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229 Cards in this Set
- Front
- Back
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Meningitis
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Inflammation of brain and spinal cord.
Bacterial or viral |
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Bacterial Meningitis
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Spread by direct contact with discharge from infected persons respiratory tract.
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Viral Meningitis
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"Aseptic meningitis"
More common, rarely serious Fluelike s/s - recovery in 1-2 weeks |
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Meningitis
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Infection usually starts in upper resp tract, enters blood, invades CNS, causing meninges to become inflammed and IICP.
Vessel occlusion may occur and necrosis of brain Cranial nerve function may be damaged |
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Meningitis Prevention
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Hib vaccines are given right after born
S. pneumoniae vaccine given after 2 years old and recommended for 65 years or older |
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Meningitis S/S
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Most common= HA, caused by tension on blood vessels and irritation of the pain sensitive dura mater.
High fever, stiff neck, photophobia, petechiae on skin and mucous mem., N&V from IICP, Nuchal rigidity, positive kernigs and Brudzinskis signs, encephalopathy Late S/S= lethargy, seizures |
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Nuchal Rigidity
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Pain and stiffness when neck is moved, caused by extensor muscles of the neck
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Kernigs sign
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Flex hip to 90 degrees and try to extend knee
Pain and spasm of hamstring= positive |
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Brudzinskis sign
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Positive when flexion of neck causes hips and knees to flex
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Encephalopathy
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Short attention span, poor memory, disorientation, difficulty following commands, misinterperet environmental stimuli
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Complications of Meningitis
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Blindness or deaf r/t cranial nerve damage
Memory impairement and learning disabilities |
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DX test for Meningitis
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Lumbar puncture
Viral Meningitis= Clear CSF with normal glucose levels and increased WBCs Bacterial Meningitis= Turbid or cloudy CSF r/t massive amounts of WBCs -----Gram stain and culture and sensitivity to determine best antibiotic |
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Interventions for Meningitis
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Antibiotics for bacterial
Acetaminophen for fever, cooling blanket Don't cool too much b/c will raise metabolic demands for oxygen and glucose Analgesics for head/neck pain Corticosteroids/Antiinflam to decrease swelling Antiemetics for nausea Meningococcal meningitis= isolation Keep pt from harming themselves |
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Meningitis Possible Nursing DX
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Hyperthermia r/t meningitis
Risk for injury r/t positive culture in CSF Acute pain r/t nuchal rigidity |
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Encephalitis
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Inflammation of brain tissue
Nerve cell damage, edema, necrosis cause neurological findings localized to specific areas of brain affected Hemorrhage may occur in certain types of encephalitis IICP may cause herniation of brain |
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Causes of Encephalitis
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Viruses (most common)
West nile Mono or mumps carried to brain Parasites, toxic substances, bacteria, vaccines, fungi Herpes simplex most common noninsectborne |
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S/S of Encephalitis
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HA, fever, N&V, malaise, nuchal rigidity, confusion, decreased LOC, seizures, sensitivity to light, ataxia (lack of muscle coordination), abnormal sleep patterns, tremors, hemiparesis (weakness on oneside of body)
Pt comatose before treatment=70-80 percent mortality rate 72 hours when edema is worse= most likely to die |
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Pts w/ Herpes Encephalitis
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Develop edema and necrosis commonly in temporal lobes
Cerebral edema causes IICP and can lead to herniation of brain |
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Complications of Encephalitis
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Cognitive disabilities, personality changes, ongoing seizures, motor deficits, blindness
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DX test for encephalitis
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CT scan, MRI, lumbar puncture to obtain CSF, EEG.
CSF= Increased WBCs and protein levels, normal glucose. Breakdown of blood after cerebral hemorrhage results in yellow colored CSF |
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Interventions for Encephalitis
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No specific treatments
Anticonvulsants, antipyretics, analgesics, to reduce seizures, fever, and HA Corticosteroids to decrease inflammation Sedatives for irritability Antiviral (Zovirax) for herpes simplex |
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Increase Intracranial Pressure (IICP)
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Normal ICP= 0-15 mm Hg
Fluctuates w/ posture, arterial pulsations, increases in intrathoracic pressures (cough, sneeze) Common causes= brain trauma, intracranial hemorrhage, brain tumors |
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Skill has 3 compartments
Brain, Blood, CSF |
If one increases and the others dont compensate, IICP will result
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Methods of compensation for IICP
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CSF can shunt to subarachnoid space.
