Week 5 & 6: Nursing Priorities in Stroke & Neuro Disorders - PDF

Week 5: 1. Neurological Assessment History & Symptoms: Headaches, dizziness, seizures, weakness, numbness, difficulty swallowing/speaking. Physical Exam: o ABC & Vital Signs o Glasgow Coma Scale (GCS) – Measures eye, verbal, and motor responses....

Week 5: 1. Neurological Assessment History & Symptoms: Headaches, dizziness, seizures, weakness, numbness, difficulty swallowing/speaking. Physical Exam: o ABC & Vital Signs o Glasgow Coma Scale (GCS) – Measures eye, verbal, and motor responses. o Pupil Response – Size, equality, and reaction to light. o Motor & Sensory Function – Reflexes, coordination, strength. o Cranial Nerve Exam – Speech, facial symmetry, swallowing. 2. Stroke (Cerebrovascular Accident - CVA) Definition: Sudden loss of brain function due to interrupted blood flow. Risk Factors: o Nonmodifiable: Age, sex, race, genetics. o Modifiable: Hypertension, diabetes, obesity, smoking, alcohol use. Types of Stroke Type Cause Treatment Ischemic Blockage (thrombus or tPA (if within 4.5 hrs), aspirin, Stroke (80%) embolus) endovascular thrombectomy Hemorrhagic Ruptured vessel (aneurysm, Blood pressure control, surgery Stroke hypertension) (clipping, coiling) Stroke Symptoms (FAST) F – Face drooping A – Arm weakness S – Speech difficulty T – Time to call 911 Right vs. Left Brain Stroke Right Brain Stroke Left Brain Stroke Spatial-perceptual Speech/language impairment deficits (aphasia) Impulsive behavior Slow, cautious behavior Left-side paralysis Right-side paralysis 3. Increased Intracranial Pressure (ICP) Causes: Stroke, brain injury, hemorrhage, infection. