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Nursing, LPN, Year 2 > X Neuro: Mrs Si (Burke) > Flashcards

X Neuro: Mrs Si (Burke) Flashcards

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1
Q

Assessing Mental Status

A
  • Orientation (person, place, time, event)
  • Mood/Behavior
  • General knowledge
  • ST/LT memory
  • attention span/ability to focus
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2
Q

Assessment: Orientation

A

-person, place, time, event/purpose

A+Ox3 w understanding of event, or document pt doesn’t know whey they are here if they are A+O all three except event.

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3
Q

Adequate cerebral functioning is determined by ..

A

assessing mental status

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4
Q

Ability to show orientation depends on

A

memory and attention

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5
Q

Orientation Questions

A
  • Person: What is your name?
  • Place: Can you tell me the name of this facility? What town? (DON’T ask pt Do you know where you are? Insults them)
  • Time: What year is it? What month? Who is president? (understand time frame)
  • Purpose/Event: What brought you here?
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6
Q

Mood/Behavior: Mood

A

-How does pt feel? person has their own perception of how they feel. Opinion. They may look happy but not be.

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7
Q

Mood/Behavior: Behaviour

A

Cooperative? Agitated? Pleasant?

-be objective not subjective. i.e. if you document it, make sure you have proof to back it up.

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8
Q

General Knowledge Assessment Question

A
  • Who’s the president of USA?
  • What major holiday is in Nov?
  • What was last big storm?
  • What wars are we involved in recently?
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9
Q

Test for short term memory

A
  • list 3 objects
  • ask pt to repeat them
  • check recall in 5 min
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10
Q

Test for Long Term memory

A
  • job history
  • where born/raised
  • family hx, brothers, sisters?
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11
Q

Do demented pts have short term mem?

A

no

-talk about past to make them comfortable

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12
Q

Attn Span and Ability to Focus

A

ability to focus or concentrate over time on 1 task or activity.
-if inattentive, pt has hard time providing their med hx

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13
Q

LOC (Level of Consciousness)

A
  • indicator of brain fx

- earliest sign of changes in MS

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14
Q

What are the 2 components of LOC

A
  • Arousal (wakefulness)

- Awareness

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15
Q

LOC’s

A

ACLOSC

  • alert
  • confused
  • lethargic
  • obtunded (alertness w slow psycho motor response)
  • stuporous (sleep like state, not coma, little or no spontaneous activity. only responds to vigorous stimulate)
  • comatose (unable to respond to any stimuli verbal/physical)
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16
Q

When documenting LOC, Orientation

A

AA+Ox3 (awake, alert, oriented x3)

i.e. lethargic, easily arousable, oriented x3

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17
Q

Awareness

A
  • ability to interact w and interpret your environment.

- higher fx controlled by brain stem

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18
Q

Components of Awareness

A
  • orientation
  • memory
  • calculation (planning, time mgmt.)
  • Fund of knowledge (the historically accumulated and culturally developed bodies of knowledge and skills essential for household or individual functioning and well-being”)
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19
Q

Glasgow Coma Scale

A
  • assess of pt’s level of responsiveness
  • use for pts who have suffered head injuries
  • indicates severity of coma
  • predicts possible pt outcomes
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20
Q

Glasgow Coma Scale evaluates…

A
  • motor
  • verbal
  • eye opening responses
  • scale of 3-15
  • 3 = coma, 15 = normal
  • not to replace a neuro assessment
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21
Q

Glasgow Coma Scale scores

A 
Eye Opening
4 - Spontaneous
3 - to loud voice
2 - to pain
1 - none
Verbal Response
5 - oriented
4 - confused, disoriented
3 - inappropriate words
2 - incomprehensible sounds
1 - none
Best Motor Response
6 - obeys
5 - localizes
4 - withdraws (flexion)
3 - abnormal flexion (posturing)
2 - extension posturing
1 - none
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22
Q

2 Types of Posturing

A

Decorticate: pt turning inward
Deceribrate: turning outward

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23
Q

Stroke (CVA, Brain Attack)

A

Cerebrovascular accident: sudden death of brain cells due to lack of oxygen when blood flow to brain is impaired by blockage or rupture of an artery to the brain. Symptoms of a stroke depend on the area of the brain affected.

