Neural Flashcards

Question

What type of injuries can result in a spastic neurogenic bladder? How is it managed for both males and females? What type of injueris can result in a flaccid neurogenic bladder? How is it managed?

Answer 1

upper neuron injuries in the brain Males use a condom catheter and micturition reflex stimulation (tugging on the pubic hair) Females use an indwelling urinary catheter d/t unpredictable urine release lower neuron injuries in the spinal nerves Males' and females' interventions include intermittent catheterization and Crede method (downward pressure placed on the bladder to manually express the urine)

Answer 2

Change position every 2 hours, every 1 hour if in wheelchair Pressure ulcers can develop within 6 hours Monitor Cervical collars- skin breakdown under chin, on the shoulders, and at the occiput Use pressure relief devices continuously

Answer 3

An abnormal, overreaction of the involuntary (autonomic) nervous system to a stimulus The stimulus causes an overreaction by the injured sympathetic system and an attempt to compensate by the parasympathetic system Sympathetic stimulation is usually caused by a triggering stimulus in the lower part of the body Distended bladder MOST COMMON CAUSE CHECK PATENCY OF FOLEY CATHETER Distention or contraction of visceral organs Such as constipation Stimulation of the skin by a compressive dressing or a skin infection because of the resulting extreme hypertension SC lesion above T6

Answer 4

Extreme hypertension Severe pounding headache- Why? What is the risk? Pallor below the level of SC lesion’s dermatome Flushing and profuse diaphoresis above the spinal level of lesion Blurred vision Restlessness Nausea Nasal congestion Bradycardia

Answer 5

Place client in sitting position immediately- this is priority! Notify the healthcare provider Determine and treat the cause Check patency of urinary catheter or insert catheter for distended bladder Remove fecal impaction Assess for injury (skin, fractures, infection) Remove tight clothing Adjust room temperature and block drafts Monitor VS Administer antihypertensives (nitrates or hydralazine)

Answer 6

Provides traction and or immobilizes the spinal column Nursing actions Maintain body alignment and ensure weights hang freely Monitor skin integrity- assessing under the vest Provide pin care Do not use the device to turn or move the client Good skin care- dry, no powder Teach vest care- liner should not get wet, liner should be changed periodically

Answer 7

Decompressive laminectomy removes a section of lamina, removes bone fragments, foreign bodies, or hematomas that can place pressure on the cord Donor bone is often obtained from the iliac crest and is used to fuse the vertebrae together Paravertebral rods are used to immobilize several vertebral levels Assess for airway compromise from swelling or hemorrhage with cervical fusions Assess neurological status and VS every hour the first 4 hrs. post op

Answer 8

Inflammation/infection of the meninges which cover brain and spinal cord Types Bacterial- a contagious infection with a high mortality rate Otitis media, sinusitis can spread to meninges Viral- the most common form that usually resolves without treatment Measles, mumps, herpes, West Nile virus Fungal meningitis is common with AIDS or immunosuppression Cryptococcus neoformans

Answer 9

Hemophilus influenzae type b (Hib) Infants, 4 doses starting at 2 months of age Pneumococcal polysaccharide vaccine (PPSV) Also intended to prevent respiratory infections For adults who are at risk (immunosuppressed or crowded living conditions) Meningococcal vaccine (MCV4) Adolescents prior to living in a college dorm or military base Recommended at age 11 or 12 with a booster at age 16

Answer 10

Excruciating, constant headache Nuchal rigidity (stiff neck) Altered level of consciousness Positive Kernig sign- thigh flexed on abdomen, can’t fully extend Positive Brudzinski sign- with neck flexed, flexion of knees and hips is produced Fever and chills Nausea and vomiting Behavioral changes Photophobia Hyperactive deep tendon reflexes Tachycardia Seizures Red macular rash (petechiae) Restlessness, irritability

Answer 11

lumbar puncture Cloudy: bacterial Clear: viral Elevated WBC Elevated protein Decreased glucose: bacterial Elevated CSF pressure

Answer 12

Isolate the client as soon as meningitis is suspected! Droplet precautions Continue precautions until antibiotics have been administered for 24 hrs. and secretions are no longer infectious. Those with bacterial meningitis may need precautions continuously. Follow hospital policy.

