Neuro2

Question 1

Disruption in blood flow in or out leads to cerebral tissue death.

Answer 1

Cerebrovascular accident (CVA)/Stroke/Brain attack.
Must be evaluated within 10 minutes of arrival to the ED.

Question 2

Blood spills out from break in blood vessel in the brain.

Answer 2

Hemorrhagic stroke. Hemorrhage/blood leaks into brain tissue.

Question 3

A thrombus or embolus blocks blood flow to part of the brain.

Answer 3

Ischemic stroke. Clot stops blood supply to an area of the brain.

Question 4

Explain FAST?

Answer 4

Face: does one side of the face droop? Ask the person to smile.
Arms: Is one arm weak or numb? Ask the person to raise both arms. Does one drift downward?
Speech: Is it slurred? Ask to repeat a simple sentence.
Time: If the person shows any s/s it’s an emergent condition

Question 5

Explain a thrombotic ischemic stroke?

Answer 5

Usually slow, gradual onset of s/s. Rupture of plaque leads to clot formation which occludes the vessel which leads to decreased or absent blood flow to an area which leads to ischemia.

Question 6

Explain an embolic ischemic stroke?

Answer 6

Usually develops suddenly with rapid onset of neurologic deficits. Atrial fibrilation is a common etiology. Middle cerebral artery is the most common one that’s involved.

Question 7

Explain a hemorrhagic stroke?

Answer 7

Cerebral tissue damage due to bleeding. Ruptured aneurysm (which is a weakened area on a cerebral vessel). Ruptured AV malformation. Severe HTN, which is common.

Question 8

A spaghetti-like tangle of blood vessels with abnormal blood flow between arteries and veins.

Answer 8

Hemorrhagic arteriovenous malformation (AVM)

Question 9

Risk factors for a stroke?

Answer 9

Hypertension, smoking, obesity, sedentary lifestyle, oral contraceptives, heavy alcohol use, substance abuse, atrial fibrillation, heart disease, DM, elevated cholesterol, hypercoagulability, family history, estrogen therapy.

Question 10

Often precede ischemic strokes. Causes a transient episode of neurological dysfunction.

Answer 10

Transient ischemic attack (TIA). Lasts from a few minutes to less than 24 hours and usually resolves within 30-60 minutes. S/s come and go which includes motor, sensory, and/or visual function.

Question 11

What should be assessed for a stroke?

Answer 11

LOC/glasgow coma, orientation, speech, motor response, extremity movement, mood, behavior, posturing, severe headache, n/v, pupils, balance instability, muscle strength different on one side, past medical history, illegal drug use

Question 12

Allows for a rapid neurological assessment, one that’s standardized. Scored on what three areas?

Answer 12

Glasgow coma scale. Eye opening, motor response, verbal response. The higher the score, the better. 15 is the best score, while 3 is the lowest possible.

Question 13

Must be very exact with the documentation of this. Subtle changes can be a big deal.

Answer 13

LOC. Changes can include headache, restlessness, irritability, being very quiet, slurred speech, changes in level of orientation

Question 14

Manifestations of increased intracranial pressure?

Answer 14

Altered LOC, leathery, restlessness, headache, n/v, changes in speech, aphasia, vision changes, double vision, seizures, HTN, widened pulse pressure, bradycardia, posturing

Question 15

Checking pupillary reaction?

Answer 15

PERRLA: pupils are equal, round and regular, react to light and accommodation.
Dilated or non-reactive pupils are a sign of neurological deterioration.

Question 16

What side of the hemisphere dominates the speech?

Answer 16

Left cerebral hemisphere. Expressive aphasia and receptive aphasia.

Question 17

Right hemisphere problems mean what? And vice versa?

Answer 17

It means left-sided paralysis because the motor nerve fibers cross the midline before going to the spinal cord. Neglect syndrome.

Question 18

Diagnostic tests for a stroke?

Answer 18

CT scan or CT angiography. Goal is to have the CT scan done and read within 45 minutes.
MRI/MRA can show problems earlier than the CT scan but it takes longer.

Question 19

Helps identify abnormalities and visualizes cerebral circulation.

Answer 19

Cerebral angiogram/angioplasty.

Question 20

Patient preparation for a cerebral angiogram/angioplasty?

Answer 20

Check allergies. Obtain consent. NPO. Baseline neurological assessment. Explain procedure. Will need to be still/lay on hard table. May or may not receive sedation. Will feel pressure in the groin area when the catheter is inserted.

Question 21

Post angiogram/angioplasty care?

Answer 21

Assess vitals frequently. Neurologic and neurovascular checks frequently. Check pulses/color/sensations. Bed rest with legs straight and immobilized. Assess insertion site frequently. Encourage fluids.

Question 22

Interventions for a stroke?

Answer 22

Depends on the kind. 4.5hr window for thrombolytic agents. ABC’s. Priority is to obtain and maintain airway. Signs of IICP. Changes in LOC, behavior, vitals.

Question 23

IICP?

