Stroke, Cranial Nerves Flashcards
1
Q
Cranial nerve 1, function, assessment
A
Olafactory (smell)
Have patient smell something like alc swab
2
Q
Cranial nerve 2, function, assessment
A
Optic (vision)
Ask how many fingers/reading
3
Q
Cranial nerve 3, function, assessment
A
Oculomotor (eye movement, pupil constriction)
H formation
4
Q
Cranial nerve 4, function, assessment
A
Trochlear (eye movement)
H formation
5
Q
Cranial nerve 5, function, assessment
A
Trigeminal ( face pain, touch, chewing)
Light touch to 6 spots on face
6
Q
Cranial nerve 6, function, assessment
A
Abducens (eye movement)
H formation
7
Q
What three cranial nerves are associated with eye movement?
A
Cranial nerves 3,4, and 6
8
Q
Cranial nerve 7, function, assessment
A
Facial (facial movement) Facial expressions (symmetry)
9
Q
Cranial nerve 8 and function
A
Vestibulaocular (hearing, balance)
Whisper in ear (we don’t test this one)
10
Q
Cranial nerve 9 and function
A
Glossopharyngeal (taste, swallowing)
Say ah, swallow
11
Q
Cranial nerve 10 and function
A
Vagus (throat and pharynx muscle)
Say ah, swallow
12
Q
Cranial nerve 11 and function
A
Spinal accessory ( neck muscle movement) Shoulder shrug, hand against head on both sides
13
Q
Cranial nerve 12 and function
A
Hypoglossal (tongue movement)
Check if tongue is midline
14
Q
Infarction
A
Death of tissue due to diminished blood supply from obstruction of bv from blood clot or narrowing of bv
15
Q
Penumbra
A
When an ischemic stroke occurs, some of the tissue damage still may be reversible/salvageable if perfused
16
Q
What is tPA and when would it be used?
A
tPA (tissue plasminogen activator) is a clot buster; it breaks clots up to allow restoration of blood flow to brain
tPA can be used to revitalize penumbra
17
Q
Hemiplegia
A
Total or nearly complete paralysis of one side of body, limiting movement
18
Q
Hemiparesis
A
One sided weakness (some motor function remains in weakened area)
19
Q
Expressive aphasia and causes
A
One is able to get out a few words at once due to difficulty finding the right words/expressing what they want
Causes: injury to speech/language center of brain from stroke or brain trauma
20
Q
Receptive aphasia
A
Difficulty understanding language
21
Q
TIA abbreviation
A
Transient ischemic stroke
22
Q
What happens in a TIA and how long might it last
A
Cerebral artery temporarily blocked, decreasing blood flow to brain. This causes temporary reduced neuro function
Time: lasts around 15 min or less
23
Q
What causes ischemic strokes
A
Ischemic strokes occur due to atherosclerosis in bvs —> piece of plaque break off and get lodged causing obstructed blood flow to brain
24
Q
What causes hemorrhagic stroke
A
BVS stiffen from atherosclerosis, making them likely to rupture (stiffening = weaker). Blood accumulates in brain tissue —> increased ICP
25
SXS of stroke
```
Numbness or weakness of face, arm, leg unilaterally
Speech difficulty
Visual disturbances
Severe sudden headache
Confusion
Altered mental status
Difficulty walking
Loss of coordination/balance
```
26
Risk factors of stroke (modifiable)
HTN, diabetes, smoking, diet, obesity, sleep apnea, afib, oral contraceptives, cocaine/amphetamines, high cholesterol, alcohol,
27
Non modifiable risk factors of stroke
Family hx, race (African American), 55 y.o>, male, TIA or previous stroke,
28
Why are African Americans at higher risk for stroke?
African Americans since increased risk HTN
29
What are some changes people can make to decrease their risk of stroke
```
Decrease alcohol intake
Smoking cessation
DASH diet
Exercise
Manage HTN
Manage dyslipidemia
Manage diabetes
Healthy weight
```
30
Medical management of stroke (what does provider order?)
```
Anticoagulants (warfarin)
Antiplatelets (aspirin, plavix)
Stent placement in artery
Bed rest
Surgery (remove clot, stent placement, clipping aneurysm, cerebral revascularization, draining blood from intracranial space)
O2 administration
```
31
Ischemic stroke treatment
```
Statins (artorovastatin)
Antihypertensives (ACE inhibitors and diuretics)
tPA
Antiplatelets (aspirin)
Endovascular treatment
```
32
What is the time frame to administer TPA? Why can’t we give it past this window?
3 hours
| Can cause ischemic stroke to become hemorrhage or cerebral edema (increased ICP)
33
Hemorrhage stroke treatment
```
Bed rest with sedation
Avoid extreme hypertension or hypotension (BP meds and monitoring BP)
Anticonvulsant meds
Surgery to evacuate blood
Surgical clip
```
34
What is the significance of “last time patient was seen well?”
