Unit 2 - Sensory & Neuro assessment/stroke Flashcards
(161 cards)
1
Q
What does the external ear consist of? Think lets go out to “EAT”
A
- Auricle (pinna)
- External auditory canal
- Tympanic membrane (ear drum)
2
Q
What is the role of the external ear?
A
The role is to collect and transmit sound waves to tympanic membrane.
3
Q
What does the middle ear consist of?
A
- ossicles (malleus, incus, and staples) three small bones that are connected and transmit the sound waves to the inner ear
- Eustachian tube
- Mastoid/temporal bone
- Airspace in temporal bone
- Vibrations-> ossicles-> oval window.
4
Q
What is the function of the ossicles in the middle ear?
A
- Three small bones that are connected and transmit the sound waves to the inner ear.
- Vibrations -> ossicles–> oval window
5
Q
What is the function of the eustachian tube in the middle ear?
A
- A canal that links the middle ear with the back of the nose. The eustachian tube helps to equalize the pressure in the middle ear. Equalized pressure is needed for the proper transfer of sound waves. The Eustachian tube in lined with mucous, just like the inside of the nose and throat.
6
Q
What does the inner ear consist of? Think- inside “CVS”
A
- Cochlea- This contains the nerves for hearing
- Vestibule- This contains receptors for balance.
- Semicircular canals- This contains receptors for balance
7
Q
What is Cranial Nerve VIII (8) and what is its role?
A
Known as the Auditory (vestibulocochlear) its role is hearing and balance
8
Q
How can hearing loss affect a patient?
A
- Ineffective communication
- Decreased interaction
- Withdrawal
- Suspicion
- Loss of self-esteem and security
9
Q
What parts of the ear is affected by conductive hearing loss?
A
Outer and middle ear
10
Q
What causes conductive hearing loss?
A
Sound waves are blocked to the inner ear fibers
11
Q
What are the signs and symptoms of conductive hearing loss
A
Patient hears better in noisy environments
12
Q
How do you treat conductive hearing loss?
A
- Fix the direct problem (blockage)
- Hearing aid
13
Q
Is conductive hearing loss preventable? How?
A
Yes, monitor and evaluate for problems and treat
14
Q
Is conductive hearing loss permanent?
A
- Majority of the time no, the exception is when it is caused by tumors that cause damage or damage related to surgery scar tissue.
15
Q
What parts of the ear is affected by sensorineural hearing loss?
A
Inner ear damage (nerve pathways)
16
Q
What causes sensorineural hearing loss?
A
Damage to the inner ear structures, damage to CN VIII (8) or the brain itself, prolonged exposure to loud noises, medication, trauma, inherited problems, metabolic circulatory problems, infections, surgery, Minieres, DM, Myxedema, aging (presbycusis)
17
Q
How do you treat sensorineural hearing loss?
A
- Depends on the problem
- Mediation
- Surgery
18
Q
Is sensorineural hearing loss permanent?
A
Yes, most common type of permanent hearing loss. There is NO cure!! When damage to the nerve pathways occur it cannot be fixed
19
Q
Is sensorineural hearing loss preventable? How?
A
- Ototoxicity (if caught early)- Is preventable if caught early and medication is discontinued immediately.
- Listening to loud music– Avoid listening to loud music can prevent hearing loss
Ototoxicity and loud music are the ONLY preventable causes of sensorineural hearing loss.
20
Q
What are the signs and symptoms of sensorineural hearing loss?
A
- Hearing deficit and balance problems
- If caused by Meniere’s disease: Vertigo and Tinnitus
21
Q
What medications can cause Ototoxicity? List 6
A
- Aspirin
- Cisplatin (Cancer med)
- Furosemide
- Gentamycin
- Quinine (anti-malaria medication)
- Vancomycin
22
Q
What parts of the ear is affected by mixed hearing loss?
A
- Outer
- Middle
- Inner
23
Q
What causes mixed hearing loss?
