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)
Childhood, brief starting speel, often occurs unnoticed with brief loss of consciousness
Absence seizure
Confined to one area of the side of the brain. May be simple or complex.
Partial seizure
When completely conscious and having a seizure in a localized portion of the body - no control over it until the seizure is over
Jacksonian
Nursing management during a seizure.
Observe and note: the sequence of symptoms and time it started
Safety - prevent patient injury; ensure airway stays open
Nursing management after a seizure.
Document the events leading to and during the seizure
Prevent complications
Prevent aspiration through proper positioning - recovery positioning or through suctioning
After a seizure, patients may be at risk for what?
Hypoxia, vomiting, and aspiration pneumonia
You are caring for a client with a history of seizures. As you enter the room to assess vitals, you see your client standing and looking out the window. As you approach him, he begins to have a seizure.
What nursing actions do you take?
Yell: "I need assistance, STAT" Protect the head Remove obstacles Ease the patient to the floor Protect privacy (DO NOT PRY OPEN MOUTH or restrain client) Place something under their head Place in recovery position post-ictally Reorient patient
Bell’s palsy:
- Paralysis or weakness of the muscles on one side of the ____
- Damage to the __th _____ nerve by ________
- Cause not clear, thought to be caused by ______ virus
- Nerve damage may also affect sense of _____, and ____ and ______ production
- Condition comes on _______, (often ________), and is usually _____-_____
Not the result of a stroke or TIA
face 7th, cranial nerve, inflammation herpes taste, saliva and tears suddenly, overnight self-limiting (gets better within a few weeks)
Neuromuscular disorder characterized by variable weakness of voluntary muscles, which often improves with rest and worsens with activity. Caused by an abnormal immune response.
Myasthenia Gravis
Myasthenia gravis:
- Improves with ____ and worsens with _____
- Treatment?
Rest, activity
Treatment is deep rest - no tv, no lights, all electronics off, blinds and door closed, no visitors - absolutely no stimulation
Drooping of a side of the face (medical term). (eye lid drooping)
Ptosis
Describe the biochemistry of myasthenia gravis.
ACh is blocked at the NMJ by auto-antibodies
Post-infectious poly-neuropathy, potentially fatal with rapid onset.
Guillain-Barre syndrome
What is the most important symptom to consider for Guillain-Barry syndrome?
Paralysis of respiratory musculature - patient is sent to ICU if diagnosed to be closely monitored
There is no know cure for Guillain-Barre syndrome, but what treatments are used?
Plasma exchange (plasmapheresis) and high dose immunoglobulin therapy
Chronic, progressive, degenerative autoimmune disorder of the CNS. Demyelination of nerve fibers of the brain and spinal cord.
MS
What is the reason for not taking a BP or blood from the affected side of a stroke patient?
The blood vessels lose elasticity and you may not get a true reading
Lack of this vitamin may play a role in MS development.
Vitamin D
What gender is more affected in MS?
What ethnicity is most affected?
females > males
Caucasians of northern European descent
Describe the impact of the following risk factors for MS:
- Gender
- Age
- Genetics
- Viral infection Hx
Gender - women 3:1 men
Age - can occur at any age; best prognosis for early onset
Genetics - not inherited but genetic predisposition
MS risk is 10x greater post EBV infection, and 20x post mononucleosis
Geographically, most MS patients are in the _______.
North
MS
- Cause is _______, but research suggests nerve damage is caused by _______, the source of which is unknown
- __-cells attack the myelin sheath
unknown
inflammation
T-cells
The most common early signs of MS are ______ problems, clinically called ____ ______.
Inflammation affects the _______ nerve.
vision, optic neuritis, optic nerve
Early in MS, messages from the brain are slowed down, distorted or, no signals are sent, which results in the most common symptom ______.
Numbness
These are the most common warning signs of MS.
Tingling sensations and numbness (face, arms, legs, fingers)
Other early signs of MS that affect the muscles/joints are?
What region is predominantly affected?
Muscle stiffness or spasms, most often of the legs; back pain is also common
Unexplained _______/________ and weakness affect about 80% of people in the early stages of MS. The weakness is most noticeable in the _____.
fatigue/exhaustion
legs
Approximately 80% of MS patients have trouble with _____ and _______ control.
bowel, bladder
Later signs of MS:
- it is common for those with more advanced MS to suffer from mental symptoms such as what?
______ are common in patients with MS due to the development of lesions in the cerebral cortex
memory loss, inability to focus and speech/language issues
seizures
Involuntary, rhythmic eye movements
Uncoordinated movement, staggering gait
nystagmus
ataxia
What are the four different types of MS?
Progressive-relapsing
Secondary progressive
Primary progressive
Relapsing-remiting
Name the MS type based on the description:
A - steady increase in disability without attacks
B - Steady decline since onset with superimposed attacks
C - unpredictable attacks which may or may not leave permanent deficits followed by periods of remission
D - Initial relapsing-remitting MS that suddenly begins to have decline without periods of remission
A - primary progressive
B - Progressive-relapsing
C - Relapsing-remitting
D - Secondary progressive
MS treatment:
- __ cure yet
- Treatment focuses on ________ management
- Rehab and PT: Teach energy conservation and pacing early on become valuable. Many clients rely on their _____ ______.
- Balanced _____; adequate _____
no
symptom
ADL routine
diet; rest
ADP pays __% of the cost of items like orthopaedic braces, wheelchairs, and breathing aids.
Assistive devices program
75%
Cognitively intact while wasting away.
ALS
Loss of motor neurons in brainstem and spinal cord, death within 2-6 years.
ALS
What does amyotrophic stand for?
no muscle nourishment
Describe the treatments for ALS.
No cure yet
Rilutek slows the progression of ALS in some clients
What are the big complications of ALS?
Respiratory infections - causing respiratory arrest
Many patients will need to have a tracheostomy
Disease of the basal ganglia.
Also called Shaking palsy.
PD
PD:
- Degeneration of the ________-producing neurons in the _______ _____ of the midbrain. Symptoms do not occur until __% of neurons in the _______ ______ are lost.
dopamine
substantia nigra
80%
substantia nigra
PD is more common in what gender?
There is a _______ connection (predisposition).
men
genetic
