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58 Cards in this Set
- Front
- Back
Describe what happens in the brain during a CVA "brain attack"
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Disruption in the nml blood supply to the brain
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What is Cerebral Autoregulation? How is it characterized?
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1000ml/min blood flow
Dilation/constriction prn Lack of perfusion |
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Name the 2 types of strokes and their subsets.
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Ischemic (occlusive)
Thrombolic stroke Embolic stroke Hemorragic |
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Describe the etiology of an embolic stroke.
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Embolus/emboli travel to cerebral arteries via carotid artery
Sources of emboli are cardiac Can be TIA's, RIND's or permanent Accounts for 1/3d of all strokes |
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Describe the etiology of a Thrombolic Stroke. Acounts for 1/2 of all strokes
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Associated with atherosclerosis, plaques build up and occlude vessels
slow onset of s/s occurs at bifurcations of the common carotid and vertebral arteries at juncture with basilar artery |
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What types of medications will be given for the eschimic stroke?
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Heparin initially until INR's are therapeutic then concurrent Coumadin for a few days before d/cing Heparin.
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Aphasia
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inablility to use/ comprehend
expressive/ receptive |
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Alexia
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reading difficulty
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agraphia
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writing difficulty
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hemiplegia
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paralysis, one sided
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hemeparesis
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weakness, one sided
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flaccidity (hypotonia)
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nurse notes a fall to one side
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what is the etiology of an Hemorragic stroke?
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weakened vessel walls cause a rupture and brain bleed
Saccular or Berry aneurysm |
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What is a TIA
What is a RIND how are they the same and how are they different. what type of stoke are they associated with? |
TIA = few minutes, <24 hours
Blurred/double/blindness/tunneling Weakness/gait disturbance Numbness (transient) Vertigo Aphasia/dysarthria (slurred speech) RIND = > 24 hours <week |
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what are some physical assessments of an eschimic stroke
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Cognitive changes:
LOC may vary Hemiparesis Denial Spatial/ proprioceptive dysfx memory impairment Prolem solving/decision-malking issues |
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What types of manifestations are seen with the Left sided brain injury/stroke?
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Aphasia, alexia, agraphia. This is the speech/language center
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What clinical manifestations are associated with Right sided brain injury/stroke?
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Neglect syndrome
visual field deficitsamaurosis fugax/brief blindness may be impulsive emotional lability if frotal lobe is involved. |
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Causes of Hemorrhagic Stroke?
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HTN--stretches and thins vessel wall
genetic/traumatic weakening of the vessel walls Rupture usually occurs with activity |
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Risk Factors for hemoragic stroke
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HTN, diabetis mellitus
heart disease nonvalvular a-fib smoking/substance abuse sedentary lifestyle WOMEN--high Hgb (>14) |
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what kind of Hx is gathered for stroke pts.
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Accurate history
Important to affected area s/sx? When did it start? (ischemic = sleep; hemorrhagic = activity usually) How the s/sx progressed? Onset important (embolic/hemo = abrupt; thrombolytic = gradual usually) S/Sx come and go? (TIA, RIND) Observe LOC during interview Monitor speech pattern/body posture, etc Medical hx? Family hx? Diet? |
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interventions for stroke pts
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Stabilize patient, reduce further injury
Determined by type/extent of injury Nonsurgical management Patient may be at risk for increased ICP Glasgow Coma Scale (GCS) |
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What are key features of increased ICP
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Decreases LOC sensorimotor ^
Behavioral^s pupillary^ HA cranial nerve involve N/V ataxia Speech ? sz Aphasia Cushings' Triad Slurred speech Posturing |
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What is Cushings Triad/ cuushings reflex?
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Bradycardia, hypertension, widening pulse pressure
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Nursing interventions for ICP increase
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Frequent nursing assessments
First 72 hours critical Elevate HOB Maintain head position ¨ drainage Avoid extreme flexion (ª ITP) Avoid clustering of activities |
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Drug Therapy for increased ICP
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Thrombolytic therapy - dissolves occlusion
Rt-PA (recomb tissue plasminogen act) Anticoagulants |
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What labs for drug therapy
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PT
PTT INR |
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wHAT TYPES OF SURGICAL MGT IS USED FOR STROKES
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Endarterectomy
Extracranial-intracranial bypass AVM management Craniotomy Remove clots |
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Nursing interventions FOR SURGERY of stroke pts
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Self-Care Deficit
Facilitate increased muscle strength/function Positioning important Splinting Avoid contractures DVTs are a risk to develop Antiembolism stockings Compression boots Frequent position changes Mobilization of the client |
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Disturbed Sensory Perception interventions (r-sided)
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visual/perceptual or spatial impairments depth erception/discrimination (up/down) thus ADLs
Provide frequent cues Break down tasks into simple steps Approach from UNAFFECTED side UNAFFECTED side: should FACE the door Teach patient to scan environment Diplopia: use patch Remove clutter |
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interventions for L sided repercussions?
