Cerebrovascular Disorders Flashcards
Used to assess level of consciousness
Glasgow Coma Scale
what is the Glasgow Coma Scale score for awake, alert and oriented?
15
What is a score of the galsgow coma scale that represents comatose?
7
pressure or steady constriction on both sides of the head
tension headache
classic migraines
some people are prone to migraines
prodromal period before the headache is marked by a change in mood, difficulty, concentration, unusual fatigue, throbbing or bursting pain, nausea, vomiting, vertigo, sensitivity to light, irritability (change makes a person not be able to function)
Aura
pain on one side of the head, usually nasal congestion, rhinirrhea, tearing, redness of the eye (seasonal headaches)
Cluster headache
medical management for tension headaches
relieved by rest, mild analgesic, stress management techniques (how to relieve stressors)
-For severe, recurrent tension headaches, counseling and psychotherapy may help clients deal with emotional stressors; antidepressants may also help clients
-Migraine headaches: drug therapy
-Mild analgesics to start since its the least invasive
-Methysergide (Sansert), topiramate (Topamax)—prevent migraine
-Increase dose gradually; monitor drug levels
-Sumatriptan (Imitrex)—interrupt migraines that have already developed (most popular)
-Oral, intranasal spray, or subcutaneous injection
medical management for cluster headaches
drug therapy:
-Dihydroergotamine (Migranal), methysergide (Sansert), corticosteroids such as triamcinolone (Aristocort), prednisone (Deltasone)
-Vasoconstricting drugs such as sumatriptan (Imitrex), anticonvulsants such as gabapentin (Neurontin), beta-adrenergic blockers such as atenolol (Tenormin)
-Oxygen: reduces the vasodilating compensatory response occurring in the brain
kills nerve fibers to decease headache pain
Rhizotomy
-Patho: Sudden, brief episode of neurologic impairment caused by a temporary interruption in cerebral blood flow (sometimes are frequent and are very dangerous)
-Causes: atherosclerosis, arteriosclerosis, cardiac disease, diabetes
-TIA is a warning that a cerebrovascular accident (CVA) can occur in the near future; one-third of people who experience TIA subsequently develop a stroke.
-S/S: Temporary lightheadedness; confusion; speech disturbances; loss of vision; diplopia; variable changes in consciousness; and numbness, weakness, impaired muscle coordination, or paralysis on one side (could last hours, days, weeks. Make sure we are checking on those who live alone)
-Diagnostics: Examination: auscultation of the carotid artery may reveal a bruit (look up bruit online and listen to it; abnormal sound caused by blood flowing over the rough surface of one or both carotid arteries)
-Other: ultrasound examination, carotid arteriogram, CT scan, MRI
-Gerontologic considerations: older adults may ignore the symptoms of a TIA, attributing them to part of the normal aging process. Healthcare providers will also ignore these signs from elderly don’t do that.
-Medical Management: Control blood pressure (high BP), lose excess weight (see nutritionist), stop tobacco and alcohol use; Manage atherosclerosis and cardiac dysrhythmias; cholesterol-lowering drugs, prophylactic anticoagulant or antiplatelet
-Aspirin, clopidogrel (Plavix), warfarin (Coumadin) these are most common
-Diabetic education- can control vasoconstriction
-Surgical Management: if lifestyle changes have not happened. Carotid endarterectomy, Percutaneous transluminal angioplasty and stent placement (all to take that pressure off)
-Nursing Management: Obtain a complete history of symptoms, medical, drug, allergy histories, weights, capillary blood sugar, vital signs, smoking history, neurologic examination
-Carotid artery surgery: postoperative- a day icu then go to the floor
-Frequent neurologic checks to detect paralysis, confusion, facial asymmetry, aphasia; monitor heart rhythm, neruo checks are a must
Transient Ischemic Attacks (TIA)
-Patho: Prolonged interruption in the flow of blood through one of the arteries supplying the brain resulting in infarction
-Types of Stroke
-Ischemic stroke: a thrombus (thrombotic) or an embolus (embolic) obstructs an artery carrying blood to the brain (huge blood clot) TPA within 3 hours (clot buster/heparin)
-Hemorrhagic stroke: a cerebral blood vessel ruptures and blood is released in the brain; elevated pressure (the brain is not forgiving and pressure can cause cell death and oxygen to the brain)
-S/S: Numbness or weakness of one side of the face, arm, or leg; mental confusion; difficulty speaking or understanding; visual disturbances impaired walking or coordination; severe headache (considers medical emergency and time sensitive emergencies, the sooner we can get to patient and do prevention from it worsening the better)
-Prioritize: ABC’s; Patients may have difficulty keeping an open and clear airway secondary to decreased level of consciousness.
-Hemiplegia (paralysis on one side of the body)
-Right-sided: expressive aphasia (repeat sounds of the alphabet), receptive aphasia, slow and cautious behavior
-Left-sided: spatial–perceptual deficits, poor judgment, misjudge distances
-Hemianopia: half field of vision blindness
-Diagnostics: CT scan, MRI, transcranial Doppler ultrasonography( to see where the hemorrhage is coming from), single-photon emission computed tomography (SPECT), electroencephalogram. Lumbar puncture; if subarachnoid bleeding has occurred, cerebrospinal fluid will be bloody. Cerebral angiography shows displacement or blockage of cerebral vessels (To find location)
-Medical and Surgical Management: Ischemic: Tissue plasminogen activator (TPA) aka Thrombolytic therapy (within 3 hours most optimal outcome and stop cell death)
-TPA is contraindicated in hemorrhagic stroke! 3 hours window to figure it out get the data
-Arteriosclerotic: Endarterectomy removing the clot
-Nursing Care Plan: CVA: Impaired Swallowing (big one) related to hemiplegia; Use a thickening agent; keep a suction machine. Risk for Imbalanced Nutrition. Request small, frequent nourishment(puree foods). Risk for Impaired Skin Integrity related to immobility. Use pressure-relieving devices or therapeutic beds (turn every 2 hours). Impaired Verbal Communication related to aphasia. Instruct the client to speak slowly. Risk for Ineffective Coping. Acknowledge personal strengths. Use their strengths and weaknesses. If there is right side paralysis how can they use the left side to their most
Cerebrovascular Accident (CVA) aka stroke
a thrombus (thrombotic) or an embolus (embolic) obstructs an artery carrying blood to the brain (huge blood clot) TPA within 3 hours (clot buster/heparin)
Ischemic Stroke
a cerebral blood vessel ruptures and blood is released in the brain; elevated pressure (the brain is not forgiving and pressure can cause cell death and oxygen to the brain)
Hemorrhagic Stroke
Right Sided stroke symptom’s
expressive aphasia (repeat sounds of the alphabet), receptive aphasia, slow and cautious behavior