A
A mix of causes associated with both conductive and sensorineural damage
24
Q
What are the main functions of each cranial nerve
A
- I Olfactory: smell
- II optic: Visual acuity
- III Oculomotor: Opening of eyelid/eye movement
- IV Trochlear - eye movement
- V Trigeminal: Facial sensation, chewing movements
- VI Abducens: Eye movement
- VII Facial: Facial muscle movements, and eyelid closing
- VIII Auditory (vestibulocochlear): Hearing and balance
- IX Glossopharyngeal: Taste on posterior 3rd of tongue
- X Vagus- Uvula (palate muscle) and swallowing
- XI Accessory: Shoulder shrug
- XII Hypoglossal- Tongue movement.
25
What is tinnitus and how does tinnitus affect the patient?
1. Ringing of the ears
2. Grief and depression (suicidal ideation)
26
What is Vertigo? How does vertigo affect the patient?
1. Room Spinning while still because of the fluid in the ears or compression CN VIII (8)- "hearing and balance"
27
What are patients with vertigo most at risk for?
Falls
28
What is the weber's test?
Detects unilateral hearing loss
29
What is the Rinne's test?
Compares air conduction with bone conduction
30
What is Meniere's disease?
Dilation of endolymphatic system by over production or decreased reabsorption of endolymphatic fluid
31
What causes Meniere's disease?
Any factor that increases endolymphatic secretion in the labyrinth, viral and bacterial infections, allergic biochemical and vascular disturbance, changes in the microcirculatory in the labyrinth, long term stress
32
What are the clinical manifestations/signs and symptoms for Meniere's disease?
Fullness in the ear, tinnitus, vertigo, n/v, nystagmus, severe headache
33
What interventions should the nurse focus on for a patient with Meniere's disease?
1. Safety measures
2. Enviromental control
3. Surgery
4. Post-op interventions
34
How is Meniere's disease treated?
1. Medication/symptom management
2. Surgery
3. Stunt
4. Resection of CN8 or total resection of labyrinth
35
Nursing care of hearing loss? What are the eight important key factors for caring for a patient with a hearing deficit?
1. Assessment= early detection
2. Safety measures (due to loss of hearing)
3. Dietary (nutrition, hydration)
4. Medication
4. Surgery (ex. cochlear devices)
5. Hearing aids
6. Community services
7. Community techniques
8. Communication techniques
36
Why is assessment of our patient an important key factor in caring for a patient with hearing deficits?
1. You want to make sure that you are assessing your patient for hearing loss. Remember for sensorineural hearing loss can lead to permanent hearing loss so we want to try and prevent any further damage
37
Why is safety measures an important key factor for caring for a patient with a hearing deficit?
It is important to educate patients and have them teach back to you to ensure that they understand. Also, make sure to educate the patient to check both ways before they cross the street and always be aware of there surroundings because they might not be able to hear a vehicle coming etc.
38
Why is dietary an important key factor for caring for a patient with a hearing deficit?
Ensures that the patient has adequate nutrition and hydration to ensure that their oil and sebaceous glands can properly maintain their hearing.
39
Why is community resources and hearing aids an important key factor for caring for a patient with a hearing deficit?
1. Important to educate patients on how to maintain their hearing aids (how to change batteries, have back up batteries, and how to properly store)
2. Hearing aids are expensive so we can give patients community resources to help get hearing aids because the majority of insurances companies wont cover them as they are seen as a necessity
40
Why is communication techniques an important key factor in caring for a patient with a hearing deficit?
You never want to shout or yell at a patient to get them to hear you. You want to talk low and slow directly next to a patient. Many patients have adapted to reading lips along with hearing. LOW and SLOW. If the patient still can not hear you, you can try and write out what you are saying if the patient can read on the white board or piece of paper.
41
What are some specific safety measures and environmental control interventions you could focus on for a patient with meniere's?
1. Prevent injury during vertigo attacks (fall bundle)
2. Provide bed rest in a quiet environment
3. Provide assistance walking
4. Instruct patient to move their head slowly to prevent worsening of the vertigo
5. Initiate a sodium and fluid restrictions as prescribed
6. Instruct the patient to stop smoking
7. Instruct the patient to avoid watching tv because of flickering of lights may exacerbate symptoms, allow the patient to rest
8. And control vertigo N/V, mild diuretics may also be prescribed to decrease endolymph fluid
9. Inform the patient about vestibular rehab as prescribed
42
What are some specific surgical and post- op interventions you focus on for a patient with Meniere's?
