Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
58 Cards in this Set
- Front
- Back
|
CVA or Stroke
|
is a Brain Attack
occurs when ischemia or hemorrhage into the brain results in death of brain cells |
|
|
Safety measures for seizure patients
|
Wear helmet if risk for head injury
general health habits (diet, exercise) Assist to identify events or situations precipitating seizures, and avoid if possible Avoid excessive alcohol, fatigue, and loss of sleeo |
|
|
Emergency treatment for seizures 1st things
|
Maintain patent airway, support head, turn on side, lossen constrictive clothing, ease to floor,
|
|
|
Emergency treatment for seizures 2nd things
|
AFTER all saftey measures are met observe and record details of the event for treatment.
What events preceded it? When did it occur? How long did each phase (aural, ictal, postictal) last? What occurred during each phase? |
|
|
Side effects of phenytoin (Dilantin) and all anti-seizure meds
|
diplopia, drowsiness, ataxia, and mental slowing
Outside the CNS- Rashes (butterfly) hyperplasia of gingiva, blood dyscrasias, and effects on liver and kidneys |
|
|
Status epilepticus treate with
|
IV lorazepam (Ativan and diasepam (Valium)
-Must be followed with long-acting drugs |
|
|
Consideration for phenytoin (Dilantin)
|
may be problematic for older aduts with compromised liver function
|
|
|
Males are more likley
|
to develop epilepsy than women, higher incidence in those over 60
|
|
|
Strokes
|
Are the 3rd most common cause of death in the US
|
|
|
Cell eath with out oxygen
|
after 3-5 minutes
|
|
|
Nonmodifiable risk factors for strokes
|
Age
Gender Race Heredity/family history |
|
|
Modifiable Risk Factors
|
Hypertension
Metabolic syndrome Heart disease Heavy Alcohol use Poor Diet Drug abuse Sleep apnea Obesity Physical inactivity Smoking |
|
|
Acute care of thrombotic, embolic, and hemorrhagic patients
|
ABC's, Call stroke code, remove dentures, perform O2 sat, maintian adequate O2, Establish IV access with NS, Maintain BP with stroke guidlines, remove clothing, obtain CT scan and baseline labs, Position head midline, Elevate head of bed 30 degrees, watch for seizures, keep pt NPO
|
|
|
BP is commonly elevated after a stroke and only needs treatment if
|
arterial pressure greater than 130 or systolic pressure greater than 220
|
|
|
Hemorrhagic stroke
|
caused by Hypertension, clotting issues, a bleed with anticoagulants, trama, anuerisms
|
|
|
Hemorrhagic stroke S and Sx
|
Neurologic deficits
HEADACHE Nausea Decreased LOC Hypertenstion |
|
|
Subarachnoid Hemorrhagic Stroke (Aneurysms) S adn Sx
|
Discribed as the worse headache of ones life is a symptom of a ruptured aneurysm
|
|
|
Ischemic Strokes
Thrombotic or Embolic |
Inadequate blood flow to the brain from partial or complete occlusion of an artery
80% of all strokes |
|
|
TIA's (Transient ischemic attack)
|
is a transient episode of neurologic dysfunction caused by focal brain, spinal cord, retinal ischemia, but lasts less than 1 hour without brain involvement
|
|
|
TIA's affecting the carotid S and Sx
|
Temporary loos of vision in one eye, a transient hemiparesis, numbness of loss of sensation, or sudden inability to sleep
|
|
|
TIA's with vertebrobasilar system s and sx
|
tinnitus, vertiga, darkened or blurred vision, diplopia, ptosis, dysarthria, dysphagia, ataxia, and unilateral or bilateral numbness
|
|
|
Risk for TIA's
|
They are a warning sign of progressive cerebrovascular disease
|
|
|
Treatment for TIA's
|
Pt should still go to hospital, 1/3 of TIA's progress to full strokes. Most resolve and do not reoccur, pt teaching would be needed
|
|
|
Thrombotic stroke
|
occurs in relation to injury to a blood cessel wall and formation of a blood clot, most common cause of stroke
|
|
|
Thrombotic stoke S and Sx
|
They do not have decreased LOC for the 1st 24 hours
Symptoms develop slowly, 30%-50% of cases happen after a TIA, often during or after sleep symptoms start |
|
|
Embolic stroke
|
occus when an emblous lodges in and occludes a cerebral artery, 2nd most common cause of stroke
|
|
|
Embolic Stroke S and Sx
|
Onset is usually sudden, pt is usually conscious but has headache.
