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Neurological Function Part 2


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What are some of the first things you do to manage a stroke including tests?
Dx problems and risk factors
Lumbar Puncture
What is the #1 prevention of strokes?
Control of reversible factors in pt. at risk.
What are some of the reversible factors in pts. at risk?
HTN, Diabetes, cardiac problems, lower cholesterol.
What does diabetes contribute to that makes it important to control?
HTN, Atherosclerosis
What can you do for cardiac problems?
give dig, plavix, aspirin for prevention of clots.
What is the #2 management for prevention of stroke?
Surgery for TIAs = endarterectomy
How can you determine if there is a rebleed?
If there is a slow onset of LOC and motor/sensory activity change.
How can you determine if the problem a pt. is having is from a vasospasm causing ischemia?
If there is a sudden change in LOC, sensory/motor activity.
A sudden chagne in LOC, sensory/motor activity could indicate what?
vasospasm causing ischemia
A slow onset of change in LOC and sensory/motor activity change could indicate what?
What is retroperfusion of brain?
Increase pressure in those vessels causes vessels to rupture.
Do you have vasospasms with subarachnoid hemorrhage?
Yes, 1st 2 weeks - 48 hours and day 7-10.
What do you treat vasospasms from subarachnoid hemorrhage with?
nimopidine (Ca channel blocker) and fluids.
What are the risks of a rebleed? What do you treat with?
Risk for 10-14 days - peaks day 4-8. Treat with antifibrinolytics.
What is important to increase but not too much in the medical management of stroke?
increase cerebral blood flow but control IICP.
What medications are used for the medical management of strokes?
What are the goals of rehabilitation in the chronic management of strokes?
#1 prevent deformity
#2 maintain function
#3 restore function to maximum to make the pt. as independent in ADL as possible.
What are some community resources for stroke pt.
Home health agencies
Rehabilitation facilities
American Heart Assoc. - education
Easter Seal Society - possibly wheelchairs, braces, etc.
Senior Citizen groups - information and contacts.
What is the #1 nursing management of stroke pt?
Respiratory problems
What are other nuring management resposibilities for stroke pts?
Monitor all neuro signs esp. changes in LOC.
Cardiovascular - circulation - change in BP effects cerebral blood flow.
Musculoskeletal - paralyzed, risk for thrombophlebitis.
What are some things to be done for a pt. with increased risk from thrombophlebitis from paralysis?
TEDS, ROM, compression hose, position pt. so that blood flows back to center of body.
What is another reason it is important for the nurse to manage musculoskeletal in a stroke pt?
To prevent contractures and muscle atrophy with active ROM.
Why is muscle atrophy a big problem?
It leads to a bigger problem of joint dislocation - especially elbows, shoulders.
What does passive ROM do?
Keeps joints mobile only.
What is another big problem for stroke pts. with paralysis?
Skin problems.
How can the nurse prevent skin problems?
Turn pt.; keep clean, keep sheets clean, wrinkle free.
How is turning pt. affected by paralyzed side.
They may not be able to remain on paralyzed side 2 hours.
Are BP readings the same on affected side?
Usually not as good on bad side.
Is the IV on paralyzed side contraindicated?
Could cause venous pooling.
What are some GI concerns of the stroke pt.
What nuring management should be done regarding nutrition?
Monitor I & O; Asphagia - aspiration. Tilt head forward to swallow.
What is an elimination problem?
Constipation. May use stool softeners, bulk laxatives. High fiber diet, fluids, schedule time for BM. Doesn't matter when just that it is regular time > bowel retraining. Don't want catheter in any longer than necessary - UTI.
How can the nurse help with communication?
Use ABC board, picture board, have pt. write. Should not stop trying to communicate with pt.
Where should items be placed for pt.
On the unaffected side. Perceptual problems can cause safety hazards.
Contraint Induced Movement Therapy.
Studies where the pts. good side was restrained to force the use of bad side.
How important are the families of pts. with strokes?
They need to understand the goal of care and importance of rehab so they can be more cooperative.
What are some of the feelings the family members of a pt. might have.
They need help dealing with the anxiety of a serious illness, the reality of pt. disability (may deny this) guilt and anger related to illness.
What is a typical reaction of a family member that interferes with rehabilitation?
they sometimes are overly helpful instead of just being a part of rehab.
What are some chronic neurologic problems assoc. with stroke?
Headache is a symptom from
2.Migraine - vascular
vasoconstriction > prodrome
3.Cluster - Vascular
What is a cluster H/A?
The pain of a cluster headache commences quickly, without warning, and reaches a crescendo within 2 to 15 minutes. It is often excruciating in intensity, and is deep, nonfluctuating, and explosive in quality. The pain usually begins in, around, or above the eye or the temple
What is a migraine headache?
Doctors think migraines may be caused by a chemical or electrical problem in certain parts of the brain. A key element of a migraine headache is blood flow change in the brain. According to theory, the nervous system responds to a trigger such as stress by creating spasms in the nerve-rich arteries at the base of the brain. The spasms constrict several arteries supplying blood to the brain, including arteries from the scalp and neck. As these arteries constrict, the flow of blood to the brain is reduced. At the same time, platelets clump together and release a chemical called serotonin. Serotonin acts as a powerful constrictor of arteries further reducing blood and oxygen supply to the brain. In reaction to the reduced oxygen supply, certain arteries within the brain dilate to meet the brain's energy needs. This dilation spreads, finally affecting neck and scalp arteries. Doctors believe this dilation causes the pain of migraine.
What is a tension H/A?
Most people describe a tension headache as a constant dull, achy feeling on both sides of the head. Some people with tension headaches also have a tight feeling in their head or neck muscles. Tension headaches usually begin slowly and gradually. They often start in the middle of the day.

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