Hyperventialtion may trigger constriction of cerebral vessels, decreasing blood in cranium Temorary and not very effective with severe or sudden IICP |
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S/S of IICP
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Restlessness, irritability, decreased LOC b/c cerebral cortex function is impaired.
If not intubated, pt may hyperventilate trying to compensate. As pressure increases oculomotor nerve may be compressed, pupils wont dilate or react |
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Increasing ICP can cause pupils to
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become dilated and fixated
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VS changes are a __________ ________ of IICP
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late sign
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Cushings response from IICP
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Bradycardia, bradypnea, aterial HTN (increasing systolic bp while diastolic stays same) resulting in wide pulse pressure
Late sign of IICP, interventions may not work |
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Monitoring IICP
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Cath in ventricle of brain into cerebral parenchyma, or in subdural or subarachnoid space
-----Require anesthetizing and burr hole drilled in skull |
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Monitoring IICP
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Placement into later ventricles is called external ventricular drainage
---Allows drainage and pressure monitoring ---Disadvantage: Difficult locating ventricle, clotting of blood in cath. |
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Monitoring IICP
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Subarachnoid bolt can be put into place and helps with ease of placement
---Disadvantage: Occlusion of sensory portion of the bolt with brain tissue and inability to drain CSF |
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Monitoring IICP
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Intraparenchymal monitor placed directly into brain tissue
---Most accurately reflects situation w/i skull ---Can't drain CSF and can be occluded by brain tissue |
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Patients with ICP monitors are cared for in
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ICU and are often mechanically ventilated
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Nursing Process for Pt with Infectious or Inflammatory Neurological Disorder
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Neuro Assessment
Pupil response, LOC, VS monitored for IICP, headache measured on pain scale, Glasgow coma scale |
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Pain (headache & nuchal rigidity) r/t IICP
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Use 0-10 pain scale
Pt may not be able to communicate pain Analgesics ordered (not codeine) ---Codeine masks neuro changes Dark, quiet room, avoid extra stimuli |
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S/S of IICP
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Vomiting, HA, dilated pupil on affected side, hemiparesis, decorticate then decerebrate posturing, decreased LOC, increasing systolic BP, increase then decreasing pulse rate, rising temp
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Interventions to Prevent IICP
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Keep HOB 30 degrees to decrease ICP
Keep head midline, flexion may cause obstruction of blood flow Admin antiemetic/antitussives as ordered Admin stool softeneres to prevent straining Minimize suctioning b/c increases ICP Avoid hip flexion, intra abd and throacic pressure increase ICP Prevent environmental stimuli that may start startle pt Space cares to provide rest |
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Headaches
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Symptom of neurological disorders
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Tension or Muscle Contraction Headaches
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Contraction of scalp and facial, cervical and upper thoracic muscles can cause tension HAs
May be related to premenstrual syndrome or anxiety, emotional distress, or depression Radiation of pain to crown of head and base of skull Symptom management with massage, rest, heat, analgesics, counseling |
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Migraine HAs
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Caused by vasoconstriction followed with vasodilation
Vasocontriction may be caused by trigger of trigeminal nerve which is stimulated by release of substance P, a pain transmitter Migraines may be hereditary Throbbing, boring, viselike, pounding Usually one sided Triggers: food, noise, bright light, alcohol, stress |
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Two types of Migraines
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Classic migraine and common migraine
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Classic Migraine
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Has preheadache (prodromal) phase, visual disturbances, difficulty speaking, numb, tingling, N&V
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Common Migraine
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No preheadache phase, sudden onset of throbbing headache
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Treatment of Migraine
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Prophylactic for pts getting 1 or more per week
Nifedipine (CCB), Beta Blockers control BP, help prevent vascular changes Amitriptyline (tricyclic antidepressant) |
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Treatment of Acute Migraine
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Ergot (cafergot) vasocontrictor, take 30-60 minutes before HA
Imtrex, Zomig |
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Cluster HA's
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Vascular disturbances, stress, anxiety, emotional distress are some causes
Alcohol may worsen Start at same time of day typically Throbbing, excruciating Unilateral Usually eyes, nose, forehead (bloodshot teary eye) They are short and hard to treat NSAIDS or trycyclic antidepressants |
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Seizures/Epilepsy
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Sudden abnormal electrical discharges from the brain that can change motor or autonomic function, consciousness, or sensation
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Partial Seizures
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Begin on one side of cerebral hemishpere
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Cause of Seizures/Epilepsy
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Idiopathic, brain injury, anoxic events
Most common at 20 years old |
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S/S of Seizures/Epilepsy
