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Adults 1 > Neurology > Flashcards

Neurology Flashcards

1
Q

what is a stroke?

A

disruption in brains blood supply; can be ischemic or hemorrhagic

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2
Q

ischemic stroke

A

blockage in blood vessel that decreases or stops flow of oxygenated blood to portion of the brain; can be embolic or thrombotic

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3
Q

hemorrhagic stroke

A

rupture of a blood vessel that decreases or stops flow of oxygenated blood to portion of brain; blood into brain tissue, subarachnoid space, and ventricles increasing pressure; can be intracerebral or subarachnoid

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4
Q

general stroke symptoms

A

sudden weakness, numbness, difficulty speaking, loss of coordination

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5
Q

nonmodifiable risk factors for stroke

A

age, gender (males more likely), ethnicity (African Americans more likely), genetics

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6
Q

modifiable risk factors for stroke

A

HTN, atherosclerosis, Atrial fib., anticoagulation therapy, stress, obesity, oral contraceptives, DM

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7
Q

how does oral contraceptives place on at higher risk for having a stroke?

A

contraceptives increases ones coagulation ability placing them at a higher risk for ischemic stroke

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8
Q

stroke process

A

cerebral anoxia- lack of O2 to the brain which can cause cell damage, cerebral infarction- death of brain tissue from lack of O2/blood supply, cerebral edema- brain swelling (compensatory mechanism that can damage the brain further due to increased ICP), cerebral dysfunction- portion of brain that lost function d/t death

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9
Q

primary cause of hemorrhagic stroke

A

Hypertension

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10
Q

2 types of ischemic strokes

A

embolic and thrombotic

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11
Q

embolic ischemic stroke

A

clot or debris that travels to brain; sudden and severe signs/symptoms; less common warning signs; pt remains conscious; headache

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12
Q

thrombotic ischemic stroke

A

build up of plaque in artery in brain; gradual compared to other strokes; no decrease in LOC in first 24 hours; signs/symptoms progressively get worse as infarction and edema occurs

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13
Q

transient ischemic attack

A

temporary neurologic deficit resulting from temporary blood flow impairment; warning sign of potential impending stroke; requires medical attention to rule out infarction

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14
Q

manifestations of ischemic stroke

A

sudden severe headache; weakness/numbness; difficulty speaking/understanding speech; loss of balance/difficulty walking/dizziness; confusion/altered LOC; dysphagia; facial droop to one side

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15
Q

manifestations of hemorrhagic stroke

A

sudden severe headache (worst headache of pt life); weakness/numbness; N/V; difficulty speaking/understanding speech; vision problems; loss of balance/difficulty walking/dizziness; confusion/altered LOC; seizures

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16
Q

manifestations of TIA

A

transient and short-lived symptoms; same symptoms as ischemic stroke; weakness/numbness; difficulty speaking/understanding speech; vision problems; difficulty walking/loss of balance/dizziness; facial droop to one side

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17
Q

stroke on right side of brain causes…

A

paralyzed left side- hemiplegia; left-sided neglect; spatial-perceptual deficits; denying/minimizing problems; rapid movements; short attention span; impulsive (causing safety problems); impaired judgement; impaired concept of time

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18
Q

stroke on right side of brain causes…

A

paralyzed left side- hemiplegia; aphasia; impaired left/right discrimination; slow cautious movements; aware of deficit causing anxiety/depression; impaired comprehension related to language and math

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19
Q

common assessment findings of a stroke

A

agnosia, apraxia/dyspraxia, hemianopsia, neglect syndrome, proprioception alterations, aphasia

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20
Q

agnosia

A

inability to recognize familiar objects or people

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21
Q

apraxia/dyspraxia

A

loss of ability to carry out skilled movements or gestures, despite having desire and physical ability to perform them

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22
Q

hemianopsia

A

blindness in half of the visual field

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23
Q

neglect syndrome (unilateral neglect)

A

patient unaware of existence of his or her paralyzed side

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24
Q

proprioception alterations

A

altered position sense that places patient at risk of injury

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25
Q

expressive vs receptive aphasia

A

expressive is difficulty speaking or getting words to come across appropriately; receptive is difficulty understanding what is being said

