neuro Flashcards
what causes a stroke
stroke is caused by a narrowing or blocking of view.
ischemic and hemo stroke and tia
ischemic
ischemic
embolic stroke: afib blood clot that travels the blood vessels
thrombotic: HTN/hyperlipidemia: in the circulatory sys
where do the blood flow come from
carotid or vertebral arteries
apraxia
you cant use objects properly or carry our commands/movements
agonsia
cant recognize objects
loss of comprehension of visual, auditory through sensory sphere
dysphagia
cant swallow
dysphasia
cant comprehend or speak
dysarthria
difficulty speaking because of tongue muscles
hemiplegia
paralysis on one half of the body
paraplegic
lower body
quadplegic
4 extremities
hemiparesis
mild or partial weakness/loss of strength on one side of the body
subjective
- PMH
- Meds?
- ask them if they had any surgerys
- developmental delays
objective
- assess their appearance
- behavior
- cognition: time place person situation
- mooood aand affect.
- cranial nerves
- motor system
- sensory: touch
- reflexes
glasgow coma scale
3-15
higher the better
eyes
mouth
moving
less than 8 glasglow
intubate
NIH stroke scale
15
0-15
0 is normal
CSF
CSF Analysis-lumbar puncture
- is there a signed consent?
- what position should the patient be?
- what should the patient do after the procedure?
- what should the nurse encourage/advise the patient to do?
- nursing intervention
- yes. invasive and its aspects
- lateral recumbent position
- lay for an hour
- encourage fluids
- take vital signs and neuro status for headache
Cerebral Angiography
prep op
- is patient on NPO
post op
- how frequent are VS
- is patient ambulating or bedrest
- yes because its dye
- 15-30 mins for 2 hours, 1 for 6 hours, 2 for 24 hours
- bedrest
CT scan neuro with dye
assess for allergeis
IV in case allergies
patient is still
give IV fluids
MRI
MRI with angiography
metallic (tattoo)?
pacemaker)
may need xanny for claustrrophobia
takes one hour
SPECT
IVs
no sedatives
empty bladder
glucose monitor
myelogram
dye is injected into the spinal cord
empty bladder
SEDATE THE PATIENT
REMAIN FLAT
EEG
hold anti seizure meds because we want to see the seizures for one day
seizure
uncontrolled electrical discharge of neurons
seizures metabolic disturbances
- acidosis
- electrolyte imbalances
- hypoglycemia
- alc or barb withdrawal
- too much water too little water
extracrancial disorders
sepsis
lupus
HTN
DM
heart lung kidney liver
risk factors for seizures
low ses
AA
male
heredity
60 yrs old
when is the sensory warning phase
aural
tonic-clonic
LOC
stiffening(tonic)
jerking (clonic)
could have tongue or cheek biting or incontinence
post itcal: muscle soreness, no memory, fatigue
abscene seizure
- happens in children
- daydreaming spell
- can be mis dx as ADHD
- child is hyperventilation and flashing lights
what can patients do in the prodromal stage
take their shirt off
what can patients do during the aural phase
smell things
hallucinate
atypical absence seizure
staring pell
lip smacking and eye twitching
myoclonic
excessive jerking
atonic: drop attack they will gain con after drop
tonic
increased muscle tone
clonic
LOC
loss of muscle tone while jerking
and it could be ASSYMETRIC
partial seizures
stays on one side but can spread to other side to turn into generralized
partial seizures only include
simple and complex
simple seizure
patient is conscious
has weird feelings of emotions like happy and sad
starts to hallucinate and see smell taste things that are not there
complex focal seizures
change or LOC: dream like
automatic behavior: repetitive movement
does not remember activity before the seizure
lasts a few sec
psychogenic seizures
physical manifestation of a psych disturbance
how long does status epi last
more than 5 mins back to back
why is SE an emergency
patient can go into respiratory or cardiac arrest
which seizure for SE is the worst
tonic clonic
what can happen from SE
permanent brain damage or even death or severe injurry
SE is more common in what gender
male
what meds do you give for SE
IV lorazepam and diazepam
what drugs do you give for generealized tonic clonic
pheny
carb
phenobarb
depakote
what do the meds do for patients with seizures
stabilize nerve cell membrane and prevent spread of epileptic discharge
what drug is contraindicated for liver disease
phenytoin
absence and myoclonic meds
clozepam
depakote
what are other therapies for seizures
- keto
- vagal nerve stimulation
- anterior temporal lobe resection
Nursing Assessment Subjective and Objective for seizures
what were you doing before? auras? where was it? also the time of it?
what the the post itcal phase? LOC/VS/ Muscle soreness and weakness
1 number NANDA for seizures
ineffective breathing pattern
can you leave the seizure patient alone
NO
what should you do if the patient is having a seizure
place them on the side, loosening clothes, ease to the floor
PATENT AIRWAY
do not restrain patient
observe the movements and location
DO NOT POSITION, SUCTION, OR GIVE OXYGEN
how can we prevent injury for seizures
wear helmet
padded bed rails
what is TIA
transient episode of neuro dysfunction caused by focal brain, spinal cord, retinal ischemia
how long can a TIA last
less than 1 hour
what are carotid system symptoms?