  • # 1 cause of adult disability
  • 5th leading cause of death in US
  • Affects all ages
  • # 3 for women
  • # 5 for men
  • # 1 preventable cause of disability
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24
Q

Stroke Stats

A
  • In US, stroke every 40sec
  • 795,000 have stroke every year
  • 6.8mil Americans 20yrs UP have had a stroke
  • once you have a stroke, poss of 2nd very real
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25
Q

Stroke Prevention

A
  • diet
  • exercise
  • HTN controll
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26
Q

Stroke Risk Factors

A
  • HTN
  • Obesity
  • DM
  • AFIB (atria doesn’t pump well, while hesitating, blood stagnant and starts to clot, pump can send clot through body, candidates for AntiCoag meds, but if they are risk for fall bc can bleed out)
  • Cocaine: vaso constrictor
  • ETOH
  • Male
  • Oral Contraceptives
  • Race (AfAm, Hispanic, Caucasion)
  • Age 65 UP
  • Family Hx
  • Sleep Apnea
  • Smoking
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27
Q

Stroke: Major Players

A
  • HTN
  • Cholesterol
  • Smoking
  • 40% of Americans have had at least 1 stroke
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28
Q

Stroke: Def

A

sudden loss of brain fx d/t blockage of rupture of blood vessel in or to the brain

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29
Q

Types of Strokes

A
  • Ischemic (blockage)

- Hemorrhagic (ruptured BV)

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30
Q

Ischemic Stroke

A
  • most common, 80%

- interruption of blood flow to brain causing hypoperfusion, hypoxia, cell death

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31
Q

Types of Ischemic Stroke

A
  • Thrombotic

- Embolic

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32
Q

Thrombotic Stroke (Cerebral Thrombosis): Def

A

-clot forms in cerebral artery (supply blood to brain)

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33
Q

Thrombotic Stroke (Cerebral Thrombosis): Causes

A
  • Atherosclerosis *** (most common)
  • HTN
  • DM (w accelerate Atherosclerosis)
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34
Q

What is Atherosclerosis?

A
  • Accumulation of lipids, cholesterol on intimal layer of artery.
  • causes narrowing
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35
Q

Atherosclerosis risks

A

if piece breaks off, the body sends inflammatory response and the artery clogs up. The cells and platelets obstruct entire vessel –> Ischemic Stroke

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36
Q

Thrombotic Stroke

A
  • plaque narrows the artery
  • The plaque ruptures
  • clot forms
  • clot blocks blood flow
  • Ischemia occurs
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37
Q

Embolic Stroke

A
  • blood clot forms in vessel, not in brain
  • travels thru blood, lodges in small brain artery
  • r/t afib
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38
Q

Embolic Clot

A

travelling clot

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39
Q

Other types of embolism

A
  • Air Embolism (30ml air)
  • Fat embolism (orthopedic sx, GU sx)
  • Amniotic fluid (following child birth)
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40
Q

Hemorrhagic Stroke

A

Rupture of blood vessel in brain

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41
Q

Hemorrhagic Stroke: cause

A
  • uncontrolled HTN
  • aneurism
  • arteriovenous malformations (AVMS)
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42
Q

Types of Hemorrhagic Stroke

A
  • intracerebral (in brain)(d/t HTN)

- subarachnoid hemorrhage (in space btwn skull and brain)

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43
Q

Arterial Aneurysm

A
  • dilation, ballooning of portion of artery
  • forms at weak point
  • rupture –> hemorrhage and death (arteries under high pressure)
  • cause :trauma, congenital defect, infection
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44
Q

arteriovenous malformations (AVMS)

A
  • congenital disorder
  • direct connection btwn veins and arteries . cluster of blood vessels lacking capillaries
  • risk for hemorrhage
  • mostly asymtomatic, usually revealed in autopsy
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45
Q

Blood Vessels: hi pressure to Lo

A

Artery–arterioles–capillaries–venues–veins

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46
Q

See pic is AVM

A

arteriovenous malformations (AVMS)

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47
Q

Is hemorrhage d/t head injury considered a stroke?