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26
Q

diagnostic tests for stroke

A

CT without contrast, electroencephalogram (EEG), cerebral angiography, MRI

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27
Q

medications used to prevent strokes

A

anticoagulant therapy, antiplatelet therapy, antihypertensive therapy, dyslipidemia therapy

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28
Q

carotid endarterectomy

A

surgical procedure used to reduce risk of stroke; removal of plaque build up that could lead to ischemic stroke; undergo general or local anesthesia; done around 70% occlusion

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29
Q

immediate/acute stroke management

A

CT scan without contrast to identify if stroke is hemorrhagic or ischemic; if ischemic use of thrombolytic therapy

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30
Q

time window to administer thrombolytic therapy

A

3-4.5 hours of onset of symptoms in ischemic stroke

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31
Q

nursing intervention of acute phase of stroke

A

maintain airway, supplemental O2, neuro exam- monitor ICP within first 72 hours, elevate HOB and place pt on side to prevent aspiration, foley catheter, fluid and electrolyte admin., medication admin., quiet environment, seizure precautions

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32
Q

nursing intervention of post-acute phase of stroke

A

position 2 hours on unaffected side and 20 minutes on affected side, antiembolism stockings, ROM exercises, eval. gag reflex and ability to swallow, NPO to begin and advance as tolerated

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33
Q

pt post stroke eating tips

A

sit out of bed with head and neck slightly forward, food in back of mouth on unaffected side (non-paralyzed side)

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34
Q

nursing interventions chronic phase after stroke

A

unilateral neglect (touch and use both sides of body), hemianopsia (scan full field of vision; dress weaker side first), approach from unaffected side, PT/OT intervention, encourage fluids and high fiber diet, stool softener, independence and assistive devices for ADLs

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35
Q

what is a seizure?

A

abnormal, sudden, excessive discharge of electrical activity in the brain

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36
Q

epilepsy

A

disorder characterized by chronic seizure activity; indicative of CNS or brain irritation

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37
Q

causes of seizures

A

genetics, tumors, trauma, circulatory or metabolic disorders, toxicity, infectionsstat

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38
Q

status epilecticus

A

rapid succession of epileptic spasms without intervals of consciousness and can occur with any type of seizure

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39
Q

why are seizures so dangerous?

A

brain damage can occur

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40
Q

3 main types of seizures

A

focal onset- localized to one area of brain, generalized onset- more wide spread brain activity, unknown onset

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41
Q

6 types of seizures

A

tonic-clonic (gen), absence (gen.), myoclonic, atonic/akinetic, simple partial (focal), complex partial (focal)

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42
Q

tonic clonic seizures

A

might begin with aura; tonic phase- stiffening or rigidity of muscles in arms/legs for 10-20 seconds followed by loss of consciousness; clonic phase- hyperventilation and rapid jerking of extrem. that lasts ~30 seconds and may lose bladder control; postictal-recovery phase and may take several hours

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43
Q

if seizure last …

A

> 5 minutes then seek immediate medical attention

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44
Q

absence seizures

A

brief seizure that lasts seconds; occurs in both sides of brain at the same time; may or may not lose consciousness; no change in muscle tone; can happen multiple times throughout the day; common in children; recovery is immediate

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45
Q

myoclonic seizure

A

minor and brief generalized jerking or stiffening of extremities; can cause a fall to the ground; pt is alert of event

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46
Q

atonic seizure

A

sudden loss of muscle tone that can cause a person to fall/drop to the ground; both sides of brain are usually affected; can happen to part or entire body; lasts less than 15 seconds; pt is not completely aware

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47
Q

simple seizure

A

occur in one area on one side of brain; sensory and motor symptoms localized to specific area; pt remains conscious; rarely lasts longer than an hour; may report aura

48
Q

complex seizure

A

most common in adults; consists of blank stare (usually involves temporal lobe); periods of altered behavior that pt is unaware of; lasts longer than a minute; pt loses consciousness for few seconds

49
Q

nursing assessment- seizure

A

seizure Hx, type of seizure, what happened before during and after, were there prodromal signs/, was there an aura?, loss of bowel/bladder function?, loss of consciousness?, details of postictal state (subjective and objective)