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Some get an aura before seizure occurs
May be visual distortion, noxious odor, unusual sound |
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Partial Seizures
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Repetitive, purposeless behaviors called automatisms (classic s/s)
Pts are in a dreamlike state, picking at clothes, chewing, smacking lips, spitting Lasts less than 1 min Start in parietal lobe may cause paresthesias on side of body opposite from seizure focus Visual disturbances if occipital lob is originating site Movements start at arm and hands and may spread |
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Simple Seizure
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Pt doesnt lose conciousness
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Complexe partial seizure or Psychomotor Seizure
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Pt loses conciousness
May last 2-15 minutes |
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Generalized Seizures
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Affects entire brain
Two Types: Absence and tonic clonic |
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Absence Seizures
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Petit Mal
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Tonic Clonic
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Grand Mal
Tonic phase= 30-60 seconds, pt falls, pupils dilates and fixed, hands and jaw clenched, may temporarily stop breathing Clonic phase= Contracting and wild muscle movements, pt may be incontinent and bite lip |
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Postictal Period
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Recovery after seizure
Few minutes of disorientation Pt may sleep and wakeup w/ HA, confusion, fatigue |
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DX for Seizures
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EEG- determines where it starts and duration. Shows presence of asymptomatic seizures.
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Treat Seizures
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Anticonvulsants- Dilantin, Luminal, Tegretol, Depakote, Neurontin, Topax
Can cause gingival hyperplasia, drowsiness |
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Emergency care of Seizure
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Prevent injury
Padded side rails Don't restain once seizure starts After seizure assess pt for breathing and suction if necessary CPR if indicated |
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Status Epilepticus
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30 minu or more of seizure activity w/o return to conciousness
Medical Emergency, reduce neuro damage Usually caused by abruptly stopping anticonvulsants Seizure increases brains needs for glucose and oxygen May need intubated Treat: IV valium or Ativan may cause resp distress IV Penobarbital if still seizing M |
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Interventions for Seizures
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Call light in reach, assist with ambulating, keep suction and oral airway at bedside
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During Seizure Intervention
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Stay with pt, don't restrain, protect from injury, loosen tight clothes, turn to side, suction if needed, monitor VS
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Traumatic Brain Injury (TBI)
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Trauma can result from hemorrhage, contusion, laceration in brain, and damage of cellular level.
May be compounded by cerebral edema, hyperemia, or hydrocephalus |
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Cause of TBI
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Motor vehicle accidents are largest cause
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Closed Head Injury or Nonpenetrating Injury
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From rapid back/forth movements causing bruising and tearing of brain tissue and vessels but skulls intact
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Open head injury or Penetrating
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Break in skull
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Acceleration Injury
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Moving object hits stationary head
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Deceleration Injury
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Head in motion hits something stationary
Seen in pts who trip and fall |
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Acceleration/Deceleration Injury
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Stationary head gets hit with moving object then hits stationary object
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Rotating Injury
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Car gets hit on side (T-Boned)
Twists brainstem damaging reticular activating system losing conciousness |
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Concussion
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Mild brain injury
Loss of consciousness 5 mins or less HA, dizziness, N&V Amnesia before or after event No skull or dura injury |
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Contusion
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Bruising of brain or brain tissue, possibly with hemorrhage
Severe contusion can = diffuse axonal injury DAI Brainstem contusion affects LOC ---Transient or permanent Resps, pupil reaction, eye movement, motor response may be affected Autonomic nervous system may be affected by edema causing rapid heart rate, resp rate, fever, diaphoresis |
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Subdural Hematoma
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Acute= S/s show w/i 24hrs
Blood accumilates b/w dura and arachnoid membrane 24% of pts who get sever brain injury develop acute subdural hematoma Pt may have one sided paralysis of extraoccular movement, weak extremities, dilated pupil Alcoholics and older adults more susceptible ---Atrophy of brain is common ---Stretches veins b/w brain and dura |
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Chronic Subdural Hematoma
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Forgetful, lethargic, irritable, complains of HA,
If increases in size, pt may get hemiparesis and pupillary changes May not connect with injury and delay seeking medical help |
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Epidural Hematoma
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10% of sever brain injury pts get epudural hematoma
Collection of blood b/w dura mater and skull Usually associated with skull fracture Arterial bleed causes it to increase in size fast |
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S/S of Epidural Hematoma
