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NURS 640 > Neuro chapter 11 Syncope > Flashcards

Neuro chapter 11 Syncope Flashcards

1
Q

Syncope

A

Partial or complete LOC with interruption of self-awareness and awareness of surroundings. The LOC is temporary, and recovery occurs spontaneously. Associated with inability to maintain postural tone.

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2
Q

Vasovagal

A

Due to decreased CO from peripheral vasodilation and bradycardia

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3
Q

Orthostatic hypotension

A

Due to medications, hypovolemia, autonomic dysfunction

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4
Q

Situational syncope

A

due to coughing, micturition, or defecation

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5
Q

Cardiac

A

due to suddent decrease in CO:
aortic stenosis
arrhythmias (heart blocks, V-tach, A-fib/flutter)
SSS

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6
Q

carotid sinus syncope

A

due to manual pressure/stimulation of the carotid arteries

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7
Q

cerebrovascular disease

A

due to decreased perfusion of the vertebrobasilar system

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8
Q

other causes

A

depression, alcohol ingestion, drug abuse, psychogenic, subclavian steal syndrome, cardiomyopathy

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9
Q

neurological

A

seizures, TIA

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10
Q

Incidence

A

6% in people older than 75
more common in older adults
unidentifiable cause in 48% of patients

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11
Q

Risk Factors

A
  • underlying cardiac disease
  • patients taking antihypertensive agents, antiarrhythmics, antidepressants, diuretics, phenothiazines, vasodilators
  • malfunctioning pacemaker
  • dehydration
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12
Q

Assessment findings

GENERAL

A
  • feelings of lightheadedness, weakness, nausea, vomiting, diaphoresis
  • LOC
  • loss of postural tone
  • spontaneous recovery
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13
Q

Assessment findings

Vasovagal

A

Fear, anxiety, or sudden emotion may precipitate syncopal episode
- sudden onset of weakness, sweating, nausea

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14
Q

Assessment

Orthostatic hypotension

A
  • occurs with standing
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15
Q

Assessment

Situational syncope

A

may be precipitated by swallowing, coughing, micturition, defecation

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16
Q

Assessment

Cardiac arrhythmias

A

abrupt onset without warning is typical

  • related to physical activity
  • may be precipitated by electrolyte imbalance (especially potassium, calcium, or magnesium), malfunction of prosthetic heart valve or pacemaker, hypoxia, coronary artery disease
17
Q

assessment

carotid sinus syncope

A
  • bradycardia often precipitates syncope

- turning of neck may precipitate syncope

18
Q

assessment

cerebrovascular disease

A
  • may experience auditory, visual, or vestibular symptoms prior to syncope
  • may have history of previous transient ischemic attack
19
Q

Differential diagnosis

A 
vertigo
seizure activity
cerebellar disease
space-occupying lesion in the cranial cavity
psychological stress
cardiac vs. noncardiac syncope
20
Q

Diagnostic studies

Goal is to identify….

A

life-threatening conditions or those associated with significant risk of injury.

21
Q

Diagnostic studies

A
  • detailed H&P
  • ECG
  • CMP
  • 24-hour ECG monitoring
  • BP lying and standing
  • flexion/extension of neck 10 times to stimulate vertebrobasilar insufficiency
  • complete neuro exam
  • carotid auscultation/studies for suspected carotid artery disease: bruit indicates probable blockage.
  • ECG if valvular or cardiomyopathy is suspected
  • Tilt testing
22
Q

Prevention

A
  • Rise slowly from lying or sitting to standing.
23
Q

Nonpharmacologic therapy

A
  • maintain good hydration and normal salt intake
  • educate about premonitory signs
  • elevate legs if due to vasovagal cause or hypotension
  • compression stockings to prevent orthostatic hypotension
  • change positions slowly
  • teach safety measures (standing on stools, operating heavy machinery)
  • increased sodium intake to help expand volume
24
Q

Pharmacologic therapy

A
  • Targeted toward specific underlying cardiac or neurologic abnormalities
  • beta-blockers may prevent recurrent vasovagal symptoms
  • antiarrhythmic drugs for documented arrhythmias
  • alpha-adrenergic agonists (midodrine) for orthostatic hypotension
25
Q

Pregnancy/lactation considerations

A
  • vasovagal syncope may present in pregnant women due to compression of the vena cava and aorta
  • positioning the pregnany woman on her left side should relieve the compression and the symptoms.
26
Q

Consultation / referral

A
  • refer to cardiologist or neurologist, depending on etiology
27
Q

Possible complications

A
  • head injury from falls during episode

- sudden death (more common if cardiac etiology)

NURS 640 (12 decks)

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