Neuro Pt. 2 strokes, TIA, headaches-DONE Flashcards
Medical Management of Migraines (pp slide 4, ATI pg.61)
Mild analgesics: NSAIDS (ibuprofen, naproxen) acetaminophen, & OTC anti-inflammatory medications in formulations w/migraines
Methysergide (Sansert), topiramate (Topamax) = prevent migraine
*Increase dose gradually, monitor drug levels
Sumatriptan (Imitrex) =interrupt migraines that have already developed
(oral, intranasal spray, subcutaneous injection)
Antiemetics: metoclopramide to relive n/v
Nursing Management of Migraines (pp slide 6, ATI pg.62)
Avoid triggers
Feverfew prophylactically (herbal non medicated OTC for cluster headaches)
Massage
Journal keeping (to keep track of patterns, triggers.)
Cool, dark, quiet environment
Triggers for migraines (pp slide 6, ATI pg.62)
Stress
Flashing lights
Foods high in tyramine (salt, caffeine, MSG, wine, pickles, aged cheese)
Alcohol
Hormones
Odors
Sleep interruptions
Sumatriptan/ Zolmitriptan K,H, K (MS pg.491, Pharm pg.179)
Interrupts migraines that have already developed
Facial flushing is normal
Take as soon as headaches begin to make med most effective
If given w/SSRI or SNRI monitor for serotonin syndrome (shivering, diarrhea, muscle rigidity, fever & seizures)
Do not use injectable form if cloudy or yellow
Do not give to clients with ischemic heart disease, angina, MI, TIA or uncontrolled HTN or someone taking MOAIs
Medical treatment of strokes (ATI pg.52)
-TPA (tissue plasminogen activator) -Thrombolytics: not for people who just had surgery, accident ect due ot risk for bleeding ,only for ischemic stroke
-can only be given w/in 3hrs from onset of stroke
-Antiplatelets (low dose 24-48hr following ischemic stroke to reduce risk for further clot formation
-Anticoagulants (not for hemorrhagic stroke)
Nursing interventions for strokes
Act fast, call rapid response or call 911, note the time
FAST (Face droop, Arm numbness or weakness, Speech difficulty, Time)
Monitor VS: BP(^), HR(decreased), RR(decreased)
Monitor for N/V, LOC, pupil response
Monitor Airway: issues swallowing, have suction @ bedside
Monitor Cranial nerves: pupils, swallowing, facial gaze, gag reflex
Monitor Bladder & bowel function (bedpan, foley w/bladder scan)
Monitor Skin & Limb integrity – neglect syndrome (have pt constantly touch affected side of body)
Nursing interventions for strokes include aphasia
-Be patient
-Use communication board
-short phrases & simple details
-use gestures & point
-remove distractions
-let them speak, don’t rush
-ask one question at a time
Dysphagia Nursing Interventions:
-Make sure client eats w/unaffected side
-Tuck chin to chest while swallowing (stroke pts have difficulty swallowing)
-remove distractions during mealtime
Hemianopsia Nursing Interventions:
-Client needs to scan visual field from side to side, even when eating
-put tray on unaffected side so client can see it
Diagnostic tests for strokes
MRI
CT scan
Risks for stroke
Smoking
Thinners (blood thinners)
Rhythm changes (AFIB, Aflutter)
Oral contraceptives
Kin (family hx)
Excessive weight
Senior citizens
HTN
Atherosclerosis
Physical inactivity
Previous TIA
Elevated glucose (diabetes mellitus)
aNeurysm (brain)
Tension headache
pressure or steady constriction on both sides of the head
Migraines:
Aura- prodromal period before headache > change in mood, difficulty concentrating, unusual fatigue, throbbing or bursting pain, nausea, vomiting, vertigo, sensitivity to light, irritability
Cluster headache:
pain on one side of the head usually nasal congestion, rhinorrhea (runny nose main indicator), tearing, redness of the eye
Difference between TIA and stroke
TIA: Mini stroke
warning sign of a stroke
symptoms will resolve & go away (intermittent)
the more TIA’s, the higher chance of actual stroke
Strokes: happen suddenly, need to act fast, call rapid response or 911
Manifestations of TIA (ATI pg.50)
visual disturbances
dizziness
slurred speech
A weak extremity
Causes of hemorrhagic stroke
Brain aneurysm
Uncontrolled HTN
Causes of Ischemic stroke
Heart valve or AFIB
Right Side of brain actions
Attention span
Ability to solve everyday problems by making decisions /plans
Showing emotions
-Memory recall
Making judgement calls
Music/art awareness
Reasoning (reading between the lines, understanding jokes)
Controls the left side of the body
Depth perception
Right sided injury manifestations
-confused on date, time, place
-cannot recognize faces or the persons name
-cant see on the left side
-loss of depth perception
-left sided weakness: hemiplegia
-left side neglect(ignores left side of body
-Trouble staying on topic when talking
-Trouble w/maintaining proper grooming
-Poor ability to make decisions & assessing spatial elements (shapes)
-impairment in creativity :arts & music
-not able to interpret nonverbal language or understanding things
-Emotionally not going to think things through (very impulsive)
-very short attention span
-denial about limitations
Left brain injury manifestations
-Short retention
-trouble understanding written text
-Aphasia (trouble formulating words & comprehending them)
-Aware of their limits (experience depression, anger, frustration)
-Right side hemiplegia (right side weakness)
-memory intact
-issues/writing (agraphia)
-impaired math skills
-issues with seeing on the right side
Neglect Syndrome
The affected side of body gets neglected. (Constantly touch affected side)
Post stroke surgery interventions
Assess for breathing & swallowing due to swollen throat
Frequent neuro checks
Bruit is heard on the neck if there is plaque blocking flow of blood (carotid artery)
cerebral aneurysms intervention
Avoid valsalva maneuver: coughing, straigning, position changes, heavy lifting
What medications interfere with neuro assessment?
opiods
Left side brain actions
-Speaking
-Writing
-Analyzing info
-Math skills
-Planning
-Reading
