Rehab Test #1 - CVA, Neuro Flashcards

Question

Differentiate among the drug therapy, and surgical therapy for patients with ischemic strokes and hemorrhagic strokes

Answer 1

Drug therapy for ischemic strokes include: Fibrinolytic therapy, recombinant tissue plasminogen activator (tPA) can only be used w/in 3 to 4 and 1/2 hours of stroke. Aspirin 325 mg, platelet inhibitors (Plavix), statins. Surgical therapy for ischemic strokes include: Stent retrievers (Solitaire FR, Trevo) are used to open blocked arteries in the brain it starts in the femoral. Another surgical approach uses the mechanical embolus removal in cerebral ischemia (MERCI) retriever, this tehcnique allows the surgeon to go inside the blocked artery of a patient experiencing ischemic strokes. Drug and surgical therapy for hemorrhagic strokes Management of oral hypertension with oral and IV meds. Anticoagulants and antiplatelets are contraindicated. Seizure prophylaxis can be used in certain situations. Surgical therapy include: Evacuation of aneurysm-induced hematomas or cerebellar hematomas > 3cm. Individuals w/ an arteriovenous malformation (AVM) can experience a hemorrhagic stroke if the AVM ruptures; treatment for this is surgical resection and/or radiosurgery (i.e. gamma knife).

Answer 2

Collaberative care: ischemic The goals for collaborative care during the acute phase are preserving life, preventing further brain damage, and reducing disability. Acute care begins with managing the airway, breathing, and circulation. Elevated BP is common immediately after a stroke and may be a protective response to maintain cerebral perfusion. Baseline neurologic assessment is carried out, and patients are monitored closely for signs of increasing neurologic deficit and increased ICP. Fluid and electrolyte balance must be controlled carefully. The goal generally is to keep the patient adequately hydrated to promote perfusion and decrease further brain injury. During initial evaluation, the single most important point in the patient's history is the time of onset. Recombinant tissue plasminogen activator (tPA) must be administered within 3 to 4.5 hours of the onset of clinical signs of ischemic stroke. It is used to reestablish blood flow through a blocked artery to prevent cell death. After the patient has stabilized and to prevent further clot formation, patients with strokes caused by thrombi and emboli may be treated with platelet inhibitors and anticoagulants. Collaberative care: hemorrhagic Goals for managing airway, breathing, circulation, and intracranial pressure are the same as for the patient with ischemic stroke. A number of surgical interventions are used to treat hemorrhagic strokes, including resection, clipping of an aneurysm, and evacuation of hematomas. The procedure chosen depends on the cause of the stroke. Seizure prophylaxis is recommended. Additional drug therapy is used to manage hypertension and reduce the incidence of cerebral vasospasms.

Answer 3

Dysphagia- choking and aspiration pneumonia, pt aren’t allowed to drink thin liquid, so would add thickness to it

