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NURS 3512 acute & chronic > Week 11 Intracranial Regulation Meningitis, TIA, Stroke > Flashcards

Week 11 Intracranial Regulation Meningitis, TIA, Stroke Flashcards

1
Q

how does bacterial meningitis enter the body?

A
  1. Bloodstream
  2. Respiratory tract
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2
Q

Bacterial meningitis is a medical emergency. How quickly do we need to treat it to avoid mortality?

A

Within 24 hours

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3
Q

What is viral meningitis caused by?

A

enterovirus
aboviruses
HIV
Mumps
Chickenpox

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4
Q

Which meningitis is typically more severe, bacterial or viral?

A

Bacterial

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5
Q

Which meningitis has long term residual effects as opposed to full recovery, bacterial or viral?

A

Bacterial

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6
Q

What are some key features of meningitis?

A
  1. *petechial rash (meningococcal)
  2. Severe headache
  3. *Nuchal rigidity (stiff neck)
  4. *positive Kernig’s sign (knee extension = head/neck pain)
  5. *positive brudinski sign (flex neck, knees follow)
  6. photophobia
  7. N&V
  8. decreased LOC
  9. coma
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7
Q

What type of PPE precautions does meningitis require?

A

droplet precautions
-gown
- mask
- eye protection
- gloves

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8
Q

What is the goal of care in meningitis?

A

prevent increased ICP

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9
Q

What is the treatment for bacterial meningitis?

A

Antibiotics immediately (even before diagnosis confirmed)

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10
Q

How many hours is someone with bacterial meningitis on transmission precautions?

A

48 hours after antibiotics started

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11
Q

besides antibiotics what other medications do we give someone with bacterial meningitis?

A
  1. Steroids (dexamethasone) IV
  2. Anytipyretics (fever)
  3. Anticonvulsants
  4. Pain meds- hydromorph PO
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12
Q

What type of environment is needed for bacterial meningitis patients?

A

Safe- padded siderails
low lighting
low stimuli
Calm environment

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13
Q

what test confirms meningitis diagnosis ONLY?

A

Lumbar puncture analysis of CSF

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14
Q

What diagnostics are helpful but not THE confirming diagnostic test?

A
  1. Blood cultures
  2. CT scan
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15
Q

What are the 2 types of strokes?

A
  1. Ischemic
  2. Hemorrhagic
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16
Q

what are the 2 types of ischemic stroke?

A

Thrombotic stroke
Embolic stroke

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17
Q

What is a TIA?

A

Transient Ischemic Attack
- Brief interruption of blood flow, easy/often ignored or missed

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18
Q

What is a TIA a warning of?

A

thrombotic or embolic stroke

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19
Q

What 4 things can stroke affect?

A

Visual
mobility
sensory
speech

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20
Q

How often does TIA usually resolve?

A

30-60 min

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21
Q

How long can a TIA last?

A

24 hrs

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22
Q

What is the ABCD risk assessment for stroke?

A

A-Age - >60
B-BP >140/90
C-Clinical TIA features (one sided weakness)
D-Duration of symptoms - the longer the greater the risk

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23
Q

What is the other stroke risk assessment we can use besides ABCD?

A

NIHSS score
The National Institutes of Health Stroke Scale
-Assess how much impairment there is and plan post acute care

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24
Q

What’s the number one way to prevent ischemic stroke post TIA?

A

manage the risk factors

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25
Q

What are the risk factors for Stroke?

A

HTN
DM
Cardiac problems
Sleep apnea
high cholesterol

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26
Q

What can some one do to avoid a stroke?

A
  1. Healthy diet
  2. Exercise
  3. smoking cessation
  4. control BP
  5. limit alcohol
  6. no street drugs that increase stroke risk
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27
Q

What medications are given post TIA to prevent ischemic stroke?

A

-Platelet inhibiters: ASA (Aspirin), clopidogrel (Plavix)
-Anticoagulants for A-Fib: riveroxaban (Xarelto)
-HTN- Antihypertensives (CCBs, Ace Inhibitors ,Diuretics)
-Statins lovastatin (Mevacor)

28
Q

What are 2 surgical interventions post TIA?

A

-Transluminal angioplasty (intervention)
-Carotid endarterectomy (preventative surgery)

29
Q

What is one surgery used to prevent stroke and what does it do?

A

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

30
Q

What is another prevention surgery used to prevent stroke and what does it do?

A

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

31
Q

What vital are we concerned with for carotid endarterectomy and why?

