Neuro 4 LURN: Stroke/CVA and Seizures

Question 1

What is a stroke/cerebrovascular accident (CVA)?

Answer 1

Sudden interruption of blood supply to the brain

Question 2

What is the patho of a stroke/cva?

Answer 2

Deprivation of oxygen and nutrients leads to brain tissue damage/necrosis

Question 3

What are the three causes of stroke/cva?

Answer 3

• Hemorrhagic: ruptured artery/aneurysm
• Thrombotic: blood clot in cerebral artery
• Embolic: Blood clot from another part of the body that travels to the cerebral artery

Question 4

What are the stroke/cva risk factors?

Answer 4

• Smoking
• HTN
• Diabeties
• Obesity
• AFIB
• Hyperlipidemia
• Hx of transient ischemic attack (TIA)

Question 5

What are the general s/s of stroke/cva?

Answer 5

• Unilateral limb weakness
• Facial drooping
• Slurred speech
• Visual disturbances (homonymous hemianopsia)
• Dizziness

Question 6

The left hemisphere is responsible for what aspects of being?

Answer 6

Language/math, analytical thinking

Question 7

What are the s/s of left-sided stroke/cva?

Answer 7

• Expressive aphasia (inability to speak/understand language)
• Reading and writing difficulty
• Right-sided hemiparesis (weakness) and/or hemiplegia (paralysis)

Question 8

The right hemisphere is responsible for what aspects of being?

Answer 8

Visual and spatial awareness

Question 9

What are the s/s of right-sided stroke/cva?

Answer 9

• Overestimation of abilities
• Poor judgement and impulse control
• Left-sided hemiparesis and/or hemiplegia

Question 10

What are the dx tests used for stroke/cva?

Answer 10

• CT
• MRI
• Cerebral angiogram

Question 11

What is the tx for ischemic stroke?

Answer 11

• Thrombolytics (TPA) w/in 3hrs of symptoms
• Anticoags
• Antiplatelets
• Surgery
  
  • Embolectomy

Question 12

What is the tx for hemorrhagic stroke?

Answer 12

• Antihypertensives
• Surgery
  
  • Aneurysm repair

Question 13

What is our nursing care for stroke/cva?

Answer 13

• Closely monitor pt’s BP
• Implement fall precautions
• Assess swallowing and gag reflex before allowing pt to eat
• Thicken liquids and teach pt to tuck chin to chest when swallowing
• Reposition pt frequently to protect them from pressure injuries
• Teach pt to use scanning technique
  
  • Turn head from direction of unaffected side to affected side for homonymous hemianopsia

Question 14

What are seizures?

Answer 14

• Uncontrolled electrical discharge of neurons in the brain
• Epilepsy is ≥ 2 unprovoked seizures

Question 15

What is the patho of seizures?

Answer 15

Disease, injury or unknown cause results in hyperexcitability of neurons and decreased inhibition of neuron activity

Question 16

What are the risk factors for seizure?

Answer 16

• Fever
• Cerebral edema
• Infection
• Toxin exposure
• Brain tumor
• Hypoxia
• Alcohol/drug withdrawal
• F&E imbalances

Question 17

What are some triggers for seizures?

Answer 17

• Fatigue
• Stress
• Flashing lights
• Caffeine

Question 18

What are four types of seizures?

Answer 18

• Tonic clonic
• Absence
• Myoclonic
• Atonic

Question 19

What is a tonic clonic seizure?

Answer 19

Tonic-clonic seizures involve both tonic (stiffening) and clonic (twitching or jerking) phases of muscle activity.

Question 20

A tonic clonic seizure may be proceeded by an aura. What is an aura?

Answer 20

The person may experience changes in sensation, mood or emotion leading up to the tonic-clonic seizure.

Question 21

What are the three phases of a seizure? Describe each.

Answer 21

• Tonic episode: stiffening of muscles, loss of onsciousness
• Clonic episode: 1-2 min of rhythmic jerking of extremities
• Postictal phase: confusion, sleepiness, agitation

Question 22

What is an absence seizure and what are its s/s?