|
|
|
Thrombotic Stoke Risk Factors
|
2/3's of these are associated with Hypertension & diabetes mellitus which accelerate atherosclerosis
|
|
|
Embolic Stroke Risk Factors
|
Affect any age group, Rheumatic heart disease is a cause in yound to middle aged adults
Embolus is more common in older adults |
|
|
Left Brain Stroke
|
Paralyxed right side hemiplegia
Impaired speech/language aphasia, right/left discrimination, slow performace, cautious, aware of deficits, depression, anxiety, impaired comprehension r/t languague, math |
|
|
Right-brain Stroke
|
Paralyzed left side: hemiplegia, left-sided neglect, spatial-perceptual deficits, tends to deny or minimize problems, rapid performance, short attention span, impulsive, safety problems, impaired judgement and time concepts
|
|
|
Diagnostic Studies for a stroke
|
CT scan is the primary diagnostic test, do a Non contrast CT first to avoid causing further damage,
|
|
|
Anticoagulants
|
are used in pts with atrial fib at risk for stroke (usually has a hx of TIA's)
|
|
|
Carotid endarterectomy
|
the atheromatous lesion is removed from the carotid artery to improve blood flow. Used in prevention of TIAs
|
|
|
tPA or Recombinant tissue plasminogen activator
|
used to reestablish blood flow through a blocked artery to prevent cell death in patients with acute onset of ischemic stoke syptoms
must give within 3-4.5 hours of onest of clinical signs of ischemic stroke |
|
|
Lacunar Strokes
|
are from occlusion of a small penetrationg artery with development of a cavity in the place of the infarcted brain tissue
Usually no symptoms |
|
|
Left sided strokes
|
result in memory problems r/t languauge
|
|
|
Right sided strokes
|
tend to be more impulsive and the pt mores quickly, forgetting deficits
|
|
|
Most obvious effect of strokes include impairment of
|
Mobility
Respiratory function Swallowing and Speech Gag reflex Self-care abilites inital period of flaccidity Spasticity of the mucles after flaccidity |
|
|
Motor deficits post stroke
|
Loss of skilled voluntary movement
Impairment of integration or movments Alterations in muscle tone Alterations in reflexes |
|
|
Aspirin and anticoagulants
|
may be used with in 24-48 hours after a stroke in pts with a thrombus and embolus stroke
NOT indicated in a hemorrhagic stroke |
|
|
Aphasia communication (the total loss of comprehension and use of language)
|
decrease stimuli
treat pt as adult present on idea at a time simple yes or no questions do not interrupt them encourage them to show you what they need do not preted to understand the person speak with normal volume and tone give time for info to be processed allow body contact do not push if the pt is tired or upset |
|
|
1st oral feeding after storke
|
BE CAUTIOUS
Check of gag reflex before feeding (may be impared due to dysphagia) Sit in high fowlers of ina chair when eating teach chin tuck to assist in swallowing |
|
|
Once pt is stable and rehab plan is being initiated
|
obtain current illnes with attention to inital symptoms
Hx of similar symptoms previously current meds hx of risk factors and family hx or stroke or cardiovascular disease |
|
|
To reduce the incidence of stroke
|
focus on pt teaching toward stroke prevention
risk factors hypertenstion control early symptoms of TIA or stroke when to seek health care |
|
|
Hemonymous hemianopsia (blindness in the same half of each visual field)
|
Initially arrange the food tray so all food is in the correct visual field
Later teach the pt to compansate by SCANNING the neglected side |
|
|
Nursing managment Cardiovascular system
|
Adjust fluid intake PRN
monitor lung sounds for crackles and rhonchi (pulmonary congestions from fluid overload) heart sounds for murmurs or S3 or S4 heat sounds |
|
|
Stroke risks for DVTs
|
At risk for deep vein thrombosis r/t immobility, loss of venous tone and decreased pumping in leg, keep the pt moving!
|
|
|
Rehab at home assessment
|
1) rehab potential of the pt
2) physical status of all body systems 3) presence of complications by the stroke or other chronic conditions 4) cognitive status of pt 5)family resources and support 6) expectations fo the pt and family r/t rehab program |
|
|
Musculoskeletal system rehab post stroke
|
ROM in acute phase, special attention to weak side
trochanter roll at hip to prevent external rotation Hand cones to prevent contractures arm supports with slings and lab boards to preven shoulder displacement do not pull arm high top tennis shoes to prevent foot drop |
|
|
Integumentary system rehab post stroke
|
Pressure relief by postition changes, special mattresses, or wheelchair cushions
early mobility position pt on weak side for only 30 minutes |
|
|
Gastrointestinal system rehab post stroke
|
place on stool softeners to prevent constipation
promote physical activity for bowel function |
|
|
Urinary system rehab post stroke
|
Poor bladder control in the acute phase, avoid catheters
|
|
|
Coping for family
|
Family needs carful detailed explanation of what has happened to the pt
refer to social services to help |
|
|
Flaccid muscles several weeks after a stroke
|
prognosis for regaining function is poor
Focus on preventing additional losses most pts show signs of spasticity within 48 hours of a stroke Some show loss of postural stability and walking apraixa, prop with pillows PRN |
|
|
Consideration for stroke on right side of brain
|
Diffuculty judging postion, distance, and movement
impulsive, impatient and denying problems r/t stroke |
|
|
Consideration for stroke on left side of brain
|
slower in organization and performance of tasks
impaited spatial discrimination fearful anxious response to stroke respond well to non-verbal cues |
|
|
Interventions of atypical emotional response
|
distract the pt
explain that emotional outbursts my occur maitain a calm enviroment avoid shaming or scolding patient |
