Neuro 5 Flashcards
s/s of Anterior Cerebral Artery stroke
- *frontal lobe problems: personality changes
- Confusion
- Weakness
- Numbness on the affected side
- Paralysis of the contralateral foot and leg
- Incontinence
- Poor coordination
- Impaired motor and sensory function
- Personality changes, such as flat affect and distractibility
s/s of Vertebral Basilar Artery stroke
- *back of head
- Mouth and lip numbness
- Dizziness
- Weakness on the affected side
- Visual changes, color blindness, lack of depth perception and diplopia
- Poor coordination
- Slurred speech
- Amnesia
- ataxia
s/s of posterior cerebral artery stroke
Visual field cuts Sensory impairment Dyslexia Coma Blindness from ischemia in the occipital area
what is neglect
*middle cerebral stroke
pt doesn’t know they have a L or R side of their body (will not brush hair or get dressed on that side)
what is Hemianopsia
- *lose peripheral vision on that side (HALF VISION)
- cannot see L peripheral on each eye: may walk into walls, see food on that side
- CANNOT drive, do not show up on left side, come from the front
where should you put their food/utensils, if true hemianopsia
- *put IN FRONT of them so they learn to scan environment and turn head
- get them dressed on unaffected side first
if ischemic stroke what should be given immediately
Thrombolytics within 3 hours
if thrombosis or embolism what should be given
TPA IV (up to 8 hrs since stroke)
treatment of CVA
-CT or MRI immediately
-meds:
ASA or Plavix: antiplatelets
Anticonvulsants
Antihypertensives and Antiarrhythmics
Stool Softeners
what is a Cerebrovascular accident
aka stroke or CVA
protocol for brain attack
1) Neuro consult,
2) CT in 20 min,
3) swallowing study (choke…)
initial stroke algorithm
Identify signs- Stroke Assessment
Assess oxygenation, IV access, obtain BG and VS
Contact Stroke Team for Assessment and order CT
after CT if NO hemorrhage…
- *thrombolytics
- If thrombolytics, no ASA or antiplatelets for 24 hours
- Monitor BP and neurologic assessment
after CT if hemorrhage…
consult neurosurgeon Give ASA (aspirin)
FAST stroke assessment
1) Facial dropping (ask them to smile)
2) Arm drooping (one arm weak/numb?, raise arms are any downward?)
3) Speech difficulties (slurred? can they repeat sentence?)
4) Time (call 911 immediately if have these s/s)
Cincinnati Pre-Hospital Stroke Scale
-Facial Droop- patient shows teeth or smiles (both sides should be equal)
-Arm drift- closes eyes and extends both arms straight out for 10 seconds (Both arms move the same or both don’t move)
-Speech- patient repeats, “the sky is blue in Cincinnati”
(no slurring of words)
describe spinal shock
- flaccid paralysis, loss of DTR and loss of motor and sensory function
- spinal cord not working, flacid paralysis
describe neurogenic shock
-bradycardia, orthostatic hypotension, inability to sweat below the level of injury
what should you assess if spinal cord injury suspected
Assess level of damage- what level is respiratory compromise?
types of spinal cord injuries
spinal shock and neurogenic shock
what to remember about spinal cord injuries
- Remember the damage can extend due to swelling- ASSESS respiratory and cardiac status every hour
- Stabilize the spine and treat the symptoms with ventilator and vasopressor support
hyperflexion
Sudden deceleration of the head and neck- MCA
type of spinal cord injury
hyperextension
Most common type, fall, read-end MVC or hit in the head
type of spinal cord injury
axial loading
compression of vertebral column
type of spinal cord injury
