Assessments and Diagnostics Flashcards
(126 cards)
1
Q
Guaiac test
A
- Hemoccult, Fecult
- chemical test to ID blood in stool
- possible causes: cancer, hemorrhoids, GI bleed
2
Q
upper GI series
A
- series of barium X-rays (oral) of esophagus, stomach, small intestines
- used to ID problems with swallowing, stomach ulcers, twisting of small intestine
3
Q
lower GI series
A
- series of barium X-rays (enema) to show large intestine and rectum
- can ID diverticulitis/diverticulosis, tumors, etc.
4
Q
endoscopy
A
- flexible, fiberoptic instrument with camera used to visualize esophagus, stomach, large bowel
- different names used for each area explored (colonoscopy)
5
Q
colonoscopy
A
flexible, fiberoptic instrument with camera used to visualize large bowel
6
Q
ultrasonography (ultrasound)
A
- high-frequency sound waves used to visualize internal organs
- primarily for abdominal and pelvic organs
7
Q
pitting scale
A
8
Q
Braden scale
A
9
Q
delirium rating scale
A
- tool used to determine level of delirium or likelihood of pt becoming delirius
- Fundamentals Ch. 25
10
Q
blanch (capillary refill) test
A
- tests integrity of circulation by applying, then releasing pressure to a fingernail or toenail
- expected: regains color in 2-3 sec.
- > 3 sec. indicates impaired blood flow
11
Q
jugular/neck vein distension
A
- visualized with pt supine, HOB about 45°, head turned to side, tangential light
- can palpate to determine if pulsation is from vein or artery (vein easily occluded)
- sign of increased venous pressure
- used to estimate right atrial pressure
- indicates backup of blood from heart
- seen in heart failure, superior vena cava obstruction, tricuspid valve disease, and pericardial disease
12
Q
corneal light reflex
A
13
Q
accommodation
A
14
Q
red reflex
A
15
Q
red reflex
A
16
Q
accommodation
A
17
Q
corneal light reflex
A
18
Q
jugular/neck vein distension
A
- visualized with pt supine, HOB about 45°, head turned to side, tangential light
- can palpate to determine if pulsation is from vein or artery (vein easily occluded)
- sign of increased venous pressure
- used to estimate right atrial pressure
- indicates backup of blood from heart
- seen in heart failure, superior vena cava obstruction, tricuspid valve disease, and pericardial disease
19
Q
blanch (capillary refill) test
A
- tests integrity of circulation by applying, then releasing pressure to a fingernail or toenail
- expected: regains color in 2-3 sec.
- > 3 sec. indicates impaired blood flow
20
Q
delirium rating scale
A
- tool used to determine level of delirium or likelihood of pt becoming delirius
- Fundamentals Ch. 25
21
Q
Braden scale
A
22
Q
pitting scale
A
23
Q
otoscope
A
instrument with light designed to examine outer ear and tympanic membrane
uses disposible specula in 4 mm for adults and 2 mm for peds
24
Q
nares
A
- nostrils
- inspect for alignment of septum, drainage (note purulence, blood content, viscosity), coloration of nasal mucosa, edema
- occlude one at a time to check for patency
25
CN I
* olfactory
* (assess patency of nostrils) coffee/mint smell test
* sensory
26
CN II
* optic
* Snellen chart
* sensory
27
CN III
* oculomotor
* draw H to test EOM, test pupillary reflex (PERRLA)
* motor
28
CN IV
* trochlear
* draw H to test EOM, test PERRLA
* motor
29
CN V
* trigeminal
* test
* motor: palpate temporal and masseter muscles as the person clenches the teeth
* sensory: light touch on forehead (ophthalmic), cheek (maxillary), and chin (mandibular); also corneal reflex test, which we don't do
* both
30
CN VI
* abducens
* draw H to test EOM, test for PERRLA
* motor
31
CN VII
* facial
* test
* motor: smile and frown, close eyes tightly, lift eyebrows, show teeth and puff cheeks (press cheeks to check for even air escape)
* sensory: test sense of taste with lemon, salt, etc., which we don't do
* both
32
CN VIII
* acoustic
* test hearing: whisper test, normal conversation, Weber & Rinne tuning fork tests (which we don't do)
* sensory
33
CN IX
* glossopharyngeal
* test
* motor: gag reflex
* sensory: none; taste from back of tongue, sensory from sinuses, etc.