Answer 4

``` During the acute phase following a stroke, management of the respiratory system is a nursing priority. Stroke patients are particularly vulnerable to respiratory problems, including atelectasis, airway obstruction, and aspiration pneumonia. The patient's neurologic status must be monitored closely to detect changes suggesting extension of the stroke, increased ICP, vasospasm, or recovery from stroke symptoms. Nursing goals for the cardiovascular system are aimed at maintaining homeostasis; the nurse must perform a thorough cardiac assessment, manage infusions, and monitor fluid balance. Measures to prevent deep venous thrombosis (DVT) are often implemented. To maintain optimal function of the musculoskeletal system, measures are used to prevent joint contractures and muscular atrophy. The skin of the patient with stroke is particularly susceptible to breakdown related to loss of sensation, decreased circulation, and immobility. The most common bowel problem for the patient who has experienced a stroke is constipation. Patients may be prophylactically placed on stool softeners and/or fiber. The primary urinary problem is poor bladder control, resulting in incontinence. Efforts should be made to promote normal bladder function and to avoid the use of indwelling catheters. The patient may initially receive IV infusions to maintain fluid and electrolyte balance, as well as for administration of drugs. Patients with severe impairment may require enteral or parenteral nutrition support. Swallowing ability will need to be assessed. Assess the patient both for the ability to speak and the ability to understand and support the patient accordingly. Homonymous hemianopsia (blindness in the same half of each visual field) is a common problem after a stroke. Persistent disregard of objects in part of the visual field should alert you to this possibility. A stroke is usually a sudden, extremely stressful event for the patient, caregiver, family, and significant others. Use nursing interventions designed to facilitate coping by providing information and emotional support. ```

Answer 5

The patient is usually discharged from the acute care setting to home, an intermediate or long-term care facility, or a rehabilitation facility. Regardless of the care setting, ongoing rehabilitation is essential to maximize the patient's abilities. Rehabilitation requires a team approach so the patient and family can benefit from the combined, expert care of a stroke team. The goals for rehabilitation of the patient with stroke are mutually set by the patient, family, nurse, and other members of the rehabilitation team. Initially you emphasize the musculoskeletal functions of eating, toileting, and walking for the rehabilitation of the patient. Interventions advance in a manner of progressive activity. After the acute phase, a dietitian can assist in determining the appropriate daily caloric intake based on the patient's size, weight, and activity level. The diet must also be adjusted for the ability of the patient to swallow solids and fluids. A bowel management program is implemented for problems with bowel control, constipation, or incontinence. Nursing measures are also focused on promoting urinary continence. Patients who have had a stroke frequently have perceptual deficits. For example, patients with a stroke on the right side of the brain usually have difficulty in judging position, distance, and rate of movement. The patient with a stroke may experience many losses, including sensory, intellectual, communicative, functional, role behavior, emotional, social, and vocational losses. As a nurse, you should help patients and families cope with these losses. Speech, comprehension, and language deficits are the most difficult problems for the patient and family. Speech therapists can assess and formulate a plan of care to support communication.

Answer 6

Patients who have had strokes often exhibit emotional responses that are not appopriate or typical for the situation. Sometimes those w/ a stroke on the left side of the brain (right hemiplegia) have exaggerated mood swings that they cannot control. Nursing interventions include: distracting the patient on outbursts, explain to pt and family that the outbursts are due the stroke, maintain a calm environment and avoid shaming or scolding the patient during the outbursts. Patient may deal with maladjusted dependence when inadequate coping occurs when the patient cannot function like before; the patient and the family may resent each other. In order to deal with the situation: recognition of behavioral changes resulting from neurologic deficits that are not changeable, responses to multiple losses by both the patient and the family, and behaviors that may have been reinforced during the early stages of stroke as continued dependency.

Answer 7

CNS is brain and spinal cord. PNS are the sensory and motor neurons. The PNS breaks down further into the autonomic and the sensory-somatic nervous system. The autonomic breaks down further into the sympathetic and parasympathetic nervous systems. It is very complex but to answer your question when you touch a hot stove sensory neurons (PNS) send a message to the brain (CNS) and the brain process that the hand is being injured and reacts by sending motor neurons (PNS) to tell the hand to pull away.

Answer 8

a long, slender projection of a nerve cell, or neuron, that typically conducts electrical impulses away from the neuron's cell body

Answer 9

a mixture of proteins and phospholipids forming a whitish insulating sheath around many nerve fibers, increasing the speed at which impulses are conducted.

Answer 10

Upper- brain to spine Degeneration- lose the ability to regulate it, because of that muscle becomes spasm and atrophy. More muscle contraction, reflexes, disuse of the muscle, and toes point up Disuse atrophy Lower- spine and brain branch to the muscles Degeneration- losing the innovation of the muscle

Answer 11

autoimmune: inappropriate activation of immune system; autoimmune antibodies destroy receptors or peripheral myelin and include guillain-barre syndrome, multiple sclerosis, and myasthenia gravis degenerative: breakdown in the body; impairment or loss of motor functions; amyotrophic lateral sclerosis and Parkinson's disease

Answer 12

