Neuro 4 LURN: Stroke/CVA and Seizures Flashcards

1
Q

What is a stroke/cerebrovascular accident (CVA)?

A

Sudden interruption of blood supply to the brain

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2
Q

What is the patho of a stroke/cva?

A

Deprivation of oxygen and nutrients leads to brain tissue damage/necrosis

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3
Q

What are the three causes of stroke/cva?

A
  • Hemorrhagic: ruptured artery/aneurysm
  • Thrombotic: blood clot in cerebral artery
  • Embolic: Blood clot from another part of the body that travels to the cerebral artery
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4
Q

What are the stroke/cva risk factors?

A
  • Smoking
  • HTN
  • Diabeties
  • Obesity
  • AFIB
  • Hyperlipidemia
  • Hx of transient ischemic attack (TIA)
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5
Q

What are the general s/s of stroke/cva?

A
  • Unilateral limb weakness
  • Facial drooping
  • Slurred speech
  • Visual disturbances (homonymous hemianopsia)
  • Dizziness
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6
Q

The left hemisphere is responsible for what aspects of being?

A

Language/math, analytical thinking

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7
Q

What are the s/s of left-sided stroke/cva?

A
  • Expressive aphasia (inability to speak/understand language)
  • Reading and writing difficulty
  • Right-sided hemiparesis (weakness) and/or hemiplegia (paralysis)
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8
Q

The right hemisphere is responsible for what aspects of being?

A

Visual and spatial awareness

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9
Q

What are the s/s of right-sided stroke/cva?

A
  • Overestimation of abilities
  • Poor judgement and impulse control
  • Left-sided hemiparesis and/or hemiplegia
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10
Q

What are the dx tests used for stroke/cva?

A
  • CT
  • MRI
  • Cerebral angiogram
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11
Q

What is the tx for ischemic stroke?

A
  • Thrombolytics (TPA) w/in 3hrs of symptoms
  • Anticoags
  • Antiplatelets
  • Surgery
    • Embolectomy
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12
Q

What is the tx for hemorrhagic stroke?

A
  • Antihypertensives
  • Surgery
    • Aneurysm repair
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13
Q

What is our nursing care for stroke/cva?

A
  • Closely monitor pt’s BP
  • Implement fall precautions
  • Assess swallowing and gag reflex before allowing pt to eat
  • Thicken liquids and teach pt to tuck chin to chest when swallowing
  • Reposition pt frequently to protect them from pressure injuries
  • Teach pt to use scanning technique
    • Turn head from direction of unaffected side to affected side for homonymous hemianopsia
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14
Q

What are seizures?

A
  • Uncontrolled electrical discharge of neurons in the brain
  • Epilepsy is ≥ 2 unprovoked seizures
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15
Q

What is the patho of seizures?

A

Disease, injury or unknown cause results in hyperexcitability of neurons and decreased inhibition of neuron activity

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16
Q

What are the risk factors for seizure?

A
  • Fever
  • Cerebral edema
  • Infection
  • Toxin exposure
  • Brain tumor
  • Hypoxia
  • Alcohol/drug withdrawal
  • F&E imbalances
17
Q

What are some triggers for seizures?

A
  • Fatigue
  • Stress
  • Flashing lights
  • Caffeine
18
Q

What are four types of seizures?

A
  • Tonic clonic
  • Absence
  • Myoclonic
  • Atonic
19
Q

What is a tonic clonic seizure?

A

Tonic-clonic seizures involve both tonic (stiffening) and clonic (twitching or jerking) phases of muscle activity.

20
Q

A tonic clonic seizure may be proceeded by an aura. What is an aura?

A

The person may experience changes in sensation, mood or emotion leading up to the tonic-clonic seizure.

21
Q

What are the three phases of a seizure? Describe each.

A
  • Tonic episode: stiffening of muscles, loss of onsciousness
  • Clonic episode: 1-2 min of rhythmic jerking of extremities
  • Postictal phase: confusion, sleepiness, agitation
22
Q

What is an absence seizure and what are its s/s?