A

NO

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48
Q

TIA (Mini Stroke)

A
  • Transient Ischemic Attack
  • decrease in blood to area of brain
  • results in brief neuro dysfx lasting
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49
Q

TIA S/S

A
  • temp vision loss
  • apasia (A language disorder that affects a person’s ability to communicate.)
  • contralateral hemiparesis (opposite side weakness, face, arms, hands, legs)
  • paresthesia (numbness/tingling)
  • vertigo
  • ataxia (impaired coor)
  • loss of consciousness (uncommon)
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50
Q

TIA is warning sign for what?

A
  • CVA
  • 33% w TIA will have CVA in 2-5yrs
  • need to dx underlying cause (afib?)
  • anti platelet aggregation/anticoag meds
  • factor Xa inhibitor med
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51
Q

MED: Anti-Platelet Aggregation

A
  • ASA
  • Clopidogrel (Plavix)
  • Aggrenox
  • Ticlopidine (Ticlid)
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52
Q

MED: Anti Coag

A

Cumadin

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53
Q

MED: Factor Xa Inhibitor

A

Eliquis

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54
Q

MED: Aspirin (ASA)

A
  • Class: salicylate
  • decreases platelet aggregation
  • Use: LO risk of thrombotic CVA
  • Dose: 50mg - 325mg/day
  • SE: bleeding, tinnitus
  • Monitor: Liver, renal Fx
  • Teach: swallow enteric whole
  • Warning: use w caution for asthma, can worsen
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55
Q

MED: Aggrenox

A
  • combo of ASA (25mg) and Dipyridamole (200mg)
  • Class: platelet aggregate inhibitor
  • Use: LOwer risk of thrombotic CVA
  • Dose: 1cap BID
  • SE: weakness, faint, hypotension, bleed, HA
  • Monitor: liver/renal fx
  • Teach: SS bleeding, no preg, no ETOH (cause stomach bleeding)
  • Class D: w cause damage to fetus, goes into breast milk
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56
Q

MED: Plavix

A
  • Class: platelet aggregation inhibitor
  • Use: LO risk of thrombotic CVA
  • Dose: 75mg po qd
  • SE: pruritis, purpuria (large petechia), hemorrhage
  • Monitor: CBC, Liver fx
  • Teach: bleeding precautions
57
Q

MED: Ticlid

A
  • Class: platelet aggregation inhibitor
  • Use: LO risk of thrombotic CVA
  • Dose: 250mg BID w food
  • SE: bloody dyscrasias, hepatitis (non viral), GI upset
  • Monitor: CBC, Liver fx
  • Teach: bleeding precautions
58
Q

MED: Coumadin

A
  • Class: anti coag aka Warfarin
  • Action: interferes w blood clotting
  • Use: PE, DVT, MI, CVA, Atrial Dysrhythmias, post valve replacement
  • Dose: /
  • SE: bleeding, hepatitis
  • Monitor: PT/INR (doses based on INR)
  • Teach: bleeding precautions (can bleed anywhere, nose, cut, gut…)
  • Reversal Tx for OD: Shot of Vit K
59
Q

MED: Coumadin: more teaching

A
  • if already eat leafy greens, base dose on that, but don’t all of a sudden eat greens if it’s not your normal diet.
  • drug works when INR is 2-3. (doc needs to determine what dose w keep you at 2-3)
  • less than 2, risk for clotting
  • over 3, risk for bleeding
  • no vit k (dk leafy greens)
  • do not double dose if missed
  • reg blood checks
  • same time every day
  • don’t miss dose
  • Reversal Tx for OD: Shot of Vit K
60
Q

MED: Eliquis

A
  • Class: factor Xa inhibitor
  • Use: LO risk of CVA and clots in pt w afib
  • Dose: 5mg bid
  • SE: easy bruising, bleeding
  • Teach: doesn’t need as much blood work as Coumadin
  • Neg: no reversal agent to combat OD. Must give Fresh Frozen Plasma (blood product)
61
Q