Answer 23

Increased intracranial pressure. Evidence usually occurs within the first 72 hours. Edema from IICP can impair cerebral tissue perfusion.

Question 24

What is controversial and contraindicated for hemorrhagic strokes?

Answer 24

Anticoagulants, anti platelet medications. Used more to prevent recurrent strokes.

Question 25

Med that prevents platelet aggregation; slows down clot formation

Answer 25

clopidogrel (Plavix)
Side: diarrhea, GI disturbance
Adverse: Bleeding, jaundice, angioedema
Considerations: Assess platelet counts, h/h. Teach to take with food and to report s/s of bleeding. May be given with aspirin to maintain the patency of vessels.

Question 26

Med with antiplatelet effects; prevents blood clotting by reducing platelet adhesiveness

Answer 26

Aspirin
Side: bruising, GI upset
Adverse: Hemorrhage, liver disease, bleeding, thrombocytopenia, tinnitus
Considerations: Recommended within 24-48h after onset of CVA; should not be given within 24h of tPA. Assess platelet count, h/h. Instruct pt to report s/s of bleeding &/or tinnitus.

Question 27

Med that’s antiplatelet.

Answer 27

ticlopidine hydrochloride (Ticlid)
Side: diarrhea, n/v
Adverse: agranulocytosis, aplastic anemia, neutropenia, thrombotic thrombocytopenia purpura-TTP.
Consider: Monitor platelet counts, may be given with aspirin to maintain the patency of vessels

Question 28

Med that inhibits thrombus formation

Answer 28

dipyridamole (Persatine)
Side: dizziness, upset stomach, diarrhea, vomiting
Adverse: hives, difficulty breathing, angioedema
Consider:Instruct patient to not drive, use machinery, or do any activity that requires alertness until sure they can perform such activities safely. Limit alcoholic beverages.

Question 29

Med that is a protein that is involved in the breakdown of blood clots. Used to treat embolic or thrombotic stroke.

Answer 29

Tissue plasminogen activator (tPA)
Side: bleeding, headache
Adverse: Hemorrhage, extension of CVA
Consider:contraindicated in hemorrhagic stroke & head trauma. Monitor VS and labs to assess for bleeding. Make sure patient not taking aspirin or other antiplatelet or anticoagulants.

Question 30

Supplemental medications for strokes?

Answer 30

Seizure meds, calcium channel blockers, still softeners, analgesics, anti anxiety drugs

Question 31

Surgical interventions for a stroke? Complications?

Answer 31

Extracranial- intracranial bypass
AVM/aneurysm seal or clip
Hydrocephalus, vasospasms, re-bleed

Question 32

How to deal with swallowing deficits?

Answer 32

Assess ability to swallow early on and on-goging. Position upright to eat/drink. Soft/semisoft foods usually tolerated better than liquids, which may need to be thickened. Work with dietician and a speech therapist. Swallow study.

Question 33

Point of weakness, dilation, or out pouching of an artery.

Answer 33

Aneurysms. Most commonly found in the abdominal aorta but can occur anywhere.

Question 34

Causes/risk factors for aneurysms?

Answer 34

Atherosclerosis (HTN, hyperlipidemia, smoking). Congential/genetic disorders. Connective tissue disorders (Marfan syndrome). Trauma, infections, syphilis.

Question 35

Uniform dilation all around an artery.

Outpouching affecting only a distal portion of an artery.

Answer 35

Fusiform aneurysm.

Saccular aneurysm.

Question 36

Break in the blood vessel

Involves the layers of the blood vessel separation or a tear between.

Answer 36

Ruptured aneurysm

Dissecting aneurysm

Question 37

S/s of aneurysms?

Answer 37

May be asymptomatic. Leaking, rupturing, expanding (severe back pain radiating to groin, buttocks, legs; signs of shock; decreased RBC; increased WBC). Palpable mass in the ab, systolic bruit, ab or back pain, visible pulsation in the upper ab wall, pain steady and growing for days not related to movement.
Chest wall pain, dyspnea, cough, wheezing

Question 38

S/s of a ruptured aneurysm?

Answer 38

Tachycardia, hypotension, severe pain, diaphoresis, loss of pulses distal to the rupture, decreased LOC

Question 39

Typical aneurysm patient?

Answer 39

Male, over 60, mildly obese, sentry, smoker, HTN, CAD, DM

Question 40

Diagnostic tests for aneurysms?

Answer 40

History and physical exam. X-rays/CT scans. Ultrasounds.

Question 41

The most frequent life-threatening complication of an aneurysm is?

Answer 41

Rupture. Abrupt and massive hemorrhage leading to death. Call RRT and start a large-bore IV.

Question 42

Treatment for an aneurysm?

Answer 42

Stop smoking. Control BP; the best way to control small ones.
Surgery may be emergent if a rupture occurs. Usually only done if greater than 6cm. Major surgical procedure. Diseased area is replaced with a graft.

Question 43

Endovascular repair of AAA?

Answer 43

Stent is placed early. Hospitalization time is decreased, monitor for complications. Bleeding, movement of the stent, aneurysm rupture, emboli