Week 11 Intracranial Regulation Meningitis, TIA, Stroke Flashcards
how does bacterial meningitis enter the body?
- Bloodstream
- Respiratory tract
Bacterial meningitis is a medical emergency. How quickly do we need to treat it to avoid mortality?
Within 24 hours
What is viral meningitis caused by?
enterovirus
aboviruses
HIV
Mumps
Chickenpox
Which meningitis is typically more severe, bacterial or viral?
Bacterial
Which meningitis has long term residual effects as opposed to full recovery, bacterial or viral?
Bacterial
What are some key features of meningitis?
- *petechial rash (meningococcal)
- Severe headache
- *Nuchal rigidity (stiff neck)
- *positive Kernig’s sign (knee extension = head/neck pain)
- *positive brudinski sign (flex neck, knees follow)
- photophobia
- N&V
- decreased LOC
- coma
What type of PPE precautions does meningitis require?
droplet precautions
-gown
- mask
- eye protection
- gloves
What is the goal of care in meningitis?
prevent increased ICP
What is the treatment for bacterial meningitis?
Antibiotics immediately (even before diagnosis confirmed)
How many hours is someone with bacterial meningitis on transmission precautions?
48 hours after antibiotics started
besides antibiotics what other medications do we give someone with bacterial meningitis?
- Steroids (dexamethasone) IV
- Anytipyretics (fever)
- Anticonvulsants
- Pain meds- hydromorph PO
What type of environment is needed for bacterial meningitis patients?
Safe- padded siderails
low lighting
low stimuli
Calm environment
what test confirms meningitis diagnosis ONLY?
Lumbar puncture analysis of CSF
What diagnostics are helpful but not THE confirming diagnostic test?
- Blood cultures
- CT scan
What are the 2 types of strokes?
- Ischemic
- Hemorrhagic
what are the 2 types of ischemic stroke?
Thrombotic stroke
Embolic stroke
What is a TIA?
Transient Ischemic Attack
- Brief interruption of blood flow, easy/often ignored or missed
What is a TIA a warning of?
thrombotic or embolic stroke
What 4 things can stroke affect?
Visual
mobility
sensory
speech
How often does TIA usually resolve?
30-60 min
How long can a TIA last?
24 hrs
What is the ABCD risk assessment for stroke?
A-Age - >60
B-BP >140/90
C-Clinical TIA features (one sided weakness)
D-Duration of symptoms - the longer the greater the risk
What is the other stroke risk assessment we can use besides ABCD?
NIHSS score
The National Institutes of Health Stroke Scale
-Assess how much impairment there is and plan post acute care
What’s the number one way to prevent ischemic stroke post TIA?
manage the risk factors
What are the risk factors for Stroke?
HTN
DM
Cardiac problems
Sleep apnea
high cholesterol
What can some one do to avoid a stroke?
- Healthy diet
- Exercise
- smoking cessation
- control BP
- limit alcohol
- no street drugs that increase stroke risk
What medications are given post TIA to prevent ischemic stroke?
-Platelet inhibiters: ASA (Aspirin), clopidogrel (Plavix)
-Anticoagulants for A-Fib: riveroxaban (Xarelto)
-HTN- Antihypertensives (CCBs, Ace Inhibitors ,Diuretics)
-Statins lovastatin (Mevacor)
What are 2 surgical interventions post TIA?
-Transluminal angioplasty (intervention)
-Carotid endarterectomy (preventative surgery)
What is one surgery used to prevent stroke and what does it do?
Carotid Artery Angioplasty with Stenting
- Transluminal Angioplasty
Catheter is inserted via femoral artery
Balloon is threaded via a catheter to the blocked artery and is inflated
Stent is deployed and keeps the artery opened
Filter also put in to catch debris
What is another prevention surgery used to prevent stroke and what does it do?
Carotid Endarterectomy
- Tube is inserted above and below the blockage to reroute bloodflow
-Arthlerosclerotic plaque in the common carotid artery is removed
-Once the artery is stitched closed the tube can be removed
What vital are we concerned with for carotid endarterectomy and why?