A
  • Loss of consciousness for a few seconds
    • Resembles “day dreaming”
  • s/s:
    • blank staring
    • eye fluttering
    • lip smacking
    • picking at clothes
23
Q

What is a myoclonic seizure?

A

Brief jerking of extremities

24
Q

What is an atonic seizure?

A
  • Loss of muscle tone
  • Often results in falling
25
Q

What dx test is used to identify origin of seizure?

A

EEG

26
Q

What type of medication is used for seizures?

A

Antiepileptics

27
Q

What are some procedural treatments for seizures?

A
  • Vagal nerve stimulator
  • Craniotomy to remove seizure causing tissue
28
Q

What is our nursing care during seizure?

A
  • Lower pt to bed or floor if standing/sitting
  • Turn pt on their side (pre or post seizure, NOT DURING)
  • Loosen restrictive clothing
  • Do NOT put anything in pts mouth
  • Do not restrain pt
  • Note onset/duration of seizure
29
Q

What is our post seizure nursing care?

A
  • Check VS, neuro status
  • Reorient pt
  • Keep pt on side and allow to rest
  • Implement seizure precautions
  • Document the seizure
30
Q

What is status epilepticus?

A

Life threatening condition where a person has a prolonged seizure (> 5min) or fails to regain consciousness in between seizures

31
Q

What are the risk factors for status epilepticus?

A
  • CNS infection
  • Head trauma
  • Drug withdrawal/toxicity
32
Q

What medications are used for status epilepticus?

A
  • Benzodiazepines (lorazepam)
  • Antiepileptics (phenytoin)
  • Anesthetic agents (propofol)
  • Barbiturates (phenobarbital)
33
Q

What factors do we document in a focused assessment of a seizure?

A
  • How often do seizures occur
    • Date, time and duration
  • Description of seizure
    • Tonic, clonic, staring spells, etc
  • Sequence of progression
    • where it began and how it progressed
  • Observations during seizure
    • Changes in pupil size, eye deviation
    • LOC change
    • Apnea, cyanosis, salivation, incontinence
  • Pt actions post seizure
    • Drowsy/weak?
    • Aware or unaware of seizure activity?
  • How long it takes for pt to return to pre-seizure status
34
Q

Describes what happens with breathing in a tonic clonic seizure.

A
  • Tonic phase = apnea and loss of consciousness, lasts about 10 sec
  • Clonic phase = breathing w/ convulsions
35
Q

If a pt must take antiepileptic meds to prevent seizures, what must we educate them about doses?

A
  • Don’t skip any doses!
  • If dose is skipped, seizure may be triggered
36
Q

If drugs don’t work to prevent seizures, what else may be attempted to do so in pts ≥12 yrs?

A

Vagus nerve stimulator

37
Q

Describe the vagus nerve stimulator?

A
  • A device to stimulate the vagus nerve with electrical impulses
  • There’s one vagus nerve on each side of the body, running from the brainstem through the neck to the chest and abdomen
  • The device is surgically implanted under the skin on the chest, and a wire is threaded under the skin connecting the device to the left vagus nerve.
  • When activated, the device sends electrical signals along the left vagus nerve to the brainstem, which then sends signals to certain areas in the brain.
  • The right vagus nerve isn’t used because it’s more likely to carry fibers that supply nerves to the heart.
38
Q

What does a magnet do when passed over a vagus nerve stimulator?

A
  • By swiping a magnet across the left chest, the magnet can send an additional electrical burst to the brain that may help stop the seizure or decrease the seizure’s length
  • Can be used at anytime during seizure, but most effective if at start
39
Q

Some of the side effects and health problems associated with implanted vagus nerve stimulation can include:

A
  • Voice changes
  • Hoarseness or throat discomfort
  • Coughing, difficulty swallowing
  • Neck/chest pain
  • SOB
  • Tingling skin
  • Worsening of pre-existing sleep apnea