Surgical Interventions for TIA

A
  • carotid endarterectomy

- transluminal angioplasty

62
Q

Carotid Endarterectomy

A
  • correct carotid stenosis, limit blood flow to brain
  • remove inner lining of carotid artery
  • risk: dislodging plaque –> emboli –>CVA, will travel to brain
  • done when 70-99% occluded
  • done when pt is symptomatic
  • pt awake to ensure no stroke
63
Q

Transluminal Angioplasty

A

balloon squished plaque against wall of artery

64
Q

Stroke: S/S

A
  • visual field deficit
  • motor deficit
  • sensory-perceptual deficit
  • verbal deficit
  • cognitive deficit
  • emotional deficit
65
Q

Visual Field Deficits

A
  • Homonymous Hemianopsia
  • Loss of peripheral vision
  • Diplopia (double vision)
66
Q

Homonymous Hemianopsia

A

loss of half field of vision on same side in both eyes

67
Q

Diplopia (double vision)

A

simultaneous perception of 2 images of 1 object

68
Q

Motor Deficits: Hemiparesis

A
  • weakness on a hemisphere
  • Rt sided CVA = L sided damage
  • face, arms, legs
69
Q

Motor Deficits: Hemiplegia

A
  • paralysis
  • Lt sided CVA = Rt sided paralysis
  • face, arms, legs
70
Q

More Motor Deficits

A
  • Ataxia (staggering, unsteady gait)
  • Dysarthria (diff forming words/articulation)
  • Dysphagia (diff swallowing)
71
Q

Sensory Deficit

A
  • Paresthesia (numbness/tingling)

- Rt brain CVA w have L paresthesia

72
Q

Sensory-Perceptual Deficits

A
  • Agnosia: diff recognizing and identifying objects or person
  • Apraxia: diff performing tasks or mvmts when asked
  • Neglect Syndrome: deficit in attention to and awareness of 1 side of space/body
73
Q

Verbal Deficits - Aphasia

A

DEF: loss of ability to produce and comprehend language
CAUSE: Injury to areas of brain responsible for language production and interpretation.
Broca - Production
Wernicke - Language, Understanding

74
Q

What are these areas responsible for?

BROCA and WERNICKE

A

Broca - comprehension and production

Wernicke - language, understanding

75
Q

Sensory Aphasia (Receptive)

A

inability to comprehend spoken or written word

76
Q

Motor Aphasia (Expressive)

A

inability to use symbols of speech. They understand but can’t verbalize

77
Q

Global Aphasia

A

inability to understand the spoken word or to speak

78
Q

Dysphasia

A

difficulty speaking

79
Q

Dysphagia

A

difficulty swallowing

80
Q

Dysarthria

A

difficulty i speaking due to problems with muscles of speech

difficult or unclear articulation of speech that is otherwise linguistically normal.

81
Q

Agnosia

A

not able to recognize and identify objects or person

82
Q

Apraxia

A

unable to preform tasks or mvmts when asked

83
Q

Neglect Syndrome

A

deficit in attention to and awareness of 1 side of space

84
Q

Ataxia

A

unsteady gait

85
Q

Paresteshia

A

numbness/tingling

86
Q

Cognitive Deficits d/t stroke

A
  • ST/LT mem loss
  • DEC attention span
  • impaired ability to concentrate
  • poor abstract reasoning
  • altered judgement
87
Q

Emotional Deficits d/t stroke

A
  • loss of self control
  • DEC tolerance to stressful situations
  • depression/withdrawal
  • fear, hostility, anger, feelings of isolation
88
Q

Comparison of L v R hemispheric stroke

A

LEFT

  • paralysis on R side
  • R visual field deficit
  • Aphasia (expressive, receptive, global)
  • Altered intellectual ability
  • Slow cautious behavior

RIGHT

  • paralysis on L side
  • L visual field deficit
  • Spatial/Perceptual deficits
  • Increased distraction
  • impulsive behavior, poor judgement
  • lack of awareness of deficits
89
Q

Stoke MM

A
  • treat rapidly
  • IV access
  • CT scan or MRI (thrombotic or hemorrhagic? Tx diff for each)
90
Q

Single most important factor dealing w stroke?