1. Surgery- Teach the patient that surgery is performed when medical therapy is ineffective, and the functional level of the patient has decreased significantly. Insertion of shunt may be an option early in the course of the disease to assist with the drainage of excess fluids. A resection of the vestibular nerve or total removal of the labyrinth may be performed.
2. Post-operative interventions- packing and dressing on the ear. Speak to the patient on the side of the UNAFFECTED ear. Perform neuro assessments. maintain safety. Assess when ambulating. Encourage the patient to use a bedside commode rather than ambulating to the bathroom. Administer antivertigo and anti emetic medications as prescribed
43
What is the process of administering eye drops?
1. Apply to conjunctive sac
2. Light amount of pressure to the canthus (nasolacrimal duct) to avoid a systemic effect
44
What are the four leading causes of blindness?
1. Age related macular degeneration
2. Cataracts
3. Diabetic retinopathy
4. Glaucoma
45
What is the aqueous humor? What is it made of? Where is it made? What is its fuction?
1. 99.9% water and 0.1% sugar, vitamins, proteins
2. The aqueous humor helps maintain intraocular pressure, transports Vitamin C to and from the segment and acts as an antioxidant
46
What is the normal flow of aqueous humor?
1. Posterior chamber to
2. Anterior chamber to
3. Canal of schlemm to
4. Trabecular meshwork
47
What is vitreous humor? What is it made of? What is its function?
1. 99% water
2. 1% collagen
3. The function is to keep the shape of the eye
48
Cranial nerves that affect the eye? What are their functions?
1. II Optic-Visual Acuity
2. III- Oculomotor- opening of eyelids/eye movement
3. IV Trochlear- eye movement
4. VI Abducens- Eye movement
5. VII Facial- Facial muscle movements and eye lid closing
49
What are cataracts?
Opacification of the lens. As the lens age fibers and proteins change. They will begin to clump together causing opacification of the lens. As the lens becomes opaque the patients visions will become blurred, foggy or fuzzy.
50
What are the risk factors/causes that attribute to cataracts?
1. Age related (regardless of health you become at risk as you age) **
2. Congenital
3. Secondary to DM, UV light, Corticosteriods
4. Trauma
51
What are the clinical manifestations/ signs and symptoms of cataracts?
1. Opaque lens
2. Blurred vision
3. Foggy or fuzzy vision
4. Decreased visual acuity
5. No pain
6. Occurs gradually
7. Decreased night vision
52
What are the treatment options for cataracts? How do you "cure" cataracts?
1. Surgery is the only "cure"
2. You can suggest visual aids (change in RX, reading glasses, magnifiers, increase lighting, adjust life style)
53
What do the three phases involve for surgical intervention of cataracts? (summarize each phase)
1. pre-op
2. Intra-op
3. Post-op
54
What should the nurse do if the patient has complications after cataract surgery?
1. Notify the surgeon of health care provider immediately.
55
What is glaucoma? Where is the initial visual loss going to occur.
1. Disturbance of the functional/structural integrity of the optic nerve.
2. Increase of intraocular pressure.
3. Peripheral
56
What is closed-angle glaucoma? Clinical manifestations? treatment?
1. Increase IOP that rise is sudden
2. Fluid builds in the posterior chamber and directly affects the optic nerve
3. Can cause irreversible damage to the optic nerve with 1-2 days.
4. EMERGENCY!!!
57
What are some other names that closed angle glaucoma might be called?
1. Narrow angle glaucoma
2. Congestive glaucoma
3. Pupillary closure glaucoma
58
What is open-angle glaucoma? Clinical manifestations?
1. Outflow is decreased--- Fluid build up in anterior portion of the eye in front of the lens.
2.manifestations can include halo seen around light, loss of peripheral vision, and headaches.
59
What are beta-adrenergic blocking agents and what are their functions?
1. Lower IOP by reducing production of aqueous humor.
60
What are timolol contraindications? Adverse reactions? Patient teaching for home use/precautions?
1. Contraindications: Asthma, COPD, Sinus Bradycardia, Heart failure, 2nd/3rd degree block.
2. Bronchospasm, dyspnea, Bradycardia, dizziness, heart block
61
What is macular degeneration? Where is the initial visual loss going to occur? When you are going over the discharge paperwork with the patient where will you want to stand to talk to the patient?