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Pt loses conciousness after injury or coherint for short amount of time, dilated pupils, paralyzed extraocular muscles on side of hematoma, seizures or hemiparesis may occur
Once S/S show, deterioration may be rapid If IICP not controlled, pt will die |
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DX test for Hematomas
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CT scan faster than MRI
MRI can show how much tissue is damaged |
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Interventions for Brain Injuries
Medical Management |
Pt may be partially or completely dependant for maintainence of resps, nutrition, elimination, movement, skin integrity
Monitor ICP If ICP stays elivated then use osmotic dieuretic (IV Mannitol) May have reboudn once Mannitol DCed High dose barbiturate to enduce coma to decrease metabolic needs of brain |
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Complications of Traumatic Brain Injury
Brain Herniation |
Displacement of brain tissue out of normal position
Places pressure on brainstem Usually results in death |
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Diabetes Insupidus
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Edema may cause pressure on posterior pit or hypothalmus causing excess release of ADH
Fluid replacement and vasopressin to treat |
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Acute Hydrocephalus
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Edema in skull can interfere with CSF circulation causing hydrocephalus
Treat with ventricle drain followed by ventriculoperitoneal shunt |
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Labile Vital Signs
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Trauma to brainstem causes changes in BP, heart rhythm, resp pattern
Treatment aimed at control of ICP |
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Posttraumatic Syndrome
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Pts who have concussion may have HA, fatigue, difficulty concentration, depression, memory impairment that interferes with school work and relationships
Establish need for cognitive rehab 3-12 months to resolve |
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Cognitive and Personality Changes
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May have short term memory impairement
Problems remembering spouse |
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Nursing Process for Pt with TBI
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Monitor ICP
Assess Neuro frequently |
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Possible Nursing Dx for TBI
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Distrubed thought process r/t edema or IICP
Self care deficit r/t IICP Pain r/t cerebral edema |
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Brain Tumors
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Growth of brain or meninges
Rarely metastasize, if it does it goes to spine Compress brain 10-20% are secondary from malignancy in body ---Cause IICP which can cause death |
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Intra-axial tumors
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Arise from glial cells
Infiltrate and invade brain tissue |
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Extra-axial Tumors
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Arise from skull or meninges, pit gland, or cranial nerves
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S/S of Brain Tumor
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R/t location and rate of growth
Seizures, motor and sensory deficits, HA, visual disturbances. If pit gland involved= abnormal growth or fluid volume changes |
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Meningiomas
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Arising from meninges
Slow growing Get large before S/S appear |
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Glioblastomas or Metastic Tumors
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May cause seizures or hemiparesis
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Other types of Brain Tumors
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Oligodendroglioma, astrocytoma, acoustic neuroma
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DX test for Brain Tumors
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MRI gives clearest image of tumors
Usually get CT first because its cheaper Angiogram if tumor is highly vascular or close to major blood vessels If tumor by pit gland=hormones checked |
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Interventions for Brain Tumor
Medical Treatment |
Surgery to remove as much as they can
Control s/s Seizure pts put on anticonvulsants If edema or HA, steroid (Decadron) Typically dont need narcotics |
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Radiation Therapy for Brain Tumors
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5 Days a week for 6 weeks
Hyperfractionated schedule= twice daily for 3 wks |
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Brachytherapy
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Radiation directly to tumor
Small cath implanted in tumor and radioactive particles inserted Not used in confused pts who cant comply with restrictions |
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Stereotactic Radiosurgery
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Radiation sent to tummor from diff. angles
Metal frame affixed to pts skull, tumor visualized w/i framework on CT or MRI |
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Chemotherapy
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BBB protects brain
To penetrate BBB, need lots of chemo Can distrupt BBB with Mannitol |
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Acute and Long Term Complications of Brain Tumor
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Hard to determine S/S of tumor from S/S from treatment
Seizures, HA, memory impairement, cognitive changes, ataxia s/s of tumor or surgery or radiation therapy Once pt is comatose, death occurs in days especially if not mechanically ventilated or IV hydration |
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Intracranial Surgery
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To remove hematomas, tumors, arteriovenous malformations, contused brain tissue, elevation of depressed skull fracture, debriding wound, resection of feizure focus
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Craniotomy
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Sugical opening of skull
Burr hole is an opening into cranium w/ drill |
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Craniectomy
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Removal of part of the cranial bone
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Cranioplasty
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Repair of bone or use of presthesis to replace bone following surgery
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Debulking
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Removal of all visible tumor
