Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

235 Med surg > Mobility > Flashcards

Mobility Flashcards

1
Q

What is a Hemorrhagic stroke

A

Bleeding into the brain that results in brain cell death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a ischemic stroke

A

Inadequate blood flow (blockage) to part of the brain

Can be complete or partial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most effective way to decrease burden of stroke is..

A

Prevention and teaching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

NON-modifiable risk factor of stroke

A

50 and up
Men more likely
African American

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Modifiable risk factor of stroke

A
  • HTN most modifiable risk factor (Sbp less than 140)

A-Fib !! Leads to Blood clots

Obesity 
Diet
Smoking
Drinking 
Sleep apnea 
Diabetic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hemorrhagic stroke results from bleeding into

A

1) subarachnoid space

2) brain tissue itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Subarachnoid hemorrhagic stroke

A

Area between the brain and skull; bleeding into the cerebrospinal fluid

Often caused by rupture of super broad aneurysms, trauma or illicit drug use 

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Intracerebral hemorrhagic stroke (ICH)

A

-  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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

2 types of ischemic stroke

A

1) thrombotic

2) embolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Thrombotic stroke (ischemic)

Extent of stroke depends on:

A
  • 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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Embolic stroke

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Transient ischemic attack (TIA)

A

“ mini stroke”

Puts at risk for actual stroke

Medical emergency that can lead to an ischemic stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical manifestations of STROKE are related to

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Most COMMON clinical manifestations of STROKE

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What to do for a stoke

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Goal of act FAST

A

Preserving life
Preventing further Brian damage
Reducing disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Motor functions affects by stroke

A 
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Initial period of flaccidity for stroke

A

Hangin lose/ poor muscle tone
- maybe ask from days to several weeks

Then spasticity of muscles follow ( tight, increase muscle tone) 

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Communication manifestations of stroke

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Stroke affect on emotions

A
  • may have hard time controlling emotions
  • emotional responses may be exaggerated or unpredictable

Magnified by:

  • depression
  • changed in body image
  • loss of function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Stroke affect on intellectual function

A

Memory and judgment may be impaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Homonymous hemianopsia

A

Blindness in one half of visual field

Reminders and arranging things in visual field important

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Stroke affect on eliminating

A

Most problems with urinary and bowel elimination occur initially and are temporary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Diagnostic study for stroke

A
  • 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?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Nurse teaching to MANAGE modifiable risk factors for stroke

A

Health diet (reduce salt and fats)
Exercise (30 minx3wk)
Stop smoking a d drinking
Meds to keep HTN below 140

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Preventive drug therapy for stroke

A

Aspirin 81 mg/day

Apixaban or warfarin for anticoagulant for A-Fib

Medications to control HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Preventative ischemic stroke surgical therapy CEA

A

Carotid endarterectomy (CEA)

Removal of atherosclerotic plaque or thrombus from carotid artery to prevent stork

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Assessment after CEA

A

Neuro frequently
BP
Keep leg straight and look at femoral site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Preventing ischemic stroke PTA and Wire Mesh

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Preventative hemorrhagic stroke surgical therapy

A

Surgical clipping or cooling of aneurysm for those at risk for hemorrhagic stroke

Aneurysm- weak vessel that could burst

31
Q

Postop care stroke interventions

A

Neuro assessment
BP management
Assess for complications
Minimize risk of bleeding at insertion site

32
Q

What to monitor for after ischemic and hemorrhagic stroke

A

Airway
Breathing
Circulation
Intracranial pressure (ICP) - manatal or HOB 30

33
Q

tPa for ischemic stroke

A

Clot buster

Given IV

3-4 hr of onset of clinical signs

DONT give if bleeding

Monitor for brushing, vs, BP > 140

34
Q

Prevention of further clots once pt stable after ischemic stroke

A

1) anticoagulant
2) platelet inhibiting meds
3) statins

35
Q

Acute care for hemorrhagic stroke

A
  • 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

36
Q

Nursing management (GOALS over time) for stroke

A 
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
37
Q

Promoting mobility with unilateral paralysis

A
  • ROM / Positioning
    • paralyzed / weak side need special attention when positioned
    • physical therapy
38
Q