A

TIME (tPA works better when given immediately)

91
Q

Ischemic CVA: MM

A
  • clot busting drugs (tPA, can kill if out of the window of effectiveness)
  • admin w/in 4.5 hrs of onset of SS (when did ss start?)
92
Q

tPA (Tissue Plasminogen Activator)

A
  • Route: IV (VERY POTENT!!)
  • strict criteria: acute Ischemic CVAs ONLY
  • Clot busting
  • use up to 4.5 hr after onset
  • SE: Hemorrhage
  • **-after tPA: NO ASA for 24hr, NO invasive procedures (foley, IBG, ABG) because you could bleed to death
93
Q

Fx of Coumadin and Heparin

A

DON’T BUST CLOTS

prevent clots from enlarging and new ones from forming

94
Q

tPA EXCLUSION criteria

A
  • later than 4.5 hrs onset
  • UP BP over 185/over 110
  • sig head trauma or cva within 3 mos
  • SS sub arachnoid of hemorrhage
  • Hx of previous brain hem.
  • prior aneurysms, AVMS, neoplasm
  • heparin within 48hrs
  • pt on Anti Coag
  • arterial puncture in last 7 days
  • BG
95
Q

SS Sub arachnoid Hemmorahge (SAH)

A

main symptom is sudden, severe headache, (THUNDERCLAP HA) which is more intense at the base of the skull. Some people may even feel a popping sensation in their head before the hemorrhage begins.

also:
neck pain
numbness throughout your body
shoulder pain
seizures
confusion
irritability
sensitivity to light
decreased vision
nausea
vomiting
rapid loss of alertness
96
Q

Hemorrhagic CVA: MM

A
  • Sx (maybe)

- Calcium Chann Blockers (prevent vasospasms)

97
Q

Hemorrhagic CVA: Sx types

A
  • *** Aneurysm Clipping (standard)
  • Aneurysm Embolization (coiling, putting wire into aneurysm to impair blood flow, as it slows, it clots.
  • Surgical AVM removal
98
Q

Aneurysm Rupture compications

A

1) rebleeding

2) vasospasm, contracts and stops blood flow

99
Q

Hemorrhagic CVA: NI (Acute phase)

A
  • assess VS
  • neuro checks
  • HOB 30* (to lower ICP)
  • NPO
  • IV fluid
  • Foley
  • safety precautions
100
Q

When do you treat BP during stroke?

A

only UP 220/UP 120

-hi pressure is delivering Ox to brain. If you treat it within limits, you impair blood flow to brain.

101
Q

NI: Communication

A
  • talk
  • tone/pace
  • avoid distractions (radio/tv)
  • adequate time, do not rush
  • communications boards (if aphasia)
102
Q

NI: Swallowing

A
  • dysphagia screen (90ml H2O in cup, drink in one gulp, if cough, NPO, swallow study, speech pathologist)
  • HOB 90* meals - 30 min after
  • oral care ac/pc
  • suction at bedside
  • thicken liquids
103
Q

NI: Sensory Perception

A
  • approach pt from unaffected side (acute phase. affected once chronic)
  • place items on unaffected side
  • teach pt to turn head to affected side
  • ***call bell always on unaffected side
104
Q

NI: Neglect syndrome

A
  • approach pt from neglected side
  • place nightstand on neglected side
  • place necessities on neglected side
  • ***Call bell on unaffected side
105
Q

NI: Elimination

A

-toileting q2-4 hrs
-encourage fluid 2000ml/day, limit at night
-skin care
Retrain pt to use bathroom

106
Q

NI: Mobility

A
  • T/P q2hr
  • proper body alignment, protect joints
  • active/passive ROM (keep joints mobile)
107
Q

NI

A
  • involve speech therapist, OT, PT
  • MEDS (dose, SE, when to take)
  • refer to support groups
  • safety precautions
  • teach prevention (control HTN, lo cholesterol, control DM, healthy weight, exercise, manage stress, ETOH moderation
108
Q

Trigeminal Neuralgia (tic douloureux): SS

A
  • causes severe pain in Trigeminal nerve (V)