50
Q

phases of seizure

A

prodromal phase, aura phase, ictal phase, postictal phase

51
Q

nursing interventions- seizure

A

note time and duration of seizure; assess behavior at start of seizure; lower pt to ground if standing or in chair; support ABCs; remain with pt; do not restrain pt; loosen tight clothing; note type of seizure; monitor incontinence; admin IV meds as ordered; monitor postictal behavior; reorient pt; monitor vitals

52
Q

pt education- seizures

A

importance of med adherence, importance of seeing neurologist, encourage medic alert bracelet

53
Q

altered LOC

A

not a disease itself; disorientation, unable to follow commands, or needs persistent stimuli to achieve alertness; gauged on continuum GCS (alert/full consciousness to coma)

54
Q

nursing interventions for altered LOC

A

ensure adequate breathing pattern, protect pt by ensuring safety (raising bed rails 3/4), maintain fluids and nutrition, mouth skin joint and eye care, prevent urinary retention, maintain body temp., promote bowel function

55
Q

headaches

A

symptom that can arise from wide range of causes like tension/stress to fatal medical conditions; important to accurately assess and identify type of headache for proper treatment; can be primary or secondary; can be tension, cluster, or migraine; can be acute or chronic

56
Q

secondary headache

A

result of another underlying condition such as trauma infection or medication overuse

57
Q

tension headache

A

most common type and usually caused by stress and muscle tension that causes dull aching pain around head; commonly caused by stress, poor posture, muscle tension; can be triggered by ack of sleep, prolonged screen time

58
Q

tension headache treatment

A

OTC analgesics, symptom management, stress reduction and relaxation techniques

59
Q

cluster headache

A

rare intense headaches that cause severe pain usually localized around 1 eye; important to recognize and manage these headaches

60
Q

migraine

A

recurrent severe headaches accompanied by symptoms like nausea, light sensitivity, visual disturbances; have distinct phases and can cause large impact on ones life

61
Q

phases of migraine

A

prodromal- depression, irritability, cold, increased urination, can appear hours days or weeks before; aura- light flashes, bright spots, numbness/tingling of lips face and hands, confusion, drowsiness, diplopia, occurs directly before onset; headache- throbbing, usually unilateral, photophobia, N/V 4-72 hours; recover- pain subsides, soreness in neck, sleep

62
Q

nonpharmacological nursing interventions for migraine

A

educate on avoiding triggers, quiet and dark room, elevate HOB to 30 degrees, massage, meditation

63
Q

pharmacological nursing interventions for migraine

A

beta blockers, topiramate (preventative), triptans- quiet down overactive nerves (abortive), tylenol + NSAIDS (abortive), ergotamines (abortive), riboflavin- vitamin B (reduce number and duration), botox

64
Q

multiple sclerosis

A

chronic progressive noncontagious disease of CNS causing demyelination of neurons; immune system attacks myelin and causes communication problems between brain and rest of body; occurs 20-40; consists of period or remission and exacerbations; EEG is abnormal

65
Q

M.S. causes

A

unknown but thought to be result of autoimmune response or viral infection

66
Q

M.S. triggers

A

pregnancy, trauma, infection, fatigue, stress

67
Q

assessment of M.S.

A

fatigue/weakness, ataxia, vertigo, tremors/spasticity of lower extrem., parasthesia, blurry vision, dysphasia, decreased perception of pain/touch, bladder/bowel incontinence, abnormal reflex (babinski present), emotional change, memory changes and confusion

68
Q

Nursing interventions of M.S.

