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stroke & neuro disea

med surge nursing

QuestionAnswer
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