S M12 Intracranial Regulation Flashcards by Josh Kotov

Cerebrovascular disorder due to stroke

functional abnormality of the CNS that occurs when the blood supply tot he brain is disrupted

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2 types of stroke

Ischemic - vascular occlusion, hypoperfusion to the brain

Hemorrhagic - extravasation of blood into brain or subarachnoid space

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Ischemic stroke

vascular occlusion and significant hypoperfusion to the brain

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Hemorrhagic stroke

extravasation of blood into the brain or subarachnoid space

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“Brain attack”

Sudden loss of function resulting from disruption of blood supply to brain

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Stroke

FAST symptoms

Face - looks uneven

Arms - one arm hangs lower

Speech - slurred

Time - call 911 now

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Ischemic stroke causes

Thrombus or emboli obstruction

Results in infarction of brain tissue

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Types of ischemic stroke

Large artery thrombosis

Small penetrating artery thrombosis

Cardiogenic embolism - most common A-fib

Cryptogenic - no cause

Other - drug use

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Ischemic stroke meds

tPA

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tPA

tissue Plasminogen Activator

101

Give within 3 hours

will minimize symptoms and loss of function

GOAL - IV tPA to be given within 60min of arriving to the ED

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Ischemic stroke Motor S/S

Hemiplagia - paralysis to one side

Hemiparesis - loss of strength to one side

Apraxia - cant perform learned movements

Difficulty walking, loss of coordination

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Ischemic stroke numbness/weakness occurs in

Face, arms, legs, especially in once side

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Ischemic stroke and sensory S/S

Agnosia - loss of sensory recognition

Dysphasia - difficulty swallowing

Visual/spatial dysfunction

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Ischemic stroke cognitive S/S?

confusion and changes in mental status

learning capacity and memory loss

Aphasia - trouble speaking and understanding speech (expressive and receptive)

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Ischemic stroke psych and pain

Sudden SEVERE headache

Depression, emotional lability, hostility, frustration, resentment

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Left side stoke

Right side body problems

Aphasia

Intellectual disability

Slow cautious behavior

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Right side stroke

Left side body problems

Left visual problems

Distractibility

Impulsive behavior

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Transient ischemic attack TIA

Temporary neuro deficit due to blood flow impairment

Sudden onset of motor sensory and visual S/S

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TIA is a precursor to

Impending stroke

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TIA last

1-2 hours

less than 24h

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Stroke prevention lifestyle

No smoking

Physical activity

Healthy weight and diet

Modest alcohol consumption

Sleep apnea

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Non modifiable risks of stroke

Older than 55

Male gender

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Modifiable risk factors of stroke

Hypertension PRIMARY RISK

cardiovascular disease - a fib, stenosis

^ cholesterol, hematocrit

Obesity

Diabetes

Oral contraceptives

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Med management of ischemic stroke

CT within 25min - determines ischemic or hemorrhagic

12 lead EKG and carotid ultrasound

CT angiography, MRI of brain and neck vessels

tPA

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Assessment tool for tPA qualification

NIHSS

tPA

dissolves clots

tPA admin

Need 2 IV sites - 1 tPA, 2 other fluids IV dosage 0.9mg/kg, ma is 90mg 10% of dose given over 1min, the rest over 1 hour

tPA monitoring

V/S q15m for 2h then q30m for 6h then q1h for 24h BP maintained greater than 180/105

tPA side effects

Risk for bleeding

tPA maintanance

Airway and ventilation Hemodynamic monitoring Neuro assessment

tPA interventions

Monitor intracranial pressure Provide O2, intubate if needed Elevate HOB to 30 degrees Hemodynamic monitoring Neuro checks

If intracranial pressure high

mannitol diuretic

Carotid endarterectomy

Removes plaque from artery Ischemic stroke prevention

Secondary prevention of Ischemic stroke

anticoagulation therapy antiplatelet therapy “statin” meds antihypertensive meds

Hemorrhagic stroke 101

bleeding into brain, ventricles or subarachnoid space

Hemorrhagic stroke causes

rupture of small vessels ruptured aneurism AVMs Trauma Hypertension

Brain exposure to blood in hemorrhagic stroke

slows brain metabolism ^ in intracranial pressure Secondary ischemia due to reduced perfusion

Hemorrhagic manifestations

Same as ischemic + Vomiting Pain and rigidity in back of neck

Secondary problems with stroke

Cerebral hypoxia Vasospasms ICP Seizures Rebleeding Hydrocephalus Hypertension

Vasospasms S/S

Intensified HA decrease in LOC aphasia partial paralysis

Rebleeding S/S

Sudden severe HA N/V Decrease in LOC Neuro deficit

Hydrocephalus S/S

Gradual drowsiness behavior changes Acute stupor/coma

Secondary stroke management

Bedrest sedation Clip aneurism Reverse anticoagulation with prothrombin

For seizures give

Dilantin anticonvulsant

To prevent DVT For fever For pain

Intermittent pneumatic compression devices Tylenol, ice Analgesics

Nursing care other assessments

I&O O2 Complications - seizures, hydrocephalus, rebleeding, vasospasms, hyponatremia

Environment for Stroke

Non-stimulating quite dim Monitor pain restrict visits Reassurance to decrease anxiety No valsalva

Post acute nursing care

set realistic goals encourage personal hygiene ensure pt does not neglect affected side use assistive devices

Nutrition post stroke

speech therapy sit upright, out of bed to eat, Chin tuck swallow method Thickened liquids and puree diet

Bowel and bladder post stroke

Voiding assessment schedule Constipation prevention - fiber fluids Bowel and bladder retraining

Edu post stroke

med education safety edu exercise and activity socialization

Ictus on exam When someone has a seuzure start a timer to know how long they are

Seizure precaution

o2 suction padded bedrails IV access make sure stuff works

Decorticate posture has a better

prognosis

Decerebrate posturing has a

poorer prognosis

Due to post concussion syndrome being treated at different time frames

Pt may lose confidence in healthcare as problem is not resolved

Know glasgow coma scale

all parts

how to read coma GCS

When axons tear due to TBI

they release toxins that worsen the condition

Know cushings triad

With ICP fluids are

Normal saline isotonic keep pressure same

Final say in brain functin

rule of 100?

For pt with seizures ask about

aura

Seizure vs epilepsy

one time vs many times

If seizure is longer than 5 min

activate emergency response

Seizure patients are at risk for

Hypoxia Vomiting Pulmonary aspiration

Visually diagnosing epilepsy

EEG

Status epilepticus

Medical emergency

Drugs of choice for epilepsy/seizure

Valium and Ativan

PT education for seizure/epilepsy

get meds follow ups S/S of toxicity med alert bracelets injury precaution avoid triggers

Meningitis bacteria

Streptococcus pneumonia Neisseria meningitidis

Opisthotonic position flexing at back

S/S of Baby will meningitis

Protein high glucose low in spinal fluids

Meningitis

Antibiotics for meningitis should be give

within 30 min of arrival to hospital

S M12 Intracranial Regulation Flashcards

(76 cards)