developing numbness starting from lower extremities and moving up; vital signs; respiratory status; maintain patient airway and manage secretions; neuro checks; ability to swallow; control pain; prevent muscle atrophy; prevent other complications related to immobility, turn them, prevent DVT ``` Definition Autoimmune disease of unknown origin that involves degeneration of the myelin sheath of peripheral nerves Incidence 2,700 annually 1 in every 100,000 Ages 15-35 and 50-75 years ``` ``` Pathophysiology 2/3 of cases proceeded by viral or bacterial infection (esp. Camphylobacter jejuni) Exposure of infectious agents triggers development of antibodies Antibodies attack peptides within peripheral myelin sheath Neither hereditary nor contagious Acute Ascending paresthesia, paresis, and paralysis Absent DTR Autonomic dysfunction Respiratory failure Plateau Symptoms remain but do not worsen Recovery Begin to improve in descending pattern Approximately 80% of patients recover completely within 1 year, severe cases take 2 years for maximal recovery Diagnosis No specific tests Lumbar puncture (↑ protein) Electromyography (EMG) Nerve conduction test Treatment Medical emergency Plasmapheresis Intravenous immunoglobulin (IVIG) Nursing management Vital signs Respiratory status Maintain patent airway & manage secretions Neuro checks Ability to swallow Control pain Prevent muscle atrophy Prevent other complications related to immobility ```

Answer 13

patient can experience relapses (p. 347). administer corticosteroids for exacerbations, administer immune suppressive agents such as interferon- ``` Definition Chronic immune-mediated demyelination and scarring of neurons in central nervous system Incidence 400,000 people in the U.S. Onset 20 - 50 years (women > men) Higher incidence in Caucasians More prevalent in colder climates ``` ``` Pathophysiology Destruction of myelin sheath surrounding neurons primarily in the central nervous system (peripheral nerves are spared) Believed to be immune mediated triggered by a virus (e.g. Epstein-Barr) in genetically predisposed Plaques form along myelin sheath, eventually causing scarring and destruction Irreversible axonal damage Clinical Manifestation Impaired visual acuity Blurred vision Diplopia Weakness Numbness Paresthesia Extreme fatigue Ataxia Gait imbalance Spasticity (late) Bladder/ bowel difficulties Pain Depression, labile mood, memory and cognitive impairment Diplopia on Lateral Gaze (33%) Chronic and unpredictable course with disease exacerbations and remissions Relapsing-remitting (RRMS) – 85%! Primary progressive Secondary progressive Progressive-relapsing Diagnosis History (episodes of neuro dysfunction) MRI of brain and spinal cord (MS plaques) Treatment Relapses & exacerbations Corticosteriods (methylprednisolone, prednisone) Immune suppressive agents such as Interferon-B SQ injection QOD ```

Answer 14

assess: ptosis; diplopia; dysphagia; dysarthria; mysathenic snarl; muscle weakness that worsens with exercise and improves with rest; respiratory insufficiency and failure management: anticholinesterase drugs; corticosteroids; immune suppressants; plasmaphersis; intravenous immune globulin (IVIG) ``` Definition Autoimmune neuromuscular disorder Incidence 60,000 people in U.S. Early onset, age 20-30 (women) Late onset, after age 50 (men) Pathophysiology Autoantibodies block the skeletal muscle receptor sites, preventing acetylcholine from attaching to them Because not enough acetylcholine is attached to the receptor sites, muscle contraction does not occur Autoantibodies Block ACh Receptors Clinical manifestations Ptosis (50-90%) - dropping of the eyelid Diplopia- double vision Dysphagia- difficulty to swollow Dysarthria - slow in speech Mysathenic snarl Muscle weakness that worsens with exercise and improves with rest Respiratory insufficiency & failure Diagnosis Serum acetylcholine receptor antibodies Tensilon test http://www.youtube.com/watch?v=k7YX9kuWrxA Electromyography (EMG) Treatment Anticholinesterase drugs (neostigmine) Corticosteroids Immune suppressants Plasmaphersis Intravenous immune globulin (IVIG) Surgery - Thymectomy ```

Answer 15

assess: initial, unexplained weakness and fasciculating (twitching) muscles in a limb; muscle atrophy with increased tone and hyperreflexia; eventually the muscles that control speech, swallowing, and breathing are affected (death); positive Babinski reflex management: maintain sensory and cognitive functions Definition Rare progressive neuromuscular disorder characterized by loss of upper and lower motor neurons leading to eventual wasting and atrophy of all voluntary muscles, including respiratory muscles. Also, known as Lou Gehrig’s disease Amyotrophy - Process of muscle atrophy Lateral - Loss of nerves on each side of the spinal cord Sclerosis -Hardened scar tissue when nerve cells die Incidence 5000 people in U.S. affected annually Onset age 40-60 years, men > women Fatal, death within 3 to 5 years Clinical manifestations Initial, unexplained weakness and fasciculating (twitching) muscles in a limb Muscle atrophy with increased tone and hyperreflexia Eventually the muscles that control speech, swallowing, and breathing are affected (death) Positive Babinski reflex Note: Maintain sensory and cognitive functions

Answer 16

assess gait, rest tremor, mask-like face, drooling, delayed swallowing management: levodopa/carbidopa (Sinamet), surgery- deep brain stimulation (for refractory PD only) monitor for dysphagia ``` Definition Chronic progressive degenerative neurologic disorder that results from loss of dopamine in the brain structures that control movement Incidence 1 million people in U.S. 60,000 new cases each year 65 years and older at greatest risk Pathophysiology Dopamine (DA) is produced in substantia nigra, which delivers it to the basal ganglia, a section of the brain that coordinates movement Degeneration of the substantia nigra leads to decrease in levels of dopamine (DA) Acetylcholine (ACh) is uninhibited, resulting in muscle tremor and rigidity Accumulation of abnormal proteins within neurons (Lewy Bodies) Clinical Manifestation Rest tremor Rigidity “Cogwheel” Flexed posture Bradykinesia Difficulty initiating movement “Freezing” Shuffling gait Decreased or absent arm swing Mask-like face Infrequent blinking Delayed swallowing Drooling Mumbled speech Small, cramped handwriting (micrographia) ``` ``` Diagnosis No definitive tests Drug challenge Treatment Levodopa/ carbidopa (Sinamet) Surgery Deep brain stimulation (for refractory PD only) Nursing management Monitor for dysphagia Education Importance of taking meds on time Constipation (↑fluids & fiber) Handle coins in pockets Fall precautions (wear sturdy shoes; remove throw rugs, electrical cords, and clutter; consciously pick up your feet to take steps; install grab bars; rock back and forth to get started) ```

Answer 17