Answer 13

Monitor VS and assess for septic shock Implement fever-reduction measures Bedrest with HOB at 30° Monitor for increased ICP. Avoid increasing ICP Seizure precautions Provide a calm and quite environment with dim lights Report meningococcal infections to the public health department

Answer 14

Ceftriaxone or cefotaxime in combination with vancomycin Given until C&S results are available Early administration of high doses of appropriate IV antibiotics for bacterial meningitis Phenytoin Anticonvulsant if ICP increases or the client has a seizure Acetaminophen, ibuprofen Analgesic for HA and/or fever Prefer nonopioids to avoid masking changes of LOC Prophylactic antibiotics (ciprofloxacin, rifampin) for those in close contact with the client

Answer 15

Increased ICP Leads to brain herniation and death Monitor signs of increased ICP and treat with mannitol SIADH Monitor blood and urine labs (serum Na, and urine specific gravity) Provide interventions such as demeclocycline and restrict fluids Daily weights Septic emboli Can occur in the hands and feet Lead to gangrene and DIC

Answer 16

Collection of infectious material within brain tissue Risk is increased in immunocompromised clients Prevent by treating otitis media, mastoiditis, sinusitis, dental infections, and systemic infections promptly Diagnosis by MRI or CT CT-guided aspiration is used to identify the causative organisms

Answer 17

Headache that is usually worse in the morning Fever Vomiting Neurologic deficits- weakness, decreasing vision Signs and symptoms of increased ICP- decreasing LOC and seizures Control ICP Drain abscess Antibiotic therapy Treat cerebral edema- corticosteroids Conduct frequent and ongoing neurologic assessment and responses to treatment Ensure client safety and protect from injury Provide supportive care Monitor for neurologic deficits

Answer 18

Acute, inflammatory process of the brain tissue Causes Viral infections HSV West Nile St. Louis Fungal infections Headache Fever Confusion Changes in LOC Vector-borne rash Flaccid paralysis Parkinson-like movements Acyclovir for HSV infection Amphotericin B and/or other antifungal agent for fungal infection Control seizures Control ICP Frequent and ongoing assessment Dim lights Limit noise PRN pain meds Use cautiously- may mask neuro symptoms Monitor intake and output- be alert for presence of renal complications from antiviral therapy Monitor for seizures

Answer 19

A chronic progressive immune-related demyelination disease of the CNS Demyelination interrupts the flow of nerve impulses Plaques can occur on axons Unable to regenerate and causing irreversible damage Most common areas include optic nerve, cerebrum, brainstem, cerebellum, and spinal cord

Answer 20

Fatigue Weakness Numbness Difficulty in coordination Loss of balance Pain or paresthesia Visual disturbances Difficulty with speech Muscle spasticity Bowel and bladder dysfunction Cognitive dysfunction Sexual dysfunction

Answer 21

Monitor the following Visual acuity Speech patterns Swallowing Activity intolerance Skin integrity Urinary incontinence Discuss coping mechanisms and resources Encourage fluid intake and other measures to decrease the risk of UTI Assist with bladder elimination Establish a voiding time schedule Every 1.5 to 2 hours Monitor cognitive changes Plan interventions to promote cognitive function Reorient as needed, place objects used in routine places Use a communication board as needed Apply eye patches to treat diplopia Alternate eyes every few hours Teach scanning technique Exercise and stretch affected muscles Balance activity and rest Maintain a safe environment- fall risk! Walk with feet apart- widen base of support Watch the feet while walking

Answer 22

Interferons beta-1a and beta-1b (injections) Start early in the course of disease Used to prevent and treat relapses Adverse effects: flu-like symptoms Corticosteroids (prednisone, dexamethasone, methylprednisolone) Reduce inflammation in acute exacerbations (very high doses used) Adverse effects: infection, hypervolemia, hypernatremia, hypokalemia, hyperglycemia, GI bleeding, and personality changes, insomnia, weight gain Antispasmodics (dantrolene, baclofen, diazepam) for muscle spasticity Anticonvulsants (carbamazepine, gabapentin, pregabalin) is used to treat paresthesia Anticholinergics (oxybutynin, tolterodine) is used for bladder dysfunction