BP
need it lower so it doesn’t blow the incision but high enough because the arteries aren’t used to the blood flow
What do we monitor for after carotid artery angioplasty with stenting?
neuro changes d/t bleeding
How many hours can someone get treatment from onset of stroke symptoms?
within 6 hours
If someone is 6-24 hours past stroke symptoms, who determines if treatment is possible?
Stroke specialist
What diagnostic tool do we use to determine ischemic stroke and amount of damage?
CT scan
What are the 4 safety things we should assess post stroke?
- swallowing (NPO till assessed by SLP)
- Mobility deficits
- paralysis, neglect, impulsiveness
- Communication
What is the max time that tPA can be given after symptom onset?
4.5 hrs
How soon should tPA be given?
within 30-60 min from door to needle time
How often do we monitor VS and neuro status during the 1 hour infusion?
Q15 min
How often to we monitor VS after the tPA infusion?
Q15 for 1hr
Q 30 for 6 hrs
Q 1 for 24 hrs
What BP do we need to maintain when someone is getting tpA?
<185/110
What do we watch for when someone is on tPA?
bleeding
- no tube insertions, no IM injections
If someone is on tPA infusion and they have serious bleeding, N&V, severe headache or severe high BP what should the nurse do?
Stop the infusion
Call the Dr. ASAP
What are the 2 acute treatments for ischemic stroke?
- tPA
- Endovascular interventions
What are the 3 endovascular interventions ?
- intra-arterial thrombolysis with tPA
- Mechanical embolectomy - surgical blood clot removal
- Carotid artery angioplasty with stent placement
What are the 2 goals of drug therapy for ischemic stroke and embolic stroke?
- prevention
- protect brain from hypoxia
What drugs are used to prevent ischemic stroke?
-antiplatelet
- ASA
- Clopidogrel (plavix)
what drugs are used to prevent Embolic stroke?
Anticoags
- Warfarin (coumadin)
- Heparin
- low molecular weight heparin
DOACs
- Rivaroxaban (Xarelto)
- Apixaban (Eliquis)
What is the treatment for Hemorrhagic stroke?
-Repair bleeding vessel and remove blood, treat for IICP,
-If on anticoags reversal drugs (Vit K, Plasma, clotting factors)
What is intracerebral hemorrhage?
-Bleeding in brain caused by ruptured vessel
-Extent of symptoms vary depending on extent of bleed and location
(INSIDE the brain- not near the skull)
What is subarachnoid hemorrhage (SAH)?
Bleeding into the cerebrospinal fluid in the subarachnoid space
(just under the skull area)
What is the most common cause of subarachnoid Hemorrhage?
Aneurysm
What is a classic symptom of hemorrhagic stroke?
worst headache ever
what is a classic symptoms more often seen in ischemic stroke?
face paralysis / droop
speech issues
one sided limb paralysis
Which type of stroke has stiff neck similar to meningitis?
hemorrhagic stroke
Seizures are common in what type of stroke?
hemorrhagic stroke
What is the treatment for Subarachnoid Hemorrhage ?
-Repair aneurysm, treat for IICP
-External Ventricular Drain (EVD) (Drains CSF and blood)
-Prevent Vasospasm
Why do we want to prevent vasospasm during a subarachnoid hemorrhage?
to prevent brain damage!
HUGE RISK for vasospasm
Why do we need to drain blood and CSF with subarachnoid hemorrhage?
b/c blood in the subarachnoid area irritates it and CSF may not absorb properly.
Why is vasospasm with subarachnoid hemorrhage so bad?
b/c vasospasm slows blood flow to the area & causes ischemia = brain damage
When does vasospasm usually occur post bleed/stroke?
4-14 days after
What medication do we give to treat & prevent vasospasm?
Calcium channel blocker - Nimodipine
How often do we give Nimodipine?
q 4h
sometimes up to 21 days
What does Nimodipine do?
relaxes smooth muscles of vessel wall
Why do we want to maintain homeostasis of fluids and electrolytes in vasospasm ?
-we want good BP to “push through” spasming vessel