* both
34
CN X
* vagus
* test
* motor: say "ah" to check for midline soft palate rise and fall; listen for smooth, unstrained voice and speech
* sensory: none
* both
35
CN XI
* spinal accessory
* test sternomastoid and trapezius muscle strength and symmetry with hand pushing against each cheek and down on shoulders
* motor
36
CN XII
* hypoglossal
* stick out tongue, should be midline with no tremor; say "light, tight, dynamite"
* motor
37
pulse deficit
difference between peripheral and apical pulses
38
pulse pressure
difference between systolic and diastolic blood pressures
39
tragus
* projection in front of the ear
* used to block hearing in one ear for testing
40
tympanic membrane
* eardrum
* expected: shiny and pearly gray with reflected cone of light
41
hyperthyroidism
* ultrasound of thyroid gland
* thyroid scan
* serum levels of free and total T4, T3, and calcitonin
42
AKI
acute kidney injury
43
ADR
adverse drug reaction
44
GCS (Glasgow Coma Scale)
* indications: LOC changes in encephalitis, cerebral lesions and infarctions, head injuries
* eye-opening response
* 4 - spontaneous
* 3 - to voice
* 2 - to pain
* 1 - none
* verbal response
* 5 - oriented
* 4 - confused
* 3 - inappropriate words
* 2 - incomprehensible sounds
* 1 - none
* motor response
* 6 - obeys commands
* 5 - localizes pain
* 4 - withdraws
* 3 - flexion
* 2 - extension
* 1 - none
45
AVPU
* **A**lert
* responsive to **V**oice
* responsive to **P**ain
* **U**nresponsive
46
common causes of pulseless electrical activity
* 5 Hs
* hypovolemia
* hypoxia
* H+ accumulation → acidosis
* hypothermia
* 5 Ts
* toxins (accidental or deliberate drug OD)
* tamponade (cardiac)
* tension pneumothorax
* thrombosis (coronary)
* thrombosis (pulmonary)
47
OLDCARTS
* onset
* location: site/radiation
* duration
* character
* alleviating/aggravating factors
* time
* severity
48
Alzheimer's dz stages
* stage 1: no apparent manifestation
* stage 2: forgetfulness, esp. of everyday objects; looks like normal age-related change
* stage 3: mild cognitive decline
* losing important things
* short-term memory loss noticeable to close relatives
* ↓ ability to plan
* ↓ attention span
* diffculty remembering names, words
* difficulty in social/work situations
* can get lost while driving
* stage 4: mild to moderate decline
* personality changes
* obvious memory loss
* ↓ knowledge and memory or recent events
* difficulty with tasks that need planning/organizing
* difficulty with complex math
* depression/social withdrawal
* stage 5: moderate decline
* ↑ cognitive deficits
* inability to recall important details
* memory of info about self and family remains intact
* assistance with ADLs necessary
* disorientation/confusion about time and place
* stage 6: moderate to severe decline
* memory problems ↑
* recalls name, but not personal Hx
* significant personality changes: hallucinations, delusions, compulsion)
* wandering
* assistance with ADLs, personal care
* sleep/wake cycle disrupted
* ↑ urinary/fecal incontinence episodes
* stage 7: severe decline
* no ability to respond, speak, control movement
* urinary incontinence
* impaired swallowing
* requires help eating
* gradual loss of ability to move extremeties (ataxia)
49
MS labs and diagnostic procedures
* labs
* CSF: ↑ protein
* slight ↑ WBC count
* diagnostic procedures
* MRI: plaques of brain and spine
50
cerebral angiography
* visualization of cerebral blood vessels
* tracks blood flow to and within brain
* indications
* aneurysms
* surgical planning for tumors
* inject meds for Tx of blood clots
* inject chemo
51
cerebral CT scan
