S M12 Intracranial Regulation Flashcards
Cerebrovascular disorder due to stroke
functional abnormality of the CNS that occurs when the blood supply tot he brain is disrupted
2 types of stroke
Ischemic - vascular occlusion, hypoperfusion to the brain
Hemorrhagic - extravasation of blood into brain or subarachnoid space
Ischemic stroke
vascular occlusion and significant hypoperfusion to the brain
Hemorrhagic stroke
extravasation of blood into the brain or subarachnoid space
“Brain attack”
Sudden loss of function resulting from disruption of blood supply to brain
Stroke
FAST symptoms
Face - looks uneven
Arms - one arm hangs lower
Speech - slurred
Time - call 911 now
Ischemic stroke causes
Thrombus or emboli obstruction
Results in infarction of brain tissue
Types of ischemic stroke
Large artery thrombosis
Small penetrating artery thrombosis
Cardiogenic embolism - most common A-fib
Cryptogenic - no cause
Other - drug use
Ischemic stroke meds
tPA
tPA
tissue Plasminogen Activator
101
Give within 3 hours
will minimize symptoms and loss of function
GOAL - IV tPA to be given within 60min of arriving to the ED
Ischemic stroke Motor S/S
Hemiplagia - paralysis to one side
Hemiparesis - loss of strength to one side
Apraxia - cant perform learned movements
Difficulty walking, loss of coordination
Ischemic stroke numbness/weakness occurs in
Face, arms, legs, especially in once side
Ischemic stroke and sensory S/S
Agnosia - loss of sensory recognition
Dysphasia - difficulty swallowing
Visual/spatial dysfunction
Ischemic stroke cognitive S/S?
confusion and changes in mental status
learning capacity and memory loss
Aphasia - trouble speaking and understanding speech (expressive and receptive)
Ischemic stroke psych and pain
Sudden SEVERE headache
Depression, emotional lability, hostility, frustration, resentment
Left side stoke
Right side body problems
Aphasia
Intellectual disability
Slow cautious behavior
Right side stroke
Left side body problems
Left visual problems
Distractibility
Impulsive behavior
Transient ischemic attack TIA
Temporary neuro deficit due to blood flow impairment
Sudden onset of motor sensory and visual S/S
TIA is a precursor to
Impending stroke
TIA last
1-2 hours
less than 24h
Stroke prevention lifestyle
No smoking
Physical activity
Healthy weight and diet
Modest alcohol consumption
Sleep apnea
Non modifiable risks of stroke
Older than 55
AA
Male gender
Modifiable risk factors of stroke
Hypertension PRIMARY RISK
cardiovascular disease - a fib, stenosis
^ cholesterol, hematocrit
Obesity
Diabetes
Oral contraceptives
Med management of ischemic stroke
CT within 25min - determines ischemic or hemorrhagic
12 lead EKG and carotid ultrasound
CT angiography, MRI of brain and neck vessels
tPA
Assessment tool for tPA qualification
NIHSS
tPA
dissolves clots
tPA admin
Need 2 IV sites - 1 tPA, 2 other fluids
IV dosage 0.9mg/kg, ma is 90mg
10% of dose given over 1min, the rest over 1 hour
tPA monitoring
V/S q15m for 2h
then q30m for 6h
then q1h for 24h
BP maintained greater than 180/105
tPA side effects
Risk for bleeding
tPA maintanance
Airway and ventilation
Hemodynamic monitoring
Neuro assessment
tPA interventions
Monitor intracranial pressure
Provide O2, intubate if needed
Elevate HOB to 30 degrees
Hemodynamic monitoring
Neuro checks
If intracranial pressure high
mannitol diuretic
Carotid endarterectomy
Removes plaque from artery
Ischemic stroke prevention
Secondary prevention of Ischemic stroke
anticoagulation therapy
antiplatelet therapy
“statin” meds
antihypertensive meds
Hemorrhagic stroke 101
bleeding into brain, ventricles or subarachnoid space
Hemorrhagic stroke causes
rupture of small vessels
ruptured aneurism
AVMs
Trauma
Hypertension
Brain exposure to blood in hemorrhagic stroke
slows brain metabolism
^ in intracranial pressure
Secondary ischemia due to reduced perfusion
Hemorrhagic manifestations
Same as ischemic
+
Vomiting
Pain and rigidity in back of neck
Secondary problems with stroke
Cerebral hypoxia
Vasospasms
ICP
Seizures
Rebleeding
Hydrocephalus
Hypertension
Vasospasms S/S
Intensified HA
decrease in LOC
aphasia
partial paralysis
Rebleeding S/S
Sudden severe HA
N/V
Decrease in LOC
Neuro deficit
Hydrocephalus S/S
Gradual
drowsiness
behavior changes
Acute
stupor/coma
Secondary stroke management
Bedrest sedation
Clip aneurism
Reverse anticoagulation with prothrombin
For seizures give
Dilantin
anticonvulsant
To prevent DVT
For fever
For pain
Intermittent pneumatic compression devices
Tylenol, ice
Analgesics
Nursing care other assessments
I&O
O2
Complications - seizures, hydrocephalus, rebleeding, vasospasms, hyponatremia
Environment for Stroke
Non-stimulating quite dim
Monitor pain
restrict visits
Reassurance to decrease anxiety
No valsalva
Post acute nursing care
set realistic goals
encourage personal hygiene
ensure pt does not neglect affected side
use assistive devices
Nutrition post stroke
speech therapy
sit upright, out of bed to eat,
Chin tuck swallow method
Thickened liquids and puree diet
Bowel and bladder post stroke
Voiding assessment
schedule
Constipation prevention - fiber fluids
Bowel and bladder retraining
Edu post stroke
med education
safety edu
exercise and activity
socialization
Ictus on exam
When someone has a seuzure start a timer to know how long they are
Seizure precaution
o2
suction
padded bedrails
IV access
make sure stuff works
Decorticate posture has a better
prognosis
Decerebrate posturing has a
poorer prognosis
Due to post concussion syndrome being treated at different time frames
Pt may lose confidence in healthcare as problem is not resolved
Know glasgow coma scale
all parts
how to read coma GCS
When axons tear due to TBI
they release toxins that worsen the condition
Know cushings triad
With ICP fluids are
Normal saline
isotonic
keep pressure same
Final say in brain functin
?
rule of 100?
For pt with seizures ask about
aura
Seizure vs epilepsy
one time vs many times
If seizure is longer than 5 min
activate emergency response
Seizure patients are at risk for
Hypoxia
Vomiting
Pulmonary aspiration
Visually diagnosing epilepsy
EEG
Status epilepticus
Medical emergency
Drugs of choice for epilepsy/seizure
Valium and Ativan
PT education for seizure/epilepsy
get meds
follow ups
S/S of toxicity
med alert bracelets
injury precaution
avoid triggers
Meningitis bacteria
Streptococcus pneumonia
Neisseria meningitidis
Opisthotonic position
flexing at back
S/S of
Baby will meningitis
Protein high
glucose low
in spinal fluids
Meningitis
Antibiotics for meningitis should be give
within 30 min of arrival to hospital
ICP pulse and resp vs BP?
