Week 9 Perception and Cognition: Neuro Flashcards
Warning sign of ischemic stroke
TIA or reversible neurologic deficit (RIND)
TIA time frame
a few minutes to 24 hours but sx usually resolve in 30-60 min
RIND time frame
24 hours to 7 days
Vision changes in TIA
blurred vision, diplopia, blindness in one eye and tunnel vision
Dysarthria
slurred speech
Onset of thrombotic stroke
slow over minutes to hours
Onset of embolic stroke
sudden
sx of cerebral aneurysm
SEVERE HA (#1) N/V, photophobia, cranial neuropathy, stiff neck, change in mental status
What is indicated by a change in LOC
increased ICP
Functions of the right cerebral hemisphere
vision, spatial awareness and proprioception
Function of the left cerebral hemisphere
language, math and analytical thinking
Unilateral neglect syndrome
common in rt side stroke
Pt is unaware of L or paralyzed side
BP needed to maintain cerebral perfusion after ischemic stroke
150/100
Higher BPs may cause another stroke
Emotional lability
Pt laughs or cries unexpectedly
Occurs when frontal lobe is affected in stroke
Tests for stroke
CT (no contrast), MRI, 12 lead and cardiac enzymes to r/o MI, elevated H&H indicate body compensation to low O2, coags used to determine baseline
Priority problems for Pt with a stroke (7)
- Inadequate perfusion to the brain
- Impaired Swallowing
- Impaired Physical Mobility and Self-Care Deficit
- Aphasia or dysarthria
- Urinary and/or Bowel Incontinence
- Sensory changes
- Unilateral body neglect syndrome
Immediate assessment in ischemic stroke
monitor for increasing ICP
Time window for rTPA
within 3 hours of time last seen normal
Time window for fibrinolytic treatment
within 6 hours
Key features of ICP
< LOC, restlessness, irritability, confusion, HA, N/V, speech changes, pupil changes, ataxia, seizures, HTN, bradycardia, wide pulse pressure
Interventions to avoid increased ICP
HOB at 30 degrees, apply O2 for <92%, keep head midline, avoid hip/neck flexion, avoid clustering care, position on the side if hemiparesis is present
What to monitor for in possible impaired swallowing
facial drooping, drooling, impaired voluntary cough, hoarseness, incomplete mouth closure, or cranial nerve palsies
Observe for fatigue
Focus of managing sensory perception after Rt sided damage
visual-perceptual or spatial-perceptual tasks and routine ADLs
Focus of managing sensory perception after L sided brain damage
Re-orient the patient d/t memory problems, establish a routine
Apraxia
Inability to perform previously learned motor skills or commands
Typically exhibits a slow and cautious behavior
Seen in L sided brain damage
Mild TBI rating
GCS of 13-15 and loss of consciousness for up to 15 min
Moderate TBI rating
loss of consciousness up to 6 hours
GSC of 9-12
Havvi difficulty with work, learning and role function
Severe TBI rating
GCS of 3-8 and loss of consciousness of > 6 hours
Post concussion syndrome
physical and cognitive problems remain despite mild initial sx and normal dx test findings
Normal ICP
10-15 mmHg
First response to increased intracranial volume
shunting or increased absorption of CSF
Epidural hematoma sx
Pt goes from being awake and talking to unconscious
Acute subdural hematoma
presents within 48 hours of injury
Subacute subdural hematoma
presents from 48 hours to 2 weeks
Chronic subdural hematoma
sx may not be present for 2 months
Uncal herniation of the brain sx
Life threatening!
Dilated/nonreactive pupils, ptosis (drooping eyelids), and a rapidly deteriorating LOC
Central herniation of the brain sx
Cheyne-Stokes respirations, pinpoint and nonreactive pupils, and hemodynamic instability
Cushing’s triad
late sign of ICP
HTN with a widened pulse pressure and bradycardia
Pulse changes in increased ICP
thready, irregular and rapid
early indicators of changes in LOC
behavior changes (e.g., restlessness, irritability) and disorientation
sx of brainstem disfunction
pinpoint nonreactive pupils
Goals of nursing care for a head injury
preventing or detecting increased ICP, promoting fluid and electrolyte balance, and monitoring the effects of treatments and drug therapy
Use of glucocorticoids in increased ICP
have no benefit
Use of osmotic diuretics in increased ICP
Mannitol is used
It pulls water out of the extracellular space of the edematous brain tissue
Best given in boulses
Administer through a filter
Use of Lasix in increased ICP
Enhances Mannitol
Also reduces edema and blood volume, decreases Na+ uptake by the brain, and decreases the production of CSF
Use of anti-seizure medication for increased ICP
Not reccomended if 1st seizure is 7+ days after injury but ok if < 7 days
Barbituate coma
used for increased ICP that can not be controlled otherwise
First sign of increased ICP
declining LOC
Teach the patient to report which sx after a carotid endarterectomy
Severe headache
Change in brain function (e.g., drowsiness, decreased cognition)
Muscle weakness
Severe neck pain
Neck swelling
Hoarseness or difficulty swallowing (due to nerve damage)
Sx of post concussion syndrome seen in a minor head injury
- Personality changes
- Irritability
- Headaches
- Dizziness
- Restlessness
- Nervousness
- Insomnia
- Memory loss
- Depression
Cranial nerve I
Olfactory
Give them something to smell
Cranial nerve II
Optic: central and peripheral vision
Have Pt read, count fingers from 6” away, test ability to see fingers moving in the periphery
Cranial nerve III
Occulomotor: pupil constriction
Test with a penlight
Cranial nerve IV
Trochlear: eye movement down and in
Have Pt follow finger toward the tip of their nose
Cranial nerve V
Trigeminal: Facial movement and sensation
Check sensation of sharp/dull, have Pt open jaw, check on scalp also
Cranial nerve VI
Abducens: eye movement to the sides
Tell Pt to look at each ear, follow finger through visual fields, make an X in the air and watch for nystagmus
Cranial nerve VII
Facial: movement and expression
Assess symmetry, wrinkle forehead, close eyes, smile, pucker
Cranial nerve VIII
Acoustic: hearing
Rub fingers beside ear, whisper
Cranial nerve IX
Glossopharyngeal: Tongue
Assess taste, ability to swallow, have Pt open mouth and say AHHH, uvula should be midline and palate should rise.
Cranial nerve X
Vagus: Throat
Ability to swallow, have Pt open mouth and say AHHH, uvula should be midline and palate should rise.
Cranial nerve XI
Spinal accessory: neck and shoulder movement
Ask to raise shoulders or turn head against hands
Cranial nerve XII
Hypoglossal: innervates the tongue
Ask to stick out tongue and evaluate if it is midline, check problems eating, swallowing, speaking