1. Degeneration of macula in back of the eye along forveacentrails
2. Side of bed.
3.central vision loss
62
Clinical manifestations for DRY macular degeneration? Is there a cure? Patient teaching?
1. Develops gradually
2. Need for brighter light
3. Gradual haziness of central or overall vision
4. Blurred spot in the center of field of vision
5. No cure, only slowing of progression
6. Antioxidants, zinc, and selenium (vit. A, C, & E)
7. Diet- fruits, vegetables, fish w/omega 3 fatty acids
63
Clinical manifestations for WET macular degeneration? Is there a cure? Patient teaching?
1. Abrupt onset
2. Rapid worsening & Vision loss
3. Well-defined blurry/blind spot of central vision
4. No cure, only slowing of progression
5. Injections into eye/laser
6. Photodynamic therapy
64
What is open-angle glaucoma?
Primary open angle glaucoma also known as chronic glaucoma or wide angle glaucoma. It is the MOST COMMON type of glaucoma and it has a gradual onset. Primary open angle glaucoma refers to the angle between the iris and the sclera. The aqueous humor outflow is decreased due to the blockages in the eyes drainage system (the canal of Schlemm and trabecular meshwork) causing a gradual rise in intraocular pressure.
65
What are treatments for open angle glaucoma?
1. Medication therapy to reduce intraocular pressure. (beta adrenergic blockers, alpha adrenergic agonists,, prostaglandin analogs, cholinergic agonist, carbonic anhydrase inhibitors)
2. Surgical intervention is indicated as intraocular pressure cannot be reduced by medications.
66
What are signs and symptoms to look out for with open angle-glaucoma?
1. Headache
2. Mild eye pain
3. Loss of peripheral vision
4. Decreased accommodation
5. Halo scene around light
6. elevated intraocular pressure great than 21 mL mercury
67
What is closed angle glaucoma in detail?
It is an emergency and is sudden onset. It is increased intraocular pressure rise that is sudden. The angle between the iris and the sclera suddenly closes, causing a corresponding increase in intraocular pressure. The optic nerve is damaged when the aqueous humor build up as a result of displacement of iris.
68
What is the Treatment for closed-angle glaucoma?
1. Early diagnosis and treatment is key in preventing vision loss.
2. Medication therapy to reduce intraocular pressure with subsequent corrective surgery for restoration of iris. (osmotic agents are first in line medications used to control the condition until corrective surgery can be implemented)
69
What are s/s of closed angle glaucoma?
1 Acute onset of ocular pain,
2. seeing halos around lights
3. Eyebrow pain,
4. Severe pain and nausea
5. Blurred vision,
6. Pupils are nonreactive to light and photophobia
70
What are the subjective parts of a nervous system assessment? List 6
1. Important health hx
2. Birth hx, TBI, stroke, degenerative disease
3. Medications
4. Surgery or other treatment
5. Growth and other developmental hx
6. Functional health patterns
71
Why is health information an important subjective data assessment of the nervous system?
1. Characteristic of present illness- helps determine if an emergency exists. If a patients demonstrating decreasing level of consciousness this clues us in to the urgency of the patients needs
2. Mode of onset and course of illness- Often the nature of a neurologic disease process can be described by these facts alone. Obtain all pertinent data in the history of the present illness, especially data related to the characteristics and progression of the symptoms.
72
Why is birth history, TBI, Stroke, and degenerative diseases important subjective data in an assessment of the nervous system.
1.The history may include birth injury (cerebral palsy as a consequence of hypoxia) and/or other neurologic insults, such as a traumatic brain injury, stroke or degenerative disease)
73
Why is medication history important subjective data in an assessment of the nervous system?
1. Give special attention to obtaining a careful medication history, especially the use of sedatives, opioids, tranquilizers, and mood elevating drugs. Many other drugs also can cause neurologic side effects. Ask the patient to describe the medication regimen to determine adherence to prescribed therapies
74
Why is surgery and other treatments important subjective data in an assessment of the nervous system?
1. Important to inquire about any surgery involving any part of the nervous system, such as the head, spine or sensory organs. If a patient had surgery, determine the date, cause, procedure, recovery and current status. Note any history of eye surgery to determine the relevance of abnormal pupil surgery.
75
Why is growth and other developmental history important subjective data in an assessment of the nervous system?
