Neurology Flashcards
what is a stroke?
disruption in brains blood supply; can be ischemic or hemorrhagic
ischemic stroke
blockage in blood vessel that decreases or stops flow of oxygenated blood to portion of the brain; can be embolic or thrombotic
hemorrhagic stroke
rupture of a blood vessel that decreases or stops flow of oxygenated blood to portion of brain; blood into brain tissue, subarachnoid space, and ventricles increasing pressure; can be intracerebral or subarachnoid
general stroke symptoms
sudden weakness, numbness, difficulty speaking, loss of coordination
nonmodifiable risk factors for stroke
age, gender (males more likely), ethnicity (African Americans more likely), genetics
modifiable risk factors for stroke
HTN, atherosclerosis, Atrial fib., anticoagulation therapy, stress, obesity, oral contraceptives, DM
how does oral contraceptives place on at higher risk for having a stroke?
contraceptives increases ones coagulation ability placing them at a higher risk for ischemic stroke
stroke process
cerebral anoxia- lack of O2 to the brain which can cause cell damage, cerebral infarction- death of brain tissue from lack of O2/blood supply, cerebral edema- brain swelling (compensatory mechanism that can damage the brain further due to increased ICP), cerebral dysfunction- portion of brain that lost function d/t death
primary cause of hemorrhagic stroke
Hypertension
2 types of ischemic strokes
embolic and thrombotic
embolic ischemic stroke
clot or debris that travels to brain; sudden and severe signs/symptoms; less common warning signs; pt remains conscious; headache
thrombotic ischemic stroke
build up of plaque in artery in brain; gradual compared to other strokes; no decrease in LOC in first 24 hours; signs/symptoms progressively get worse as infarction and edema occurs
transient ischemic attack
temporary neurologic deficit resulting from temporary blood flow impairment; warning sign of potential impending stroke; requires medical attention to rule out infarction
manifestations of ischemic stroke
sudden severe headache; weakness/numbness; difficulty speaking/understanding speech; loss of balance/difficulty walking/dizziness; confusion/altered LOC; dysphagia; facial droop to one side
manifestations of hemorrhagic stroke
sudden severe headache (worst headache of pt life); weakness/numbness; N/V; difficulty speaking/understanding speech; vision problems; loss of balance/difficulty walking/dizziness; confusion/altered LOC; seizures
manifestations of TIA
transient and short-lived symptoms; same symptoms as ischemic stroke; weakness/numbness; difficulty speaking/understanding speech; vision problems; difficulty walking/loss of balance/dizziness; facial droop to one side
stroke on right side of brain causes…
paralyzed left side- hemiplegia; left-sided neglect; spatial-perceptual deficits; denying/minimizing problems; rapid movements; short attention span; impulsive (causing safety problems); impaired judgement; impaired concept of time
stroke on right side of brain causes…
paralyzed left side- hemiplegia; aphasia; impaired left/right discrimination; slow cautious movements; aware of deficit causing anxiety/depression; impaired comprehension related to language and math
common assessment findings of a stroke
agnosia, apraxia/dyspraxia, hemianopsia, neglect syndrome, proprioception alterations, aphasia
agnosia
inability to recognize familiar objects or people
apraxia/dyspraxia
loss of ability to carry out skilled movements or gestures, despite having desire and physical ability to perform them
hemianopsia
blindness in half of the visual field
neglect syndrome (unilateral neglect)
patient unaware of existence of his or her paralyzed side
proprioception alterations
altered position sense that places patient at risk of injury
expressive vs receptive aphasia
expressive is difficulty speaking or getting words to come across appropriately; receptive is difficulty understanding what is being said
diagnostic tests for stroke
CT without contrast, electroencephalogram (EEG), cerebral angiography, MRI
medications used to prevent strokes
anticoagulant therapy, antiplatelet therapy, antihypertensive therapy, dyslipidemia therapy
carotid endarterectomy
surgical procedure used to reduce risk of stroke; removal of plaque build up that could lead to ischemic stroke; undergo general or local anesthesia; done around 70% occlusion
immediate/acute stroke management
CT scan without contrast to identify if stroke is hemorrhagic or ischemic; if ischemic use of thrombolytic therapy
time window to administer thrombolytic therapy
3-4.5 hours of onset of symptoms in ischemic stroke
nursing intervention of acute phase of stroke
maintain airway, supplemental O2, neuro exam- monitor ICP within first 72 hours, elevate HOB and place pt on side to prevent aspiration, foley catheter, fluid and electrolyte admin., medication admin., quiet environment, seizure precautions
nursing intervention of post-acute phase of stroke
position 2 hours on unaffected side and 20 minutes on affected side, antiembolism stockings, ROM exercises, eval. gag reflex and ability to swallow, NPO to begin and advance as tolerated
pt post stroke eating tips
sit out of bed with head and neck slightly forward, food in back of mouth on unaffected side (non-paralyzed side)
nursing interventions chronic phase after stroke
unilateral neglect (touch and use both sides of body), hemianopsia (scan full field of vision; dress weaker side first), approach from unaffected side, PT/OT intervention, encourage fluids and high fiber diet, stool softener, independence and assistive devices for ADLs
what is a seizure?
