Unit 5: Brain/Spinal Cord Injuries & Neuro CAs Flashcards
What is a “brain attack?”
Cerebrovascular accident (CVA). Disruption of blood flow to the brain by ischemia, hemorrhage, or embolism
Which type of CVA is most common?
Ischemia
What is brain ischemia? Are there different types?
Disruption of blood supply to the brain by thrombus or embolism. Yes.
Name the 13 risk factors for a brain attack.
Smoking, cocaine, oral contraceptives, previous CVA, A-Fib, hypercoaguability, hyperlipidemia, atherosclerosis, hypertension, obesity, DM, AVM, cerebral aneurysm
What is an AV?
Arteriovenous malformation. A vein and an artery are inappropriately linked
What does bleeding into brain tissue, subarachnoid space, or ventricles cause?
Hemorrhagic stroke
What are some causes of hemorrhagic stroke?
HTN, aneurysm, amyloid angiopathy (amyloid is a protein), AVM’s, meds (anticoagulants)
What causes brain damage in a hemorrhagic stroke?
Compression, or ischemia from reduced perfusion or vasoconstriction
What is a TIA?
Transient Ischemic Attack. Temporary impairment of blood flow to the brain. A warning of impending stroke. More TIA’s means greater risk for stroke
What are some left hemisphere stroke symptoms?
Aphasia, agnosia, alexia, agraphia, right side weakness, slow/cautious behavior, depression, frustration, anger, loss of vision in one or both eyes, one-sided neglect syndrome (forget it exists)
What are some right hemisphere stroke symptoms?
Altered perception of deficits, one-sided neglect syndrome (more common in right side), loss of depth perception, poor impulse control and impaired judgement, short attention span, hemianopsia
Do you have to be certified to do a NIHSS?
No. You must be certified to do a full neuro assessment, but not to do a partial
What does the NIHSS assess?
Degree of disability from a stroke. Max score of 42 = most disability
When is the NIHSS assessment done?
Baseline ASAP, then at 2 hr, 24 hr, 7-10 days
What is the scale on the NIHSS?
0 = no stroke. 1-4 = minor stroke. 5-15 = moderate/severe stroke. 21-42 = severe stroke
At what score on the NIHSS do you treat the patient?
5 and up
What Glasgow coma scale level is considered severe? When is organ procurement notified?
Less than or equal to 8.5 or less
What tests are done for a stroke? What is an MRA?
MRI, MRA, CT, lumbar puncture. Angiography (looks at vessels of brain)
What is Activase (Altiplase)? How is it given? Criteria for tPA?
tPA (clotbuster). Bolus then IV. 18 or over, BP < 185/110, > 3 hrs since onset, PT < 15 sec, INR < 1.7, platelets >100,000, no surgery within 14 days, no stroke/head injury/brain surgery in 3 months, no GI/Urinary bleeding within 21 days
What is the dosage for tPA?
0.9 mg/kg with a max of 90 mg
When do you do a neuro assessment for a patient receiving tPA?
Every 15 mins for 2 hrs. Every 30 mins for 2 hrs. Every hr for 24 hrs
What are some additional meds given post CVA?
Thinners = Aspirin, Heparin, Lovenox (enoxaparin), Coumadin (warfarin). Antiplatelets = Ticlopidine (Ticlid), Clopidrogel (Plavix). Antiepileptics = Phenytoin (Dilantin), Gabapentin (Neurontin)
What are some other interventions for patients with a CVA?
Turn every 2 hrs, splints, ROM 4-5 times a day, position hands/fingers (washcloth splint), prevent shoulder abduction (don’t grab by flaccid shoulder).
How can you assist with communication in a CVA patient?
Picture board, simple commands, closed ended questions (but you have to determine accuracy of answers first)