1. Can be important in determining if nervous system dysfunction was present at an early age. Specifically inquire about major developmental tasks such as walking and talking.
76
What are some objective data points that you will obtain during an assessment of the nervous system?
Physical examination
1. Mental status
2. Cranial nerve function
3. Motor function
4. Sensory function
5. Reflexes
77
True or false: Mental status gives a general impression of how the patient is functioning?
True
78
True or false: Assessment of the nervous system doesn't follow a logical sequence.
False- Follows logical sequence.
79
True or false: It is important to have constant comparison findings?
True
80
What are the different levels of consciousness and orientation?
1. Alert: awake and responsive
2. Lethargic: Sleepy but arousable
3. Stuporous: Arousable with difficulty
4. Comatose: Not arousable
81
When we are assessing appearance and behavior during a neuro assessment what are we asking or looking for?
1. How the patient is behaving?
2. How is the patients grooming
3. Asking the family if it normal or if it has changed
82
When we are assessing speech during a neuro assessment what are we asking or looking for?
1. How well can the patient express themselves
2. Is speech fluent/fragmented
3. Assess for dysarthria (difficulty articulating)
4. Assess for comprehension
83
When we are assessing constructional ability during a neuro assessment what are we asking or looking for?
1. Affects patients ability to perform simple tasks and use various objects.
84
When we are assessing cognitive function during a neuro assessment what are we asking or looking for?
1. Thought Content-Evaluating pts clarity and cohesiveness. Question hallucinations or delusions)
2. Abstract thinking- Done by asking the patient to interpret a common proverb.
3. Judgement- Ask what would person do if stopped by a police officer or what they would do in a burning building
4. Emotional status- how they feel about themselves and the future, look for signs of depression
85
What are the three areas of memory loss?
1. Long-term or remote memory- birth date, schools attended, city of birth, mother's maiden name.
2. Recall or recent memory- Accuray of medical history, health care providers seen within the past few days, mode of transportation to the hospital.
3. Immediate or new memory- Test by giving two or three words and asking the client to repeat the words to make sure they were heard. After about 5 minutes you ask the client to repeat the words.
86
What is the Glasgow Coma Scale?
It is a standardized tool used to assess a patient's neurological status. You rate the patient neuro function based on their ability to open their eyes, speak and move. Points are assigned as indicated on the scale to give an idea of the severity of any neurological deficits.
87
What should we know about Glasgow Coma scale?
1. Addresses 3 areas of neurological functioning
2. Overview of level of responsiveness
3. Evaluate neurological status of head injury patient
4. Evaluates motor, verbal, & eye opening
5. Each response awarded a number
6. Sum gives indication of severity of coma & prediction of possible outcome.
88
True or false: Level of consciousness. Even subtle changes indicate deterioration in neurologic status: Headache, restless, irritability, being usually quiet, slurred speech, change in orientation level.
True
89
When assessing sensory function what things are we assessing?
1. Pain- have pt close their eye and touch areas of the body with a sharp object and ask pt to report when and where they feel the sensation.
2. Light touch- Follow same instructions as above but use a wisp of cotton. Dont rub or sweep. Pts with peripheral neuropathy may exhibit signs of light touch but have lost their sense of pain.
3. Vibration- Use a tuning fork and apply it to bony prominence at the distal interphalangeal joint of the index finger or great toe. If they can't feel it keep moving upward along every bony prominence until it is felt.
4. Position- Have pt close their eyes while sitting, grasp sides of big toe, move toe up and down and ask pt what position it is in, do the same with upper extremities using the index finger. The pts vestibular and cerebellar functions must be intact to answer this.
5. Discrimination- Assess' the cerebral cortex's ability to interpret and integrate into., to test for stereognosis: ask the pt to close eyes and open hand, then place common object in hand (key) and ask pt to identify. To assess for graphesthesia: have pt keep eyes closes and in palm of hand draw number for pt to identify.
90
When assessing motor function what are things we are looking for with MUSCLE TONE?
1. Represents muscular resistance to passive stretching
2. ROM arm
3. ROM leg
4. Observe gait and motor activities
91
When assessing motor function what are things we are looking for with Cerebellar function?
1. Balance, coordination and gait: Should be able to sit and stand without support, then ask pt to walk across the room, turn around and walk back. Ask pt to walk heel to toe and observe balance.
