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120 Cards in this Set

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Most common type of stroke. Results from an embolus or thrombotic event - causes necrosis and infarction of involved area. Cerebral edema results and can lead to ICP.
Ischemic CVA
Bleeding into intracranial cavity or directly into brain parenchyma. Uncontrolled HTN can be the cause. subarachnoid bleed. S/SX: photophobia, nuchal rigidity, kernig's sign, brudinski's sign.
Hemorrhagic Stroke
can't passively extend knee with hip flexed 90 degrees from supine position-leg pain and spasm.
Kernig's sign
Flexion of hips and knees when head and neck are passively flexed onto chest.
Brudzinski's sign
Left hemiparesis, spatial perceptual defects, behavior impulsive, memory deficits, indifference to disability.
Right Brain damage
Right hemiparesis, speech and language deficits, behavior is slow and cautious, distress and depression related to disability.
Left brain damage
receptive aphasia
Temporal lobe comprehension deficit
left frontal lobe, cant exress oneself.
expressive aphasia
wrong words, word substitution, grammatical errors.
Paraphrasia
Blindness in one half of the field of vision in one or both eyes, results from a stroke / CVA.
Hemianopsia
Three categories: Simple, Complex, and secondary.
Partial seizures
No loss of consciousness
Simple partial seizure
AKA psychomotor, no loss of consciousness
Complex partial seizure
Partial seizure from either simple or complex progressing into a generalized seizure with tonic/clonic.
Generalized seizure
Seizure which includes loss of consciosness, involves both sides of the brain and is classified as clonic- tonic, tonic, clonic and atonic.
Generalized seizures
AKA grand-mal, may have an aura
Tonic/Clonic
sustained increase in muscle tone, generalized stiffening of all extremities.
Tonic
Sustained rhythmic contraction and relaxation of skeletal muscles. Seizure.
Clonic
Seizure, spontaneous loss of postural control for a few seconds with no loss of consciousness.
Atonic
Seizure. Involuntary muscle jerking of extremities, usually symmetrical.
Myoclonic
Seizure AKA Petit Mal. More common in children, brief and frequent staring episodes.
Abscence seizures
Intervention for seizures
Place pt. in a lateral position, Seizure precautions on a pt. in a hospital setting... airway nearby, padded bedrails and no restraints*** medication compliance is very important w/seizure meds.
Stages of a seizure...
Preictal, ictal and post-ictal
before seizure with an aura sometimes
Pre-Ictal
During seizure
Ictal
After a seizure, usually very tired and difficult to arouse.
Post-Ictal
Weakness of an extremity following a seizure
Todd's Paralysis
No recovery between seizures. Can be caused by drug withdrawal or inadequate drug levels. Establish an airway, place pt on side, monitor V.S and O2 bloodwork.
Staticus Epilepticus***
Characterized by voluntary muscle weakness and fatigability with activity, affects muscles of face, tongue, neck, throat, but can affect any muscle group. May become irreversible (muscle fiber degeneration). If respiratory muscle is affected, it may become life-threatening. *** acetylcholine deficit is involved*, presents with difficulty chewing, swallowing, sleepy-mask like expression, drooping jaw and ptosis. Short rest periods help restore function, sx worse during stress, menses, prolonged exposure to sunlight and cold.
Myasthenia Gravis**
Diagnosed with a Tensilon test-- IV injection of endrophonium or neostigmine temporarily improves muscle function.
Myasthenia gravis**
Both of these are life threatening. The first one is caused by insufficient meds., second by too much meds., Tensilon differentiates (if improves, crisis is myasthenic). Cholinergic is treated with Atropine**
Myasthenic Crisis or Cholinergic Crisis**
Treated with anticholinesterase drugs, neostigmine and pyridostigmine. Drugs are less effective as the disease progresses, steroids sometimes help.
Myasthenia Gravis
hereditary chorea (dance like movements,rapid and often violent and purposeless), progressive mental deterioration ending in dementai. late stages:emaciation and exhaustion**
Huntington's Chorea
Acute widespread inflammation or demyelinization of ascending nerves in the peripheral system, cause is unknown, onset is usually within a few weeks of mild viral infection, surgical procedure, or vaccination. Self limiting illness.**
Guillian Barre
Chronic, progressive demyelination of nerve fibers in the brain. peripheral nervous ssytem is not affected. Remissions and exacerbations.**
Multiple Sclerosis
Bacterial or viral inflammation of arachnoid and pia layers of the meninges, bacterial is most severe, presents with fever, HA, confusion, lethargy, mild to combative behavior, sizures, petechial rash, kernig's sign, nuchal rigidity and brudzinski's signs.