A

encourage independence, ensure safety, eye patch if diplopia, monitor symptoms, energy conservation during exacerbation, toileting schedule if incontinent, exercise and rest program, PT/SLP

69
Q

myasthenia gravis

A

chronic progressive neuromuscular disease characterized by severe weakness and abnormal fatigue of voluntary muscles; interruption of transmission of nerve impulses at myoneural junction

70
Q

causes of myasthenia gravis

A

insufficient secretion of acetylcholine, excessive secretion of cholinesterase, unresponsiveness of muscle fibers to acetylcholine

71
Q

role of acetylcholine neurotransmitter

A

muscle contraction and movement

72
Q

role of cholinesterase

A

destroys acetylcholine

73
Q

myasthenia gravis assessment

A

weakness, fatigue, difficulty chewing/swallowing, dysphagia, diplopia, weak/hoarse voice, difficulty breathing, ptosis

74
Q

ptosis

A

drooping of the upper eyelid

75
Q

nursing interventions for myasthenia gravis

A

monitor: respiratory, vitals, swallow ability (prevent aspiration), cough reflex, speech, muscle strength, myasthenic or cholinergic crises; educate to wear medic alert bracelet, sit up when eating, conserve strength

76
Q

treating myasthenia gravis

A

administration of anticholinesterase medications, relieving muscle weakness by blocking acetylcholine breakdown at neuromuscular junction

77
Q

endrophonium test

A

used to diagnose myasthenia gravis as well as distinguish between myasthenic and cholinergic crisis

78
Q

myasthenic crisis

A

acute exacerbation of disease that is caused rapid progression of disease, infection, too little medication, fatigue, or stress

79
Q

manifestation of myasthenic crisis

A

tachycardia, tachypnea, HTN, Dyspnea, anoxia, cyanosis, incontinence, absent cough/swallow reflex

80
Q

myasthenic crisis interventions

A

assess for symptoms, increase anticholinesterase medications as prescribed

81
Q

cholinergic crisis

A

depolarization of neuromuscular junction d/t overstimulation caused by overmedication with anticholinesterase; resultsin over stimulation by increased acetylcholine; very rare

82
Q

manifestations of cholinergic crisis

A

ABD cramps, N/V/D, blurred vision, pallor, facial muscle twitches, hypotension, constricted pupils

83
Q

cholinergic crisis interventions

A

hold anticholinesterase medications, prepare to administer atropine sulfate which is the antidote

84
Q

parkinsons disease

A

degenerative disease resulting in dysfunction of the extrapyramidal system; causes by depletion of dopamine and acetylcholine; slow progressive disease that can result in falls, self care deficits, depression, difficulty with speech

85
Q

manifestations of parkinsons

A

unintended/uncontrolled movements such as twitching, shaking, or difficulty balancing; trouble swallowing, shuffling gait, hand tremor, back rigidity, stooped posture, bradykinesia

86
Q

nursing interventions of parkinsons

A

assess neurological status, assess ability to chew/swallow, encourage high protein high cal high fiber soft diet with small frequent feedings, increase fluids to 2L/day, monitor constipation, promote independence but safety, instruct pt to rock back and forth to initiate movement, no prolonged sitting

87
Q

antiparkinsonian medications

A

aim to restore balance of acetylcholine and dopamine; dopaminergics- stimulate dopamine receptors and increase dopamine available in CNS; anticholinergics- block cholinergic receptors in CNS to suppress acetylcholine activity and reduce tremors/drooling

88
Q

trigeminal neuralgia

A

sensory disorder of trigeminal nerve (5th) that usually occurs spontaneously and causes severe sharp recurrent pain along trigeminal nerve; can be caused by pressure on nerve from artery, tumor, or result of M.S.

89
Q

manifestations of trigeminal neuralgia

A

triggered by sensation or movement surrounding nerve; severe pain on lips, gums, nose, across cheeks

90
Q

trigeminal neuralgia interventions

A

avoiding hot/cold beverages and foods, eat soft foods, eat small meals, chew on unaffected side, medications as ordered, surgery

91
Q

trigeminal neuralgia surgical interventions

A

microvascular decompression- relocates artery that causes pressure surgically; radiofrequency waveforms- creates lesions to relive pain without interrupting touch or motor function (nerve unable to transmit pain signal to brain); glycerol injection- injection into nerve to destroy myelinated fibers to relieve pain

92
Q

bells palsy

A

lower motor neuron lesion of the 7th cranial nerve (facial nerve) as a result of infection, trauma, hemorrhage, meningitis, or tumor; begins suddenly and causes paralysis on one side of face; recovery takes a couple weeks