* cross-sectional images of cranial cavity
* indications
* find tumors, infarctions, abnormalities
* monitor response to Tx
* guide needles used for Bx
52
EEG
* noninvasive
* assess electrical activity to find abnormalities in brain wave patterns
* indications
* find and determine sz activity
* sleep disorders
* behavioral changes
53
ICP monitoring
* device inserted into cranial cavity that shows pressure waveforms on monitor
* intraventricular cath (ventriculostomy): drains and monitors pressure via picture
* subarachnoid screw or bolt: hollow with fluid-filled tubing and transducer
* epidural or subdural sensor: fiber-optic, does not penetrate dura (noninvasive); numerical value
* indications
* early ID and Tx of ↑ ICP: pts comatose or GCS \< 8
* s/sx of ↑ ICP: severe HA, ↓ LOC, dilated or pinpoint pupiles, slow rxn, irritability, restlessness, alteration in breathing pattern, ↓ motor fxn, abnormal posturing
54
LP (lumbar puncture, spinal tap)
* CSF sample collection
* indications
* presence of dz: MS, syphilis, meningitis
* infection
* malignancies
* ↓ CSF pressure
* Dx by instillation of contrast or air
* Tx with meds or chemo
55
MRI of head and spine
* cross-sectional images of cranial cavity
* contrast may be used
* uses magnets, no radiation
* not suitable for those with artificial implanted devices
* discriminate soft tissue from tumor or bone
* indications
* find abnormalities
* monitor response to Tx
* guide needles for Bx
* determine tumor size and blood vessel location
56
PET and SPECT scans of head and spine
* nuclear medicine procedures
* 3-D image of head
* static or functional
* captures regional metabolic processes
* PET: glucose-based tracer injected
* SPECT: uses radioisotope tracer
* may be followed by CT for overlay/add location info
* indications
* most useful in determining tumor activity or response to Tx
* able to Dx dementia: inability of brain to respond to tracer
57
X-ray of skull and spine
* electromagnetic radiation
* captures images of internal structures
* indications for skull and spine
* fx
* curvature
* bone erosion
* dislocation
* soft-tissue calcification
58
pain categories
* acute
* chronic
* nociceptive
* somatic
* visceral
* neuropathic
59
acute pain
* protective
* temporary
* usually self-limiting
* resolves with tissue healing
* physiological response: fight-or-flight
* behavioral response
* grimacing
* moaning
* flinching
* guarding
* no response ≠ no pain
* causes: surgical incision, wounds from injury
60
chronic pain
* not protective
* ongoing or recurs frequently
* \> 3 mo
* persists beyond tissue healing
* physiological response
* not usually ↑ VS
* VS can be ↓ than normal
* depression
* fatigue
* ↓ fxn level
* disability
* can be idiopathic
* may not respond to Tx
* classified: cancer or non-cancer pain
* examples: OA, neuropathy
61
nociceptive pain
* damage to or inflammation of tissue not in PNS or CNS
* result of activation of normal processing of painful stimuli
* throbbing, aching, localized
* types
* somatic: bones, joints, muscles, skin, connective tissue
* visceral: internal organs; can be referred
62
neuropathic pain
* abnormal or damaged pain nerves
* **abnormal processing** or painful stimuli
* includes: phantom pain, pain below spinal injury, diabetic neuropathy
* intense, shooting, burning, "pins and needles"/tingling
63
labs and procedures to Dx meningitis
* culture and sensitivity of urine, throat, nose, and blood: not Dx, but can guide intial antimicrobial choice
* CBC: ↑ WBC count
* CSF analysis (definitive): ↑ WBC, protein, glucose, pressure; cloudy vs clear (bacterial vs. viral); CIE determines if viral or protozoal
