Week 10 Neurocognition II Flashcards
Acute Stoke
Disruption of perfusion of O2 & nutrients to cerebral tissues
Ischemic Stroke
Blocked vessel
Most common
Hemorrhagic Stroke
Bleeding
Less common
Transient Ischemic Attack
- Neurological dysfunction that resolves
- Without imaging evidence of infarction
Ischemic Stroke - Large Artery
- BAD
- Atherosclerotic plaque formation
- Occlusion = brain perfusion interrupted
Ischemic Stroke - Small Artery
- Emboli
- High BP
- Vasospasm
Ischemic Stroke - Cardiogenic Embolic
- Clot from heart goes to brain
- A fib
Ischemic Stroke - Cryptogenic
Idiopathic
Left Sided Stroke Impact
- Right side paralysis
- Speech issues
- Language issues
- Memory loss
- Slow & cautious
- Right sided neglect
Right Sided Stroke Impact
- Left sided paralysis
- Vision issues
- Memory loss
- Fast & risky - impulse control
- Left sided neglect
Treatment Timeline - Ischemic
- <4.5h eligible for thrombolysis
- <6h eligible for endovascular thrombectomy
Imaging
- Non-contrast CT/MRI
- Diagnosis ischemic vs hemorrhagic
Thrombolysis
- Fibrinolytic therapy: tissue plasminogen activator
- Given within 4.5 hours can dissolve clot
- Anticoagulants given to prevent further clots
Endovascular Thrombectomy
Removal of thrombus under image guidance
Intercranial Hemorrhage
- Bleeding into brain tissue
- Due to ruptured vessel
Subarachnoid Hemorrhage
Bleeding into subarachnoid space or AVM
Hemorrhage Results in
- Blood compressing brain tissue
- ICP increases
- Cerebral edema
Hemorrhagic Stroke S/S
- Rapid onset (compared to ischemic)
- Severe headache
- N/V
- Confusion, altered LOC
- 1 sided weakness
- Impaired speech
- Fixed pupils
Hemorrhage Medical Interventions
- Endovascular procedure
- Surgical procedure
ABC Management
- Swallowing
- Head of bed 30 degrees - reduce aspiration
- Oxygenation
- BP
- Fluids for perfusion
Increased ICP Management
- Cerebral edema/blood in cranial cavity
- Osmolar diuretics - mannitol
- Increase osmolality of blood
- Increase value in intravascular space
- Diuretics to excrete
- Electrolyte imbalance & seizure caution***
- Elevate head of bed - 30 degrees
- Low stim environment
Seizure
- Excessive & acute onset
- Electrical activity of cerebral neurons
- Causes abnormal motor, sensory, autonomic, psychiatric activity
Seizure Pathology
- Excitatory neurons releasing glutamate
- Not enough inhibitory neurons releasing GABA
Epilepsy
2 unprovoked seizures occurring 24 hrs apart
Seizure Triggers
- Stress
- Trauma
- Overexertion
- Period/pregnancy
- Sleep loss
- Visual disturbances, sound, smells
- Recreational drugs
- Alcohol use
- Undermedicated w/ anticonvulsants
Seizure Stages
- Prodromal
- Aura
- Ictus
- Post ictus
Prodromal Stage
- Before seizure activity
- May follow exposure to a trigger
Prodromal Stage Symptoms
- Confusion
- Anxiety
- Irritability
- Headache
- Tremor
- Anger/mood disturbances
Aura Stage
- Warning felt before seizure
- Focal aware seizure that precedes a generalized seizure
Aura Stage Symptoms
- Visual disturbances
- Cognitive disturbances
Ictus Stage
- Seizure activity
- Measure time
Post Ictus Phase
- End of seizure to return to baseline
- Altered LOC/state of inhibition
- Hours-days to resolve deficits
Seizure Underlying Causes
- Electrolyte & metabolic imbalances
- Drug toxicity
- Brain tumours
- Central nervous system infections
Focal Onset S/S
- Jerky movements
- Dysfunction of senses
- BP
- Bowel/bladder control
- Cognition disturbances