Determines onset of symptoms of stroke —> guides HCPs decisions for treatment
Avoids under treatment or over treatment
Determines if it is safe to administer tPA
We do not know the state of the penumbra if we don’t know the time frame
35
What is the time to save the penumbra
3 hours to revascularize it before dies completely
36
Why is it dangerous to give tPA past 3 hours? What can happen?
Cause more damage than benefit
| If penumbra is dead, revascularization causes ischemic —> hemorrhage bc dead tissue can’t accept
37
What imaging is used to determine if the stroke is hemorrhagic or ischemic
CT scan
38
What is tPA? How does it work?
Tissue plasminogen activator
| Protein breaks clots down
39
FAST (what does it stand for?)
Face droop
Arm weakness
Speech difficulty or slurred
Time to call 911
40
What are some manifestations of stroke
```
Numbness or weakness of face, arm, legs (on half of body)
Frustration r/t loss of functions
Confusion/ altered LOC
Difficulty walking, dizzy
Loss balance
Sudden severe headache
Visual disturbances
```
41
How does elevating bed help manage stroke
Decreased pressure in brain
42
How does O2 administration benefit stroke patients
Prevents brain tissue from starving and dying
43
Why implement seizure precautions for stroke patients? What do seizure precautions include?
Seizures are likely to occur with stroke patients
Interventions: padding side rails, set up suction, turn on side to prevent aspiration
Antisiezure meds
Frequent neuro assessment
44
Ways to prevent strokes
```
Control HTN
Diet, exercise, manage weight
Smoking cessation
Anticoagulant therapy
Statins
Anithypertensives
```
45
What is hemorrhagic stroke
Bleeding into brain tissue due to ruptured bv, increasing ICP
46
What are some causes of hemorrhagic stroke
Hypertensive crisis
| aneurysm (bursted weakened bv wall)
47
Why is hemorrhagic stroke harmful to brain
It causes increased ICP which compresses tissue—-> vasoconstriction—-> poor perfusion
48
Are the symptoms of hemorrhagic stroke different from ischemic? How do we know which type of stroke is occurring?
symptoms of both types are the same but with hemorrhagic severe headache is common
We need a CT scan to determine which type of stroke
49
Why do seizures occur with hemorrhagic stroke
Increased ICP causes seizures to occur
50
Agnosia
Decreased ability to recognize/differentiate sound, smell, taste, feel, other senses
51
What are some assessments nurses do when caring for stroke patients
Vital signs monitoring, especially BP
Ongoing Neuro assessments
Monitor for complications
52
What are some complications of stroke
Musculoskeletal problems, swallowing difficulty, respiratory problems, SxS increased ICP, dysphagia, urine/fecal incontinence, skin break down
53
Why does stroke cause skin break down?
Decreased sensation so less responsive to discomfort or pressure
54
Why does stoke cause incontinence
Confusion, hard time communicating, impaired motor function control
55
What are some nutritional considerations for stroke patients
Dysphagia puts patients at risk for aspiration
Thick liquid diet or puréed (may not want to eat bc doesn’t taste good)
Ng tube (can cause nausea so decreased appetite)
Education on smaller bites so easier to swallow
56
Hemianopsia
Blind in half field of vision
57
Nursing interventions for hemianopsia
Glasses, good lighting, teach patient to turn head, remind patient about other side of body they can’t see
58
Hemiparesis
Weakness on one side of body
59
Hemiplegia
paralysis of one side of body
60
Nursing interventions for hemiparesis
Place objects within reach on unaffected side
Teach to exercise non-effected side
Asses patients strength bilaterally
61
Nursing interventions for hemiplegia
Encourage ROM on effected side to increase blood flow to extremity
Turn Q 2 hrs
Place pillow under axilla in bed to prevent edema
62
Dysphagia
Difficulty swallowing
63
Nursing interventions for dysphagia
Involve speech therapist for swallow assessment
Educate on small bites, thick liquids
Educate to sit up right and tuck chin
(All to prevent aspiration)
64
Nursing interventions for expressive aphasia
Place important objects within reach to maximize independence
Clarify your understanding with pt for better communication
Keep other noises low to help enhance patient’s understanding (less outer stimulus)
Y/N questions
Communication board with common phrases
65
Nursing interventions for receptive aphasia
Keep language simple and clear
Provide adequate time for pt to reply so they can take time to process what is asked/said to them
communication board
66
Nursing interventions for cognitive defect
Positive feedback to promote self esteem and desire to perform correct behavior
Communicate with neuropsychologist
Observe Nuero exam results to monitor progress
67
Nursing interventions for emotional deficits
Familiarize pt with SxS of depression (stroke pts likely to have it)
Encourage independence to promote self esteem
Encourage contact with friends/fam to prevent social isolation
68
How does OT participate in stroke rehab
```
Help regain independence:
help modify tasks
Retrain in self care activities
