show size and location
- ischemic or hemorrhagic?
Nurse teaching to MANAGE modifiable risk factors for stroke
Health diet (reduce salt and fats)
Exercise (30 minx3wk)
Stop smoking a d drinking
Meds to keep HTN below 140
Preventive drug therapy for stroke
Aspirin 81 mg/day
Apixaban or warfarin for anticoagulant for A-Fib
Medications to control HTN
Preventative ischemic stroke surgical therapy CEA
Carotid endarterectomy (CEA)
Removal of atherosclerotic plaque or thrombus from carotid artery to prevent stork
Assessment after CEA
Neuro frequently
BP
Keep leg straight and look at femoral site
Preventing ischemic stroke PTA and Wire Mesh
1) PTA: ballon to open a stenosis artery( only ballon no stent)
2) brain stunting (wire mesh) or stent retrieved: to keep artery open and improve blood flow
Preventative hemorrhagic stroke surgical therapy
Surgical clipping or cooling of aneurysm for those at risk for hemorrhagic stroke
Aneurysm- weak vessel that could burst
Postop care stroke interventions
Neuro assessment
BP management
Assess for complications
Minimize risk of bleeding at insertion site
What to monitor for after ischemic and hemorrhagic stroke
Airway
Breathing
Circulation
Intracranial pressure (ICP) - manatal or HOB 30
tPa for ischemic stroke
Clot buster
Given IV
3-4 hr of onset of clinical signs
DONT give if bleeding
Monitor for brushing, vs, BP > 140
Prevention of further clots once pt stable after ischemic stroke
1) anticoagulant
2) platelet inhibiting meds
3) statins
Acute care for hemorrhagic stroke
- anticoagulant and platelet inhibitors are contraindications bc they are already bleeding !
Manage HTN w/ oral and IV meds (<140)
Pt may need a craniotomy to evacuate the blood and decrease ICP
Nursing management (GOALS over time) for stroke
Improves mobility achievement of self-care prevention of aspiration continent of bowel and bladder maintain stable or improve LOC maximize communication abilities Maintain skin integrity Restored family function Absence of complications
Promoting mobility with unilateral paralysis
- ROM / Positioning
- paralyzed / weak side need special attention when positioned
- physical therapy
Optimizing musculoskeletal function after stroke
- Trochanter roll at hips to prevent external rotation
- hand cones to prevent contractors
- posterior leg splint, footboard, tennis shoes to prevent foot drop
- hand splint to reduce spasticity
- Prevent shoulder pain
- avoid overhead pulleys
- avoid pulling on affected arm
- dislocation can occur from over stretching if arm paralyzed
How can nurse support post stroke pt
Nutrition , communication, skin, home environment
Nutrition:
- NPO til speech rule out aspiration risk, thic liquid
- HOB 30
- assistive tools to eat
Improve communication:
- writing
- picture board
Maintain skin integrity:
- Turing
- clean dry skin
- promote continence
Therapy for family
Home environment:
- PT, OT, social services
What is Multiple sclerosis
Progressive degenerative disorder of CNS with demyelination of nerve fibers of brain and spinal cord
Myelin is fatty protein that surround nerve responsible for transmission of nerve impulses
MS risk factors
Can occur at any age
Peak age 20-50 (ave 35)
Affect women more
More prevalent in temperate climates
MS cause
Unknown
Factors include:
- infection
- smoking
- physical injury
- emotional stress
- excessive fatigue
- pregnancy
- poor state of health
- genetic component
Course of MS
Different patterns
Overall trend is progressive
No cure - death usually occur due to infectious complications of immobility ( pneumonia) or unrelated disease
Relapsing remitting MS
Unpredictable attacks which may or may not leave permanent deficits followed by periods of remission
Progressive relapsing MS
Steady decline since onset with superimposed attacks
Secondary progressive MS
Initially relapsing remitting but then suddenly begins to have decline without periods of remission
Primary progressive MS
Steady decrease in ability without attacks
MS visual symptoms that affect Mobility
- blurrred / cloudy vision
- diolopia ( double)
- red green color distortion