Answer 23

Impaired transmission of impulses across the neuromuscular junction Loss of acetylcholine receptors on muscles due to autoimmune destruction Considered a motor disorder- varying degrees of weakness of the voluntary muscles

Answer 24

Symptoms frequently occur in the face Diplopia Ptosis Weakness of facial muscles Dysphonia- caused my laryngeal involvement Dysphagia- increased choking and aspiration Generalized weakness- affects extremities, intercostal muscles which leads to respiratory failure Most concerning symptom with a new diagnosis is shortness of breath, or increasing work of breathing from respiratory muscle weakness

Answer 25

Pharmacologic Therapy: (2 parts to medication treatment) Anticholinesterase meds- inhibits breakdown of acetylcholine (pyridostigmine) Immunosuppressant meds: an autoimmune disease (azathioprine, cyclosporine) Therapeutic Plasma Exchange (Plasmapheresis) Exchange of plasma Reduces the number of antibodies circulating in the bloodstream Temporary relief from symptoms- few weeks Surgery Thymectomy- removal produces antigen-specific immunosuppression and clinical improvement Frequently done to control myasthenia gravis long-term

Answer 26

Medication management- understanding actions of meds and schedule of taking them Conservation of energy- identify times of rest throughout the day Risk of aspiration- meals should coincide with peak effects of anticholinesterase meds Impaired vision- tape eyes closed for short periods, artificial tears, eye patches Avoid factors that exacerbate symptoms- emotional stress, infections, rigorous activity, heat Support groups

Answer 27

Result of disease exacerbation or a precipitating event, most commonly a respiratory infection THE COMMON COLD!!! Severe generalized muscle weakness with respiratory distress or failure Monitor for any shortness of breath, tachypnea, or increased work of breathing Client is admitted to ICU and closely monitored

Answer 28

Autoimmune disorder with acute attack of peripheral nerve myelin sheath Rapid demyelination of peripheral nerves starting in legs and arms Ascending weakness May produce respiratory failure and autonomic nervous system dysfunction with CV instability (changes in BP, HR) Most often follows a viral infection Muscle weakness Muscle paralysis Paresthesias Pain Diminished or absent reflexes that start in the lower extremities and progress upward Cranial nerve syndromes (peripheral nerves) Changes in vital signs- vagus nerve affected- tachycardia, bradycardia, hypertension, orthostatic hypotension

Answer 29

Facial paralysis caused by unilateral inflammation of the seventh cranial nerve unilateral facial muscle weakness or paralysis with facial distortion, decreased lacrimation, and painful sensations in the face; may have difficulty with speech and eating due to weak muscles, increased sound sensitivity, loss of taste to affected side, increased tearing (loss from eye leading to dry eye), and decreased saliva production bells palsy includes forehead, stroke does not

Answer 30

CT, MRI, PET scan, cerebral angiogram Determines size, location and extent of the tumor Cerebral biopsy Usually guided by CT or MRI scan Abnormal cerebral tissue is sent to pathology Benefits-minimally disruptive to the rest of the brain, decreased recovery time, and not associated with risk of an open craniotomy Negative- does not remove or debulk the tumor, results can be inconclusive, and possible misdiagnosis

Answer 31

Non-opioid analgesics Avoid opioids as they can decrease LOC Corticosteroids (dexamethasone) Reduce cerebral edema Relieves headaches, improves LOC Osmotic diuretics (mannitol) Decrease fluid content of the brain Decreases ICP Anticonvulsant medication (phenytoin) Control and prevent seizures H2-antagonist (famotidine) Decreases the risk of stress ulcers Antiemetics (ondansetron) Radiation/chemotherapy Craniotomy (if surgery is possible)

Answer 32

Slowly progressing and debilitating disorder of movement Decreased levels of dopamine which allows acetylcholine to dominate in substantia nigra

Answer 33

Four primary findings Tremor/pill-rolling tremor of fingers Muscle rigidity Bradykinesia Postural instability/stooped posture Fatigue Slow, monotonous speech Masklike facial expression Difficulty chewing and swallowing Drooling Dysarthria Mood swings Cognitive impairment/dementia (late) Autonomic findings Orthostatic hypotension Flushing Diaphoresis