Usually done under general anesthesia |
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Preop Care for Intracranial Surgery
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Baseline neuro assess
Proccess and surgery explained by surgeon 2 hr for biopsy 12 hours or more for intricate procedures Pts hair will be shaved on head Eyes will be swollen and possibly bruised after |
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Postop Nusing Care for Intracranial Surgery
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Neuro Checks
Report changes CT scan 24 hours post Position HOB 30 degrees Seizure precautions |
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Spinal Disorders
Herniated Disks |
Pain, paresthesias that follow a nerve path pattern
Disk b/w two vertebrae herniates Annulus fibrosus (tough outer ring of disk) tears Displacement of disk compresses nerve roots |
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Cause of Herniated Disks
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Fall, lifting heavy objects, motor vehicle accidents
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S/S of Herniated Disk
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Pain and muscle spasm in neck
Decreased ROM secondary to pain Hand/arm pain=unilateral Numbness/tingling in extremity Asymmetrical weakness and atrophy of specific muscle groups If entire extremity involved= not herniated disk |
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Thoracic Herniated Disks
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Are uncommon
Least mobile part Complaints of pain in back Muscle weakness uncommon |
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Herniated Lumbar Disk
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Lower back pain, pain radiating down one leg, paresthesia, weakness, may limp on affected leg, limited ROM, knee or ankle reflex may be decreased or absent
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Severely herniated L5-S1 disk
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Affect bowel or bladder continence
EMERGENCY |
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DX tests for Herniated Disks
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MRI will detect
Myelogram if MRI cant be done |
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Interventions for Herniated Disks
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Bed rest 1-2 days
Phys therapy to strengthen muscles Heat, ice, deep massage to help ROM Proper body mechanics TENS unit to decrease pain Traction to pull vertebrae and correct position Muscle relaxers (Diazepam) NSAIDS Epidural Injection if pt doesnt want surgery ---Every 3-4 months |
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Laminectomy
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Removes laminae to relieve pressure or pain
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Diskectomy
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Removes entire disk
For herniated cervial disk Use anterior approach b/c muscles are smaller than in back of neck |
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Spinal Fusion
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Bone graft to fuse two vertebrae together if area unstable
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Surgery through microscope
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For less scarring and faster recovery
Discharged in 24 hrs |
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Posterior Approach
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For herniated lumbar disks
1-2 inch incision |
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Percutaneous diskectomy
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Large needle removes herniated material
Not used for severely herniated disks |
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Complications after Surgery
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Hemorrhage
Nerve Root Damage- may lose sensory or motor function Reherniation- lumbar disks may reherniate Herniation of another disk- b/c stress put on it |
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Preop Care for Herniated Disk Surgery
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Teach Logroll
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Postop Care for Herniated Disk Surgery
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Monitor extremities, CSF drainage and bleeding
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Spinal Stenosis
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When spinal canal compresses cord
Arthritis is major cause May cause hyperreflexia and weakness of leg and arm Laminectomy done to relieve pressure on spinal cord |
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Spinal Cord Injuries
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Greatest in young ppl
Decrease of loss of sensory/motor function below injury Caused by bruising/tearing/cutting/edema/bleeding into cord from external forces or fragments of fractured bone |
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Complete Spinal Cord Injury
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No sensory or motor function below injury
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Incomplete Lesion
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Some function remains
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Cervical and Lumbar Vertebrae
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Usually hurt in Spinal cord injuries b/c most mobile
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S/S of Cervical Injuries
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Affect all 4 extremities, paralysis, paresthesias, impaired resps, loss of bowel and bladder control
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Quadriplegia
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Paralysis of all 4 extremities
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Quadriparesis
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Weakness of all 4 extremities
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Injury above c3
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Usually fatal b/c resp muscles involved
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Injury @ C4 or C5
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May require resp ventilation
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Thoracic and Lumbar Injuries
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Affects legs, bowel, bladder
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Paraplegia
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Paralysis of legs
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Paraparesis
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Weakness of legs
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Spinal Shock
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Below injury, cord stops functioning completely.
