Int Med Surg- Stroke/neuro

Front 1

What are assessments of neuro system?

Back 1

Mental status
Cranial nerves
Swallow
sensory
motor
cerebellar
reflex

Front 2

How to check mental status?

Back 2

Ask questions.

LOC, Orientation
Memory
Attention span
Language
Cognition

Front 3

How to check Swallow?

Back 3

Watch them talk

Front 4

How to check Sensory?

Back 4

Can they feel you touching their feet?

Front 5

How to check motor?

Back 5

wiggle toes, lift legs, push pull with feet

Front 6

How to check Cerebellar?

Back 6

balance

Front 7

What is used as a rapid neuro assessment?

Back 7

Glasgow Coma Scale- uses a point system to quickly assess pt neuro status

Front 8

What does the Glasgow Coma Scale consist of?

Back 8

Eye opening (spontaneous, to sound, to pain, never)
Motor response (obeys commands, localizes pain, abnormal flexion, etc.)
Verbal response (oriented, inappropriate words, etc)

Front 9

Why do we need to constantly assess our pts neuro status?

Back 9

we need to constantly assess and monitor pts because we can prevent further complications by using early recognition

Front 10

Serious & severe neurologic problems cause varying degrees of ...

Back 10

impaired mobility, sensation, and cognition
They may even cause death

Front 11

Cerebrovascular Disorders (CBVD)

Back 11

Functional abnormality of the CNS that occurs when the blood supply is disrupted

Front 12

CBVD are a group of diseases that affect...

Back 12

circulation to brain

Front 13

Most common types of CBVD are:
(4)

Back 13

Transient ischemic attack (TIA)
Stroke
Subarachnoid hemorrhage
Vascular dementia

Front 14

Stroke is also called..

Back 14

a brain attack

Front 15

______ is the primary cerebrovascular disorder and the 3rd leading cause of death in the U.S.

Back 15

Stroke

Front 16

Why does the brain need a constant supply of oxygen and glucose?

Back 16

The brain is unable to store oxygen or glucose and must receive a constant flow of blood to function.

Front 17

A change in the normal blood supply to the brain.

Back 17

stroke

Front 18

What is the #1 risk factor for a stroke?

Back 18

High Blood pressure- can cause a clot to break free

Front 19

How can A. Fib lead to a stroke?

Back 19

A. fib- top of heart quivers, increases change of blood to pool and stagnate in atrium, and clots can form- then can throw a clot

Front 20

How can DM lead to a stroke?

Back 20

affects the blood vessels, decreases elasticity of vessels,

Front 21

Ho can cholesterol lead to stroke?

Back 21

High cholesterol- can cause clots

Front 22

How can increasing age lead to stroke?

Back 22

Increasing age (esp. after 55)- lifetime of accumulation of plaque that can break off into clots

Front 23

Why are african-american & hispanics are more likely to die of stroke?

Back 23

Diet, HTN, DM, Don’t respond to treatment the same way

Front 24

Other risk factors for clots

Back 24

Heart disease, poor peripheral blood flow
Unhealthy lifestyles
Birth Control

Front 25

Warning signs of stroke

Back 25

Sudden severe headache with no known cause.
Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body.
Sudden confusion, or trouble speaking or understanding.
Sudden trouble seeing in one or both eyes.
Sudden trouble walking, dizziness, or loss of balance or coordination.

Front 26

Is a stroke an emergency?

Back 26

Yes!!!! The sooner treatment happens the better the outcomes

Front 27

What are the two types of strokes?

Back 27

Ischemic and Hemorrhagic

Front 28

What is the most common type of stroke?

Back 28

Ischemic

Front 29

What are the two types of ischemic strokes?

Back 29

Thrombotic stroke
and
Embolic stroke

Front 30

Thrombotic stroke

Back 30

caused by a clot and are associated with atherosclerosis. The onset is slow and gradual, LDL accumulates until the vessel becomes occluded, the tissues beyond the clot become ischemic.

Front 31

Embolic stroke

Back 31

caused by embolus which is usually caused by heart issues like A fib on a mechanical heart valve. Onset is Sudden. There is a rapid decline in neuro status such as, slurred speech, expressive aphasia, paralysis and ↓ LOC (level of consciousness). Embolic strokes can easily lead to hemorrhagic stroke d/t bleeding in the brain.

Front 32

Hemorrhagic stroke

Back 32

bleeding within or around the brain, it usually occurs during activity and results from HTN, rupture of Arteriovenous Malformation (AVM), or amphetamine abuse. There is rapid decrease in neuro status and deep stupor or coma.