abnormal, sudden, excessive discharge of electrical activity in the brain
epilepsy
disorder characterized by chronic seizure activity; indicative of CNS or brain irritation
causes of seizures
genetics, tumors, trauma, circulatory or metabolic disorders, toxicity, infectionsstat
status epilecticus
rapid succession of epileptic spasms without intervals of consciousness and can occur with any type of seizure
why are seizures so dangerous?
brain damage can occur
3 main types of seizures
focal onset- localized to one area of brain, generalized onset- more wide spread brain activity, unknown onset
6 types of seizures
tonic-clonic (gen), absence (gen.), myoclonic, atonic/akinetic, simple partial (focal), complex partial (focal)
tonic clonic seizures
might begin with aura; tonic phase- stiffening or rigidity of muscles in arms/legs for 10-20 seconds followed by loss of consciousness; clonic phase- hyperventilation and rapid jerking of extrem. that lasts ~30 seconds and may lose bladder control; postictal-recovery phase and may take several hours
if seizure last …
> 5 minutes then seek immediate medical attention
absence seizures
brief seizure that lasts seconds; occurs in both sides of brain at the same time; may or may not lose consciousness; no change in muscle tone; can happen multiple times throughout the day; common in children; recovery is immediate
myoclonic seizure
minor and brief generalized jerking or stiffening of extremities; can cause a fall to the ground; pt is alert of event
atonic seizure
sudden loss of muscle tone that can cause a person to fall/drop to the ground; both sides of brain are usually affected; can happen to part or entire body; lasts less than 15 seconds; pt is not completely aware
simple seizure
occur in one area on one side of brain; sensory and motor symptoms localized to specific area; pt remains conscious; rarely lasts longer than an hour; may report aura
complex seizure
most common in adults; consists of blank stare (usually involves temporal lobe); periods of altered behavior that pt is unaware of; lasts longer than a minute; pt loses consciousness for few seconds
nursing assessment- seizure
seizure Hx, type of seizure, what happened before during and after, were there prodromal signs/, was there an aura?, loss of bowel/bladder function?, loss of consciousness?, details of postictal state (subjective and objective)
phases of seizure
prodromal phase, aura phase, ictal phase, postictal phase
nursing interventions- seizure
note time and duration of seizure; assess behavior at start of seizure; lower pt to ground if standing or in chair; support ABCs; remain with pt; do not restrain pt; loosen tight clothing; note type of seizure; monitor incontinence; admin IV meds as ordered; monitor postictal behavior; reorient pt; monitor vitals
pt education- seizures
importance of med adherence, importance of seeing neurologist, encourage medic alert bracelet
altered LOC
not a disease itself; disorientation, unable to follow commands, or needs persistent stimuli to achieve alertness; gauged on continuum GCS (alert/full consciousness to coma)
nursing interventions for altered LOC
ensure adequate breathing pattern, protect pt by ensuring safety (raising bed rails 3/4), maintain fluids and nutrition, mouth skin joint and eye care, prevent urinary retention, maintain body temp., promote bowel function
headaches
symptom that can arise from wide range of causes like tension/stress to fatal medical conditions; important to accurately assess and identify type of headache for proper treatment; can be primary or secondary; can be tension, cluster, or migraine; can be acute or chronic
secondary headache
result of another underlying condition such as trauma infection or medication overuse
tension headache
most common type and usually caused by stress and muscle tension that causes dull aching pain around head; commonly caused by stress, poor posture, muscle tension; can be triggered by ack of sleep, prolonged screen time
tension headache treatment
OTC analgesics, symptom management, stress reduction and relaxation techniques
cluster headache
rare intense headaches that cause severe pain usually localized around 1 eye; important to recognize and manage these headaches
migraine
recurrent severe headaches accompanied by symptoms like nausea, light sensitivity, visual disturbances; have distinct phases and can cause large impact on ones life
phases of migraine
prodromal- depression, irritability, cold, increased urination, can appear hours days or weeks before; aura- light flashes, bright spots, numbness/tingling of lips face and hands, confusion, drowsiness, diplopia, occurs directly before onset; headache- throbbing, usually unilateral, photophobia, N/V 4-72 hours; recover- pain subsides, soreness in neck, sleep
nonpharmacological nursing interventions for migraine
educate on avoiding triggers, quiet and dark room, elevate HOB to 30 degrees, massage, meditation
pharmacological nursing interventions for migraine
beta blockers, topiramate (preventative), triptans- quiet down overactive nerves (abortive), tylenol + NSAIDS (abortive), ergotamines (abortive), riboflavin- vitamin B (reduce number and duration), botox
multiple sclerosis
chronic progressive noncontagious disease of CNS causing demyelination of neurons; immune system attacks myelin and causes communication problems between brain and rest of body; occurs 20-40; consists of period or remission and exacerbations; EEG is abnormal
M.S. causes
unknown but thought to be result of autoimmune response or viral infection
M.S. triggers
pregnancy, trauma, infection, fatigue, stress
assessment of M.S.
