Neuro Pt. 2 strokes, TIA, headaches-DONE

Question 1

Medical Management of Migraines (pp slide 4, ATI pg.61)

Answer 1

 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

Question 2

Nursing Management of Migraines (pp slide 6, ATI pg.62)

Answer 2

 Avoid triggers
 Feverfew prophylactically (herbal non medicated OTC for cluster headaches)
 Massage
 Journal keeping (to keep track of patterns, triggers.)
 Cool, dark, quiet environment

Question 3

Triggers for migraines (pp slide 6, ATI pg.62)

Answer 3

 Stress
 Flashing lights
 Foods high in tyramine (salt, caffeine, MSG, wine, pickles, aged cheese)
 Alcohol
 Hormones
 Odors
 Sleep interruptions

Question 4

Sumatriptan/ Zolmitriptan K,H, K (MS pg.491, Pharm pg.179)

Answer 4

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

Question 5

Medical treatment of strokes (ATI pg.52)

Answer 5

-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)

Question 6

Nursing interventions for strokes

Answer 6

 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)

Question 7

Nursing interventions for strokes include aphasia

Answer 7

-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

Question 8

Dysphagia Nursing Interventions:

Answer 8

-Make sure client eats w/unaffected side
-Tuck chin to chest while swallowing (stroke pts have difficulty swallowing)
-remove distractions during mealtime

Question 9

Hemianopsia Nursing Interventions:

Answer 9

-Client needs to scan visual field from side to side, even when eating
-put tray on unaffected side so client can see it

Question 10

Diagnostic tests for strokes

Answer 10

 MRI
 CT scan

Question 11

Risks for stroke

Answer 11

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)

Question 12

Tension headache

Answer 12

pressure or steady constriction on both sides of the head

Question 13

Migraines:

Answer 13

Aura- prodromal period before headache > change in mood, difficulty concentrating, unusual fatigue, throbbing or bursting pain, nausea, vomiting, vertigo, sensitivity to light, irritability

Question 14

Cluster headache:

Answer 14

pain on one side of the head usually nasal congestion, rhinorrhea (runny nose main indicator), tearing, redness of the eye

Question 15

Difference between TIA and stroke

Answer 15

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

Question 16

Manifestations of TIA (ATI pg.50)

Answer 16

 visual disturbances
 dizziness
 slurred speech
 A weak extremity

Question 17

Causes of hemorrhagic stroke

Answer 17

 Brain aneurysm
 Uncontrolled HTN

Question 18

Causes of Ischemic stroke

Answer 18

 Heart valve or AFIB

Question 19

Right Side of brain actions

Answer 19

 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

Question 20

Right sided injury manifestations

Answer 20

-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

Question 21

Left brain injury manifestations

Answer 21

-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

Question 22

Neglect Syndrome

Answer 22

The affected side of body gets neglected. (Constantly touch affected side)

Question 23

Post stroke surgery interventions

Answer 23

 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)

Question 24

cerebral aneurysms intervention

Answer 24

Avoid valsalva maneuver: coughing, straigning, position changes, heavy lifting

Question 25

What medications interfere with neuro assessment?

Answer 25

opiods

Question 26

Left side brain actions

Answer 26

-Speaking
-Writing
-Analyzing info
-Math skills
-Planning
-Reading