Neurological Disorders Flashcards
Ischemic Stroke
Diagnostics = Noncontrast CT scan and National Institute of Health Stroke Scale (NIHSS)
Medical Management = Thrombolytic Therapy (T-Pa) or Carotid Endarterectomy (CEA)
Nursing Management:
- Monitor LOC, vitals, motor function, pupils, speech, and fluid balance.
- Assess mental status, swallowing ability, nutrition, skin, and bowel/bladder function.
- Prevent complications like decreased cerebral blood flow, ICP, inadequate O2 delivery, pneumonia, or seizures.
- Enhance self care on affected side, using assistive devices.
- Bladder and bowel control through scheduled voiding and intermittent catheterization if needed.
- Addressing cognitive and perceptual deficits through retraining.
Provide emotional support and education to patient and family.
Hemorrhagic Stroke
Diagnostics = Noncontrast CT scan, Cerebral angiography (confirms aneurysm or AVM), lumbar puncture (if CT scan is neg or subarrachnoid hem is present).
Medical/Surgical Management = Bed rest with sedation to relieve ICP, BP management, surgical or medical removal of aneurysm, and antiepileptic drugs.
Nursing Management:
- Frequent LOC assessments, pupils, motor and sensory function, and cranial nerve deficits.
- Monitor for complications like vasospasm, seizures, hydrocephalus, and rebleeding.
- Optimize cerebral tissue perfusion by monitoring blood pressure and O2 sat.
- Maintain seizure precautions
- Provide anxiety relief
- Educate about causes, consequences, and treatment plan.
Seizures (focal, generalized, and unknown)
Focal (partial)= localized part of brain; has an aura
Generalized = bilateral distribution
Complex = impaired consciousness
Simple = conscious
Absence = petit mal with minimal loss of consciousness
Diagnostics = History of seizures, presence of aura, neuro and physical exam, EEG (electrical activity), SPECT (zone), and MRI (lesions).
Medical/Surgical Management = Anticonvulsant medications, vagal nerve stimulator (VNS) for refractory focal seizures, and surgery to remove epileptogenic zone (diagnosed with SPECT).
Nursing Management:
- Protect patient from injury, provide privacy, observe and record sequence of signs (including post-ictal state).
- Ensure patent airway by turning onto one side, section nearby if needed.
- Monitor vitals and LOC
- Reorient patient
- Maintain seizure precautions
Parkinsons Disease
Diagnostics = Gradual onset, slow progression of symptoms, tremor, rigidity, abnormally slow movement (bradykinesia), and postural instability.
Medical Management = Deep brain stimulation (DBS), neural transplantation, or increasing dopamine levels using carbidopa/Levidopa (sinemet).
Nursing Management:
- Focus on ADLs and functional abilities of the patient.
- Educate family and patient about the disease
- observe for functional changes including response to medication.
Multiple Sclerosis
Diagnostics = MRI (finds plaque), oligoclonal banding with electrophoresis of CSF
Medical Management = Disease modifying therapies (DMT) to reduce relapse and slow disease progression, and use meds like benzos and gabapentin
Nursing Management:
- Assess neuro deficits, mobility, balance, weakness, spasticity, visual impairment, incontinence, swallowing and speech, coping, and med adherence.
- promote physical mobility and prevent falls.
- Manage fatigue by identifying risks and promoting good sleep.
- address bladder and bowel dysfunction.
- provide referrals for counseling to help with coping.
- Monitor for complications cognitive and sexuality changes.
Emergency Care for Hemorrhagic stroke
- requires immediate attention due to increased ICP.
- Rapid CT scan needed to confirm and guide management.
- Burr holes and craniotomy to relieve ICP.
Emergency Care for Seizure Management
- Prioritize protecting the patient from injury and ensure a patent airway.
- Status epilepticus is a medical emergency requiring immediate intervention with medication to stop the seizures.
- assess the post-ictal state and administer O2
Emergency Care: Thrombolytic Therapy Contraindications
- Time sensitive (within 3 to 4.5 hours)
- Contraindicated in hemorrhagic stroke
Patient Education: OTC medications
- Consult HCP before starting OTC meds
- educate on name, purpose, does, route, schedule, side effects, and precautions
Patient Education: Self Catheterization
- Indicated for neurogenic bladder or post-stroke urinary dysfunction
- teach proper technique for insertion and removal
- Use proper hygiene to prevent UTI
- Establish a schedule for catheterization
- Know the signs and symptoms of complications (UTI, pain, difficulty).
- Ensure patient has supplies and access to obtain them.