fatigue/weakness, ataxia, vertigo, tremors/spasticity of lower extrem., parasthesia, blurry vision, dysphasia, decreased perception of pain/touch, bladder/bowel incontinence, abnormal reflex (babinski present), emotional change, memory changes and confusion
Nursing interventions of M.S.
encourage independence, ensure safety, eye patch if diplopia, monitor symptoms, energy conservation during exacerbation, toileting schedule if incontinent, exercise and rest program, PT/SLP
myasthenia gravis
chronic progressive neuromuscular disease characterized by severe weakness and abnormal fatigue of voluntary muscles; interruption of transmission of nerve impulses at myoneural junction
causes of myasthenia gravis
insufficient secretion of acetylcholine, excessive secretion of cholinesterase, unresponsiveness of muscle fibers to acetylcholine
role of acetylcholine neurotransmitter
muscle contraction and movement
role of cholinesterase
destroys acetylcholine
myasthenia gravis assessment
weakness, fatigue, difficulty chewing/swallowing, dysphagia, diplopia, weak/hoarse voice, difficulty breathing, ptosis
ptosis
drooping of the upper eyelid
nursing interventions for myasthenia gravis
monitor: respiratory, vitals, swallow ability (prevent aspiration), cough reflex, speech, muscle strength, myasthenic or cholinergic crises; educate to wear medic alert bracelet, sit up when eating, conserve strength
treating myasthenia gravis
administration of anticholinesterase medications, relieving muscle weakness by blocking acetylcholine breakdown at neuromuscular junction
endrophonium test
used to diagnose myasthenia gravis as well as distinguish between myasthenic and cholinergic crisis
myasthenic crisis
acute exacerbation of disease that is caused rapid progression of disease, infection, too little medication, fatigue, or stress
manifestation of myasthenic crisis
tachycardia, tachypnea, HTN, Dyspnea, anoxia, cyanosis, incontinence, absent cough/swallow reflex
myasthenic crisis interventions
assess for symptoms, increase anticholinesterase medications as prescribed
cholinergic crisis
depolarization of neuromuscular junction d/t overstimulation caused by overmedication with anticholinesterase; resultsin over stimulation by increased acetylcholine; very rare
manifestations of cholinergic crisis
ABD cramps, N/V/D, blurred vision, pallor, facial muscle twitches, hypotension, constricted pupils
cholinergic crisis interventions
hold anticholinesterase medications, prepare to administer atropine sulfate which is the antidote
parkinsons disease
degenerative disease resulting in dysfunction of the extrapyramidal system; causes by depletion of dopamine and acetylcholine; slow progressive disease that can result in falls, self care deficits, depression, difficulty with speech
manifestations of parkinsons
unintended/uncontrolled movements such as twitching, shaking, or difficulty balancing; trouble swallowing, shuffling gait, hand tremor, back rigidity, stooped posture, bradykinesia
nursing interventions of parkinsons
assess neurological status, assess ability to chew/swallow, encourage high protein high cal high fiber soft diet with small frequent feedings, increase fluids to 2L/day, monitor constipation, promote independence but safety, instruct pt to rock back and forth to initiate movement, no prolonged sitting
antiparkinsonian medications
aim to restore balance of acetylcholine and dopamine; dopaminergics- stimulate dopamine receptors and increase dopamine available in CNS; anticholinergics- block cholinergic receptors in CNS to suppress acetylcholine activity and reduce tremors/drooling
trigeminal neuralgia
sensory disorder of trigeminal nerve (5th) that usually occurs spontaneously and causes severe sharp recurrent pain along trigeminal nerve; can be caused by pressure on nerve from artery, tumor, or result of M.S.
