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MedSurg:Chapter 48
Interventions for Critically Ill Clients with Neurologic Problems
| Question | Answer |
|---|---|
| Stroke | Disruption in the normal blood supply to the brain in the form of an interruption in blood flow to the brain(Ischemic) or bleeding within or around the brain(Hemorrhagic Stroke)*A stroke is a MEDICAL EMERGENCY that strikes suddenly;Treat Immediately |
| Types of Strokes | Ischemic(occlusive)and Hemorrhagic |
| Ischemic Stroke- occur during sleep | Caused by the occlusion of a cerebral artery by either a thrombus(Thrombotic Stroke) or an embolus (Embolic Stroke) |
| Thrombotic Stroke | Associated with the developement of atherosclerosis |
| Atherosclerosis | Altered function of the inner linning of arterical vessels, inflammation, and increased growth of vascular smooth muscles; Plaque develop on the inner wall of the affected arterial vessel |
| Atherosclerosis 2 | Clot formation; artery becomes occluded; decreased blood flow causes transient ischemia, which progresses to complete ischemia and infarction of the brain tissue.Within 72 hours, area is edematous and necrotic and cavities develop |
| Lacunar stroke | Type of thrombotic stroke- soft area or cavity develop in the white matter or deep gray matter of the brain; may result in significant neurologic dysfunction if it damages a critical area in the brain |
| Embolic Stroke | Caused by an embolus or a group of emboli (clot) that break off from one area of the body and travel to the cerebral arteries via the carotid artery or vertebrobasilar system*Usual source is Cardiac |
| Emboli Can Occur in Clients With | Nonvalvular atrial fibrillation, ischemic heart diseas, rheumatic heart disease, and mural thrombi following a myocardial infarction or insertion of a prosthetic heart valve |
| Transient Ischemic Attack(TIA)=silent stroke and Reversible Ischemic Neurologic Deficit(RIND) | Precedes an ischemic stroke; both cause transient focal neurologic dysfunctionTIA last few minutes to fewer than 24 hoursRIND symptoms last longer than 24 hours but less than a week |
| Hemmorhagic Stroke | Vessel integrity is interrupted, and bleeding occurs into the brain tissue or into the spaces surrounding the brain; results from a ruptured aneurysm, ruptured of an arteriovenous malformation, or severe hypertension |
| Aneurysm- Usually occur duing activity | An abnormal ballooning or blister on the involved artery- weaken vessel wallContinued force on the weakened vessel wall from elevated blood pressure strtches and thins the vessel wall, causing the intimal or innermost vessel layer to protrude |
| Arteriovenous Malformation | Occur during embryonic development; a tangled or spaghetti-like mass of malformed, thin-walled, dilated vesselsAbnormal communication between the arterial and venous system- vessels eventually rupture-bleeding in SA space or IC tissue |
| Hypertension | Hemorrhagic stroke may be more likely with sudden, dramatic blood pressure elevations, such as those seen with cocaine intoxication |
| Manifestations of Stroke- Cognitive Changes | Cognitive Changes-Changes in LOCRight cerebral hemisphere- visual and spatial awareness and proprioception- unaware of any deficits and may be disoriented to time and place, poor judgement,personality changes |
| Manifestations of Stroke- Cognitive Changes | Left Cerebral Hemisphere- Center for language, mathematic skills, and analytic thinking; Results in aphasia (inability to use or comprehend language), alexia(reading problems), agraphia(difficulty with writing)- Persons are slow and cautious |
| Motor Changes-Right Side | Hemiplegia(paralysis on one side of the body) or hemipareis(weakness on one side of the body)- stroke involving the left cerebral hemisphere because the motor nerve fibers cross in the medulla before the spinal cord and periphery. |
| Motor Changes-Left Side | Left hemiplegia or hemiparesis indicates a stroke in the right cerebral hemisphere |
| Motor Changes | Hypotonia or flaccid paralysis- unable to overcome the forces of gravity, and the extremities tend to fall to the side- feel heavy, and muscle tone is inadequate for balance, equilibrium, or protective mechanisms |
| Motor Changes | Hypertonic (spastic paralysis)- cause fixed positions or contractures of the involved extremities |
| Sensory Changes | Client maybe unable to write, comprehend reading material, use an object correctly(agnosia) or carry out of purposeful motor actvity(apraxia) |
| Sensory Changes- Neglect Syndrome-Stroke in Right Cerebral Hemisphere | Client is unaware of the existence of his or her left paralyzed side- the client who washes or dressess only one side of the body |
| Neglect Syndrome | Picture: Client sitting in a wheelchair, leaning to the left with the arm caught in the wheelchair, leaning to the left with the arm caught in the wheelchair wheel- Client believes that he or she is fine and believe that he or she is sitting up straight |
| Intracranial Pressure(ICP) Monitoring | Most at risk for increased ICP resulting from edema during the first 72 hours after onset of the stroke. First sign of increased ICP is a declining level of consciousness (LOC)-Elevate HOB to 30 degrees- Head is midline, neutral position-venous drainage f |
| ICP Monitoring | AVOID Extreme hip and neck flexion *AVOID clustering nursing procedures-Eg. giving a client a bath followed immediately by changing the bed linen *Hyperoxygenate Client before suctioning *Quiet Environment *Low lights |
| Management of Arteriovenous Malformation (AVM) | Therapy to occlude abnormal arteries or veins and prevent bleeding from vascular lesion |
| Management of Cerebral Aneurysms | Repaired via a craniotomy as soon as the client's condition is stabilized; During surgery, the aneurysm is clipped or a clamp is placed at the base, or neck, of the aneurysm to prevent blood from entering the area |
| Dysarthria | Loss of motor function to the tongue or to the muscles of speech, causing slurred speech |
| Expresssive(Broca's or motor) aphasia | Damage in Broca's area of the frontal lobeClient generally understand what is said but is unable to communicate verbally- difficulty writing- deficit and may become frustrated and angry |
| Receptive (Wernicke's or sensory) aphasia | Temporoparietal areaClient unable to understandd the spoken and often the written wordClient is able to talk, language is often meaninglessNeologisms(made up words) are common parts of speech |
| Global(Mixed) | Combination of difficulty understanding words and speechDifficulty with reading and writing. |
Created by:
keisha12_18
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