Meningitis
How long should a pt. with Meningitis be isolated for?
the first 24 hours
What would labs look like in Meningitis?
CSF protein count over 50. *** WBC elevated with a decreased glucose***
treatment done for Meningitis:
Treted with an antibiotic, manage ICP, neural assessments, quiet environment.
Progressive muscle rigidity, akinesia(loss of muscle movements), involuntary tremors, deteriorates for about ten years, then dies of aspiration or infection, cause is unknown. Disease of teh extrapyramidial system (responsible for influencing initiation, modulation, and completion of a movement)--
parkinson's Disease
Dopamine Deficiency in the basal ganglia***
parkinson's Disease
What should be done post Lumbar Puncture?bandage over needle site, bed rest for 1 hour post, push fluids, monitor for leakage.
Lumbar Puncture
Done by a radiologist, contrast material into spinal canal with a syringe allows radiologist to see spinal columns and surrounding tissue. NPO after midnight except clear fluids. Takes 1 hour with 4-6 hours of post observation time.
Myelogram
after this test is done it is normal to have a HA, keep head elevate for 8 hours with bedrest, push fluids*** and give tylenol for a headache.
CT of the Spine
Surgical opening of the skull
Craniotomy
What position should a pt. with a supratentorial craniectomy who had a large tomor removed from the left side be placed in ?
The head should be in a mid line position without flexion,and not placed on the left side.
While assessing the muscle strength of a pt. you ask him to close his eyes, extend the arms with hands supinated. His left hand turns inwards and downward, this is referred to as...
Pronator Drift
Disturbance in gait
Ataxia
The inability to discern touch, like when you have a pt. close their eyes and place an object in their hand and they cannot name it.
Asterognosis
The inability to discern written symbols
Agrephesthesia
Suctioning an unconscious client should be kep at under _______ seconds to prevent cerebral hypoxia and ICP.
10
What is the best type of bowel evacuation used in pts. with intracranial pressure that is the least invasive and usually induces evacuation within an hour?
Glycerin Suppositorys
What would you do if a pt with a nasogastric tube was receiving feedings at 50 ml. per hour, but the residual was 150 Ml?
Listen for bowel sounds, assess for gastric distention, stop the feeding and call the phsician because this signifys delayed gastric emptying.
What position should the pt who has a supratentorial incision be kept in?
Head and neck mid-line with the head of the be elevated 30-45 degrees.
Initial Sx. is mild clumsiness, usually affects the distal portion of one leg. may c/o tripping and dragging one leg.
Amyotrphic Lateral Sclerosis
Most critical index of CNS dysfunction.
LOC
used to decrease CSF production.
Acetyzolamide or Diamox
Normal intracranial pressure readings...
0-10
CSF pressure should be lower than...
200
Used to diagnose Herpes Simplex Encephalitis.
Brain Biopsy
Antispasmotic used to relieve neurogenic bladder,urinary urgency, frequency,nocturia. Used for patients with M.S who have an uninhibited bladder.
Ditropan (Oxybutinin)
Development of progressive muscle weakness rapidly. No LOC.
Guillian Barre Syndrome
Tx. used for Myasthenia Gravis
Thymectomy
Patient with stroke on this side may appear oriented to time and place. Likely to hav difficulty with perception and spatial abilitys. Impulsive and confused.
Right sided hemispheric stroke
Patient with this side of stroke will have difficulty with language.
Left sided hemispheric stroke
Neglect of the affected side after a stroke
Anosognia
Stroke which may exhibit a rambling type of aphasia
Wernicke's Aphasia
Stroke client with extensive damage to the left hemisphere. Has difficulty naming objects and repeating words, poor B.
Global Aphasia
What is the initial reaction you would implement for autonomic dysreflexia?
Raise the head of the bed, then remove any noxious stimuli.
Your client is being hyperventilated by a mechanical ventilater to reduce intracranial pressure. What range should ABG's be in?
PaO2 80-100 and PaCo2 25-30
A clietn with Parkinson's should report such side effects of this medication such as.. difficulty urinating, distended abdomen, infrequent voiding in small amounts and overflow.
Benztropine maleate(Cogentin)
If a post-CVA client has increased B/P, widened pulse pressure, increased temp and a drop in pulse, what would this indicate and what should you do??
Increased ICP, call the physician.
Slight Slurring of speech, mild drowsiness, less frequent speech.
