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MED SURG > TOPIC 12 - stroke and seizures > Flashcards

TOPIC 12 - stroke and seizures Flashcards

1
Q

primary seizure (generalized-both hemispheres) examples

A

Tonic-Clonic
Absence
Myoclonic
Tonic – stiffing
Atonic (Akinetic) – loss of muscle tone
Clonic – jerking movements

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2
Q

epilepsy examples

A

can be primary or idiopathic

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3
Q

focal seizures (one hemisphere) example

A

simple, complex, evolve into secondary

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4
Q

metabolic disturbances associated with seizures

A

Acidosis
Electrolyte imbalances
Hypoglycemia
Hypoxemia
Alcohol or barbiturate withdrawal
Dehydration or water intoxication

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5
Q

extra cranial diseases associated with seizures

A

Heart
Lung
Liver
Kidneys
Hypertension
Systemic lupus erythematosus
Diabetes mellitus
Septicemia

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6
Q

complications of seizures

A

status epilepticus
severe injury and death
effect on lifestyle

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7
Q

status epilepticus

A

A state of constant seizure or condition when seizures recur in rapid succession without return to consciousness between seizures

Status epilepticus causes the brain to use more energy than is supplied.

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8
Q

risk factors for seizures

A

Metabolic Disorders
Acute alcohol withdraw or substance abuse
Electrolyte disturbances
High fever
Stroke or head injury
Heart Disease
Genetics (absence seizures)

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9
Q

precipitating factors of seizures

A

Metabolic acidosis or alkalosis
Hyperkalemia
Hypoglycemia
Dehydration
Water intoxication

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10
Q

nursing assessment of seizures

A

Bitten tongue, soft tissue damage, cyanosis
Abnormal respiratory rate
Apnea (ictal)
Absent or abnormal breath sounds
Airway occlusion
Hypertension, tachy/bradycardia
Bowel/urinary incontinence, excessive salivation
Weakness, paralysis, ataxia (postictal)
Abnormal CT, MRI, EEG

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11
Q

phases of seizures

A

Prodromal phase precedes seizure with signs or activity.
Aural phase with sensory warning.
Ictal phase with full seizure.
Postictal phase with rest and recovery.

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12
Q

acute interventions for seizures

A

Observe, treat, and document seizure.
Maintain patent airway, support head, turn to side, loosen constrictive clothing, ease to floor.
Do not restrain patient or place any objects in their mouth.
May require positioning, suctioning, or oxygen after seizure.

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13
Q

seizure precautions

A

Oxygen
Suction equipment
Airway
IV access
Side rails up and padded

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14
Q

ambulatory and home care for seizures

A

Instruct on importance of adherence to medication, not to adjust dose without physician.
Keep regular appointments.
Teach family members emergency management.
Medical alert bracelets
Referrals to agencies and organizations
Emotional support

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15
Q

medications for tonic clonic seizures

A

Lorazepam (Ativan)
Diazepam (Valium)
Diastat
IV phenytoin (Dilantin) or fosphenytoin (Cerebyx)

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16
Q

immediate medical care is needed if …

A

Status epilepticus occurs.
Significant bodily harm occurs.
The event is a first-time seizure.

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17
Q

drug adherance

A

Drugs for seizure disorder must be taken regularly and continuously, often for a lifetime.
primarily treated with antiseizure drugs
Antiseizure drugs should not be discontinued abruptly as this can precipitate seizures.

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18
Q

common side effects of antiseizure drugs

A

Common side effects involve the CNS and include diplopia, drowsiness, ataxia, and mental slowing.

19
Q

geriatric considerations for seizures

A

The incidence of new-onset seizure disorders is high among older adults.