Answer 34

Levodopa (dopaminergic) is converted to dopamine in the brain Carbidopa protects levodopa from being metabolized before it reaches the brain Allows for smaller doses and less adverse effects Muscle twitching Facial grimacing Spasmodic eye winking

Answer 35

Dopamine agonists (pramipexole) Combine with dopaminergic for better results Adverse effects: orthostatic hypotension, dyskinesias, and hallucinations Anticholinergics (benztropine) Decrease tremors and rigidity Adverse effects: anticholinergic effects COMT inhibitors (entacapone) Decrease the breakdown of levodopa Adverse effects: dark urine, diarrhea MAO-B inhibitors (selegiline) Reduce the wearing off phenomenon Avoid foods high in tyramine- can cause hypertensive crisis

Answer 36

Stereotactic pallidotomy or thalamotomy When clients are unresponsive to other therapies Causes destruction of a small portion of the brain Deep brain stimulation Electrode is implanted in the thalamus Current is delivered through a small pulse generator implanted under the skin of the upper chest Decreases tremors and involuntary movements

Answer 37

A chronic progressive hereditary (autosomal dominant) disease that results in choreiform movement and dementia Pathology involves premature death of cells in the striatum of the basal ganglia (control of movement) and the cortex (thinking, memory, perception, judgment) Occurs at midlife (30-50) Chorea Intellectual decline Emotional disturbance Uncontrollable movement Tics and grimaces Speech problems- slurred, hesitant, explosive Dysphagia- risk for aspiration Disturbed gait with eventual bedrest Impaired judgment and memory Anger, dementia, and psychosis eventually ensue

Answer 38

Three general stages Mild Alzheimer Stages 1-3 Moderate Alzheimer Stages 4 and 5 Severe Alzheimer Stages 6 and 7

Answer 39

Antipsychotics Antidepressants Anxiolytics AD Medications may temporarily improve activities of daily living Donepezil prevents the breakdown of acetylcholine Memantine blocks nerve cell damage caused by excess glutamate Adverse effects: frequent stools, upset stomach, and dizziness/headache, unsteady gait

Answer 40

amyotropic lateral sclerosis (Lou Gehrig) Unknown cause Progressive illness Loss of motor neurons in the anterior horn of the spinal cord and loss of motor nuclei of the lower brainstem Occurs most between 40 and 60 years of age

Answer 41

Fatigue Progressive muscle weakness Cramps Fasciculations (twitching) Incoordination Difficulty in talking Difficulty in swallowing Difficulty in breathing

Answer 42

Incurable disorders characterized by progressive weakening and wasting of skeletal and voluntary muscles Most are inherited disorders Muscle tissue is replaced with connective tissue

Answer 43

Cervical disc herniation (cervical radiculopathy) Lumbar disc herniation (sciatica) Spondylosis- degenerative changes in disc and adjacent vertebral bodies Paresthesia- numbness, tingling, pins & needles Pain and stiffness in the neck and shoulders Low back pain, especially with activity Postural deformity Medications- analgesics, NSAIDs, muscle relaxers, corticosteroids Surgery- discectomy with or without fusion Nursing Management Relief of pain Improve mobility Monitor for bleeding / hematoma (following surgery) Frequent neuro checks- spinal cord compression may produce rapid or delayed onset of paralysis Monitor for dysphagia- anterior approach cervical surgery

Answer 44

side-lying with pillow between legs supine with pillow under lower legs

Answer 45

Central nervous system Brain and spinal cord Peripheral nervous system Includes cranial and spinal somatic nerves (motor and sensory) and the Autonomic nervous system

Answer 46

Functions to regulate activities of internal organs and to maintain and restore internal homeostasis Sympathetic nervous system “Fight or flight” responses Main neurotransmitter is norepinephrine Sympathetic division is mainly from the thoracic sympathetic ganglion Parasympathetic nervous system "Rest and digest" responses Controls mostly visceral functions Parasympathetic division is mainly from cranial nerves and sacral nerves Regulated by centers in the spinal cord, brainstem, and hypothalamus

Answer 47

Pain Seizures Ataxia (abnormal balance or movement) and vertigo (illusion of movement, usually rotation) Visual disturbances Weakness Abnormal sensations Past health, family, social history Consciousness and cognition Cranial nerves Motor system Sensory system Reflexes

