Stroke and Neurological disorders - Part 2 Flashcards
On average, it takes about __ months to recover from a stroke.
An important part of the rehabilitation process is to let patients _____.
3
fail
Positioning for stroke patients:
- Minimum position change at what frequency?
- Positioning to prevent contractures?
- Reasoning behind prone positioning?
- 70% of patients have shoulder pain. Why?
q2hours
Positioning to prevent contractures:
- arms away from chest (affected side)
- fingers barely flexed
- subtle changes in position
Prone positioning prevents knee and hip contractures and helps develop gait
Shoulder pain - due to nurses doing a poor job when transferring patients
Capillary collapse takes only about ___ minutes. Capillary closure will occur when a pressure of ___ torr is exerted on it.
Are contractures permanent?
What angle do we want joints?
20 minutes
32 torr
Contractures are permanent and unacceptable
We want joints relaxed and at a 90° angle
What is the purpose of laying a patient prone after a stroke?
Promotes hyperextension of the hip joints - essential for normal gait
Helps to drain bronchial secretions
Helps prevent shoulder and knee contractures
How long should patients be placed prone?
15-30 minutes, several times a day if able
Describe how the client is supported when in prone position.
Feet supported
Pillow under abdomen
Pillow under head; head turned to one side
When a patient lies on the affected side, describe their positioning.
Pillow between legs, arm at 90°, and hip at 90°
Describe lying on the unaffected side.
Affected arm supported at 90°
pillow behind back, pillow below affected arm, pillow between knees
During transfers, we immobilize something in insensate patients. What is it and why is it done?
Sling around arm that is affected to prevent it from swinging and causing trauma
Worn during transfers and ambulation
Rehab self-care tips:
- Client does care on ______ side first
- Small towel and assistive devices uses
- Kleenex instead of toilet paper - why?
- Clothes adapted with fasteners or _____
- Keep environment _______ and uncluttered
- Use ______ mirrors - helps with _____
- Take breaks, self-care is tiring
affected kleenex is easier to take out velcro organized large - neglect
Why is it very important to say your instructions to your stroke patient the same way?
Because a patient may be aphasic (receptive)
Rehab care tips:
- Approach client on side where vision is ______, but stand on ______ side to encourage client to move or turn
- Provide towel when eating for _______, check cheeks for _______ food
- Establish _____ schedule
- Talk to client during care activities
intact, affected
drooling; pocketed
toilet
As clients relearn to do care as they handle objects, say what the object is and be _______ using the ____ words and gestures, each time you give instructions or ask a question.
consistent
same
What would be potential barriers for a client who has had a stroke and lives in a small town removed from a major health care facility?
Decreased access to rehab and healthcare services
Less infrastructure to support movement (e.g. ramps)
Parking at the hospital may be expensive and deter visits
IF it happens in a remote area, may not get clot busters within the 3 hour window
Uncontrolled electrical discharge of neurons in the brain that interrupts normal function. symptom of an underlying illness, trauma, drugs. Usually reversible.
seizure
Spontaneously recurring seizures caused by a chronic underlying brain dysfunction.
Epilepsy
What are the two classes of epilepsy?
How is it diagnosed?
What is the treatment?
Generalized or partial
Diagnose with an EEG
Treat with anticonvulsants or surgical procedures
When can people with epilepsy drive a car?
When they haven’t had a seizure in a year and are under medical care.
Most seizures are over within __-___ minutes. but, if they continue for ___ minutes - neurological emergency and permanent damage may occur.
3-5
15
Continuous seizure activity, this is a neurological emergency, permanent brain damage may result.
Status epilepticus
What is the treatment for status epilepticus?
Give a muscle relaxant (benzo) such as valium
Seizure and menopause?
Seizure frequency often decreases (esp, if related to menstruation)
Seizures and sex?
Rarely associated
Seizures and seniors?
Although epilepsy often beings in the first decade of life, people are even more likely to have this disorder in their sixties or seventies
People with epilepsy will have an EEG at what frequency?
once or twice a year (often have seizures during the EEG for diagnosis)
Bilateral synchronous epileptic discharges in the brain. Entire brain is affected, no warning or aura. Loss of consciousness for a few seconds to several minutes
Generalized seizure
Loss of consciousness, excessive salivation, cyanosis, tongue or cheek biting, incontinence, very tired post-ictal and no memory of seizure
Tonic-clonic (grand mal)