``` Cholinergic poisoning S salivation L lacrimation U urinary incontinence D diarrhea G GI cramps E emesis Cholinergic crisis Bronchospasm & bradycardia Leads to respiratory & cardiac arrest Antidote: Atropine Nursing management Monitor for dyspnea, ineffective cough, and swallowing difficulties Plan activities to include rest periods Educate about adverse effects both of anticholinesterase drugs and steroids ```

Answer 18

The goal is to prevent seizures with minimum toxic side effects from drug therapy (since it cannot be cured).The patient should wear helmelts in situations involving head injury; improved perinatal, labor, and delivery care to reduce fetal trauma and hypoxia (to avoid brain damage). The patient should practice good health habits (including stress management)

Answer 19

burning or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body. The sensation, which happens without warning, is usually painless and described as tingling or numbness, skin crawling, or itching.

Answer 20

-the upper eyelid droops over the eye.

Answer 21

can affect a small part of the ANS or the entire ANS. Some symptoms that may indicate the presence of an autonomic nerve disorder include: dizziness and fainting upon standing up, or orthostatic hypotension. an inability to alter heart rate with exercise, or exercise intolerance

Answer 22

the subjective complaint of seeing 2 images instead of one and is often referred to as double-vision in lay parlance

Answer 23

the medical term for the symptom of difficulty in swallowing.

Answer 24

- often is characterized by slurred or slow speech that can be difficult to understand

Answer 25

slowness of movement and is one of the cardinal manifestations of Parkinson's disease.

Answer 26

muscular rigidity in which passive movement of the limbs (as during a physical examination) elicits ratchet-like start-and stop movements through the range of motion of a joint (as of the elbow) and that occurs especially in individuals affected with Parkinson's disease The third major sign, rigidity (sometimes called "cogwheel" rigidity), is peculiar to Parkinson's disease.

Answer 27

a condition in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and can interfere with normal movement, speech and gait

Answer 28

inability to be to bent or be forced out of shape.

Answer 29

Parkinsonian tremor is a common symptom of Parkinson's disease, although not all people with Parkinson's disease have tremor. Generally, symptoms include shaking in one or both hands at rest.

Answer 30

maintaining patient airway, control process of immune activation; corticosteroids

Answer 31

The patient is unable to breathe properly during seizure activity, the patient is at risk for injury (loss of consciousness during seizure activity, and postictal physical weakness), the patient may not manage medications and modify lifestyles appropriately, the patient may feel socially isolated. Depression and hopelessness

Rehab Test #1 - CVA, Neuro Flashcards

(56 cards)