* CT scan, MRI: ↑ ICP and/or abscess
64
sz risk factors
* **genetic** predisposition: absence sz; children, familial
* acute **febrile** state: esp. \< 2 yo
* head **trauma**: early or late onset (≤ 9 mo); ↑ if **skull fx**
* cerebral **edema**: esp. acute; sz gone when edema treated
* abrupt cessation of **antiepileptics**: **rebound**
* infection: ↑ ICP or persistent **fever**
* metabolic: insufficient or excess chemicals in brain; **glucose, Na+**
* **toxins**: esp. pesticide, CO, lead
* stroke: mostly in 1st 24 hr because of **↑ ICP**
* **heart dz**: common cause of new-onset sz in adults
* brain tumor: increased **bulk** if benign; ability to **fxn** if malignant
* hypoxia: **↓ O2** in brain = ↓ fxn
* acute withdrawal: **dehydration** = **toxic level** of substance
* **fluid-electrolyte imbalance**
* associated with cerebrovascular dz in older adults
65
sz triggering factors
* ↑ physical **activity**
* excessive **stress**
* **hyperventilation**
* overwhelming **fatigue**
* acute **ETOH** ingestion
* excess **caffeine**
* flashing **lights**
* cocaine, aerosols, inhaled glue
66
tonic-clonic sz findings
* tonic episode
* duration: a few sec
* stiffening of muscles
* possible apnea
* LOC
* clonic episode
* duration: 1-2 min
* follows tonic phase
* rhythmic jerking of extremities
* irregular breathing
* possible cyanosis
* biting cheek or tongue
* incontinence
* postictal: period of confusion and sleepiness
67
tonic sz findings
* generally \< 30 sec, but up to several min
* sudden LOC
* sudden ↑ muscle tone
* autonomic manifestations
* arrhythmia
* apnea
* vomiting
* incontinence
* salivation
68
clonic sz findings
* duration: several min
* muscles contract and relax
* rhythmic, jerking movements of face, neck, arms
69
myoclonic sz findings
* duration: seconds
* brief jerking or stiffening of extremities
* symmetrical or asymmetrical
70
atonic or skinetic sz
* duration: a few seconds
* muscle tone lost
* followed by period of confusion
* frequent results in falling
71
partial or focal/local sz
* occur in only one hemisphere
* types
* complex partial sz
* simple partial sz
72
complex partial sz
* automatisms: pt unaware; lip smacking, picking at clothes
* LOC/blackout for several min
* amnesia possible immediately before and after
73
simple partial sz
* consciousness maintained
* can include
* unusual sensations
* sense of déjà vu
* autonomic abnormalities: HR changes, flushing
* unilateral abnormal extremity movements
* pain
* offensive smell
74
unclassified/idiopathic sz
* half of all sz activity
* no known cause/reason
* don't fit into other categories
75
labs and diagnostics for sz
* labs
* alcohol/illicit drug screen
* HIV test
* screen for excess toxins
* diagnostic procedures
* EEG: activity and origin
* MRI, CT, CAT, PET, X-ray
* CSF analysis
76
Parkinson's risk factors
* onset at 40-70 yo
* more common in males
* genetic predisposition
* environmental toxins and chemical solvents
* chronic use of antipsychotic meds
77
Parkinson's findings
* fatigue
* ↓ manual dexterity over time
* stooped posture
* slow, shuffling, propulsive gait
* tremors/pill-rolling tremor of fingers
* muscle rigidity
* bradykinesia/akinesia
* masklike expression
* orthostatic hypotension
* flushing
* diaphoresis
* difficulty chewing and swallowing
* drooling
* dysarthria
* progressive ADL difficulty
* mood swings
* cognitive impairment
78
Parkinson's labs and diagnostics
* there are no labs or diagnostics for Parkinson's
* diagnosed based on s/sx and ruling out other dz
79
Alzheimer's risk factors
