Neuro Ilness Flashcards
Initial Health history for strok
- time of last seen normal
- meds - anti-coagualnts use
- risk factpors
- family hsitory
what are risk factors for both types of strokes
HTN, smoking, age, previous stroken and diabetes
what are risk factors for ischemic strokes
heart diseases
previous TIA
DLP
obesity
what is risk factors for hemorrhagic strokes
brain aneurysms
AVM
drug and alcohol use
clotting disorders
what are the important components of a code stroke
- vital signs and weight
- neuro assessment
- high pressure PIV
- blood tests
- contrast allergy or management
- STAT CT and CT-A scan
penumbra
the amount of brain tissue that can be saved
what are hallmarks of left-sided stroke
- paralyzed right side
- impaired speech
- impaired right-left discrimination
- slow performance
- aware of deficits
- imapired comprehension for language and math
hallmark symptoms of right-sided stroke
- paralyzed left side
- left-sided neglect
- impulsivity
- rapid perfomance and short attention span
- imapired judgement and time concepts
ischemic stroke
cerebral blood flow is stopped by a thombus developing or travelling embolus
transient ischemic attack
usually due to a clot or mobile plauqe that blocks blood flow and affect brain fucntioning temporarily
symptoms of TIA
- unilateral vision loss
- double vision
- drooping eyelid
- dysarthria
- dysphagia
- ataxia
- unilateral numbness and weakness
what does the nurse needs to monitor post-thrombectomy
- monitor for headache
- monitor angio-groin site
- neuro signs
- 4 hours flat bedrest
what is the time frame to give tenecteplase
within 60 minutes of arrival and 4.5 hours of signs and symptoms
what should be monitored for tenecteplase
- monitor BP
- no anti-coags or antiplatelets in the next 24 hours
what are neuro vtial signs
- alert and oriented
- eye opening, PERRLA, tracking
- eye reflexes
- follows commands, limb strength
- speech
- facial weakness and droop
- intact sensation, pain, headache, parasthesias
what are nursin interventions post contrast
- promote hydration if the patient can swallow
- allergy management if needed
- follow creatinin tests
what is BP management for thrombotic strokes
- higher BP to perfuse the brain tissues
- patient lying flat on the bed
hemorrhagic transformation
damaged ischemic blood vessels that bleed from re-perfusion
why is it a priority for the patients to be D/C from hospital ASAP
to maximize neuroplasticity
hemorrhagic stroke
blood vessel that ruptures in the brain
what are the two biggest problems with hemorrhagic strokes
- increased pressure in the brain
- lack of perfusion in the brain
ICH
intracranial bleeding directly into brain tissue
causes of ICH
- HTN
- Bleeding disorders
- anticoagulant use
- AVM, AV fistula
SAH
bleeding into the subarachnoid space where CSF is usually present
what are the types of aneurysmal repair
- coiling: metal coling into aneurysm to prevent from rupturing
- clipping: if coiling is not sucessful
- AVM repair: embolization and removal
management of hydrocephalus
EVD and shunt long term
management for vasospasms
milrinone drip (vasodilator) with nimodipine (CCB)
management of cerebral salt wasting
fluid balance, hypertonic saline IV or tabs
meningeal irritation management
dexamethasone
central fever management
rule out infection, cooling measures (cooling pack, fan)
what are the main goals for SAH management in the acute phase
- prevent re-bleeding, keep SBP <160
- titrate meds labetalol and hydralazine
- elevated HOB
what is the management for ICP
- assess signs and symptoms of ICP
- align neck
- HOB 30-45 degrees
- Manage BP, stress and pain
- fever management
- minimize straining, lifting, coughing and bending
- space out actvities and interventions
what is DVT and PE prevention
- anticoagulants for thrombotics strokes
- sequential compressive devices for hemorrhagic strokes
Dysphagis management
- assess with OT
- thickened fluid and diet
- assistance and montioring when eating and drinking
mouth care post stroke
- chlorhexadine mouthwashes
- prevention of aspiration pneumonia
- suctioning PRN
UTI prevention for stroke patients
- poor bladder control, removal of Catheters
expressive aphasia
difficulty expressing thoughts through speech and writing, they know what they want to say but cannot
receptive aphasia
difficulty understanding spoken or written language
anomic aphasia
difficulty finding the correct names for specific things
global aphasia
loss of all expressive and receptive function
aphasia management
- short close ended questions
- be patient and give time for a respond
- normalize frustration and encourage ongoing engagement
- use pictograms, letter, board phone etc