manifestations of trigeminal neuralgia
triggered by sensation or movement surrounding nerve; severe pain on lips, gums, nose, across cheeks
trigeminal neuralgia interventions
avoiding hot/cold beverages and foods, eat soft foods, eat small meals, chew on unaffected side, medications as ordered, surgery
trigeminal neuralgia surgical interventions
microvascular decompression- relocates artery that causes pressure surgically; radiofrequency waveforms- creates lesions to relive pain without interrupting touch or motor function (nerve unable to transmit pain signal to brain); glycerol injection- injection into nerve to destroy myelinated fibers to relieve pain
bells palsy
lower motor neuron lesion of the 7th cranial nerve (facial nerve) as a result of infection, trauma, hemorrhage, meningitis, or tumor; begins suddenly and causes paralysis on one side of face; recovery takes a couple weeks
other causes of bells palsy
lyme disease, herpes simplex viruses
manifestation of bells palsy
softened drooping facial muscles, inability to raise eyebrows frown smile close eyelids or puff cheeks, eye moves upward when trying to close eyelid, loss of taste
interventions for bells palsy
encourage facial exercises to prevent loss of muscle tone, protect eye from dryness, promote oral care frequently, instruct to chew on unaffected side, steroid admin within 3 days of symptom onset
guillain-barre syndrome
acute infectious neuronitis of cranial and peripheral nerves; immune system overreacts to infection and destroys myelin sheath; usually preceded by mild upper resp. infection or gastroenteritis; slow recovery that can take years
manifestations of guillain-barre syndrome
abnormal EEG, parasthesias, pain/hypersensisitivty, resp. failure, dysrhythmias, weakness of lower extrem., gradual progressive weakness of upper extrem. and facia muscles
guillain-barre syndrome interventions
care directed towards treating symptoms, monitor respiratory and provide resp. treatments if needed, monitor cardiac status, assess for immobility complications, provide education for pt and family
amyotrophic lateral sclerosis
aka lou gehrigs disease; progressive degenerative disease involving motor neurons/system; causes muscle weakness and atrophy until paralysis (quadriplegia); respiratory muscles become affected and lead to resp. failure pneumonia and death
likely cause of ALS
excessive glutamate
manifestations of ALS
impaired speech, excess saliva, difficulty swallowing, SOB, restricted breathing, difficulty sleeping, hand/feet weakness, limited ROM, upper body spasms, impaired handwriting, trouble with hygiene/dressing, frequent tripping, difficulty on stairs
interventions for ALS
treatment of symptoms, monitor resp. status, prevent aspiration, resp. treatments, assess for immobility complications
encephalitis
inflammation of brain parenchyma and often meninges; affects brainstem, cerebrum, and cerebellum, often caused by viral but can be bacterial, fungal, or parasitic; requires urgent medical care
manifestations of encephalitis
cold sores/lesions/ulcerations of oral cavity, exposure to infectious disease, fever, N/V, nuchal rigidity, travel to area where disease is present, changes in LOC/mental status, signs of increased ICP, HX of insect bites and swimming in fresh water
interventions for encephalitis
monitor vitals, monitor neuro status, assess LOC using GCS, signs of increased ICP, positive kernigs and brudzinskis and nuchal rigidity, elevate HOB 30-45 degrees, assess for muscle deficits, help client to turn cough deep breath
meningitis
inflammation of the arachnoid and pia mater; caused by bacteria or viral organisms; CSF analyzed for confirmation
predisposing factors for meningitis
skull FX, brain/spinal surgery, sinus/upper respiratory infections, compromised immune system
transmission of meningitis
direct contact, droplet, in areas of high population density
manifestations of meningitis
signs of meningeal irritation (nuchal rigidity, brudzinski, kernig), irritability, headache (severe unrelenting), muscle aches/pains, N/V, fever/chills, tachycardia, photophobia, nystagmus
meningitis motor manifestations
hemiparesis, hemiplegia, decreased muscle tone, cranial nerve dysfunction
meningitis memory changes
short attention span, personality and behavioral changes, bewilderment
brudzinksis sign
pain when tilting chin to sternum
kernig sign
pain when straightening leg due to stiffness of hamstring
meningitis interventions
monitor vitals, monitor neuro status, seizure precautions, monitor for signs of meningeal irritation, cranial nerve assessment, assess peripheral vascular status, isolation precautions, urine/stool precautions, respiratory isolation, HOB elevated to 30 degrees but avoid neck/hip flexion, prevent stimulation, restrict visitors, admin of analgesics/antibx, assess for signs of ICP
bacterial meningitis vs viral
bacterial is much more severe