A

BP
need it lower so it doesn’t blow the incision but high enough because the arteries aren’t used to the blood flow

32
Q

What do we monitor for after carotid artery angioplasty with stenting?

A

neuro changes d/t bleeding

33
Q

How many hours can someone get treatment from onset of stroke symptoms?

A

within 6 hours

33
Q

If someone is 6-24 hours past stroke symptoms, who determines if treatment is possible?

A

Stroke specialist

34
Q

What diagnostic tool do we use to determine ischemic stroke and amount of damage?

A

CT scan

35
Q

What are the 4 safety things we should assess post stroke?

A
  1. swallowing (NPO till assessed by SLP)
  2. Mobility deficits
  3. paralysis, neglect, impulsiveness
  4. Communication
36
Q

What is the max time that tPA can be given after symptom onset?

A

4.5 hrs

37
Q

How soon should tPA be given?

A

within 30-60 min from door to needle time

38
Q

How often do we monitor VS and neuro status during the 1 hour infusion?

A

Q15 min

39
Q

How often to we monitor VS after the tPA infusion?

A

Q15 for 1hr
Q 30 for 6 hrs
Q 1 for 24 hrs

40
Q

What BP do we need to maintain when someone is getting tpA?

A

<185/110

41
Q

What do we watch for when someone is on tPA?

A

bleeding
- no tube insertions, no IM injections

42
Q

If someone is on tPA infusion and they have serious bleeding, N&V, severe headache or severe high BP what should the nurse do?

A

Stop the infusion
Call the Dr. ASAP

43
Q

What are the 2 acute treatments for ischemic stroke?

A
  1. tPA
  2. Endovascular interventions
44
Q

What are the 3 endovascular interventions ?

A
  1. intra-arterial thrombolysis with tPA
  2. Mechanical embolectomy - surgical blood clot removal
  3. Carotid artery angioplasty with stent placement
45
Q

What are the 2 goals of drug therapy for ischemic stroke and embolic stroke?

A
  1. prevention
  2. protect brain from hypoxia
46
Q

What drugs are used to prevent ischemic stroke?

A

-antiplatelet
- ASA
- Clopidogrel (plavix)

47
Q

what drugs are used to prevent Embolic stroke?

A

Anticoags
- Warfarin (coumadin)
- Heparin
- low molecular weight heparin

DOACs
- Rivaroxaban (Xarelto)
- Apixaban (Eliquis)

48
Q

What is the treatment for Hemorrhagic stroke?

A

-Repair bleeding vessel and remove blood, treat for IICP,
-If on anticoags reversal drugs (Vit K, Plasma, clotting factors)

49
Q

What is intracerebral hemorrhage?

A

-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)

50
Q

What is subarachnoid hemorrhage (SAH)?

A

Bleeding into the cerebrospinal fluid in the subarachnoid space
(just under the skull area)

51
Q

What is the most common cause of subarachnoid Hemorrhage?

A

Aneurysm

52
Q

What is a classic symptom of hemorrhagic stroke?

A

worst headache ever

53
Q

what is a classic symptoms more often seen in ischemic stroke?

A

face paralysis / droop
speech issues
one sided limb paralysis

54
Q

Which type of stroke has stiff neck similar to meningitis?

A

hemorrhagic stroke

55
Q

Seizures are common in what type of stroke?

A

hemorrhagic stroke

56
Q

What is the treatment for Subarachnoid Hemorrhage ?

A

-Repair aneurysm, treat for IICP
-External Ventricular Drain (EVD) (Drains CSF and blood)
-Prevent Vasospasm

57
Q

Why do we want to prevent vasospasm during a subarachnoid hemorrhage?

A

to prevent brain damage!
HUGE RISK for vasospasm

58
Q

Why do we need to drain blood and CSF with subarachnoid hemorrhage?

A

b/c blood in the subarachnoid area irritates it and CSF may not absorb properly.

59
Q

Why is vasospasm with subarachnoid hemorrhage so bad?

A

b/c vasospasm slows blood flow to the area & causes ischemia = brain damage

60
Q

When does vasospasm usually occur post bleed/stroke?

A

4-14 days after

61
Q

What medication do we give to treat & prevent vasospasm?

A

Calcium channel blocker - Nimodipine

62
Q

How often do we give Nimodipine?

A

q 4h
sometimes up to 21 days

63
Q

What does Nimodipine do?

A

relaxes smooth muscles of vessel wall

64
Q

Why do we want to maintain homeostasis of fluids and electrolytes in vasospasm ?

A

-we want good BP to “push through” spasming vessel

NURS 3512 acute & chronic (29 decks)

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