2. Romberg's test- Ask pt to stand with eyes open, feet together and arms at his side, then ask to close eyes. Be sure to hold your arms out in case pt is unable to say on feet. It pt. sways, looses balance or falls, it is considered a positive Romberg's test.
3. Finger to nose test- Used to test extremity coordination, ask pt to touch his nose and then touch your outstretched finger as you move it faster and faster. It should be accurate and smooth.
4. Rapid alternating movement test- Pt movements should be accurate and smooth. Ask pt to touch the thumb to right index and move down the fingers, then ask pt to sit and place hands on thighs, tell him to turn them up and down gradually increasing speed.
92
What information does CSF analysis tell us?
1. Provides information about a variety of CNS diseases
93
What does normal CSF look like and what is in it?
1. Clear, Colorless, specific gravity- 1.007
94
True or false: CSF contains little protein?
True
95
CSF lab tests include:
1. Cell count
2. Culture
3. Glucose
4. Protein
5. Immunoglobulins
96
What should we know about a lumbar puncture (LP)?
1. Requires patient to be relaxed
2. Strict aseptic technique is mandatory by all personal
3. Contraindicated in client with increased ICP
4. Contraindicated in clients with skin infections at or near puncture site.
97
What should we have patients do prior to lumbar punctures (LP)?
Have a patient void and inform the patient that he or she may feel temporary, sharp pain or tingling, radiating down the leg as a sterile needle is passed between 2 lumbar vertebrae
98
What does post-op LP care look like?
1. Bed rest in flat position for 4-8 hours
2. Encourage fluids to facilitate CSF production.
3. Administer analgesics as ordered if headache occurs
4. Monitor neurologic sings.
5. Watch for signs of chemical or bacterial meningitis.
-fever, stiff neck, photophobia
99
When is a lumbar puncture contraindicated?
When a patient has increased intracranial pressure-- sudden release of CSF pressure an cause a sudden shift of cranial tissue known as uncal herniation which results in more brain damage.
100
What should we know about postoperative LP headaches?
1. Ranges from mild to severe
2. Lasts a few hours to several days
3. More severe when sit or stand
4. Caused by leakage of CSF at puncture site that continues to escape into tissues by way of needle tract from spinal canal.
5. Depletes CSF in cranium producing tension & stretching when assume upright position.
101
What radiology exams can be useful in the neuro world?
1. Skull and spine x-rays
2. Cerebral angiography
3. CT Scan
4. CT angiography
5. MRI
6. MRA
7. positron emission tomography (PET)
8. Myelogram
102
Which radiology exam measures metabolic activity of brain to assess cell death or damage? & what specific neuro patients would benefit?
PET- stroke, AD, seizure disorders, PD, & tumors
103
What are myelograms?
Xray of spinal cord and vetebral column with an injection of contrast into subarachnoid space
104
Which radiology procedure is used to detect lesions such as herniated or ruptured disc and spinal tumors?
1. Myelogram
105
What are the different types of Electrographic Studies?
1. electroencephalography (EEG)
2. Electromyography (EMG)
3. Electroneurography (nerve conduction studies)
4. Evoked potentials
106
An electroencephalography (EEG) evaluates what?
Seizure disorders, cerebral disease, brain injury and BRAIN DEATH,
107
What does an EEG do?
1. Electrical activity of brain recorded using scalp electrodes
108
EEG preparation includes?
1. Maybe sleep deprived on night before to increase chances of recording seizure activity
2. Tranquilizers & stimulants should be withheld 24-48 hours before test
3. Coffee, tea, chocolate, & cola drinks omitted in meal before test
4. Meal is NOT omitted because altered blood glucose level can change brain wave patterns
5. Remove all metal
6. Procedure takes 45-60 minutes
7. Assure patient test does not cause electric shock.
109
What electrographic study records the electrical activity associated with innervation of skeletal muscle?
EMG- Electromyography EMG
Needle electrodes inserted into muscle to record specific motor units
Activity may be altered in myopathic conditions (peripheral neuropathy)
110
What are nerve conduction studies?
Stimulating peripheral nerves at several points along its course * recording muscle action potential or sensory action potential
surface or needle electrodes placed on skin over nerve to stimulate nerve
Useful in study of peripheral nerve neuropathies
111
Which electrography study is useful in the study of peripheral nerve neuropathies?