* advanced age
* chemical imbalance
* family hx of AD or Down syndrome
* genetic predisposition, apolipoprotein E
* herpes
* metal or toxic waste
* previous head injury
* more common in females
* ↑ risk in AA and Hispanic (APOE and ABCA7 genes)
80
Alzheimer's findings
* different for each client
* no universal scale for stages and manifestations
81
Alzheimer's labs and diagnostics
* labs
* genetic test for predisposition
* tests to rule out other causes of dementia
* diagnostics
* only definitive procedure: postmortem brain tissue exam
* MRI, CT/CAT, PET, EEG: rule out other causes
* LP: ↓ sBPP supports Dx of AD
82
brain tumor risk factors
* genetics
* environmental agents
* ionizing radiation
* electromagnetic fields
* previous head injury
83
brain tumor findings
* all types
* dysarthria
* dysphagia
* positive Romberg
* positive Babinski
* vertigo
* hemiparesis
* cranial nerve dysfxn
* inability to discriminate sounds
* loss of gag reflex
* loss of blink response
* papilledema
* supratentorial
* severe HA; worse on awakening, coughing, straining
* visual: blurring, field deficit
* sz
* loss of voluntary movement/control of movement
* change in cognitive fxn (memory, language)
* change in personality
* inability to control emotions
* paralysis
* infratentorial
* hearing loss, ringing
* visual changes
* facial drooping
* dysphagia
* nystagmus, crossed eyes, ↓ vision
* ANS dysfxn
* ataxia or clumsiness
* hemiparesis
* cranial nerve dysfxn
* sounds
* gag
* blink
84
lab tests for brain tumors
* CBC and diff: r/o anemia, malnutrition
* blood ETOH and tox: rule out causes
* TB and HIV screening if indicated
85
diagnostics for brain tumor
* X-ray, CT, MRI, brain scan, PET, cerebral angiography: size, location, extent of tumor
* LP: ICP
* EEG
* labs for endocrine fxn, renal status, electrolyte balance
* cerebral Bx: cell pathology
86
MS findings
* fatigue
* pain or paresthesia
* diplopia
* change in peripheral vision
* ↓ visual acuity
* scotomas
* periods of total blindness
* Uhthoff's sign
* tinnitus
* vertigo
* ↓ hearing
* dysphagia
* dysharthria
* muscle spasticity
* ataxia or muscle weakness
* nystagmus
* bowel dysfxn (constipation, incontinence)
* bladder dysfxn
* cognitive changes (↓ memory, judgment)
* sexual dysfxn
87
migraine findings
* photophobia
* phonophobia
* N&V
* stress and anxiety
* unilateral pain, esp. behind one eye or ear
* health and family Hx for HA pattern
* alterations in ADLs for 4-72 hr
* similar manifestations with each HA
88
migraine categories
* with aura (classic)
* without aura (common)
* atypical
89
migraine with aura findings
* prodromal stage
* awareness for hr or days before
* irritability
* depression
* food cravings
* diarrhea/constipation
* frequent urination
* aura stage
* develops over mins to 1 hr
* numbness and tingling of mouth, lips, face, hands
* acute confusion
* visual disturbances (light flashes, bright spots)
* second stage
* severe, incapacitating, throbbing HA
* intensifies over several hr
* N&V, drowsiness, vertigo
* third stage
* 4-72 hr
* HA dull
* recovery
* pain and aura subsiding
* muscle aches and contraction of head and neck muscles common
* physical activity worsens pain
* pt may sleep
* older adults may experience aura without pain: visual migraine
90
migraine without aura findings
* pain aggravated by physical activity
* unilateral, pulsating pain
* oe or more of: photophobia, phonophobia, nausea, vomiting
* duration: 4-72 hr
* occurs
* early in morning
* periods of stress
* with premenstrual tension
* with fluid rentention
91
atypical migraine findings
