Neuro 5 Flashcards

1
Q

s/s of Anterior Cerebral Artery stroke

A
  • *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
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2
Q

s/s of Vertebral Basilar Artery stroke

A
  • *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
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3
Q

s/s of posterior cerebral artery stroke

A
Visual field cuts
Sensory impairment
Dyslexia
Coma
Blindness from ischemia in the occipital area
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4
Q

what is neglect

A

*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)

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5
Q

what is Hemianopsia

A
  • *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
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6
Q

where should you put their food/utensils, if true hemianopsia

A
  • *put IN FRONT of them so they learn to scan environment and turn head
  • get them dressed on unaffected side first
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7
Q

if ischemic stroke what should be given immediately

A

Thrombolytics within 3 hours

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8
Q

if thrombosis or embolism what should be given

A

TPA IV (up to 8 hrs since stroke)

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9
Q

treatment of CVA

A

-CT or MRI immediately
-meds:
ASA or Plavix: antiplatelets
Anticonvulsants
Antihypertensives and Antiarrhythmics
Stool Softeners

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10
Q

what is a Cerebrovascular accident

A

aka stroke or CVA

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11
Q

protocol for brain attack

A

1) Neuro consult,
2) CT in 20 min,
3) swallowing study (choke…)

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12
Q

initial stroke algorithm

A

Identify signs- Stroke Assessment
Assess oxygenation, IV access, obtain BG and VS
Contact Stroke Team for Assessment and order CT

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13
Q

after CT if NO hemorrhage…

A
  • *thrombolytics
  • If thrombolytics, no ASA or antiplatelets for 24 hours
  • Monitor BP and neurologic assessment
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14
Q

after CT if hemorrhage…

A
consult neurosurgeon
Give ASA (aspirin)
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15
Q

FAST stroke assessment

A

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)

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16
Q

Cincinnati Pre-Hospital Stroke Scale

A

-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)

17
Q

describe spinal shock

A
  • flaccid paralysis, loss of DTR and loss of motor and sensory function
  • spinal cord not working, flacid paralysis
18
Q

describe neurogenic shock

A

-bradycardia, orthostatic hypotension, inability to sweat below the level of injury

19
Q

what should you assess if spinal cord injury suspected

A

Assess level of damage- what level is respiratory compromise?

20
Q

types of spinal cord injuries

A

spinal shock and neurogenic shock

21
Q

what to remember about spinal cord injuries

A
  • 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
22
Q

hyperflexion

A

Sudden deceleration of the head and neck- MCA

type of spinal cord injury

23
Q

hyperextension

A

Most common type, fall, read-end MVC or hit in the head

type of spinal cord injury

24
Q

axial loading

A

compression of vertebral column

type of spinal cord injury

25
Q

rotational injuries

A

Extreme twisting or lateral flexion

type of spinal cord injury

26
Q

because spinal cord injuries cause a lot of swelling…

A

do not know extent of injury until it decreases

27
Q

what are the most common causes of spinal injuries

A

45% road accidents
34% domestic or industrial accidents
15% sports injuries
6% self harm and assault

28
Q

spinal cord injury causes what

A

causes microscopic hemorrhages in the gray matter and pia-arachnoid

29
Q

hemorrhages in spinal cord increase until what

A

increase until all of the gray matter is filled with blood. THEN necrosis occurs

30
Q

describe bleeding in spinal cord

A
  • blood enters spinal column, edema causes compression and decreased blood supply
  • clot formation and damage to cell in spinal cord
  • may get function back but not level that it once was
31
Q

injuries about 6th thoracic may have what

A
  • may have bradycardia, hypotension and hypothermia

- may still have some involuntary changes, NOT cushings triad

32
Q

complete, but temporary loss of motor, sensory, reflex and autonomic function that lasts less than 48 hours, but may continue or weeks r/t swelling

A

spinal shock

33
Q

treatment of spinal cord injuries

A
  • Immobilization and keep STABLE
  • High dose IV methylprednisolone (Solu-Medrol)
  • Assess respiratory status, GI distress from Solu-medrol, renal status
  • Monitor improvement or progression of spinal damage
34
Q

how should the BP be maintained if spinal cord injury

A

BP above 90 systolic to keep perfusion to the spinal cord

35
Q

syndrome to watch for in spinal cord pt (if above T6)

A
  • *autonomic dysreflexia
  • sudden onset of excessively high blood pressure
  • BP increased dramatically and HR increases d/t epi stimulation
  • often d/t full bladder or some kind of stimuli which the pt cannot control (pain, full bowel)
36
Q

how to prevent AD

A

may need to cath, give enema to get rid of stool

37
Q

what is important to consider when dealing with a TBI

A

where did the injury occur in the brain