Answer 48

1 olfactory 2 optic 3 oculomotor 4 trochlear 5 trigeminal 6 abducens 7 facial 8 vestibulocochlear 9 glossopharyngeal 10 vagus 11 accessory 12 hypoglossal Some Say Marry Money, But My Brother Says Big Boobs Matter Most

Answer 49

Allergies to shellfish/iodine Assess BUN and Cr NPO 4 hours prior for contrast Monitor for allergic reaction Flushing out contrast by increasing PO fluids Stop metformin prior to IV contrast

Answer 50

positron emission tomography single photon emission computed tomography Both are nuclear imaging exams Produce 3D images of static (depicting vessels) or functional (brain activity) Determines tumor activity and/or response to treatment Determines dementia (the brain does not respond to the tracer) Both use radiation PET Glucose-based tracer is injected into the blood stream prior  initiates regional metabolic activity  documented by PET scanner SPECT Uses a radioisotope to initiate metabolic activity

Answer 51

magnetic resonance imaging Cross sectional images Images are obtained using magnets (not radiation) Safe for pregnancy Not compatible with some artificial devices (pacemakers, surgical clips, any metallic objects) Use MRI-approved equipment to obtain VS and provide ventilation/oxygen Done with or without contrast Capable of discriminating soft tissue from tumor or bone Determine tumor size and blood vessel location

Answer 52

Looks at circulation to the brain with a contrast agent Assesses narrowing of vessels, aneurysms, strokes, vascularity of tumors Used to inject medications to treat blood clots or administer chemo Contrast agent is injected into the femoral or carotid artery Nursing Actions NPO 4 to 6 hours prior Assess BUN and Cr Determine history or bleeding or anticoagulant use Hydrate before procedure Void immediately before procedure Mild sedation for relaxation can be used Warmth in face, behind eyes or in mouth, and metallic taste with dye injection Frequent neuro checks after the exam (embolism/arterial dissection) Assess puncture site (bleeding/hematoma) and circulation Activity restriction Ice pack to insertion site

Answer 53

electroencephalography A non-invasive test Assesses the electrical activity of the brain Most done to assess for seizure disorders Also used to evaluate sleeping disorders and behavioral changes Used to determine brain death

Answer 54

Preprocedural Review medications Client education: wash hair, stay awake the night before the test (to achieve sleep-deprivation which can induce a seizure), during the exam you might be exposed to flashing lights or asked to hyperventilate for 3-4 minutes, and avoid sedating or stimulant medications 24 hrs. prior Intraprocedural Procedure takes 45 to 120 minutes Small electrodes are placed on the scalp Notations are made when stimuli is present Postprocedural Resume normal activities

Answer 55

Spinal tap- L3/L4, L4/L5 as spinal cord ends L1, small amount of CSF is removed Can determine disease processes (MS, meningitis, syphilis) Also used to reduce ICP by removing fluid, instill contrast media for imaging, or administer chemotherapy directly to central nervous system for malignancies Obtain CSF samples for analysis Clear vs. pink-tinged (bleeding in brain) Cell count (WBC elevated with inflammation/infection) Culture (viral cultures for encephalitis, bacterial cultures for meningitis) Glucose (reduced with bacterial infection) Protein (elevated with MS, Guillain-Barre syndrome, and infections)

Answer 56

4-8 hrs Brain herniation due to removal of fluid with high ICP Spinal hematoma  compression of cauda equina and paralysis Infection introduction of the spinal canal Post- LP headaches

Answer 57

Eye opening 4 spontaneous 3 to sound 2 to pain 1 none verbal 5 coherent and oriented 4 incoherent and disoriented 3 makes no sense 2 sounds, not words 1 none motor 6 follows commands 5 local reaction to pain 4 withdraws from pain 3 decorticate posture 2 decerebrate posture 1 none

Answer 58

elbows flexed on chest, arms adducted to sides, legs internally rotated, feet flexed