Early signs of LOC
What signs would a pt exhibit if there were injury to the right side of the head?
Left sided weakness and decreased movement
Minimal amounts of stimuli are indicated for a patient with a
Brain aneurysm
What is contraindicated for a pt with a cerebral aneurysm?
Coughing, sneezing, straining and blowing the nose are avoided.
When should an anticholinesterase medication be administered to a pt. with Myasthenia gravis ?
30 minutes before meals with milk or crackers to reduce GI upset
What are some anticholinesterase meds?
Neostigmine Bromide (Prostigmin), Pyridostigmine bromide (Mestinon and Regonal), Edrophonium chloride (tensilon).
What is the anecdote for anticholinesterase drugs?
Atropine Sulfate
S/S: increased pulse, respirations, and blood pressure. Anorexia and cyanosis. Bowel and bladder incontinence, decreased urine output, absent cough and swallow reflex.
Myasthenia Crisis
What is done for a Myasthenic crisis?
Anticholinesterase medications
Overmedication with anticholinesterase...
Cholinergic crisis
Abdominal cramps, nausea, vomiting, diarrhea, blurred vision, pallor, facial muscle twitching, hypotension and pupillary miosis.
Cholinergic Crisis
Anecdote for cholinergic chrisis
atropine
Normal Depakote (Valproic acid) level is..
50-100
Area of the brain used for calculation ability and knowledge of current events. Voluntary muscle activity including speech and an impairment can result in expressive aphasia.
Frontal Lobe
Contains association for concept formation, abstraction, spatial orientation, body and object size and shape and tactile sensation.
Parietal Lobe
Area of the brain used for vision
Occipital lobe
Area of the brain used for auditory info and storage.
Temporal Lobe
What should be monitored when taking Amphoteracin-B ?
Evidence of anaphylactic shock such as shaking and chills.
The respiratory vital capacity is watched closely in this disease and the vital capacity should not fall below 15.
Guillian barre Syndrome
If a client post CVA has difficulty chewing food which cranial nerve was most likely affected?
CN #5 Trigeminal
cranial nerve #1
Olfactory smell
Cranial Nerve #2
Optic Vision
Cranial Nerve #3
Oculomotor Eye Muscles
Cranial Nerve #4
Trochlear eye movement
Cranial Nerve #5
Trigeminal sensation of cornea, nasal and oral mucosa, Facial skin and mastication
Cranial Nerve #6
Abducens - lateral eye movement
Cranial Nerve #7
Facial
Cranial Nerve #8
Vestibulocochlear Hearing and balance
Cranial Nerve #9
Glossopharyngeal - swallowing, taste, and salivation
Cranial Nerve#10
Vagus - swallowing and phonation, abdominal and thoracic sensation. Also active in the parasympathetic nervous system of the autonomic nervous system.
Cranial Nerve#11
Accessory - Uvula, soft palate, sternoclidomastoid, trapezius muscles.
Cranial Nerve #12
Tongue movements swallowing and speech
Insomnia, agitation, mania and delirium are due to excessive arousal of what?
The reticular activating system and cerebral hemispheres.
If a patient cannot recall what was eaten today, you would know what part of the brain was affected?
Hippocampus which is used for short term memory
Calculation and Current events is found in what area of the brain?
Function of the Frontal Lobes
responsible for spacial orientation, sizes and shapes
Parietal Lobe
What is important when selecting a medication used to work on the brain such as with meningitis?
The ability to cross the Blood-Brain-Barrier
Causes vasodilation of the blood vessels in the brain
Carbon Dioxide
Fight or flight system
Sympathetic Nervous System
Cranial nerve responsible for heart rate. 75% of all parasympathetic reponses are carried out by this cranial nerve.
Cranial nerve#10 Vagus
Brown Sequard's Syndrome
Ipsilateral Paralysis and loss of touch vibration
Gingival Hypreplasia is a side effect of this medication and the patient should brush teeth at regular intervals and see a dentist regularly.
Phenytoin Dilantin
Widened pulse pressure, low blood pressure, late sign of increased ICP.
Cushing's reflex
A nurse should avoid performing the Doll's Eye's maneuver (oculocephalic response) if what is present...
A cervical cord injury
Parasthesias, transient loss of speech,hemiplegia a few days prior to admission. Dizziness,cognitive changes, or seizures
Cerebral Thrombosis
Antiparkinson agent which needs to be watched for urinary retention.
Ammantidine (Symmetrol)
How would you test for proprioception?
Move the greater toe around and ask the patient what position it is in.
Normal CSF pressure is...
8-15