- Anxiety
- Fear
Tonic Seizure S/S
- Increased muscle tone
- LOC
- Eyes roll back
- Back arches
- Cyanosis or pallor - resp muscle dysfunction
Clonic Seizure S/S
- Muscle spasms
- Jerky movements
- Rapid flexion-relaxation
- Resp muscle dysfunction
Atonic
- Reduction/loss of muscle tone - collapse & limp
- Safety risk for falls (drop attacks)
Tonic Clonic Seizure
Combination of tonic & clonic S/S
Myoclonic Seizure S/S
- Rapid flexion-relaxation
- Patient retains consciousness - impaired awareness
Seizure Management
- Suction & oxygen at bedside
- IV access
- Padded bedrails
- Pillows
- Bed in lowest position
- Remove objects likely to cause injury
- Med admin - standing orders
- Time the seizure
- Turn client to side if safe
- Do not restrain
Post Ictal Stage Nursing Management
- Maintain side-lying in context of LOC changes
- Suction secretions
- Reorient to environment
- Low stim environment
- Frequent neuro assessment
Status Epilepticus
- Uncontrolled epilepsy, stroke, CNS infections
- 5 minutes = higher dose of med
- Fever
- Electrolyte imbalances
- Blood glucose imbalances
- Alcohol withdrawal
Anticonvulsant Meds
- Routine blood work monitoring
- Take same time everyday
- Don’t stop abruptly
- Can interact with one another
Valproic Acid - Epival
- Anticonvulsant
- Treats seizure disorders
Epival Side Effects
- Abdominal pain
- Constipation
- Increased appetite
- NVD
- Dizzy
- Double vision
- Drowsy
- Weight gain
- Rash
Epival Nursing Considerations
- Take at same time everyday
- Don’t stop abruptly
- Interacts with other seizure meds - phenytoin & carbamazepine
- Monitor blood levels
- Monitor liver
- WBC/platelets
Carbamazepine - Tegretol
- Anticonvulsant
- Treats partial seizure disorders
- Ineffective for absent/myoclonic
Tegretol Side Effects
- Dizzy
- Blurred vision
- Confusion
- Constipation
- Drowsy
- Nausea
Tegretol Nursing Considerations
- Take at same time everyday
- Don’t stop abruptly
- Interacts with other seizure meds - phenytoin & valproic acid
- Monitor blood levels
- Toxicity - rash/liver symptoms
Phenytoin - Dilantin
- Anticonvulsant
- Treats partial seizure disorders
- Ineffective for absent/myoclonic
Dilantin Side Effects
- Headache
- Constipation
- NV
- Drowsy
- Gum swelling
- Nervousness
- Sleep disturbances
- Increased hair growth
- Depression
- Decrease HR/BP
Dilantin Nursing Considerations
- 1 hour pre meal/2 hours post-meal
- Same time each day
- Oral care
- Interacts with other seizure meds - carbamazepine, valproic acid
- Toxicity - therapeutic range 10-20
- Suicidal ideation
- Skin rashes
Lorazapam - Ativan
- Anticonvulsant
- Treats seizure disorders
- Slows CNS
Ativan Side Effects
- Dizzy
- Confusion
- Drowsy
- NV
- Agitation
- Hyperactivity
Ativan Nursing Considerations
- Notice effect in 5-10 mins of admin
- Place between lip/cheek for sublingual
- Move client while admin, do not restrain
Midazolam - Versed
- Anticonvulsant
- Treat seizure disorders
- Slow CNS
Versed Side Effects
- Dizzy
- Confusion
- Drowsy
- Fatigue
Versed Nursing Considerations
- Avoid in clients with glaucoma
- Notice effect in 5-10 mins of admin
- Place between lip/cheek for sublingual
- Move client while admin, do not restrain
Focal Resection
Part of brain removed
Hemispherotomy
Hemispheres of brain are disconnected
Corpus Callosotomy
Corpus collosum disconnected between L&R hemispheres of brain
Vagal Nerve Stimulator
Implantable device stimulates vagus nerve to prevent seizures