* status migrainous: \> 72 hr
* migrainous infarction
* neurologic s/sx for 7 days
* neuroimaging can indicate ischemic infarct
* unclassified: does not fit other criteria
92
migraine diagnostics
neuroimaging if findings present or pt \> 50 yo with new onset
93
cluster headache risk factors
* more frequent in spring and fall
* more common in males 20-50 yo
94
cluster headache findings
* brief episode of intense, unilateral, nonthrobbing pain
* duration: 15 min to 3 hr
* can radiate to forehead, temple, or cheek
* occurring daily 1-8x/day
* followed by period of remission
* no aura or preliminary s/sx
* less common than migraines
* tearing of eye with runny nose and nasal congestion
* facial sweating
* drooping eyelid and eyelid edema
* pupil constriction
* N&V
* bradycardia
* facial pallor or flushing
* pacing, walking, or sitting and rocking
95
macular degeneration types
* dry
* wet
96
macular degeneration risk factors
* dry
* smoking
* HTN
* female
* short stature
* family Hx
* lack of carotene and vitamin E
* wet: can occur at any age
97
macular degeneration findings
* lack of depth perception
* objects appear distorted
* blurred vision
* loss of central vision
* blindness
98
macular degeneration diagnostics
* ophthalmoscopy: fundus of eyeball examined (retina, optic disc, macula, blood vessels)
* visual acuity test: Senllen and Rosenbaum charts
99
cataracts causes
* age-related: drying of lens, ↑ density
* traumatic: blunt or penetrating injury, foreign body, radiation, UV light
* toxic: long-term use of corticosteroids, phenothiazine derivatives, beta blockers, miotic meds
* associated: DM, hypoparathyroidism, Down syndrome, chronic sunlight exposure
* complicated: intraocular dz (retinitis pigmentosa, glaucoma, retinal detachment)
100
cataracts risk factors
* advanced age
* DM
* heredity
* smoking
* eyetrauma
* excessive sun exposure
* chronic use of corticosteroids, phenothiazine derivatives, beta blockers, miotic meds
101
cataracts findings
* ↓ visual acuity
* color perception
* Rx changes
* ↓ night vision
* blurred vision
* diplopia
* progressive, painless loss of vision
* visible opacity of lens
* absent red reflex
102
cataracts diagnostics
exam of lens using ophthalmoscope
103
types of glaucoma
* primary open-angle glaucoma (POAG)
* primary angle-closure glaucoma
104
POAG findings
* gradual onset/IOP buildup
* HA
* mild eye pain
* loss of peripheral vision
* ↓ accomodation
* halos around lights
* ↑ IOP (\> 21 mm Hg, usually 22-32)
105
primary angle-closure glaucoma findings
* sudden ↑ IOP (≥ 30 mm Hg)
* ↓ or blurred vision
* colored halos around lights
* pupils nonreactive
* severe pain and nausea
* photophobia
106
glaucoma risk factors
* age
* infection
* tumor
* DM
* genetics
* HTN
* eye trauma
* severe myopia
* retinal detachment
107
glaucoma diagnostics
* visual assessment: acuity and peripheral
* tonometry: measures IOP
* gonioscopy: determines drainage angle of anterior chamber
108
middle and inner ear disorder risk factors
* middle ear
* recurrent colds and otitis media
* enlarged adenoids
* trauma
* changes in air pressure (SCUBA, flying)
* inner ear
* viral or bacterial infection
* damage due to ototoxic meds
109
findings of middle ear disorders
* hearing loss
* feeling of fullness and/or pain in ear
* red, inflamed ear canal and TM
* bulging TM
* fluid and/or bubbles behind TM
* diffuse appearance of or inability to visualize normal light reflex
* fever
110
findings of inner ear disorders
* hearing loss
* tinnitus
* dizziness or vertigo
* vomiting
* nystagmus
* alterations in balance
111
diagnostics for middle- and inner-ear disorders