- shooting pain on 1 side of face

109
Q

Trigeminal Nerve responsible for

A
  • senses touch, pain, pressure, temp
  • makes saliva/tears
  • scalp, teeth sensation
  • chewing movements
110
Q

Trigeminal Neuralgia (tic douloureux): Pathos

A
  • compression of Trigeminal nerve
  • compresses on area near pons, superior cerebellar artery
  • compression w damage cells myelin sheath, can lead to eratic and hyperactive fx of nerve
  • severe pain at slightest stimulation
111
Q

Trigeminal Neuralgia (tic douloureux): Cause

A
  • Idiopathic (if not structural cause)
  • annuerism?
  • tumor
  • arachnoid cyst?
  • traumatic event (car acc, tongue piercing)
  • 2-4% (young pt d/t MS)
112
Q

Postherpetic neuralgia (PHN)

A

nerve pain (neuralgia) that persists after shingles rash has cleared. If pain goes, but then returns at a later date, this too is called PHN.

Shingles is an infection of a nerve, and causes a typical rash. It is caused by the varicella-zoster virus.

  • UP 60yrs
  • MS possible factor
  • more WOMEN
  • r/t some Sx dental procedures (damage to nerve)
  • attacks, remissions
113
Q

Postherpetic neuralgia (PHN): SS

A
  • excruciating, knife like, electrical shock pain to 1 side of face, unilateral.
  • can affect lips, gums, cheeks, side of nose
114
Q

Postherpetic neuralgia (PHN): Triggers

A
  • touching face
  • chewing
  • shaving
  • speaking
  • brushing teeth
  • drinking hot/cold
  • trigger point areas along nerve
  • pain lasts sec - minutes
115
Q 
Cranial nerves
CN 0 – Terminal
CN I – Olfactory
CN II – Optic
CN III – Oculomotor
CN IV – Trochlear
CN V (1,2,3) – Trigeminal
CN VI – Abducens
CN VII – Facial
CN VIII – Vestibulocochlear
CN IX – Glossopharyngeal
CN X – Vagus
CN XI – Accessory
CN XII – Hypoglossal
A 
Cranial nerves
CN 0 – Terminal
CN I – Olfactory
CN II – Optic
CN III – Oculomotor
CN IV – Trochlear
CN V (1,2,3) – Trigeminal
CN VI – Abducens
CN VII – Facial
CN VIII – Vestibulocochlear
CN IX – Glossopharyngeal
CN X – Vagus
CN XI – Accessory
CN XII – Hypoglossal
116
Q

Trigeminal Nerve Innervation (see pic of head w dermatomes)

A

1 - Ophthalmic Branch
2 - Maxillary
3 - Mandibular

117
Q

Trigeminal Neuralgia (tic douloureux): Dx

A
  • no specific test
  • neuro asst
  • pain Hx
  • MRI (to rule out MS or tumor)
118
Q

Trigeminal Neuralgia (tic douloureux): Sx

A

-Micro-vascular Decompression (removing or relocating BV in contact w trigem nerve)

-Gamma Knife Radiosurgery:
.surgeon directs focused dose of radiation to root of trigem nerve
.using radiation to damage nerve
.relief is gradual, may take several wks
.works in majority of pt
.can be repeated
.considered Safe
119
Q

Trigeminal Neuralgia (tic douloureux): MM

A
  • microvascular decompression
  • anticonvulsants
  • antispasmodics
  • Rhizotomy (alchohol or glycerol inj)
120
Q

Trigem Neur: Rhizotomy

A

-neurosurgical procedure that selectively destroys problematic nerve roots in the spinal cord

GLYCEROL INJ:
-needle through face to base of skull
-needle guided through
Post PO: numbness/tinging

ALCOHOL INJ:
-may need repeated injs

BALLOON COMPRESSION:

  • needle through face
  • baloon at end of catheter
  • inflate at right spot to supply pressure to trig nerve to damage it and block pn signals

SEVER NERVE COMPLETELY:
incision behind ear
Risk, perm numbness in face. instead of cutting, surgeon may decide to traumatize nerve instead (rubbing)