Use of adaptive equipment
Assessing deficits of senses
```
69
How does PT participate in stroke rehab
Implement exercises to promote regaining strength/mobility
Encouraged to move as much as they can on own
Help restore normal motor control, strength, balance
70
How do speech therapists participate in stroke rehab
Assess communication difficulties with tests
Address expressive and receptive aphasia
Swallow assessments
71
How to prevent contractures or joint deformity in stroke patients
Passive ROM 4-5x/ day prevents contractures in paralyzed extremity
Splints
Encourage movement of weak side by use of strong side
72
How to prevent shoulder pain in stroke patients
```
ROM exercises (flexing wrists
Avoid laying on shoulder
Avoid lifting patient from flaccid shoulder
Avoid shoulder abduction
```
73
Some ways to encourage self care for stroke patients
Perform self care that can be done with one hand using non affected limb
Wear one size bigger
Put clothes on seated
74
How to assist with nutrition for stroke pts
Involve speech therapy to assess swallowing
Educate on smaller bites
Educate on food easier to swallow
75
How to help pt attain bladder and bowel control after stroke
```
Assess voiding patterns
Provide bed side commode or bed pan frequently
Intermittent catheter(sphincter control loss)
```
76
Ways to improve communication in stroke pts
Have written schedule available
Checklists
Communication board w/common needs/phrases
77
How to maintain skin integrity in stroke patients
Low air loss bed
Skin dry and clean
Turn Q2 hours
78
How to enhance family coping for stroke pts
Incorporate family to help set attainable goals
| Teach about emotions lability (laughter,sobbing, anger w/o cause) —-> will improve with time
79
What are some goals for stroke recovery
```
Improve mobility
Achieve self care
Relief of sensory deprivation
Continence (urine/bowel)
Maintain skin integrity
Achieving form of communication
```
80
What are possible complications from a stroke
Pneumonia from shallow breathing
Decreased blood flow to brain
Inadequate O2 to brain
Seizures
81
What are some reasons stroke patients experience poor nutrition
Depression, difficulty eating/swallowing, puréed diet, altered taste
82
Red flags during nuero assessment
- confusion (new)
- slurred speech
- facial droop
- altered pupil size or reaction
- hemiparesis
- drift in pronation
83
What are some sensory changes related to aging
Vision (presbyopia)
Hearing (presbycusis)
Altered smell or taste
Altered peripheral senses (neuropathy)
84
Presbyopia
Decreased ability to focus on close objects
85
Cataracts
Spotty vision
86
Macular degeneration
Big spot in middle field of vision
87
Glaucoma
Peripheral vision effected
88
Diabetic retinopathy
Mini hemorrhages in eye vessels causes spotty vision
89
Normal age variations
```
Slower thought processes
Decreased sensory ability
Slower gait
Wider base
Confused easily
Decreased reflexes and deep tendon reflex
Altered coordination
```
90
Important things to consider/ assess in nuero assessment
```
History of stroke, seizures, headaches
Use of drugs, smoking, alcohol
Meds (opioids, sedatives)
Surgery
ADLS
Sensory deficits
```
91
When performing the 7 Ps what are we assessing for
We are checking for perfusion to extremities; are the extremities receiving adequate blood flow?
92
Why assess polar aspect of 7ps?
Indicates blood circulation
cold then circulation is not good
Hot = DVT or infection possible
93
Why assess palor aspect of 7ps
“Normal” color can indicate good perfusion, while pale/blue = poor perfusion to extremity
94
Why assess cap refill with 7 ps
Represents localized circulation to fingers/toes
95
Why asses pain with 7ps
Can be due to swelling or strangulating of nerves
| Can be due to injury
96
Why asses puffiness with 7 ps
May indicate bleeding into skin
DVT
Surgical patients
Wounds on extremities
97
Why assess pulse with 7ps
Tells us if blood is reaching extremities
| Recent injury may affect pulse
98
What happens if stroke affects right side of brain
```
Left sided weakness
Vision problems
Impulsive behavior
Left side neglect
Memory loss
```
99
What happens if stroke affects left of brain
Right side weakness
Difficulty speaking
Slow cautious behavior
Risk for dysphagia
100
How does sleep apnea increase chance of stroke
Builds pressure on bvs when trachea closes
101
How does afib increase risk of stroke
Pumping pattern of heart makes blood pool in heart and blood clot formation likely
102
How do oral contraceptives increase risk of stroke
Estrogen increases clot risk
103
How does cocaine use increase risk of stroke
Causes vessel damage (everything speeds up)
104
How does diabetes increase chance of stroke
Diabetes damages bvs
105
What is penumbra
Inured cell tissue that can be restored
106
Why does infarction of tissue happen in ischemic stroke
Blood flow is decreased due to blood flow blockage from obstruction (clot blockage)
107
How is a TIA different from ischemic stroke? When does it resolve? How long might symptoms last?
TIA is a temporary blockage that causes temporary neurological deficit
Resolves in ~24 hours
Symptoms ~ 15 min
“Warning sign” of later stoke
