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Nursing - Alterations in CNS function


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What is ischemic stroke?
Ischemic strokes result from cerebrovascular obstruction by thrombus or emboli. They include TIA (transient ischemic attack), thrombotic stroke, and embolotic stroke
What is transient ischemic attack (TIA)?
Is a brief period of localized cerebral ischemia that causes neurologic deficits lasting for less than 24 hours.
What is thrombotic stroke?
It is caused by occlusion of a large cerebral vessel by a thrombus (blood clot).

Most often occur in older people who are resting or sleeping
What is embolic stroke
Occurs when a blood clot or clump of matter traveling through the cerebral vessesl becomes lodged in a vessel too narrow to permit further movement.

This type of stroke is typically seen in clients who are younger than those experience thrombotic strokes and occurs when the client is awake and active.
What is hemorrhagic stroke (or intracranial hemorrhage)?
Occurs when a cerebral vessel ruptures. It occurs most often in people with sustained increase in systolic-diastolic pressure.

As a reuslt of the blood vessel rupture, blood enters the brain tissue, the cerebral ventricle, or the subaracnnoid space, compressing adjacent tissues and causing blood vessel spasm and cerebral edema. Blood in the ventricles or subarachnoid space irriteast the meninges and brain tissue, causing an inflammatory reaction and impairing absorption and circulation of cerebral spinal fluid.
Manifestations of stroke - general
Sodden in onset, focal, and usually one side.

weakness involving face and arm, and sometimes leg

numbness on one side, speech difficulties, and difficulties with balance

motor deficits
elimination disorders
sensory-perceptual deficits
langauge disorders
behavioral changes
What is hemiplegia?
Paralysis of the left or right half of the body
what is hemiparesis?
weakness of the left or right half of the body?
What is flaccidity?
absence of muscle tone (hypotonia)
What is spasticity?
increased muscle tone (hypertonia)
What is hemianopia?
The loss of half of the visual field of one or both eyes
What is homonymous hemianopia?
When the same half of the visual field is lost in each eye
What is agnosia?
inability to write, comprehend reading material, or use objects correctly
What is unilateral neglect?
The client has a disorder of attention. In this syndrome, the person cannot integrate and use perceptions from the affected side of the body or from the environment on the affected side, and ignores that part.
What is aphasia?
The inability to use or understand language.
What is expressive aphasia?
A motor speech problem in which one can understand what is being said but can respond verbally in onliye in short phrases.

also called Broca's aphasia
What is receptive aphasia?
A sensory speech problem in which one cannot understand the spoken (and often written) word. Speech may be fluent but with inappropriate content.

also called Wernicke's aphasia
What is mixed or global aphasia?
Language dysfunction in both understanding and expression
What is dysarthria?
Any disturbance in muscular control of speech
How does a CT scan help in diagnosing CVA?
CT without contrast is the first imaging technique used to demonstrate the presence of hemorrhage, tumors, aneurysms, ischemia, edema, and tissue necrosis.

Useful in distinguishing types of strokes
How is MRI used in diagnosing CVA?
MRI may be conducted to detect shifting of brain tissues as a result of hemorrhage or edema
How is positron emission tomography (PET)used to diagnose stroke?
Used to examine cerebral blood flow distribution and metabolic activity of the brain. PET allows identification of the location and size of the stroke
What is apraxia?
Inability to carry out a purposeful motor activity
What is ataxia?
What is an aura?
Peculiar sensation immediately preceding seizure symptoms; may involve visual, auditory or taste experiences, or a feeling of dizziness or numbness of body parts
What is cephalgia?
What is decussage?
cross over
What is dyskinesia?
Difficulty with movement
What is dyslexia?
Difficulty in reading
What is dysphagia?
Difficulty swallowing
What is dysponia?
A change in the tone of the voice
What is an EEG?
A diagnostic procedure that records the electrical activity of the cerebral hemisphere
What is ictus?
Refers to actual seizure
What is postitical?
Time period after seizure (lasts 30 min to several hours)
What is prodromal?
Refers to early manifestations or symptoms of a disease which may occur hours or days before onset of seizure
What is quadraplegia?
Paralysis of all four extremities
What is hemogenous hemianopia?
Right sided - no vision in left eye
Left sided - no vision in right eye
Manifestations of Left sided CVA in language?
Aphasia - inability to communicate
Alexia - visual aphasia
Agraphia - loss of ability to express thoughts in writing
Broco's aphasia - undrestands but only communicates in short sentences
What are manifestations of Left sided CVA in regards to memory?
No memory deficit
What are manifestations of Left sided CVA in regard to vision?
Unable to descriminate words and letters
Reading problems
Deficit in right visual field Homonymous hemaniopia (right side of each eye)
What are manifestations of Left sided CVA in regard to behavior?
Anxious with new tasks
Depression (response to illness)
Sense of guilt
Feeling of worthlessness
Worries over future
Quick anger and frustration
What are manifestations of Left sided CVA in regard to hearing?
No deficit
What are manifestations of Right sided CVA in regard to language?
Loss or impaired sense of humor
What are manifestations of Right sided CVA in regard to memory?
Disoriented x 3
Cannot recognize faces
What are manifestations of Right sided CVA in regard to vision?
Visual spatial (difficulty relating to space)
Neglect of L visual field
Homonymous hemianopia (left side of each eye)
Loss of depth perception
What are manifestations of Right sided CVA in regard to behavior?
Unaware of neuro deficits
Confabulates (talks)
Constantly smiles
Denies illness
Poor judgment
Over estimates abilities
What are manifestations of Right sided CVA in regard to hearing?
Loses ability to hear tonal variations
Why would you allow a CVA client to be hypertensive?
To facilitate adequate cerebral tissue perfusion
What are manifestations of a TIA?
Blurred vision
Blindness in one eye or both eyes
Tunnel vision
Transient weakness, arm, hand, leg
Ataxia - gait disturbances, loss of coordination
Transient numbness (face, hand, arm, or leg especially on one side of the body)
Dysarthria - slurred speech or difficulty understanding speech
Sudden confusion
Sudden severe HA without cause
How does a TIA differ from a RIND?
TIA lasts <24 hours
RIND lasts >24 hours
What are non-surgical nursing actions to manage CVA?
Elevate head of bed 30º to 45º (midline neutral position) - to facilitate venous drainage from brain and avoid increased intracranial pressure