Disruption of sympathetic nervous system resulting in vasodilation, hypotension, bradycardia ---Vasodilation allows more bloodflow just under skin ---Blood cools and is circulated through body causing hypothermia ---Avoid overheating Reflexes below injury lost and urine and feces retention occurs Can last a week or more |
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Complications of Spinal Cord Injuries
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Infection, DVT, Orthostatic Hypotension, Skin breakdown, renal complications, depression and substance abuse, autonomic dysreflexia
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Autonomic Dysreflexia
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Life threatening complication
Occurs in pts with injury above T6 ---Impaires equilibrium b/w sympathetic and parasympathetic Most common cause= bladder distention Other causes= bowel impaction, UTI, ingrown toenails, pressure ulcers, pain, labor |
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DX Tests for Spinal Cord Injuries
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Radiographs done to identify fractures or displacement of vertebrae
CT for identifying fractures MRI to demonstrate lesions w/i cord |
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Phrenic Nerve Stimulator
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Causes diaphragm to move, use mechanical ventilator at night
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GI Management with SCI
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Absence of bowel sounds common
Feeds held till BS return If position or paralytic ileius prevents oral feeding, IV nutrition ordered |
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GU Management with SCI
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Foley cath to prevent bladder distension
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Immobilization/Skeletal Traction
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Crutchfield or Gardner-Wells tongs
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Immobilization/Halo Brace
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Attaches to skull with 4 pins
Advantage: Not confined to bed |
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Neurodegenerative
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Term can apply to nervous system disorder that causes degeneration or wasting of neurons in the nervous system
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Dementia
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Symptom
Lose ability to solve problems and maintain emotional control may have personality changes May patients with mild cognitive impairement (MCI) likely to develop Alzeheimers than those without |
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Cause of Dementia
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Mini strokes common cause
Chronic Alcoholism, neuro infections, head injuries, meds Less intellectual stimulation can cause Alzheimers |
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S/S of Dementia
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Memory lapse
Remembers childhood Disoriented, wanders |
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DX Test for Dementia
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Early DX essential because it can be MCI can be reversed
Neuropsych testing done to determine degree of memory personality and behavior changes Mini-mental state exam commonly used |
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Meds That Cause Disturbed Thought Process
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Anticholinergics-atropine, antihistamines
Analgesics- meperidine, morphine Cimetidine- tagamet CNS depressants- sleeping pills, tranquilizers, alcohol Steroids- cortizone, prednizone |
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Interventions for Dementia
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Meds may delay some types
Maintain Pt safety |
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Delirium
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Mental disturbance that temporary
MEDICAL EMERGENCY Response to some meds Rapid or gradual onset Can be result of pain, oxygen deficiency, urinary caths, fluid/electrolyte imbalance, change in environment, nutritional deficiency |
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Parkinsons Disease
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Chronic degenerative movement disorder arising in basal ganglia in cerebrum
Usually in 4th or 5th decade of life Worse with aging Tremors, changes in posture and gait, rigigity, slow movements 1% over 65 DX |
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Substantia Nigra
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Group of cells within basal ganglia deep within brain.
Responsible for production of dopamine. Parkinsons is destruction of substantia nigra resulting in decreased dopamine production |
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Parkinsons
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Patient has access acetylcholine
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S/S of Parkinsons
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Muscle rigidity, bradykinesia, akinesia, changes in posture, tremors
Extensor muscles more affected than flexor muscles causing a stooped posture Flexion of hips knees and neck shift center of gravity forward Tremors begin in hands and progress to feet Tremors worst at rest Masklike expression, drooling |
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Complications of Parkinsons
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Mobility/Balance
Falls, constipation, impaired swallowing |
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DX Tests for Parkinsons
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History/Physical
MRI to ruse out other causes of S/S |
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Interventions for Parkinsons
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No cure
Levadopa Pts receiving max dose have "drug holidays" |
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Surgical Treatment for Parkinsons
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Pallidotomy for rigidity, tremor, and bradykinesia
Destructive lesion placed on basal ganglia one side at a time, pt awake for procedure |
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Nursing DX for Parkinsons
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Impaired physical mobility
Self Care Deficit Risk for injury |
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Huntingtons Disease
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Progressive, hereditary, degenerative, incurable neuro disorder
Inhereted from parents 50/50 chance Degeneration of corpus striatum, caudate nucleus Loss of normal movements and intellect |
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S/S of Huntingtons Disease
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Develop slowly
Cognitive s/s before movement s/s Personality changes, altering mood, paranoia, violent as dementia worsens, incontinent and need complete care, dancelike movements, start in arms face and neck, hesitant speech, eye blinking, irregular trunk movements, abnormal head tilting, gait it wide, dysphagia, aspiration is main cause of death |
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Lifespan for Huntingtons after DX
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10-20years
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Interventions for Huntingtons
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Antipsychotics, antidepressants, antichoreic
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Alzheimers Disease
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AKA: DAT (Dementia of Alzheimers)
Loss of mental function that interferes with memory, ability to think, and learn, and ability to function Chromosome 21 associated with Alzheimers and Downs Syndrome Abnormality w/i protein of cell membrane of neuron Affects hippocampus then temporal lobe and memory impairment becomes severe The younger the person at onset, the faster it spreads |
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3 Stages of Alzheimers
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1st stage- 2-4years, increased forgetfulness, needs lists and reminders, relationships diminished, work performance deteriorates
2nd stage- 2-12 years, difficulty doing simple calculations or answering questions, depression, sleep cycle disturbed, not oriented, hallucinations/seizures 3rd stage- complete dependancy, wanders, incontinent |
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DX Tests for Alzheimers
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MRI shows tangles / plaque
PET and SPECT show brain activity |
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Meds and Treatments for Alzheimers
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Aricept or Exelon inhibit breakdown of acetylcholine.
