week 9 flash part 2 Flashcards
what is meningitis
infection of the meninges of the spinal cord
means something has entered the CNS
Who is at risk for meningitis
people aged 16-21, or people who live in crowded situations like dorms
how do you diagnose meningitis
LP to get CSF
check WBC count
Xray of chest, sinuses, and mastoid to try and find opening of infection
what is kerning sign
bending leg up causes pain
what is brudzinski sign
if you try and bend neck, knees come up
what are the key signs of meningitis
headache, kerning sign, brudzinski sign, petechial rash
what is the main goal to treat meningitis
prevent IICP
which type of meningitis is a medical emergency `
bacterial meningitis
what is the main priority of bacterial meningitis
get antibiotics immediately! if cultures dont come back, just use broad spectrum
priority is to give abx 1-2 hours after being ordered
what are some other important aspects of care for a bacterial meningitis patient
transmission precautions
give medication to decrease ICP
close contact tracing
where does viral meningitis come from
herpes, chicken pox, shingles, etc.
whats another word for viral meningitis
aseptic meningitis
what is a TIA
brief interruption of blood flow to the brain, usually a warning sign for a stroke
how long do TIA symptoms last
30-60 minutes
what are the main nursing assessments for a TIA
- focused neuro assessment
- ABCD (age, BP, Clinical TIA features, duration of symptoms)
blood work, head CT, angio
what is the ABCD assessment for a TIA
Age: over 60
BP: over 140/90
Clinical TIA features
Duration of symptoms: the longer the symptoms, the greater the risk of stroke
what is the main procedure used to prevent
stroke
carotid endarterectomy (cut into carotid and remove plaque)
what is an arteriovenous malformation
arteries/veins in the brain are malformed (can cause hemmorhagic stroke)
what should you include for patient history in a stroke patient
- when did the symptoms begin and what was the patient doing at the time
- how did the symptoms progress
- LOC and GCS
- medical history, current meds, allergies
also assess airway and cough obviously
what deficits would a patient have if they had a stroke in the right brain
- visual and spacial awareness
- patient will be unaware of deficits
- disoriented to time and place
- impulsive, poor judgement
what deficits would a patient have if they had a stroke in the left brain
- dominant hemisphere,
- obvious deficits
- language, math, analytic thinking
whats the difference in symptoms between a thrombotic and embolic stroke
thrombotic: thrombus in the brain or carotid artery, slow onset (evolves over minutes to hours)
embolic: dislodged clot, sudden onset with max deficits
what causes embolic stroke
usually fib or valve issue
what are the main risk factors for thrombotic stroke
DM and HTN
how long after symptom onset are you allowed to give TPA
3-4.5 hours
whats door to needle time
45 minutes
what are the BP parameters when getting TPA `
under 185/110
how often do you monitor vitals when getting TPA
- 10-15 mins during treatment
- 30 mins 6 hours after treatment
- 1 hour 24 hours after treatment
what are some signs that you need to call a Dr. if a patient is getting TPA
- bad bleed
- nausea/vomiting
- headache
- increase BP
what is something I just learned about warfarin
high alert drug that needs a two nurse check
what is the priority treatment with a hemmorhagic stroke
remove blood
repair bleeding
treat IICP
what are some signs of a hemmorhagic stroke
severe headache
seizures
nausea/vomiting
what is a vasospasm
vessels slam closed
happens when brain is irritated
when does a vasospasm in the brain usually happen
4-14 days after a stroke
what do we do to prevent vasospasm
- keep SBP 150-160
- give CCB (nimodipine)
what are parameters of CPP for people with brain injuries
70-100
what are burr holes used for
subdural hematoma
whats the difference between a thrombotic and an embolic stroke
thrombotic: slower onset
embolic: sudden onset
what is the main treatment for Guillian barre syndrome
plasmapheresis, IVIG
