Neurological 2
Terms
undefined, object
copy deck
- What is a stroke?
-
Disruption in the normal blood supply to the brain
* Cerebral vascular accident (CVA) "brain attack"
*Medical emergency that strikes suddenly
*Should be treated immediately
T*hird most common cause of death in U.S.
Primary cause of adult disability - What are the 2 types of strokes?
-
Ischemic
Hemorrhagic - An Ischemic stroke is...?
- Caused by occulusion of cerebral artery by thrombus or embolus.
- What accounts for more than 1/2 of all strokes? and what is it associate with.
-
Thrombolic, atherosclerosis.
* a lacunar stroke is a type of thrombotic causes a soft area or cavity to develop in the white matter of the brain. - 1/3 of all strokes are this kind.
- embolic
- What are the sources of embolic strokes?
- Cardiac and carotid artery (neck)
- What is the pathophysiology of an embolic stroke.
-
·Middle cerebral artery (MCA) most commonly involved
·Emboli occlude the vessel, ischemia develops
·Occlusion often temporary, > fragments
·become lodged in smaller bifurcations or where lumen narrows - What is the definition of a TIA?
-
·"Silent" stroke
·precedes other strokes
·Reversible Ischemic Neurologic Deficit (RIND)
·Transient focal dysfunction d/t brief interruption of blood flow, e.g., spasms
·TIA and RIND differ in duration - S/S of a TIA
-
lasts a few minutes, <24 hours
Blurred/double/blindness/tunneling
Weakness/gait disturbance
Numbness (transient)
Vertigo
Aphasia/dysarthria (slurred speech) - What is the difference between a TIA and a RIND?
-
TIA < 24 hrs
RIND >24 < week - The 4 types of Ischemic strokes?
-
Thrombotic
Embolyic
TIA
RIND - What is a hemorrhagic Stroke?
-
·Interruption of vessel integrity
·Bleeding occurs into tissue/spaces
Ventricular, subdural, subarachnoid - What is believed to cause a berry (saccular) aneurysm?
- rupture of an arteriovenous malformation (HTN)
- Saccular (berry) aneurysms and crebral aneurysm cause hemorrhagic strokes T or F?
- True
- AVM (arteriovenous malformation) is what?
- tangled spagetti-like mass of malformed, thin-walled, dilated vessels.
- Risk factors for a stroke:
-
·HTN
·Diabetes mellitus
·Heart disease
·Nonvalvular atrial fibrillation
·Smoking/substance abuse
·Sedentary lifestyle
·Women: ^Hgb (>14 g) < bone density, migraines - S/S of a stroke:
-
· Cognitive changes
·Motor changes
·Sensory changes
·Cranial nerve intactness
·Cardiovascular assessment
·Psychosocial assessment - When performing a neurological assessment what do you want to look for?
-
·Cognitive Changes
LOC may vary
Denial
Hemiparesis
Spatial/proprioceptive dysfunction
Memory impairment
Problem-solving/decision-making ? - What areas are effected with Left sided strokes? The dominant hemisphere!
-
Language, math skills, and analytic thinking.
Aphasia = inability to use/comprehend
Alexia = reading difficulty
Agraphia = writing difficulty
Hemiplegia = paralysis, one side
These people are slow and cautious
Hemiparesis = weakness, one side - What areas are effected with Right sided stroke?
-
Disorientation to time, place and person
Visual spatial
neglect syndrome
Lack of awareness of neurologic deficits
Euphoria - Motor changes to look for with a stroke, which will help identify which hemisphere.
-
·Nurse must assess for hypotonia (flaccidity) = tends to fall to one side
·Extremities may feel heavy
·Inadequate balance, equilibrium
·Hypertonia (spastic paralysis) which can lead to a fixed or contractures - Sensory changes
-
Response to stimuli
Neglect syndrom
(carotid artery may cuase:Ptosis, visual field deficits,palor/petechiae of conjuctiva, amaurosis fugax(brief blindness), hemianaopsia - Cranial Nerve V affects what?
- Chew
- Cranial Nerve IX and X
- swallow
- Cranial nerve VII
- facial paralysis or paresis
- Cranial nerve IX
- absent gag reflex
- Cranial nerve XII
- impaired tongue movement
- A client has a murmur, HTN, or a dysrhythmia what type of stroke would you suspect?
- embolic
- Labs that would be done for stroke:
-
> HCT
INR
PT
PTT
CT
MRI - Drug therapy for strokes
-
Thrombolytic therapy to dissolve occlusion (Rt-PA)
Anticoagulants (PT,PTT,INR)
anti seizure meds - What type of aphasia would you have if the frontal lobe is involved?
- Expressive or Broca's
- Wernick's aphasia is what kind?
- Receptive and also involves the temporoparietal area.
- Dysarthria is what?
- loss of motor funciton oto the tongue or to the muscles of speech.
- According to the GCS define the range for a mild, Mod and severe HEAD injury.
-
Mild- 13-15
Mod 9-12 includes LOC
Severe: <9 require critical care & monitoring - A bruising of the brain and most comonly fount at the site of impact (coup) in in a line opposite the site (countercoup) is called what?
- contusion
- What is the normal ICP?
- 10-15 mm Hg
- FYI: as ICP increases -blood flow <, leading to hypoxia, a < in serum pH, > in CO2. This cause creebral vasodilation, edema and further > ICP. If this is untreated the brain herniated and cuses irreversible brain damage and possible death (UN
- IS the leading cause of death ICP!
- Vasogenic edema
- > in brain tissue volume caused by an abnormal permeability of the walls of the cerebral vessesl, which allows plasma infiltrate to leak into the extracellular space of the brain. (white matter)
- Cytotoxic edema is casused from hypoxic insult which causes...
- a disturbanc ein cellular metabolism, the Na pump and active ion transport. This edema can lead to vasogenic and a further > ICP.
- Three types of hemorrhage?
- epidural, subdural, and intracerebral
- Epidural hematoma results from...?
- arterial bleeding into the space between the dura and the inner table of the skull. often cause by a fracutre of thtemporal bone.
- Characteristics of an epidural hematoma.
- "lucid interval" last for minutes (client awake and talking). This follows unconsciousness.
- Subdural hematoma results from ....?
-
venous bleeding into the space beneath the dura and above the arachnoid.
Have the > mortality rate.
Bleed is slower. - Intracerebral Hemorrhage.....
- is an accumulation of blood within the brain tissue in the white matter.
- Uncal herniation is life threatening. What is it?
- Cause by a shift of one or both areas of the temporal lobe, known as the uncus. This shift creates pressure on the 3rd cranial nerve and result in dilated and nonreactive pupil, ptosis, and a reapid < LOC.
- Central Herniation is caused by...?
- a downward shift of the brainstem and the diencephalon from a supratentorial lesion. Manifested by Cheyne-Stokes respiration and pinpoint, nonreactive pupils.
- What is the Cushing reflex?
- severe HTN with a widened puulse pressure and bradycardia.