20
Q

surgical therapy for seizures

A

Anterior temporal lobe resection is the most common surgical intervention.
Surgical intervention to remove the epileptic focus or prevent spread of epileptic activity in brain

21
Q

three requirements for surgery

A

Diagnosis of epilepsy confirmed
Adequate trial with drug therapy without satisfactory results
Electroclinical syndrome defined

22
Q

vagal nerve stimulation

A

Adjunct to medications when surgery is not feasible
Exact mechanism not known
Thought to interrupt synchronization of epileptic brain-wave activity and stop excessive discharge of neurons

23
Q

what diet is effective in controlling seizures

A

ketogenic
high fat, low carb
ketones replace glucose as energy source

24
Q

how long does a seizure need to be to be a medical emergency

A

last more than 5 min or repeated seizures over course of 30 min – medical emergency!

25
Q

status epilepticus interventions

A

Establish airway
ABGs
IV push lorazepam, diazepam
Rectal diazepam
Loading dose IV phenytoin

26
Q

two types of cerebral vascular accidents

A

ischemic or hemorrhagic

27
Q

ischemic cerebral vascular accidents

A

Blood vessel is blocked off
Lack of oxygen & nutrients
Thrombotic or embolic

28
Q

hemorrhagic cerebral vascular accidents

A

Bleeding into the brain tissue
Causes pressure increases (ICP)
Lack of oxygen & nutrients

29
Q

two types of hemorrhagic strokes

A

Intracerebral – bleeding in the brain, usually a ruptured vessel
Subarachnoid – bleeding in the CSF space between the pia matter and arachnoid space, usually an aneurysm

30
Q

risk factors for cerebral vascular accidents

A

Hypertension
Heart disease, diabetes
Smoking
Obesity
Sleep apnea
Metabolic syndrome
Lack of activity/exercise
Poor diet
Drug & ETOH abuse
Genetics
Age
Gender
Ethnicity of African Americans, Hispanics, Native Americans, Asian Americans

31
Q

major types of strokes

A

thrombotic
embolic
hemorrhagic

32
Q

differences in strokes based on artery involvement

A

Anterior Cerebral – motor and/or sensory deficit (contralateral), sucking/rooting reflex, rigidity, gait problems, loss of proprioception & fine touch

Middle Cerebral – Dominant side: aphasia, motor and sensory deficit, hemianopsia
- Non Dominant side: Neglect, motor and sensory deficit, hemianopsia

Posterior Cerebral – hemianopsia, visual hallucination, spontaneous pain, motor deficit

Vertebral – Cranial nerve deficits, diplopia, dizziness, nausea, vomiting, dysarthria, dysphagia, coma

33
Q

transient ischemic attack

A

TIA is a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, but without acute infarction of brain

Symptoms typically last < 1 hour

34
Q

right brain damage manifestations

A

paralyzed left side
left sided neglect
spatial perceptual deficit
tend to deny or minimize problems
impulsive, safety problems
impaired judgment
impaired time concepts
rapid performance, short attention span

35
Q

left brain damage manifestations

A

paralyzed right side
impaired speech/language aphasia
impaired right/left discrimination
slow performance
aware of deficits : depression, anxiety
impaired comprehension related to language, math

36
Q

when does aphasia occur with strokes

A

Aphasia occurs when stroke damages dominant hemisphere of brain and affects language

37
Q

types of aphasia

A

Receptive – loss of comprehension
Expressive – loss of production of language
Global – total inability to communicate

38
Q

diagnostics for strokes

A

CT/MRI/MRI Angiography
Cerebral angiography
Carotid angiography
Digital subtraction angiography
Transcutaneous doppler ultrasonography
Carotid duplex scanning

39
Q

labs for strokes

A

CBC
Coagulation (PT/INR, aPTT)
Electrolytes, blood sugar
Renal & hepatic labs
Lipid profile
CSF

40
Q

planning goals for stroke patients

A

Stable/Improved LOC
Attain max physical functioning
Attain max self-care abilities
Maintain stable body functions
Attain max communication ability
Maintain adequate nutrition
Avoid complications
Maintain effective personal/family coping

41
Q

signs of stroke

A

Face droop
Arm numbness
Speech difficulty
Time - act fast !

42
Q

surgical interventions for strokes

A

Carotid endarterectomy
Transluminal angioplasty
Stenting

43
Q

what med is never used for hemmorhagic strokes

A

tPA

MED SURG (30 decks)

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