Answer 59

arms adducted and extended, hand flexed, feet flexed

Answer 60

10-15 mmHg

Answer 61

systolic increased diastolic decreased

Answer 62

CPP is closely linked to ICP CPP is determined by mean arterial pressure minus intracranial pressure Provides an estimation of the blood pressure that allows blood to flow to brain CPP = MAP – ICP Normal CPP is 70 to 100 mm Hg A CPP of less than 50 results in permanent damage

Answer 63

Administer mannitol and dexamethasone every 6 hrs. for 24 to 72 hrs. post-op to reduce ICP and cerebral edema Administer phenytoin or diazepam to prevent seizure activity Monitor ICP Supratentorial surgery Maintain HOB of at least 30° with proper body positioning to prevent increased ICP Infratentorial Keep client flat and on either side for 24 to 48 hrs. to prevent pressure on the neck incision site Maintain a calm environment Provide emotional support (brain surgery is an extremely fearful procedure)

Answer 64

Tonic-clonic seizure Breathing can stop, cyanosis, biting, incontinence Period of confusion and sleepiness follows the seizure Tonic seizure Sudden increased muscle tone, loss of consciousness, and autonomic manifestations (vomiting, incontinence, salivation) Clonic seizure Muscles contract and relax, can last several minutes Myoclonic seizure Brief jerking or stiffening of the extremities for few seconds Atonic or akinetic seizure Muscle tone is lost, clients frequently fall Confusion follows the seizure

Answer 65

Involves only one side of the hemisphere Two types Simple partial Consciousness is maintained Can cause unusual auras as well (sense of déjà vu, offensive smell) Results in focal symptoms such as movement of an arm or leg Complex partial Associated with automatisms (unaware of lip smacking or picking at clothes) Can cause a loss of consciousness or black out for several minutes Amnesia can occur immediately before and after

Answer 66

Genetic predisposition Cerebrovascular disease Hypoxemia Fever (childhood) Head injury Cerebral edema Hypertension Central nervous system infections like encephalitis or meningitis Metabolic (hypoglycemia or hyponatremia) Brain tumor Drug and alcohol withdrawal Allergies Abrupt cessation of antiepileptic drugs Toxins Stroke Heart disease Fluid and electrolyte imbalances

Answer 67

Repeated seizure activity within a 30-min time frame without full recovery or a single, prolonged seizure lasting more than 5 minutes (ATI, 2023) Medical emergency to stop the seizure (prevent hypoxemia/ischemia to brain) Usual causes ETOH withdrawal, sudden withdrawal from antiepileptic drugs, head injury, cerebral edema, infection, metabolic disturbances Complications Decreased oxygen levels, inability to return to normal functioning, and continued assault on neuronal tissue Treatment ABC, oxygen, IV access, ECG, and O2 sat monitoring IV/IM diazepam or lorazepam followed by IV phenytoin infusion

Answer 68

Prodromal phase- awareness of symptoms before onset of headache (irritability, depression, food cravings, diarrhea, constipation, frequent urination); often hours to days prior to headache Aura stage- numbness/tingling, confusion, visual disturbances; minutes to hours prior to headache. Can be confused with a stroke due to initial neurological symptoms Second stage- severe throbbing headache that intensifies over several hours, NVD, vertigo, photophobic, and phonophobia Third stage- dull headache that lasts 4 to 72 hrs. Recovery- with pain and aura subsiding, muscles ache, physical activity worsens pain

Answer 69

NSAIDs (ibuprofen, naproxen) or acetaminophen products Antiemetics such as metoclopramide or ondansetron Triptans (sumatriptan) Cause vasoconstriction to treat the migraine HA Educate the client to notify the provider for continuous or severe chest pain Contraindicated for those who have a history or are at risk for MI Ergot alkaloids (ergotamine) Cause powerful vasoconstriction to control migraine HA Can cause hypertension, chest pain, and ischemia to fingers and toes Adverse effects: GI discomfort with nausea and vomiting Toxicity: paresthesia in fingers and toes, peripheral ischemia Not for long-term use to avoid physical dependence Pregnancy category X

Answer 70

transient ischemic attack Temporary neurologic deficit resulting from a temporary impairment of blood flow All neurological function returns to normal, usually within minutes to hours “Warning of an impending stroke” in the future

Answer 71

Facial drooping (ask client to smile—look for unilateral facial drooping.) Arm weakness (ask client to raise both arms—look for downward drift.) Speech impairment or difficulty speaking (ask client to repeat a simple phrase—listen for unexpected findings such as slurred speech.) Time to call 911 (if any of above findings present, call 911 immediately.)