- nystagmus
- patchy blindness (Scotoma)
- total blindness
Normally first signs to appear
MS musculoskeletal and sensory symptoms that impact mobility
- limb weakness
- numbness/ tingling
- vertigo
- ataxia (impaired coordination)
- partial / complete paralysis
- parenthesia ( abnorm sensation)
- decrease sense of temp
- loss of proriception ( sense of body movement)
- spasticity (hypertonicity)
Fatigue in MS
Very common
Often the most disabling symptom
Pain in MS
Due to lesions on sensory pathway
- can contribute to Social isolation/ depression
May require daily analgesic or may require opioids, anti seizure medications or antidepressants
MS 2 neurologic signs
1) uhthoff sign: sudden worsening of motor symptoms after hot shower or bath
2) Lhermitte sign: temporary sudden, electric shock sensation extending down the spine when the neck is flexed downward
MS s/s
Mind, mouth, bathroom
Memory deficits- word finding Impaired judgment/ decrease concentration Chewing / swallow difficult Constipation / incontinence Urinate retention/ freq
MS diagnostic test
No definitive test
Base on history, s/s and results of certain test
MRI- too look for plaque, inflammation, atrophy of CNS and is used to track disease
MS immunomodulators
AVONEX
Used to modify disease progression and prevent relapses
Flu like symptoms are common
- IM once a wk
- rotate injection sites
- assess for suicidal ideation
- pt must wear sunscreen
MS immunomodulators
Fingolimod
Oral
Shown to decrease relapsing
Meds for symptom relief of MS
1) Spasticity: Baclofen
2) Severe fatigue that interferes with activities: Amantadine
3) Ataxia: gabapentin
4) UTI: vitamin C
Corticosteroids
Nursing teaching for MS
- help identify trigger and ways to avoid
- assist with dealing with anxiety
- prevent complications from immobility
- help avoid fatigue, extreme hot/ cold or infections
- teach balance exercise and rest
- *** minimal caffeine intake !!!
- well balance meals
- teach self catheter if necessary
- *** high fiber for constipation
Parkinson’s disease is characterized by
- bradykinesia
- rigidity
- Tremor at rest
- gait changes
PD risk factors
Men more likely
Risk increased by rural living
- exposure to well water
- pesticides
- herbicides
- industrial chemicals
- wood pulp mill
PD manifestations
TRAP
Tremor
Rigidity
Akinesia - loss of voluntary movement(drool, shuffle)
- Postural instability- unable to stop self (push/pull) forward tilt
Blank facial expressions
Lewy bodies: clumps of protein found in brain of dead
PD complications
- Dyskinesia- spontaneous movement
- weakness
- dementia
- hallucinations
- dysphagia
- loss of postural reflexes- lead to falls
PD Diagnostic studies
No specific test
History and S/S (TRAP)
May use CT or MRI to rule out stroke
Sinemet for PD
Primary treatment
Stimulate dopamine production
Prolong use leads to “on/off” period where med will randomly stop or start working - take break and start back w/ low dose (can use amandine)
Avoid giving with food
Miraplex for PD
Enhances relapse of dopamine
Can use alone or with sinemet
Give with food to avoid nausea
Notify MD if uncontrollable urges, confusion, vision change, rigidity, excessive urination or SOB
Gocovril for PD
Antiviral that increase dopamine release
Use Alone early or later with sinemet
Reduces dyskinesia
Cogentin for PD
Decrease acetylcholine activity
Decrease extremity stiffness sweating production of saliva and improve walking
Stalevo for PD
Combo drug for late stage
Treat stiffness, tremor, spasm
Increase dopamine
Don’t crush
Deep brain stimulation (DBS) for PD
Most common surgical intervention
Electrode in thalamus and generator on chest
Program to deliver special current
Improve motor function
Ablation surgery for PD
Finding and destroying effected area of brain
Transplantation for PD
Fetal neural tissue into basal ganglia to provide dopamine cells
Nutrition for PD
Need fiber
6 small meals /day
Appetizing foods that are easy to chew and swallow
Avoid taking meds with food
interventions for PD
PT exercise plan- assistive devices
OT- eating and drinking
Maximize safety in home