NMDA antidepressants, antipsychotics, antianxiety |
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Cerebrovascular Disorders
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Vessels are unable to supply blood and oxygen to brain cells and tissue, causing stroke, brain tissue dies
TIA and SAH most common |
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Transient Ischemia Attack TIA
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Temporary impairement of cerebral circulation causing neuro impairment <24 hrs
S/S similar to stroke Pt has complete recovery |
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Reversible Ischemic Neuro Deficits (RINDS)
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Symptoms last longer than 24 hours but dont cause permanent damage
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Cerebral Vascular Accident (CVA) or Stroke
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Symptoms dont reverse b/c area of brain is permanently damaged
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24-29% of pts who have TIA have
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Stroke within 5 years
Highest risk 1 month after TIA TIA treated like stroke |
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Cerebrovascular Accident (CVA)
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Death of brain tissue caused by disruption of blood flow to brain.
Pt doesnt return to baseline function 3rd biggest killer High risk in pregnant women and 6 wks following delivery Duration determines transient or permanent Stroke caused by ischemia or hemorrhage CT or MRI needed to DX stroke whether it is due to ischemia or hemorrhage |
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Penumbra
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Area of brain tissue surrounding damage, which may be revived if brain is reperfused quickly.
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Ischemic Stroke
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Caused by embolism or thrombosis that result in decreased perfusion
Carotid artery most common location Arteries narrowed b.c plaque Emboli in brain may be arterial or cardiac in orgin |
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Cardiac Sources for Embolism
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SA disorder, recent MI, subacute bacterial endocarditis, cardiac tumors, valve disorders
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Most strokes of cardiac orgin occurs
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first week after AMI
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Stroke happens due to
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Decreased perfusion with severe stenosis of carotid or basilary arteries
-Small distal vessels are affected first "watershed infarction" |
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Decreased perfusion may result from
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Vasculitis or inflammed cerebral blood vessels
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Common causes of Ischemic Stroke
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Lupus, bacterial or tuberculous meningitis, fungal infection, herpes zoster artheritis
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Hemorrhagic Stroke
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Caused by rupture of cerebral blood vessel
Beyond ruture, brain doesnt get blood/oxygen and dies Most common cause= Poorly controlled HTN or ruptured aneurysm Tend to occur deep within tissue |
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Subarachnoid hemorrhage (SAH)
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Caused by rupture of blood vessels on surface of brain
-Slowest rate of recovery -Most common cause in young= drug use |
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Risk Factors for Ischemic Stroke
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Nonmodifiable= Age race gender sex hereditary
Modifiable= Increased BP, cessation of smoking |
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Warning signs of Hemorrhagic Stroke
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Sudden numbness or weakness of face arm leg especially one sided.