Nerve conduction studies
112
What is evoked potentials?
1. Electrical activity associated with nerve conduction along sensory pathways
2. Recorded by electrodes on skin & scalp
3. Used to diagnose MS
113
Which electrography study is used to dx MS?
Evoked potentials
114
Carotid artery duplex scan
Transcranial doppler
Biopsies (neurologic pathology tests)
are examples of what rad exam?
1. Ultrasounds
115
What is a carotid artery duplex scan?
1. It is a noninvasive study that evaluates the degree of stenosis of carotid and vertebral arteries. It combines ultrasound and doppler technology. Increased blood flow velocity can indicate stenosis of vessel.
116
What are the non-modifiable risk factors of stroke?
1. Age- stroke doubles each decade after 55
2. Gender- More common in males
3. Ethnicity Race- Higher incidence in African Americans
4. Hereditary/family history
117
What are the modifiable risk factors of stroke?
1. Hypertension
2. Heart disease
3. Diabetes
4. Serum Cholesterol
5. Smoking
6. Drug/alcohol use
7. Obesity
8. Sleep apnea
9. Metabolic syndrome
10. Lack of physical activity
11. Poor diet
118
What are the types of strokes?
1. TIA
2. Ischemic
-Thrombotic
-Embolic
3. Hemorrhagic
-Intracerebral
- Subarachnoid
119
What is a TIA?
Transient episode of neurologic dysfunction and serves as a warning sign of further cerebrovascular disease
120
What is an Ischemic stroke?
Results from inadequate blood flow to brain from partial or complete blockage of an artery
121
What are the two types of ischemic stroke?
1. Thrombotic- Clot formation--> narrow lumen--> blocks passage
2. Embolic- Blood clot/debris circulating reaches an artery in brain to narrow to pass
122
What is a thrombotic ischemic stroke?
Occurs from injury to a blood vessel wall and formation of blood clot
results from thrombosis or narrowing of blood vessels.
It is the most common cause of strokes
123
Ischemic stroke is associated with ___ &___ because it can increase the risk of plaque build up?
1. HTN
2. DM
123
The extent of a stroke depends on the____?
1. Onset
2. Size of damaged area
3. Presence of collateral circulation
123
What is a Embolic Ischemic stroke?
Embolus dislodges and occludes a cerebral artery resulting in infarction & Edema
Mostly originates from the endocardial layer of the heart.
Afib, MI, Valve replacement, septum defects are may be factors
124
True or false: Prognosis of an embolic ischemic stroke is not related to amount of brain tissue deprived of blood supply?
1. False-- It is related to
124
True or false: Patient may remain conscious during an embolic ischemic stroke?
True
125
Do embolic ischemic strokes commonly reoccur?
Yes- unless you tx underlying causse
126
What is a hemorrhagic stroke?
Bleeding into the brain tissue, ventricles or subarachnoid space.
127
What are the causes of hemorrhagic stroke?
Causes can vary
1. HTN, aneurisms, IC neoplasm, AVM
128
What is recovery like after a hemorrhagic stroke?
Deficits are severe & recovery is long
129
What is an intracerebral hemorrhagic stroke?
1. Bleeding within brain caused by rupture of a vessel
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How fast are the onset of symptoms with a intracerebral hemorrhagic strokes?
Sudden onset with progression over mins to hours because of ongoing bleeding
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What is the most common cause of intracerebral hemorrhagic stroke?
Hypertension
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The extent of symptoms of intracerebral hemorrhagic stroke depends on what?
Amount, location and duration of bleeding
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What is a subarachnoid hemorrhagic stroke?
Intracranial bleeding into cerebrospinal fluid filled space between arachnoid and pia matter
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What commonly causes a subarachnoid hemorrhagic stroke?
Commonly caused by rupture of a cerebral aneurysm.
majority are in circle of willis
incidences increase with age; higher in women
Silent killer
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What are the warning s/s of a subarachnoid hemorrhagic stroke?
1. N/V
2. Seizures
3. Stiff Neck
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What are some complications of hemorrhagic stroke?
1. Neurologic and systemic compilations
2. Cerebral vasospasm- narrowing of the blood vessels which can result in cerebral infarction which leads to tissue death.