93
Q

other causes of bells palsy

A

lyme disease, herpes simplex viruses

94
Q

manifestation of bells palsy

A

softened drooping facial muscles, inability to raise eyebrows frown smile close eyelids or puff cheeks, eye moves upward when trying to close eyelid, loss of taste

95
Q

interventions for bells palsy

A

encourage facial exercises to prevent loss of muscle tone, protect eye from dryness, promote oral care frequently, instruct to chew on unaffected side, steroid admin within 3 days of symptom onset

96
Q

guillain-barre syndrome

A

acute infectious neuronitis of cranial and peripheral nerves; immune system overreacts to infection and destroys myelin sheath; usually preceded by mild upper resp. infection or gastroenteritis; slow recovery that can take years

97
Q

manifestations of guillain-barre syndrome

A

abnormal EEG, parasthesias, pain/hypersensisitivty, resp. failure, dysrhythmias, weakness of lower extrem., gradual progressive weakness of upper extrem. and facia muscles

98
Q

guillain-barre syndrome interventions

A

care directed towards treating symptoms, monitor respiratory and provide resp. treatments if needed, monitor cardiac status, assess for immobility complications, provide education for pt and family

99
Q

amyotrophic lateral sclerosis

A

aka lou gehrigs disease; progressive degenerative disease involving motor neurons/system; causes muscle weakness and atrophy until paralysis (quadriplegia); respiratory muscles become affected and lead to resp. failure pneumonia and death

100
Q

likely cause of ALS

A

excessive glutamate

101
Q

manifestations of ALS

A

impaired speech, excess saliva, difficulty swallowing, SOB, restricted breathing, difficulty sleeping, hand/feet weakness, limited ROM, upper body spasms, impaired handwriting, trouble with hygiene/dressing, frequent tripping, difficulty on stairs

102
Q

interventions for ALS

A

treatment of symptoms, monitor resp. status, prevent aspiration, resp. treatments, assess for immobility complications

103
Q

encephalitis

A

inflammation of brain parenchyma and often meninges; affects brainstem, cerebrum, and cerebellum, often caused by viral but can be bacterial, fungal, or parasitic; requires urgent medical care

104
Q

manifestations of encephalitis

A

cold sores/lesions/ulcerations of oral cavity, exposure to infectious disease, fever, N/V, nuchal rigidity, travel to area where disease is present, changes in LOC/mental status, signs of increased ICP, HX of insect bites and swimming in fresh water

105
Q

interventions for encephalitis

A

monitor vitals, monitor neuro status, assess LOC using GCS, signs of increased ICP, positive kernigs and brudzinskis and nuchal rigidity, elevate HOB 30-45 degrees, assess for muscle deficits, help client to turn cough deep breath

106
Q

meningitis

A

inflammation of the arachnoid and pia mater; caused by bacteria or viral organisms; CSF analyzed for confirmation

107
Q

predisposing factors for meningitis

A

skull FX, brain/spinal surgery, sinus/upper respiratory infections, compromised immune system

108
Q

transmission of meningitis

A

direct contact, droplet, in areas of high population density

109
Q

manifestations of meningitis

A

signs of meningeal irritation (nuchal rigidity, brudzinski, kernig), irritability, headache (severe unrelenting), muscle aches/pains, N/V, fever/chills, tachycardia, photophobia, nystagmus

110
Q

meningitis motor manifestations

A

hemiparesis, hemiplegia, decreased muscle tone, cranial nerve dysfunction

111
Q

meningitis memory changes

A

short attention span, personality and behavioral changes, bewilderment

112
Q

brudzinksis sign

A

pain when tilting chin to sternum

113
Q

kernig sign

A

pain when straightening leg due to stiffness of hamstring

114
Q

meningitis interventions

A

monitor vitals, monitor neuro status, seizure precautions, monitor for signs of meningeal irritation, cranial nerve assessment, assess peripheral vascular status, isolation precautions, urine/stool precautions, respiratory isolation, HOB elevated to 30 degrees but avoid neck/hip flexion, prevent stimulation, restrict visitors, admin of analgesics/antibx, assess for signs of ICP

115
Q

bacterial meningitis vs viral

A

bacterial is much more severe

Adults 1 (10 decks)

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