Answer 72

Ischemic Decreased oxygenation to the brain r/t vascular occlusion from thrombotic or embolic event Thrombotic stroke: Occurs secondary to a blood clot on an atherosclerotic plaque Embolic stroke: Caused by embolus traveling from another part of the body to a cerebral artery such as atrial fibrillation Hemorrhagic Bleeding into the brain from a ruptured artery or aneurysm Main risk factor is chronic hypertension Poorer prognosis Significant ischemia and increased ICP

Answer 73

responsible for language, mathematics skills, and analytical thinking Expressive or receptive aphasia (inability to speak or understand language) Agnosia (unable to recognize familiar objects) Alexia (reading difficulty) Agraphia (writing difficulty) Right hemiplegia (paralysis) and hemiparesis (weakness) Hemianopsia (loss of visual field) Slow, cautious behavior Depression, anger, and quick to become frustrated

Answer 74

Responsible for visual and spatial awareness and proprioception Altered perception of deficits Unilateral neglect syndrome (more common in R) Loss of depth perception Poor impulse control and judgment Left hemiplegia or hemiparesis Hemianopsia

Answer 75

Coagulation panel: PT/INR/aPTT prior to initiating fibrinolytic or anticoagulation medications 12 lead ECG Doppler ultrasound: (carotid) to determine perfusion to the brain, check for occlusions or blockage Non-contrast CT scan: Used emergently to assess for strokes Perform within 25 minutes of arrival to the ED! Used to determine the type of stroke (ischemic or hemorrhagic) and whether the client is a candidate for thrombotic therapy (t-PA) Cerebral Angiography: Outlines the entire vascular tree to the brain A cerebral CTA is often used (combination of a CT with angiography) MRI: Can identify edema, ischemia, and necrosis Not used emergently since a much longer test to perform GCS: to assess and follow the level of consciousness (LOC) with acute stroke Dysphagia screening: Speech-language pathologist can perform a swallowing study

Answer 76

Early treatment is important (time is brain tissue) Thrombolytic therapy (also known as fibrinolytic therapy) if appropriate Tissue plasminogen activator (t-PA) Administer within 3 to 4.5 hours of initial manifestations Only given for ischemic strokes

Answer 77

Thrombectomy (Intra-arterial t-PA administration): Directly infuses t-PA into occluded artery to dissolve the clot Endovascular therapy: With a guidewire system, the clot is removed from occluded artery Carotid artery angioplasty with stenting (CAS) Stent is placed to open a blockage Performed within 6 hours of onset of manifestations Carotid endarterectomy (if occluded carotid artery) Removes atherosclerotic plaque in the carotid artery

Answer 78

Monitor VS every 1 to 2 hours Monitor LOC and treat fever which can increase ICP (increase metabolic demands of brain) Maintain SpO2 >92% if the client has a decreased LOC Monitor ECG for cardiac dysrhythmias Conduct a cardiac assessment to detect murmurs and irregularity Monitor for hyperglycemia which is associated with poor neurologic outcomes Elevate HOB to at least 30°, prevent extreme flexion/extension of head Institute seizure precautions

Answer 79

decreased visual field Instruct the client to use a scanning technique when eating and ambulating Put items in the room within the client’s view

Answer 80

cerebral perfusion pressure 70-100 mmHg MAP - ICP = CPP a low MAP or high ICP

Answer 81

changes in LOC restlessness, agitation, confusion weakness in one side drowsiness HA increasing in intensity

Answer 82

respiratory and vasomotor changes projectile vomiting dixed dilated pupils seizure coma posturing changes in VS, Cushing's triad

Answer 83

increased CO2 suctioning coughing/straining neck/hip flexion or extenaion laying flat, bed less than 30 degrees constrictive clothing Valsalva maneuver HOB 30-45 degrees keep head and neck still ventilation prevent constipation

Answer 84

sleep deprivation flashing lights hyperventilation

Answer 85

benzodiazepine followed by phenytoin IV access in the event of a seizure