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Memory deficits, simple tasks difficult
Reorient to month, day, year Establish routine schedule Structured environment Familiar objects Step by step teaching |
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Unilateral Neglect
Goal: compensate for affected side Most common with R-sided stroke increased risk for injury |
Teach patient to touch/use both sides
Affected side first Turn head for full vision fields "scanning" technique |
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Impaired Verbal Communication l-sided
Goal: effective communication |
Language/speech (dominant hemisphere)
Aphasia: Expressive (Broca's; motor) frontal Receptive (Wernicke's; sensory) Temporal/Parietal area: may talk but language is meaningless Global (mixed) |
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Describe Broca's
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Expressive
1. Motor speech problem 2. Understands but unable to communicate 3. Difficulty with writing 4. Frustration and anger |
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describe Wernicke's
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Receptive /sensory
1. Unable to understand spoken and written word 2. Neologisms 3. Global or mixed aphasia 4. Reading and writing equally affected |
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Waht are foods that facilitate salivary production and aid is swollowing. What interventions for cliet iwth difficulty swallowing?
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Beef broth, sweek, sour, salty
Place food on the unaffected side reduce distratctions observe for s/s of fatigue |
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Health Teaching for stroke pt and their families
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Medication schedule (s/s bleeding, electric razor, avoid Vit.K etc.)
Mobility Communication (patience, shortcommands) Safety Dietary (fat reduction diet with thrombotic stoke) Activity/self-care skills Psychosocial intervention (lability) (depression precautions) Families encouraged to permit individual to do as much as possible Families - take and plan for extra time to do things Care givers may need respite/time to relax Counseling |
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what age grou[ is most affected by TBIs
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18-34year olds
MVA, most common cause Summer, spring, pm, noc, weekends 3X more in males |
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TBI: Glascow Coma Scale
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Mild :13-15 gait altered
Mod: decreasing LOC GCS 9-12¨ 24 h observation Severe: GCS <9 ¨ critical care |
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What is the problem with increased ICP
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increased ICP = decresed cerebral blood flow = tissue hypoxia = ¯decreased serum pH and increased CO2 = cerebral vasodilation = edema = increased ICP = brain hernation = irreversible brain damage = death (uncal herniation)
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when there is an increase in ICP, what happens to the cerebral blood flow
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decreases
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what happens with increase ICP and decreased cerebral blood flow?
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tissue hypoxia, decrease in pH
increase in CO2 (causing cerebral vasodilation, edema, further increaseing iCP brain my herniate into brainstem (uncal) |
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Cytotoxic, cellular edema
From hypoxia etiology |
Disturbance in cellular metabolism
Sodium pump Active ion transport Brain depleted of O2, CHO, glycogen Na+ pump fails, Na+ enters the cells and pulls H2O Simultaneous decrease Na+ serum (<120 mEq/L) |
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Interstitial edema:
Acute brain swelling |
Assoc with HTN,increased ICP
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Three types of cerebral hemorrhage
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Epidural Hematoma
Subdural Hematoma (SDH) Intracrebral Hemorrhage |
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Epidural Hematoma
Arterial bleeding |
Space: skull and dura mater
Frequent site: temporal lobe injury "lucid" interval leading to unconsciousness May proceed to coma and death |
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Subdural Hematoma (SDH)
venous |
Space: dura mater and arachnoid
Common: laceration of brain tissue Bleed is slower Acute - preseents with 48 hourse after impact Subacute - between 48 hours and 2 weeks Chronic - form 2 weeks to several months following the injury |
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Intracrebral Hemorrhage
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Intracrebral Hemorrhage
Accumulation of blood within tissue |
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Hydrocephalus
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Abnormal increase CSF volume
Caused dilation of ventricles May lead to increased ICP |
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Herniation
Uncal: life threatening |
Shift of one/both temporal lobes (uncus)
Pressure on 3rd cranial nerve S/Sx: dilated/fixed pupils Ptosis Rapid? in conciousness |
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CENTRAL HERNIATION
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Downward shift of brainstem
Diencephalon S/Sx: Cheyne-Stokes respirations Pinpoint, fixed, nonreactive pupils |
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Traumatic Brain Injury-Interventions
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Prevention of increased ICP
Fluid and electrolyte balance Positioning/hyperventilation Induction of barbiturate coma/drug therapy (mannitol) Strategies for sensory/perceptual alterations Pulmonary management/behavioral management Strategies for preventing complications of immobility Nutrition management |
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Surgical management for TBI's
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Intracranial pressure monitoring
Craniotomy |
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Brain Tumors-Complications
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Cerebral (vasogenic) edema/ ^ ICP
Herniation of brain tissue/ischemia of affected area Rupture/hemorrhage into brain tissue Seizure activity/hydrocephalus Pituitary dysfunction/SIADH/diabetes insipidusFluid and electrolyte imbalances |
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Brain Tumors-Classification
PnMalignant or benign |
Gliomas (malignant)
Meningiomas (benign) Pituitary gland (benign) Acoustic neuromas |
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Brain Tumors-Symptoms
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Headache (severe on awakening in the AM)
Nausea and vomiting Visual symptoms Seizures Changes in mentation or personality Papilledema (swelling of the optic disk) |
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Brain Tumors-Interventions
Nonsurgical management |
Radiation/chemotherapy
nBlood brain barrier disruption Recombinant DN Monoclonal antibodiesPnAntineoplastic drugs Immunotherapy/hyperthermia |
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Interventions
Surgical management |
nBiopsy
Craniotomy |
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Brain Tumors-Postoperative Complications
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Increased ICP
Hematomas Hydrocephalus accumulation of the fluid Respiratory problems Neurogenic pulmonary edema Would infection Meningitis Fluid/electrolyte imbalance |