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stroke & neuro disea
med surge nursing
| Question | Answer |
|---|---|
| Ischemic Stroke s/s | numbeness weakness of face, leg, arm on one side of body |
| Hemorrhagic stroke | Exploding headache decreased LOC |
| Aphasia | Receptive (Wernickes) Expressive (brocas) |
| Middle Cerebral artery | Stupor Coma Hemiplegia Aphasia Contralateral drowsiness |
| Right Cerebral Hemisphere symptoms | unaware of limits neglect syndrome loss of depth perception impulse poor judgemetn left hemipegia hemianopsia |
| Left cerebral hemisphere symptoms | aphasia, agraphia (diff writing), Right hemiplegia Depression Slow cautious behavior Frustrations Hemianopsia (blindness one sided in both eyes) memory problems |
| Anterior Carotid Artery | loss descison making loss voluntary actions contralateral paralysis urinary incontience |
| Internal Carotid | Most common Hemianopsia hemiplegia aphasia apraxia agnosia unilateral neglect |
| Veretbrae | Pain in face, nose, eyes numbness face weak-ipsilateral dysarthia gait problems |
| carotid endarectomy post op care | place pt flat or elevate HOB 30 degrees on unoperated side support head to avoid rotation, flexing, extending assess for hemorrhage, RESP distress, hyper/hyptoension number one complication is stroke |
| TpA contraindication | after 3 hours pt is on warfarin or INR above 1.7 recent head injury or trauma |
| Management of pt on Tpa | vitals q 15 min for first 2 hrs then 30 min for next 6 hrs bo less than 180/105 |
| S/s ICP | common in hemorrhagic strokes caused by HTN cerebral edema hydrocephalus, vasospasm |
| Drug to control ICP | mannitol |
| Classic symptoms of Parkinsons | Need 2 out of 4 symp and + resp to park drugs RIgidity- cog wheel(jerking movt) Bradykinesia Postural change others included masklike expression, shuffling gait, dysphagia, wt loss, dementia |
| COmmon complications associated with Parkinsons | Resp tract infections UTI constipation pain sleep disorders |
| Sinemet and levadopa | precursor to dopamine, could wear off after years of therapy- not initaiated til moderate symptoms Entracapone and talcopone prolong its effect |
| Neuroleptic Malignant syndrome | result of long term parkinsons drugs severe stupor, rigidity, and hyperthermic Hypomobility-inability to speak/walk--use apokyn to treat |
| Drugs to decrease tremors in parkinsons | antihistamines, beta blockers, and antivirals |
| Parlodel, Requip, Miroplex | parkisons drug used after sinemet is no longer effective |
| MS s/s | dysarthia, parastesias, intentional tremor, bowel. bladder dysfunction exacerations/remissions emotional disorders weakness/paralysis |
| MS patho | unknown cause- in colder climates impaired nerve imuples conduction due to destruction of myelin -plaque on myelin Autoimmune/viral |
| MS medication management | Muscle relaxants (Valim) decrease spasms Steriods Imuran/Cytoxan-immunosuppressants Cholinergic-urinary retention Interferon B- decreases exacerbations Diazepam/Baclofan- decrease spasity |
| Management of MS | Void q 3hrs (self cath) increase fiber, high protein, low fat, gluten free- raw veggies megavitamins Avoid laxatives and enemas Cool environment ROM q 2 times per day Se |
| ALS | impaired impulse conduction d/t degeneration of motor neruons muscle weaknes (begins in legs), atrophy, parlaysis fatigue resp failure |
| Management of ALS | riluzole-slows progression 2-3months antibiotics propholactic decrease pain, injury, risk of aspiration ask for living will |
| Myasthenia GRavis Crisis | trigger by emotional distress, withdraw or infection weak voice, unable to swallow, absent cough, increased Bp and HR, may need intubated |
| Cholinergic crisis in MG | n/v/d r/t overmedication, incresaed saliva and increased antibodies |
| Tenslon test | tensilon stops break down of ach Used to dx myasthenia gravis |
| Mestinon | inhibits break down of ach for MG S.e. cramps, n/v/d, excessive saliva helps regain muscle strength NEED ATROPINE as antidote |
| Management of MG | steriods-may initally worsen symp but then better- given indef plasmaphoresis- removes plasma that contain antibodies (s.e. myasthenia crisis) o2 may be needed sit upright w chin down to eat avoid hot/cold, infect, stress |
| Myastenia Gravis | autoimmune antibodies attack ach receptors Profound weakness fatigue masklike expresion diplopia, ptosis= droop of upper eyelid diff swallowing/chewing |
| Gullian Barre | progressive demyelination of peripheral nerves from feet to head, numbness, tingling, autonomic dysfxn, autoimmune |
| Gullian Barre management | Intubation, plasmaphersesis, TPN, corticosteriods, turn q 2hrs, ROM, chest physiotherapy SCDs |
| Gullian Barre Dx | Increased protein in CSF nerve conduction slowed in EMG |
| TIC Douloureux | cranial nerve 5 (trigeminal nerve) sudden intense facial pain sudden eye closing |
| Management of TIC Douloureux | tegretol- monitor liver enzymes and bone marrow suppression; decrease neuro repolarization NARCOTICS do NOT work Antispasmatics (Baclofen, liorsal) |
| Rhizotomy | TIC Douloureux- destroys nerve recurrenses and complications are high |
| Education for TIC pts | test food temp before eating High cal, high protein, easy to chew use h20 jet instead toothbrush use artifical tears for eyecare |
| Bell's Palsy | Numbnessand tingling, Upward movt of eyeball Lag in closing eye Inflammation of CN 7 Unilateral facial weakness, difficulty eating, speech difficulties |
| Management of Bell's Palsy | Corticosteriods, heat therapy, |
Created by:
heatherlynn131
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