Sudden confusion, trouble speaking and understanding, trouble walking, dizziness, loss of balance, sudden HA with no known cause |
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Acute S/S of Hemorrhagic Stroke
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Visual disturbances, language disturbance, weakness or paralysis on one side, dysphagia
-Same for ischemic and hemorrhagic Rapid deterioration, drowsiness, severe HA |
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Language Disturbance
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Associated with TIA and stroke
Trouble writing |
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Aphasia
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Absence of language
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Dysphagia
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Difficulty with speech
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Global aphagia
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Both expressive and receptive aphasia present
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Dysarthria
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Slurred indistinct speech
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Motor Disturbances
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Side of body opposite to damaged area
Whole side can become flaccid |
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Visual Disturbances
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Loss of vision in part or one eye
Eye involved on same side as diseased artery |
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Horizontal
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Top or bottom
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Bitemporal
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Outside half
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Homonymous
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Same side half
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Hemianopsia or Quadrantic
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One quarter visual loss
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DX Tests
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CPSS, CT scan immediately, ECG to see if A fib present, CBC, PT, INR, NIH stroke scale, carotid doppler to determine if stenosis of carotid artery exists
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CPSS 3 findings for ischemic stroke
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1) Pt smile, look for asymmetry
2) Have pt hold out both arms and close eyes, watch to see if one arm decends 3) Have pt repeat sentence All 3= 85% One= 72% |
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t-PA (thrombolytic)
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Used for stroke (not hemorrhagic-will worsen)
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Plasmin
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Enzyme that breaks down thrombi
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Thrombolytics work by
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converting plasminogen to plasmin
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Can only give t-PA
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3 hours after stroke
If patient older than 18 NIH stroke scale score of 4 or greater |
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Interventions for Stroke
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Don't lower BP more than 10% of baseline at one time
Pt may need antiseizure to prevent spasms of veins CCB to reduce vasospasms Start on aspirin regimen Watch for aspiration with decreased LOC |
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Carotid Stenosis Surgical Management
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70% carotid endarterectomy
Plaque removed |
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Preventing Stroke
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Keeping HTN, CHO levels, DM controlled, smoking cessation, prevent clots
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Long Term S/E of Stroke
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Arm may be weaker than leg or vice versa
Sensation changes Infarction on dominant side= speech problems Aphasia-expressive, receptive or global |
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Emotional Lability
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Crying to smiling
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Impaired Judgement
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Safety risks
Frontal lobe involved= social behavior lost May undress in public...etc Dont punish |
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Unilateral Neglect
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Seen in pts with R hemisphere infarction
Pt wont pay attention to L side of body |
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Homonymous Hemianopsia
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Neglect of one side of meal tray or side of body
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Other long term effects of stroke
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Pneumonia, DVT, PE, pressure ulcers, malnutrition, depression
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Cerebral Aneurysm and Subarachnoid Hemorrhage
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Weakness in wall of cerebral artery
Aneursym ruptures= subarachnoid hemorrhage Can cause same s/s of brain tumor 80% of cerebral aneurysms occur in circle of Willis Most common=bifurcation of artery ---Causes outpouching |
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S/S of Cerebral Aneurysm and Subarachnoid Hemorrhage
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Small hemorrhage before DX of subarachnoid hem.
Causes HA, vomitting, disorientation, flulike s/s Ruptured aneurysm=severe HA Sensitivity to light Decreased LOC Serizures Blood causes menigeal irritation Affects CN 3 and 6 Enlarged pupils, abnormal gaze |
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DX Tests
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CT for location of hem
Cerebral angiogram |
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Interventions for Cerebral Aneurysm and Subarachnoid Hem
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Arterial line and central venous pressure monitoring cath
Increased BP= risk for rupture Decreased BP= ischemia Systolic kept 120-160 |
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If Aneurysm has neck (berry aneurysm)
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Clamped with metal clip
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Aneurysm without neck
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Sterile plastic, muslin wrap
Provides stable walls |
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Nonsurgical Management for Cerebral Aneurysm and Subarachnoid Hem
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Metallic coil or fibrin glue to occlude aneurysm
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Complications of Cerebral Aneurysm and Subarachnoid Hem
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Rebleeding, hydrocephalus, vasospasm, rehab
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Nursing Assessment for Cerebral Aneurysm and Subarachnoid Hem
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Watch for s/s of decreased cerebral tissue perfusion
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Diplopia
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Double sight
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Nursing DX Cerebral Aneurysm and Subarachnoid Hem
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Impaired physical mobility
Imbalanced nutrition Disturbed sensory perception |
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Feeding pts with swallowing disorders
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Eat slowly, avoid distractions, dont talk while eating, sit up straight, use teaspoon, half teaspoon at a time, swallow completely b/w bites and sips
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Nursing interventions with pts with swallowing disorders
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Remove loose dentures, position head correctly, place food on unaffected side, consult with dietitian about thickening liquids
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