Front 33

When do ischemic strokes usually occur?

Back 33

During sleep, or early in the morning

Front 34

What is the artery usually involved when having an ischemic stroke?

Back 34

MIDDLE CEREBRAL ARTERY MCA

Front 35

Causes of ischemic stroke

Back 35

occlusion of cerebral artery either by thrombus or embolus

Front 36

Causes of Hemorrhagic stroke

Back 36

In this type of stroke, tissue integrity is interrupted and bleeding occurs into the brain tissue or into the surrounding brain (ventricular, subarachnoid, or subdural).

Front 37

Complications from stroke?

Back 37

Increased intracranial pressure (ICP): the patient is most at risk for ICP resulting from edema during the first 72hrs after onset of stroke.

Front 38

S/S of increased intracranial pressure (ICP)?

Back 38

decreased LOC, behavior changes, headache, Nausea, vomiting, change in speech pattern, aphasia, slurred speech, pupillary changes (dilated, nonreactive, or constricted), severe HTN, widening pulse pressure, Bradycardia, ataxia, seizures, cushings triad. Note: LOC changes will depend on extent of ICP

Front 39

What med helps decrease intracranial pressure?

Back 39

Mannitol

Front 40

elevate bed to what degree to reduce intracranial pressure?

Back 40

HOB elevated but no more than 30° ( (will promote venous drainage and decrease intracranial pressure)

Front 41

What positioning is contraindicated for cases of intracranial pressure?

Back 41

No hip flexion: this will push more blood up to the brain from the lower extremities

Front 42

If brain aneurysm suspected what room precautions can we have?

Back 42

Relieve sensory deprecation and anxiety.
Keep sensory stimulation to minimum for aneurysm precautions

Front 43

What safety precautions are necessary for stroke patients?

Back 43

Seizure precautions

Front 44

What labs diagnose stroke?

Back 44

No definitive lab test to Dx a stroke. Some lab values can clue you in the right direction, such as bleeding times; however, prior to Lab tests a thorough assessment must be made.

Front 45

What is neglect syndrome?

Back 45

particularly common with strokes in the right cerebral hemisphere. The patient is unaware of the existence of his/her paralyzed side. Will groom the functioning side but totally ignore the affected side of the body

Front 46

What are the major concerns for stroke patients? (long list)

Back 46

Seizure
Communication
neglect syndrome
Feeding/swallowing
psychosocial/depression
fall risk
bowel/bladder training
etc

Front 47

What is Brocca's?

Back 47

Expressive aphasia-damage to the Broca’s area of the frontal lobe. It’s a motor speech problem in which the patient generally understands what is said but cannot communicate verbally. He/she also has difficulty writing but may be able to write.

Front 48

What is Wernicke's?

Back 48

Understanding/Receptive aphasia- injury involving the Wernicke’s area in the temporoparietal area. Patient cannot understand the spoken and often the written word. Although he/she may be able to talk, the language is often meaningless. Neologism (make up of words)

Front 49

Ways to improve communication for stroke patients

Back 49

Simple one step commands
Flashcards/computer/communication board
avoid yes no questions

Front 50

What is a TIA?

Back 50

Transient Ischemic Attack (TIA)- Temporary neurologic deficit resulting from a temporary impairment of blood flow

Front 51

How long do TIAs last?

Back 51

Symptoms Lasts a few minutes But are always < 24 hrs.

Front 52

Why is it important to pay attention to TIAs?

Back 52

“Warning of an impending stroke”
Multiple TIAs increase risk of major stroke

Front 53

Why do TIA pts need diagnostic workup?

Back 53

required to treat and prevent irreversible deficits and to prevent stroke and permanent damage

Front 54

What is the 2nd most common cause of stroke?

Back 54

hemorrhagic strokes

Front 55

When do hemorrhagic strokes usually occur?

Back 55

During activity

Front 56

What do hemorrhagic strokes result from?

Back 56

- Ruptured aneurysm
- Rupture of an AVM-
- Severe HTN
- Amphetamine abuse

Front 57

What is an AVM?

Back 57

happens during embryonic development, a thin mass of vessels- like spaghetti- that can easily rupture, a rise in BP can cause this

Front 58

Do hemorrhagic strokes gradually come on?

Back 58

No, They occur suddenly (for the most part unless they are due to HTN)

Front 59

What does it look like when a person suffers a hemorrhagic stroke?