* audiometry: noninvasive, tests hearing ability; frequency, pitch, intensity
* tympanogram: measures mobility of TM and middle ear structures
* WEBER and Rinner tests: tuning forks; tests for presence of hearing loss
* otoscopy: exam of canal, TM, malleus bone
* ENG: detects involuntary eye movement to test for vestibular dysfxn
* caloric testing: concurrent w/ ENG
112
types of brain injury
* concussion (mild traumatic brain injury)
* contusion
* diffus axonal injury
* intracranial hemorrhage
113
brain injury risk factors
* MVA or motorcycle accident
* illicit drug and ETOH use
* sports injuries
* assault
* gunshot wound
* falls
114
brain injury findings
* amnesa before or after injury
* LOC: duration significant
* CSF leakage from nose and ears: basilar skull fx; + halo sign
* s/sx of ↑ ICP
* severe HA, N&V
* ↓ LOC, restlessness, irritability
* dilated or pinpoin nonreactive pupils
* cranial nerve dysfxn
* alteration in breathing pattern
* ↓ motor fxn, abnormal posturing
* Cushing's triad: late finding
* sz
115
halo sign
* clear or yallow-tinted ring surround drop of blood on gauze
* indicates CSF drainage
116
electronystagmography (ENG)
used to test for vestibular disorders via measurement of nystagmus, usually in response to temperature change in ear
117
Cushing's triad
* severe HTN
* widening pulse pressure
* bradycardia
118
labs for brain injury
* ABGs
* CBC with diff
* BG level
* electrolytes
* blood and urine osmolarity
* toxicology screen
* anti-sz med blood levels (monitor)
119
diagnostic procedures for brain injury
* cervical spine films to Dx injury
* CT and/or MRI of head and/or neck (w/ or w/o contrast)
* calculation of cerebral perfusion using ICP monitor
120
types of strokes
* hemorrhagic
* thrombotic
* embolic
* ischemic
121
risk factors for stroke
* smoking
* cerebral aneurysm
* arteriovenous (AV) malformation
* DM
* obesity
* HTN
* atherosclerosis
* hyperlipidemia
* hypercoagulability
* atrial fibrilation
* oral contraceptives
* cocaine
122
stroke findings
* TIA
* can warn of impending stroke
* antithrombotic meds and/or surgical removal of plaques can prevent subsequent stroke
* left hemisphere: language, math, analysis
* receptive and expressive aphasia
* agnosia
* alexia
* agraphia
* right extremity hemiplegia or hemiparesis
* slow, cautious behavior
* depression, anger, frustration
* visual changes (hemianopsia)
* right hemisphere: visual and spatial awareness, proprioception
* altered perception of deficits
* unilateral neglect syndrome (left side; more common in right hemisphere stroke)
* loss of depth perception
* poor impulse control/judgment
* visual changes (hemianopsia)
123
stroke diagnostics
* non-contrast CT: initial, within 25 min of pt arrival
* MRI: edema, necrosis, ischemia
* MRA or cerebral angiography: hemorrhage, vessel structures, blood flow
* LP: blood in CSF
* GCS: check for changes in LOC
124
spinal cord injury risk factors
* high-risk activities
* impact sports
* acts of violence
* substance use
* dz (cancer, arthritis of spine)
* falls, esp. in older adults
125
spinal cord injury findings
* lack of sensation of dermatomes below lesion
* report of neck or back pain
* inability to
* feel light touch
* discriminate between sharp and dull
* discriminate between hot and cold
* absent DTRs
* flaccidity of muscles
* hypotension, more severe sitting upright
* shallow respirations
* spinal shock
* total, temporary loss of reflexive, autonomic fxn below injury
* duration: days to wks
126
spinal injury labs and diagnostics
* urinalysis
* Hgb
* ABG
* CBC
* X-ray, MRI, CT/CAT