Avoid hip flexion (increases intra thoracic pressure)

Avoid neck flexion - decreases venous drainage from brain

Don't cluster activities - keep environment quiet (headaches)

Vital signs - keep BP within normal limits for that client - to facilitate adequate cerebral tissue perfusion
What drugs are used to prevent CVA?
Drugs that prevent clot formation and blood vessel occlusion

What drugs are used in the treatment of CVA?
No anticoagulants are given with a hemorrhagic stroke

Anticoagulants, ASA, coumadin, heparin prevent further extension of the clot and formation of new clots (decrease thrombosis, need for PT and PTT)

Antiseizure: Dilantin, Tegretol, Pheobarbital

Calcium Channel blockers - Treats vasospasms, decreases contractibility

Activase rt-pa given sometimes with anticoagulants - conversts plasminogen to plasmin, resulting in fibrinolysis of the clot. To be effective, must be given within 3 hours of onset of manifestations
What is endarterectomy?
Removal of artherosclerotic plaque from inner lining of carotid artery
What is anastomosis?
STA-MCA (Superior Temporal Artery, Middle Cerebral Artery)

A bypass of the blocked artery by making a graph or bypass from STA to the MCA (To establish blood flow around the blocked artery)
What is multiple sclerosis?
A chronic demyelinating disease of the central nervous system, associated with an abnormal immune response to an environemntal factor.
Describe the pathophysiology of MS
Multiple sclerosis is a disease that causes a disruption in communication between the central nervous system and the rest of the body. Inflammation occurs due to T cells triggering infiltration of leukocytes. This inflammation destroys the myelin. Transmission of nerve impulses becomes slower, distorted, or blocked. Plaque and disease lesions form from the inflammation. Scarring forms with progression of the disease and degeneration of axons. This lead to continued loss of function which lead to permanent disability.
What are manifestations of MS mixed or general type?
Manifestations include optic nerve involvement with visual blurring, fogginess, or haziness; and impaired color perception. There is also decreased central visual acuity, area of diminished vision in the visual fields, acquired color vision deficit (especially to red and green), and an altered papillary reaction to light.

Brainstem lesions (cranial nerves III to XII) are noted, with nystagmus, dysarthria, deafness, vertigo, vomiting, tinnitus, facial weakness, and decreased sensation. Other manifestations include diploplia and eye pain, and cognitive dysfunctions involving concentration, short-term memory, word finding, and planning.

Mood alterations are manifested as depression more often than euphoria
What are manifestations of MS spinal type?
· Weakness and/or numbness is noted inone or both extremities (most often the legs).
· Upper motor neuron involvement is manifested by stiffness, slowness, weakness (spastic paresis).
Bladder dysfunctions include urgency, hesitancy, and incontinence.

Bowel dysfunctions is most often seen as constipation.

Neurogenic impotence is noted.
What are manifestations of MS cerebral type?
Client shows manifestations of nystagmus, ataxia, and hyptonia
What are manifestations of MS amaurotic type?
Client develops blindness
MS affects the ___ matter of the brain?
How does cerebral spinal fluid analysis help to diagnose MS?
reveals an increased number of T lymphocytes that are reactive with antigens, indicating the presence of an immune response in the client. Of MS patients 80% have elevated levels of immunoglobulins G (IgG) in the CSF.
How does MRI studies help diagnose MS?
cerebral MRI detects multifocal lesions in the white matter. Serial MRIs can be done to project the course of the disease.
How does CT scane help diagnose MS?
shows atrophy and white matter lesions. In about 25% of clients with MS, enlarged ventricles are visible on CT.
How does PET scan help diagnose MS?
measures brain activity. In MS clients, the scan reveals areas with changes in glucose metabolism
What is the most definitive test for diagnosing MS?
What is a side effect of interferon beta-1b?
Suicidal tendencies
How are immunomodulators used in MS?
used to prolong the time of onset to disability. May produce in the MS lesions.
What are examples of immunomodulators?
Interferon beta -1a (Avonex)
Inteferon beta - 1b (Betaseron)
Glatiramer acetate (Copaxone, Coplymer-1)
How are adrenocorticosteroids used in treating MS?
used both to sustain a remission and to treat exacerbations of MS. The drugs are given to suppress the immune system, implicated in the etiology of MS.
How are muscle relaxers used in treating MS?
given to relieve muscle spasms
What are examples of muscle relaxants?
Baclofen (Lioresal)
Dantrolene (Dantrium)
Diazepam (Valium)

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