Answer 22

• Loss of consciousness for a few seconds
  
  • Resembles “day dreaming”
• s/s:
  
  • blank staring
  • eye fluttering
  • lip smacking
  • picking at clothes

Question 23

What is a myoclonic seizure?

Answer 23

Brief jerking of extremities

Question 24

What is an atonic seizure?

Answer 24

• Loss of muscle tone
• Often results in falling

Question 25

What dx test is used to identify origin of seizure?

Answer 25

EEG

Question 26

What type of medication is used for seizures?

Answer 26

Antiepileptics

Question 27

What are some procedural treatments for seizures?

Answer 27

• Vagal nerve stimulator
• Craniotomy to remove seizure causing tissue

Question 28

What is our nursing care during seizure?

Answer 28

• Lower pt to bed or floor if standing/sitting
• Turn pt on their side (pre or post seizure, NOT DURING)
• Loosen restrictive clothing
• Do NOT put anything in pts mouth
• Do not restrain pt
• Note onset/duration of seizure

Question 29

What is our post seizure nursing care?

Answer 29

• Check VS, neuro status
• Reorient pt
• Keep pt on side and allow to rest
• Implement seizure precautions
• Document the seizure

Question 30

What is status epilepticus?

Answer 30

Life threatening condition where a person has a prolonged seizure (> 5min) or fails to regain consciousness in between seizures

Question 31

What are the risk factors for status epilepticus?

Answer 31

• CNS infection
• Head trauma
• Drug withdrawal/toxicity

Question 32

What medications are used for status epilepticus?

Answer 32

• Benzodiazepines (lorazepam)
• Antiepileptics (phenytoin)
• Anesthetic agents (propofol)
• Barbiturates (phenobarbital)

Question 33

What factors do we document in a focused assessment of a seizure?

Answer 33

• How often do seizures occur
  
  • Date, time and duration
• Description of seizure
  
  • Tonic, clonic, staring spells, etc
• Sequence of progression
  
  • where it began and how it progressed
• Observations during seizure
  
  • Changes in pupil size, eye deviation
  • LOC change
  • Apnea, cyanosis, salivation, incontinence
• Pt actions post seizure
  
  • Drowsy/weak?
  • Aware or unaware of seizure activity?
• How long it takes for pt to return to pre-seizure status

Question 34

Describes what happens with breathing in a tonic clonic seizure.

Answer 34

• Tonic phase = apnea and loss of consciousness, lasts about 10 sec
• Clonic phase = breathing w/ convulsions

Question 35

If a pt must take antiepileptic meds to prevent seizures, what must we educate them about doses?

Answer 35

• Don’t skip any doses!
• If dose is skipped, seizure may be triggered

Question 36

If drugs don’t work to prevent seizures, what else may be attempted to do so in pts ≥12 yrs?

Answer 36

Vagus nerve stimulator

Question 37

Describe the vagus nerve stimulator?

Answer 37

• A device to stimulate the vagus nerve with electrical impulses
• There’s one vagus nerve on each side of the body, running from the brainstem through the neck to the chest and abdomen
• The device is surgically implanted under the skin on the chest, and a wire is threaded under the skin connecting the device to the left vagus nerve.
• When activated, the device sends electrical signals along the left vagus nerve to the brainstem, which then sends signals to certain areas in the brain.
• The right vagus nerve isn’t used because it’s more likely to carry fibers that supply nerves to the heart.

Question 38

What does a magnet do when passed over a vagus nerve stimulator?

Answer 38

• By swiping a magnet across the left chest, the magnet can send an additional electrical burst to the brain that may help stop the seizure or decrease the seizure’s length
• Can be used at anytime during seizure, but most effective if at start

Question 39

Some of the side effects and health problems associated with implanted vagus nerve stimulation can include:

Answer 39

• Voice changes
• Hoarseness or throat discomfort
• Coughing, difficulty swallowing
• Neck/chest pain
• SOB
• Tingling skin
• Worsening of pre-existing sleep apnea