Optimizing musculoskeletal function after stroke

A
  • 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
39
Q

How can nurse support post stroke pt

Nutrition , communication, skin, home environment

A

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

40
Q

What is Multiple sclerosis

A

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

41
Q

MS risk factors

A

Can occur at any age
Peak age 20-50 (ave 35)

Affect women more

More prevalent in temperate climates

42
Q

MS cause

A

Unknown

Factors include:

  • infection
  • smoking
  • physical injury
  • emotional stress
  • excessive fatigue
  • pregnancy
  • poor state of health
  • genetic component
43
Q

Course of MS

A

Different patterns

Overall trend is progressive

No cure - death usually occur due to infectious complications of immobility ( pneumonia) or unrelated disease

44
Q

Relapsing remitting MS

A

Unpredictable attacks which may or may not leave permanent deficits followed by periods of remission

45
Q

Progressive relapsing MS

A

Steady decline since onset with superimposed attacks

46
Q

Secondary progressive MS

A

Initially relapsing remitting but then suddenly begins to have decline without periods of remission

47
Q

Primary progressive MS

A

Steady decrease in ability without attacks

48
Q

MS visual symptoms that affect Mobility

A
  • blurrred / cloudy vision
  • diolopia ( double)
  • red green color distortion
  • nystagmus
  • patchy blindness (Scotoma)
  • total blindness

Normally first signs to appear

49
Q

MS musculoskeletal and sensory symptoms that impact mobility

A
  • 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)
50
Q

Fatigue in MS

A

Very common

Often the most disabling symptom

51
Q

Pain in MS

A

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

52
Q

MS 2 neurologic signs

A

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

53
Q

MS s/s

Mind, mouth, bathroom

A 
Memory deficits- word finding 
Impaired judgment/ decrease concentration 
Chewing / swallow difficult 
Constipation / incontinence 
Urinate retention/ freq
54
Q

MS diagnostic test

A

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

55
Q

MS immunomodulators

AVONEX

A

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
56
Q

MS immunomodulators

Fingolimod

A

Oral

Shown to decrease relapsing

57
Q

Meds for symptom relief of MS

A

1) Spasticity: Baclofen
2) Severe fatigue that interferes with activities: Amantadine
3) Ataxia: gabapentin
4) UTI: vitamin C

Corticosteroids

58
Q

Nursing teaching for MS

A
  • 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
59
Q

Parkinson’s disease is characterized by

A
  • bradykinesia
  • rigidity
  • Tremor at rest
  • gait changes
60
Q

PD risk factors

A

Men more likely

Risk increased by rural living

  • exposure to well water
  • pesticides
  • herbicides
  • industrial chemicals
  • wood pulp mill
61
Q

PD manifestations

TRAP

A

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

62
Q

PD complications

A
  • Dyskinesia- spontaneous movement
  • weakness
  • dementia
  • hallucinations
  • dysphagia
  • loss of postural reflexes- lead to falls
63
Q

PD Diagnostic studies

A

No specific test

History and S/S (TRAP)

May use CT or MRI to rule out stroke

64
Q

Sinemet for PD

A

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

65
Q

Miraplex for PD

A

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

66
Q

Gocovril for PD

A

Antiviral that increase dopamine release

Use Alone early or later with sinemet

Reduces dyskinesia

67
Q

Cogentin for PD

A

Decrease acetylcholine activity

Decrease extremity stiffness sweating production of saliva and improve walking

68
Q

Stalevo for PD

A

Combo drug for late stage

Treat stiffness, tremor, spasm

Increase dopamine

Don’t crush

69
Q

Deep brain stimulation (DBS) for PD

A

Most common surgical intervention

Electrode in thalamus and generator on chest

Program to deliver special current

Improve motor function

70
Q

Ablation surgery for PD

A

Finding and destroying effected area of brain

71
Q

Transplantation for PD

A

Fetal neural tissue into basal ganglia to provide dopamine cells

72
Q

Nutrition for PD

A

Need fiber

6 small meals /day

Appetizing foods that are easy to chew and swallow

Avoid taking meds with food

73
Q

interventions for PD

A

PT exercise plan- assistive devices

OT- eating and drinking

Maximize safety in home

235 Med surg (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions