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NURS 3512 acute & chronic > Week 11 Intracranial Regulation Meningitis, TIA, Stroke > Flashcards

Week 11 Intracranial Regulation Meningitis, TIA, Stroke Flashcards

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1
Q

how does bacterial meningitis enter the body?

A
  1. Bloodstream
  2. Respiratory tract
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2
Q

Bacterial meningitis is a medical emergency. How quickly do we need to treat it to avoid mortality?

A

Within 24 hours

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3
Q

What is viral meningitis caused by?

A

enterovirus
aboviruses
HIV
Mumps
Chickenpox

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4
Q

Which meningitis is typically more severe, bacterial or viral?

A

Bacterial

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5
Q

Which meningitis has long term residual effects as opposed to full recovery, bacterial or viral?

A

Bacterial

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6
Q

What are some key features of meningitis?

A
  1. *petechial rash (meningococcal)
  2. Severe headache
  3. *Nuchal rigidity (stiff neck)
  4. *positive Kernig’s sign (knee extension = head/neck pain)
  5. *positive brudinski sign (flex neck, knees follow)
  6. photophobia
  7. N&V
  8. decreased LOC
  9. coma
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7
Q

What type of PPE precautions does meningitis require?

A

droplet precautions
-gown
- mask
- eye protection
- gloves

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8
Q

What is the goal of care in meningitis?

A

prevent increased ICP

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9
Q

What is the treatment for bacterial meningitis?

A

Antibiotics immediately (even before diagnosis confirmed)

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10
Q

How many hours is someone with bacterial meningitis on transmission precautions?

A

48 hours after antibiotics started

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11
Q

besides antibiotics what other medications do we give someone with bacterial meningitis?

A
  1. Steroids (dexamethasone) IV
  2. Anytipyretics (fever)
  3. Anticonvulsants
  4. Pain meds- hydromorph PO
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12
Q

What type of environment is needed for bacterial meningitis patients?

A

Safe- padded siderails
low lighting
low stimuli
Calm environment

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13
Q

what test confirms meningitis diagnosis ONLY?

A

Lumbar puncture analysis of CSF

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14
Q

What diagnostics are helpful but not THE confirming diagnostic test?

A
  1. Blood cultures
  2. CT scan
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15
Q

What are the 2 types of strokes?

A
  1. Ischemic
  2. Hemorrhagic
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16
Q

what are the 2 types of ischemic stroke?

A

Thrombotic stroke
Embolic stroke

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17
Q

What is a TIA?

A

Transient Ischemic Attack
- Brief interruption of blood flow, easy/often ignored or missed

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18
Q

What is a TIA a warning of?

A

thrombotic or embolic stroke

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19
Q

What 4 things can stroke affect?

A

Visual
mobility
sensory
speech

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20
Q

How often does TIA usually resolve?

A

30-60 min

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21
Q

How long can a TIA last?

A

24 hrs

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22
Q

What is the ABCD risk assessment for stroke?

A

A-Age - >60
B-BP >140/90
C-Clinical TIA features (one sided weakness)
D-Duration of symptoms - the longer the greater the risk

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23
Q

What is the other stroke risk assessment we can use besides ABCD?

A

NIHSS score
The National Institutes of Health Stroke Scale
-Assess how much impairment there is and plan post acute care

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24
Q

What’s the number one way to prevent ischemic stroke post TIA?

A

manage the risk factors

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25
What are the risk factors for Stroke?
HTN DM Cardiac problems Sleep apnea high cholesterol
26
What can some one do to avoid a stroke?
1. Healthy diet 2. Exercise 3. smoking cessation 4. control BP 5. limit alcohol 6. no street drugs that increase stroke risk
27
What medications are given post TIA to prevent ischemic stroke?
-Platelet inhibiters: ASA (Aspirin), clopidogrel (Plavix) -Anticoagulants for A-Fib: riveroxaban (Xarelto) -HTN- Antihypertensives (CCBs, Ace Inhibitors ,Diuretics) -Statins lovastatin (Mevacor)
28
What are 2 surgical interventions post TIA?
-Transluminal angioplasty (intervention) -Carotid endarterectomy (preventative surgery)
29
What is one surgery used to prevent stroke and what does it do?
Carotid Artery Angioplasty with Stenting - Transluminal Angioplasty Catheter is inserted via femoral artery Balloon is threaded via a catheter to the blocked artery and is inflated Stent is deployed and keeps the artery opened Filter also put in to catch debris
30
What is another prevention surgery used to prevent stroke and what does it do?
Carotid Endarterectomy - Tube is inserted above and below the blockage to reroute bloodflow -Arthlerosclerotic plaque in the common carotid artery is removed -Once the artery is stitched closed the tube can be removed
31
What vital are we concerned with for carotid endarterectomy and why?
BP need it lower so it doesn't blow the incision but high enough because the arteries aren't used to the blood flow
32
What do we monitor for after carotid artery angioplasty with stenting?
neuro changes d/t bleeding
33
How many hours can someone get treatment from onset of stroke symptoms?
within 6 hours
33
If someone is 6-24 hours past stroke symptoms, who determines if treatment is possible?
Stroke specialist
34
What diagnostic tool do we use to determine ischemic stroke and amount of damage?
CT scan
35
What are the 4 safety things we should assess post stroke?
1. swallowing (NPO till assessed by SLP) 2. Mobility deficits 3. paralysis, neglect, impulsiveness 4. Communication
36
What is the max time that tPA can be given after symptom onset?
4.5 hrs
37
How soon should tPA be given?
within 30-60 min from door to needle time
38
How often do we monitor VS and neuro status during the 1 hour infusion?
Q15 min
39
How often to we monitor VS after the tPA infusion?
Q15 for 1hr Q 30 for 6 hrs Q 1 for 24 hrs
40
What BP do we need to maintain when someone is getting tpA?
<185/110
41
What do we watch for when someone is on tPA?
bleeding - no tube insertions, no IM injections
42
If someone is on tPA infusion and they have serious bleeding, N&V, severe headache or severe high BP what should the nurse do?
Stop the infusion Call the Dr. ASAP
43
What are the 2 acute treatments for ischemic stroke?
1. tPA 2. Endovascular interventions
44
What are the 3 endovascular interventions ?
1. intra-arterial thrombolysis with tPA 2. Mechanical embolectomy - surgical blood clot removal 3. Carotid artery angioplasty with stent placement
45
What are the 2 goals of drug therapy for ischemic stroke and embolic stroke?
1. prevention 2. protect brain from hypoxia
46
What drugs are used to prevent ischemic stroke?
-antiplatelet - ASA - Clopidogrel (plavix)
47
what drugs are used to prevent Embolic stroke?
Anticoags - Warfarin (coumadin) - Heparin - low molecular weight heparin DOACs - Rivaroxaban (Xarelto) - Apixaban (Eliquis)
48
What is the treatment for Hemorrhagic stroke?
-Repair bleeding vessel and remove blood, treat for IICP, -If on anticoags reversal drugs (Vit K, Plasma, clotting factors)
49
What is intracerebral hemorrhage?
-Bleeding in brain caused by ruptured vessel -Extent of symptoms vary depending on extent of bleed and location (INSIDE the brain- not near the skull)
50
What is subarachnoid hemorrhage (SAH)?
Bleeding into the cerebrospinal fluid in the subarachnoid space (just under the skull area)
51
What is the most common cause of subarachnoid Hemorrhage?
Aneurysm
52
What is a classic symptom of hemorrhagic stroke?
worst headache ever
53
what is a classic symptoms more often seen in ischemic stroke?
face paralysis / droop speech issues one sided limb paralysis
54
Which type of stroke has stiff neck similar to meningitis?
hemorrhagic stroke
55
Seizures are common in what type of stroke?
hemorrhagic stroke
56
What is the treatment for Subarachnoid Hemorrhage ?
-Repair aneurysm, treat for IICP -External Ventricular Drain (EVD) (Drains CSF and blood) -Prevent Vasospasm
57
Why do we want to prevent vasospasm during a subarachnoid hemorrhage?
to prevent brain damage! HUGE RISK for vasospasm
58
Why do we need to drain blood and CSF with subarachnoid hemorrhage?
b/c blood in the subarachnoid area irritates it and CSF may not absorb properly.
59
Why is vasospasm with subarachnoid hemorrhage so bad?
b/c vasospasm slows blood flow to the area & causes ischemia = brain damage
60
When does vasospasm usually occur post bleed/stroke?
4-14 days after
61
What medication do we give to treat & prevent vasospasm?
Calcium channel blocker - Nimodipine
62
How often do we give Nimodipine?
q 4h sometimes up to 21 days
63
What does Nimodipine do?
relaxes smooth muscles of vessel wall
64
Why do we want to maintain homeostasis of fluids and electrolytes in vasospasm ?
-we want good BP to "push through" spasming vessel

NURS 3512 acute & chronic (29 decks)

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