121
Q

Trigem Neur: Radiofrequency Thermal Lesioning

A
  • destroy nerve fibers asociated w pain
  • while dedated, insert hollow needle thru face to base of skull to trig nerve
  • when needle in position, awaken pt.
  • dr sends electrode thru needle and send current through
  • pt lets dr know when and where they feel tingling
122
Q

Trigem Neur: AntiConvulsants

A
  • **most common
  • also used to treat behavioral probs
  • MED: Tegretol, Carbatrol (Carbamazepine)
  • MED: Dilantin, Phenytek (Phenytoin)
  • MED: Lamictal (Lamotrigine)
  • MED: Neurontin (Gabapentin)
123
Q

Trigem Neur: Antispaciticity

A

helps w pain, muscle relaxant
-MED: Baclofen (alone or w Tegritol and/or Dilantin)

SE: drowsiness, N, confussion

124
Q

Trigem Neur: Comfort Measures

A
  • avoid touching face
  • no shaving/washing area
  • avoid extreme hot/cold fluid
  • puree food, straw (eliminate chewing)
  • IV fluids
  • Monitor I/O
  • soft foods, hi caolorie/protein
  • poor oral hygiene becasue brushing may cause pain
  • permanent numbness d/t Sx possible
  • RSK: won’t feel cavities, tooth pain, biting skin, burns from hot food etc
125
Q

Bells Palsy

A
  • damage to CN VII.
  • nerve goes through tunnel of bone on face, if inflamed, could be compression
  • usually temporary
  • weakness/paralysis
  • sudden onset, 24-48hrs (peak 48hrs)
  • rare in children
  • men/women equal
  • 50/60s
  • DM more prone
  • last trimester of preg
  • unilateral, rarely bilateral
  • sudden onset
  • some recover quickly (few wks)
  • 35% take longer to fully recover
126
Q

Bells Palsy: Cause

A

Inflammation d/t

  • Herpes Simplex
  • Herpes Zoster (chix pox)
  • Epstein Barr (mono)
  • Cytomegalovirus (herpes fam)
  • Lyme Disease
127
Q

Bells Palsy: SS

A

-***facial paralysis
-muscle weakness/paralysis
-temporary
-facial drooping
-drooling
-dry eye/mouth
-loss of blink reflex (dry eye)
-excessive tearing
-distortion of face
-pain in ear (early)
-loss of taste
-changes ear/saliva production
-sound louder on affected side
-

128
Q

Bells Palsy: Dx

A
  • no specific test, rule out others
  • ct scan to rule out tumor
  • med hx of virus
  • blood titres (antibodies)
129
Q

Bells Palsy: MM

A
  • MED: Corticosteroids (Prednisone, Man Tx for inflammation)
  • MED: Acyclovir (antiviral, herpes types)
  • Physical therapy (massage facial muscles)
  • Analgesics (pain)
  • Sx: not recommended, surgically open bony passage and decompress
130
Q

Bells Palsy: Prognosis

A
  • 85 fully recover in wks - 1 yr
  • recover taste w’in 1st week = sign of recovery
  • 15% have continued asymmetric facial muscle mvmts.
131
Q

Meningitis

A

.use handout
and
http://www.cdc.gov/meningitis/index.html

132
Q

Difference btwn CVA and TIA

A

CVA: sudden death of brain cells due to lack of O2.
TIA: decrease in blood supply to area of brain resulting in brief neuro disfunction

133
Q

Patient w Dysphasia is at risk for?

A

Aspiration, Malnutrition

134
Q

2 radiology tests used to Dx CVA

A

CT Scan, MRI, Carotid US, Cerebral Angiogram

135
Q

Common SS of Subarachnoid Hemorrhagic Stroke

A

-sudden sever HA (Thunderclap HA)

136
Q

Causes of Subarachnoid Hemorrhagic Stroke

A
  • Aneurysm
  • AVM
  • Cocaine
  • HTN
137
Q

Should a pt w Dysphagia use a straw?

A

NO

138
Q

A pt who has suffered brain injury becomes ?? very quickly

A

fatigued

Nursing, LPN, Year 2 (27 decks)

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