3. Hyponatremia
4. Myocardial ischemia and infarction ARDS
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What should you administer if a patient is experiencing a cerebral1 vasospasm?
1. Admin of calcium channel blocker, nimodipine
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What are the clinical manifestations of a stroke?
1. Motor deficits
2. Communication
3. Cognitive impairment
4. Psychological effects
5. Elimination
6. Spatial-perceptual alterations
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What kind of motor deficits might we see in a stroke patient?
1. Hemiplegia: paralysis in one side of the body
2. Hemiparesis: Weakness (partial) in half of the body
3. Ataxia: Lack of muscle control/voluntary muscle control
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What kind of communication deficits might we see in a stroke patient?
1. Dysarthria: disturbance in the muscle control of speech
2. Dysphasia: Difficulty breathing
3. Aphasia: Different kinds
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What are some cognitive impairments you might see in a stroke patient?
1. Memory loss
2. Decreased attention span
3. Poor reasoning
4. Altered judgement
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What are some psychological effects that you might see in a stroke patient?
1. Loss of self control
2. Depression
3. Emotional ability
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What are some elimination deficits you might see in a stroke patient?
1. Urinary/bowel incontinence
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What are some spatial-perceptual alterations you might see in a stroke patient?
1. Homonymous hemianopsia- like they are blind on one side
2. Loss of peripheral vision
3. Agnosia: inability to recognize objects by touch hearing and site
4. Apraxia: Difficulty w/skilled movements even when a person has the ability/desire to do so
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What is the most definitive test for diagnosis of stroke?
CT scan or MRI
- Indicate size and location of lesion
- Differentiate between ischemic and hemorrhagic stroke
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What are the other diagnostic studies you might see a patient have in relation to stroke?
1. CTA or MRI
2. Cerebral angiography
3. Digital subtraction angiography
4. Transcranial doppler ultrasonography
5. Carotid duplex scanning
6. Cardiac imaging, ECG, chest xray
7. CBC
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What is the medical management for ischemic stroke?
1. Thrombolytic therapy within 3 hours of s/s "TPA"
-Noncontrast CT of head
- Blood test for coagulation studies before administration of drugs
-Screening for hx of GI bleeding in the past 3 months or major surgery in the last 14
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What is the surgical management for strokes?
1. Carotid endarterectomy: Lesion is removed from carotid artery to improve blood flow (ischemic stroke)
2. Carotid stenting
3. Aneurysm clipping, coiling (hemorrhagic)
4. Resection of arteriovenous malformations (AVM)
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What are complications of the drug TPA for stroke?1
1. bleeding - contraindicated for GI bleeds, head trauma, surgery, recent stroke
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What are some preventative therapy suggestions for stroke patients?
Promotion for healthy lifestyle and medication management
1. Healthy diet
2. Weight control, regular exercise
3. No smoking, limiting alcohol
4. Bp management & other diseases
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What are some preventative drug therapy suggestions for stroke patients?
1. Warfarin for a fib
2. Antiplatelet: Clopidogrel, aspirin
3. Statins: cholesterol
4. Antihypetensives
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What are some acute nursing interventions for strokes?
1. Support resp system
2. Frequent neuro exams
3. Monitor cardiovascular system
4. Monitor MS system
5. Monitor for skin breakdown
6. Monitor for constipation
7. Promote normal bladder function
8. Be supportive w/communication efforts
9. Assess and monitor nutritional status
10.Initially arrange clients environment within perceptual field
11. Give client and family clear and understandable explanations regarding situation and procedure.
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What are some goals for stroke patients and their families?
1. Improvement of mobility
2. Avoidance of shoulder pain
3. Achievement of self care
4. Attainment of bladder control
5. Improved though process
6. Achievement of some form of communication
7. Maintenance of skin integrity
8. Restoration of family functioning
9. Absence of complications
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What side should you start with when attempting to help a stroke patient cloth?
1. Start with affected side
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What are some nursing dx for stroke patients?
1. Ineffective cerebral tissue perfusion
2. Decreased intracranial adaptive capacity
3. Risk for aspiration
4. Impaired physical mobility
5. Impaired swallowing
6. Impaired verbal communication
7. situational low self esteem
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