numbness
hemiparesis
loss of sensation and vision
can’t speak
what are vertebrobasilar systems
tinnitus
vertigo
blurred vision
ataxia
what is the most common stroke
thrombotic
⅔ of the cases is because HTN and DM
what is the main symptoms of intracerebral hemorrhage
HA
N
V
decreased LOC
what causes intracerebral hemorrhage
HTN
what causes subarachnoid hemorrhage
coke, aneurysm rupture, trauma
what are signs and symptoms of subarachnoid
LOC
N
V
SEIZURES
STIFF NECK
what is the right sided stroke
- left-sided neglect ONLY WITH THE RIGHT SIDED STROKE
- spatial and perceptual deficits
- impulsive
- short attention span
*
what is the left sided stroke
- math
- speech
- writting
- slow and cautious
aphasia
total loss of comprehending and using lang
expressive aphasia
patient can understand but can’t speak brocas
receptive aphasia
patient cant understand whats writtten
wernecks
dysphasia
impaired ability to understand or use the spoken word
expressive dysphasia
they can’t put words together to make a meaning
receptive dysphasia
difficult in comprehending. speak slowly so the patient can understand
right side spatial and perceptual
agnosia
apraxia
incorrect perception of themselves
what is the most important for stroke dx
non-contrast CT scan
MRI
how can we prevent strokes
-healthy diet
weight control
regular exercise
no smoking
limit alc
control BP
how can we prevent thrombus/emobolus
ASA and Plavis
anticoag with a fib and TIAA
rda ans and warfarin
what surgical interventions can we do for TIAA
- carotid endartectomy
- transluminal angioplasty
- stenting
carotid endarterectomy
move fatty plaques from BV
transluminal angioplasty
balloon to crack it up
stent
put a stent that holds up the blood vessel especially when its weakneded
hemorrhage stroke surgical therapy
resection
clip the aneurysm
get rid of the hematomas
tpa should be
administered within:
rule out:
prior to admin:
after admin:
3 hours
hem. stroke, GI bleeds, BP over 190, stroke, head trauma, major surgery in last 14 days
prior to admin: foley, IV sites, NG tube
after admin: monitor for bleedings, neuro EVERY 30 mins, BP control.
what drugs are contraindicated in hem. strokes
anti coags and platelets
for hem. strokes how can we manage HTN
IV metoprolol
make sure the BP is less than 160
for hem. strokes how can we manage HTN
IV metoprolol
make sure the BP is less than 160
MANAGE SEIZURES
how can we management ICP for hem strokes
dopamine(vasoconstrict)
mannitol
drain the fluid(ventriculostomy)
SEIZURES CAN HAPPEN WITH WHAT STROKE
Hem Stroke
what are the goals for stroke
preserve life
no furture brain damange
reduce disability
emergency care for stroke: nurse should
airways: get rid of dentures
IV
CT scan non contrast for I stroke or H stroke
Elevate patient
Seizure precautions
NPO BECAUSE RISK OF ASPIRATION!
who assessing the the gag reflex
speech therapist
priority for stroke patients
risk for aspiration pneumonia if patient has dysphagia
vital signs for stroke
assess for lung sounds because remember patient got mannitol
BP
bleeding
VTE assessment in case the clot travels or forms
range of motion for stroke
early mobility
hand cones for contractures(hardening of muscles and this can stiffen their joints)
trochanter roll at hip
DO NOT pull the patient
use splints
left-sided stroke communication
nonverbal cues and can’t comprehend
Multiple Sclerosis is CPD
chronic
progressive
degenerative
demylination of nerrve fibers
risk factors for multiple sclersosis
- gender and age: women between age of 20-40
- climate: temperate climites
what triggers MS
bacterial
viral
MS death occurs because of
infection
lifespan for MS
more than 25 years after dx
what are the first symptoms of MS
visual distubrances
motor MS signs and symptoms
- weakness
- spanning speech: long pauses
- spasticity of muscles
sensory
- flaccid/spastic bladder(incontience)
- lhermittes
- numbness/tingling
- tinnitus
cerebellar
dysphagia
dysarthria
DX for MS
MRI: plaques
CSF: oliogbands
how to diagnosis MS
evidence at least 2 lesions at two different locations within CNS
damange occuring usually one month part
eveything else has to be rule out
what should you give if the MS is being exacerbations
corticos
MS nutrition
Vitamin B12 and C
low fat, gluten free diet
high protein
MS
Impaired physical mobility
can ms patients have dysphagia
mid
a male client is having a tonic clonic seizures what should you do first
take measures to prevent injury. dont elevate bed you have to lower it.
can you give patients thin liquids if they have strokes
no
does generalized have an aura
NO