Back 59

Pts may go into a deep stupor or coma, and seizures can occur

Front 60

Hemiplegia

Back 60

Half sided paralysis

Front 61

Apraxia

Back 61

Inability to carry out purposeful movement

Front 62

Hemiparesis

Back 62

half sided weakness

Front 63

Dysarthria

Back 63

slurred speach

Front 64

Hemianopsia

Back 64

Half of field of vision of ONE eye is lost

Front 65

Agnosia

Back 65

cannot recognize objects- usually due to a loss of sensation

Front 66

expressive aphasia

Back 66

(Broca’s area)

Front 67

receptive aphasia

Back 67

(Wernicke’s area)

Front 68

Which hemisphere is the dominant one?

Back 68

Left Side- language, words

Front 69

How quickly must a pt be evaluated if a stroke is suspected?

Back 69

10 minutes!

Front 70

What must be evaluated when stroke suspected?

Back 70

Cognitive, motor, & sensory changes
cranial nerve assessment
CV assessment

Front 71

Cranial nerves mnemonic

Back 71

Oh, Oh, Oh, To Touch A Female's Vagina Gives Vinny A Hard-on

Front 72

Cranial nerve V

Back 72

trigeminal- facial

Front 73

Cranial nerve VII

Back 73

facial, expressions, smiling

Front 74

Cranial nerve IX, X

Back 74

glossopharynegeal, vagus

Front 75

Cranial nerve XII

Back 75

hypoglossal

Front 76

Cranial Nerve 2,4,6

Back 76

eye movement- cardinal signs

Front 77

What to assess before any lab work is done on a stroke patient?

Back 77

Assess LOC!!

Front 78

The amount of change in LOC is going to depend on the extent of ______ ________

Back 78

intercranial pressure

Front 79

What type of tests are used to find out the cause of a stroke?

Back 79

Angiogram of head
carotid duplex
CT
MRI
MRA
Doppler
ECG

Front 80

What is a carotid duplex, and what will it tell us?

Back 80

Is an ultrasound of the carotids and will show if the neck arteries have narrowed

Front 81

What type of CT for stroke pts and what will it tell us?

Back 81

non contrast- identify ischemic or hemorrhagic cause- will show wether there is a bleed or not

Front 82

What will an MRI tell us about stroke pt?

Back 82

more useful after a stroke in order to show any edema or necrosis

Front 83

What is an MRA and what does it tell us for a stroke pt?

Back 83

Magnetic resonance angiography (MRA)- Shows vessel structure looking for abnormal vessels in the brain

Front 84

When is an ECG done for stroke pt?

Back 84

measures cardiac output, done if stroke is caused by blood clot, and shows irregular HB such as A fiv and how ventricles are doing

Front 85

Why do we need to closely monitor BP for stroke pts?

Back 85

high BP more increase risk of stroke

Front 86

Why check PT, INR, PTT for stroke pts?

Back 86

is there is any bleeding we want to see what bleeding times are

Front 87

Why are stroke pts on EKG?

Back 87

Holter monitor, cardiac enzymes- to see if there is an issue with the heart that i causing a clot

Front 88

What tool do we use to assess stroke patient's neurological status?

Back 88

NIHSS (National Institute of Health Stroke Scale )

Front 89

To repeat for the 50th time, what do we continuously monitor with stroke pts?

Back 89

Carefully monitor intracranial pressure!!!
Continue to assess LOC and neuro status!
Monitor BP!

Front 90

What to do to help intracranial pressure?

Back 90

Mannitol- helps to decrease intracranial pressure
HOB up- more more than 30 decrees
No hip flexion- pushes more blood up to increase intracranial pressure
Maintain BP- do not want it to get any higher
Frequent neuro assessments- Keep assessing LOC!!!

Front 91

What sensory stimulation to modify for stroke pts?

Back 91

Keep sensory stimulation to a minimum for aneurysm precautions

Front 92

Carotid Endarterectomy

Back 92

Procedure will help remove plaque from the carotid artery, will open artery enough to reestablish blood flow to go through, and will then decrease risk of stroke

Front 93

Post-Op Endarterectomy

Back 93

Maintain BP (too high may cause hemorrhage)
Neuro checks (CNVII, X, XI, XII)
Gag reflex (CN IX)
Assess for difficulty swallowing, hoarseness
Monitor labs

Front 94

FAST

Back 94

Face
Arms and Legs
Speech/smile
Time

Front 95

ataxia

Back 95

gait disturbance

Front 96

neoglism

Back 96

make up of words

Front 97

Agnosia

Back 97

loss of ability to recognize or use objects correctly

Front 98

Apraxia

Back 98

Loss of ability to perform purposeful movements.
Example: a person may be unable to shave, dress, of perform other once familiar and purposeful tasks