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120 Cards in this Set
- Front
- Back
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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.
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Ischemic CVA
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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.
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Hemorrhagic Stroke
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can't passively extend knee with hip flexed 90 degrees from supine position-leg pain and spasm.
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Kernig's sign
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Flexion of hips and knees when head and neck are passively flexed onto chest.
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Brudzinski's sign
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Left hemiparesis, spatial perceptual defects, behavior impulsive, memory deficits, indifference to disability.
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Right Brain damage
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Right hemiparesis, speech and language deficits, behavior is slow and cautious, distress and depression related to disability.
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Left brain damage
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receptive aphasia
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Temporal lobe comprehension deficit
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left frontal lobe, cant exress oneself.
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expressive aphasia
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wrong words, word substitution, grammatical errors.
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Paraphrasia
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Blindness in one half of the field of vision in one or both eyes, results from a stroke / CVA.
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Hemianopsia
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Three categories: Simple, Complex, and secondary.
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Partial seizures
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No loss of consciousness
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Simple partial seizure
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AKA psychomotor, no loss of consciousness
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Complex partial seizure
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Partial seizure from either simple or complex progressing into a generalized seizure with tonic/clonic.
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Generalized seizure
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Seizure which includes loss of consciosness, involves both sides of the brain and is classified as clonic- tonic, tonic, clonic and atonic.
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Generalized seizures
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AKA grand-mal, may have an aura
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Tonic/Clonic
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sustained increase in muscle tone, generalized stiffening of all extremities.
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Tonic
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Sustained rhythmic contraction and relaxation of skeletal muscles. Seizure.
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Clonic
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Seizure, spontaneous loss of postural control for a few seconds with no loss of consciousness.
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Atonic
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Seizure. Involuntary muscle jerking of extremities, usually symmetrical.
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Myoclonic
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Seizure AKA Petit Mal. More common in children, brief and frequent staring episodes.
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Abscence seizures
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Intervention for seizures
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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.
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Stages of a seizure...
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Preictal, ictal and post-ictal
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before seizure with an aura sometimes
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Pre-Ictal
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During seizure
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Ictal
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After a seizure, usually very tired and difficult to arouse.
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Post-Ictal
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Weakness of an extremity following a seizure
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Todd's Paralysis
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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.
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Staticus Epilepticus***
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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.
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Myasthenia Gravis**
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Diagnosed with a Tensilon test-- IV injection of endrophonium or neostigmine temporarily improves muscle function.
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Myasthenia gravis**
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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**
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Myasthenic Crisis or Cholinergic Crisis**
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Treated with anticholinesterase drugs, neostigmine and pyridostigmine. Drugs are less effective as the disease progresses, steroids sometimes help.
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Myasthenia Gravis
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hereditary chorea (dance like movements,rapid and often violent and purposeless), progressive mental deterioration ending in dementai. late stages:emaciation and exhaustion**
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Huntington's Chorea
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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.**
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Guillian Barre
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Chronic, progressive demyelination of nerve fibers in the brain. peripheral nervous ssytem is not affected. Remissions and exacerbations.**
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Multiple Sclerosis
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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.
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Meningitis
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How long should a pt. with Meningitis be isolated for?
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the first 24 hours
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What would labs look like in Meningitis?
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CSF protein count over 50. *** WBC elevated with a decreased glucose***
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treatment done for Meningitis:
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Treted with an antibiotic, manage ICP, neural assessments, quiet environment.
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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)--
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parkinson's Disease
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Dopamine Deficiency in the basal ganglia***
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parkinson's Disease
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What should be done post Lumbar Puncture?bandage over needle site, bed rest for 1 hour post, push fluids, monitor for leakage.
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Lumbar Puncture
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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.
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Myelogram
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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.
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CT of the Spine
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Surgical opening of the skull
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Craniotomy
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What position should a pt. with a supratentorial craniectomy who had a large tomor removed from the left side be placed in ?
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The head should be in a mid line position without flexion,and not placed on the left side.
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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...
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Pronator Drift
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Disturbance in gait
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Ataxia
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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.
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Asterognosis
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The inability to discern written symbols
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Agrephesthesia
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Suctioning an unconscious client should be kep at under _______ seconds to prevent cerebral hypoxia and ICP.
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10
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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?
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Glycerin Suppositorys
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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?
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Listen for bowel sounds, assess for gastric distention, stop the feeding and call the phsician because this signifys delayed gastric emptying.
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What position should the pt who has a supratentorial incision be kept in?
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Head and neck mid-line with the head of the be elevated 30-45 degrees.
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Initial Sx. is mild clumsiness, usually affects the distal portion of one leg. may c/o tripping and dragging one leg.
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Amyotrphic Lateral Sclerosis
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Most critical index of CNS dysfunction.
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LOC
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used to decrease CSF production.
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Acetyzolamide or Diamox
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Normal intracranial pressure readings...
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0-10
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CSF pressure should be lower than...
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200
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Used to diagnose Herpes Simplex Encephalitis.
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Brain Biopsy
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Antispasmotic used to relieve neurogenic bladder,urinary urgency, frequency,nocturia. Used for patients with M.S who have an uninhibited bladder.
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Ditropan (Oxybutinin)
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Development of progressive muscle weakness rapidly. No LOC.
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Guillian Barre Syndrome
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Tx. used for Myasthenia Gravis
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Thymectomy
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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.
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Right sided hemispheric stroke
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Patient with this side of stroke will have difficulty with language.
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Left sided hemispheric stroke
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Neglect of the affected side after a stroke
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Anosognia
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Stroke which may exhibit a rambling type of aphasia
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Wernicke's Aphasia
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Stroke client with extensive damage to the left hemisphere. Has difficulty naming objects and repeating words, poor B.
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Global Aphasia
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What is the initial reaction you would implement for autonomic dysreflexia?
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Raise the head of the bed, then remove any noxious stimuli.
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Your client is being hyperventilated by a mechanical ventilater to reduce intracranial pressure. What range should ABG's be in?
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PaO2 80-100 and PaCo2 25-30
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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.
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Benztropine maleate(Cogentin)
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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??
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Increased ICP, call the physician.
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Slight Slurring of speech, mild drowsiness, less frequent speech.
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Early signs of LOC
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What signs would a pt exhibit if there were injury to the right side of the head?
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Left sided weakness and decreased movement
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Minimal amounts of stimuli are indicated for a patient with a
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Brain aneurysm
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What is contraindicated for a pt with a cerebral aneurysm?
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Coughing, sneezing, straining and blowing the nose are avoided.
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When should an anticholinesterase medication be administered to a pt. with Myasthenia gravis ?
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30 minutes before meals with milk or crackers to reduce GI upset
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What are some anticholinesterase meds?
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Neostigmine Bromide (Prostigmin), Pyridostigmine bromide (Mestinon and Regonal), Edrophonium chloride (tensilon).
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What is the anecdote for anticholinesterase drugs?
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Atropine Sulfate
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S/S: increased pulse, respirations, and blood pressure. Anorexia and cyanosis. Bowel and bladder incontinence, decreased urine output, absent cough and swallow reflex.
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Myasthenia Crisis
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What is done for a Myasthenic crisis?
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Anticholinesterase medications
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Overmedication with anticholinesterase...
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Cholinergic crisis
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Abdominal cramps, nausea, vomiting, diarrhea, blurred vision, pallor, facial muscle twitching, hypotension and pupillary miosis.
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Cholinergic Crisis
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Anecdote for cholinergic chrisis
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atropine
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Normal Depakote (Valproic acid) level is..
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50-100
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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.
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Frontal Lobe
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Contains association for concept formation, abstraction, spatial orientation, body and object size and shape and tactile sensation.
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Parietal Lobe
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Area of the brain used for vision
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Occipital lobe
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Area of the brain used for auditory info and storage.
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Temporal Lobe
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What should be monitored when taking Amphoteracin-B ?
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Evidence of anaphylactic shock such as shaking and chills.
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The respiratory vital capacity is watched closely in this disease and the vital capacity should not fall below 15.
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Guillian barre Syndrome
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If a client post CVA has difficulty chewing food which cranial nerve was most likely affected?
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CN #5 Trigeminal
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cranial nerve #1
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Olfactory smell
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Cranial Nerve #2
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Optic Vision
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Cranial Nerve #3
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Oculomotor Eye Muscles
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Cranial Nerve #4
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Trochlear eye movement
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Cranial Nerve #5
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Trigeminal sensation of cornea, nasal and oral mucosa, Facial skin and mastication
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Cranial Nerve #6
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Abducens - lateral eye movement
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Cranial Nerve #7
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Facial
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Cranial Nerve #8
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Vestibulocochlear Hearing and balance
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Cranial Nerve #9
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Glossopharyngeal - swallowing, taste, and salivation
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Cranial Nerve#10
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Vagus - swallowing and phonation, abdominal and thoracic sensation. Also active in the parasympathetic nervous system of the autonomic nervous system.
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Cranial Nerve#11
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Accessory - Uvula, soft palate, sternoclidomastoid, trapezius muscles.
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Cranial Nerve #12
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Tongue movements swallowing and speech
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Insomnia, agitation, mania and delirium are due to excessive arousal of what?
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The reticular activating system and cerebral hemispheres.
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If a patient cannot recall what was eaten today, you would know what part of the brain was affected?
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Hippocampus which is used for short term memory
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Calculation and Current events is found in what area of the brain?
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Function of the Frontal Lobes
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responsible for spacial orientation, sizes and shapes
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Parietal Lobe
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What is important when selecting a medication used to work on the brain such as with meningitis?
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The ability to cross the Blood-Brain-Barrier
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Causes vasodilation of the blood vessels in the brain
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Carbon Dioxide
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Fight or flight system
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Sympathetic Nervous System
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Cranial nerve responsible for heart rate. 75% of all parasympathetic reponses are carried out by this cranial nerve.
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Cranial nerve#10 Vagus
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Brown Sequard's Syndrome
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Ipsilateral Paralysis and loss of touch vibration
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Gingival Hypreplasia is a side effect of this medication and the patient should brush teeth at regular intervals and see a dentist regularly.
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Phenytoin Dilantin
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Widened pulse pressure, low blood pressure, late sign of increased ICP.
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Cushing's reflex
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A nurse should avoid performing the Doll's Eye's maneuver (oculocephalic response) if what is present...
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A cervical cord injury
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Parasthesias, transient loss of speech,hemiplegia a few days prior to admission. Dizziness,cognitive changes, or seizures
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Cerebral Thrombosis
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Antiparkinson agent which needs to be watched for urinary retention.
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Ammantidine (Symmetrol)
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How would you test for proprioception?
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Move the greater toe around and ask the patient what position it is in.
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Normal CSF pressure is...
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8-15
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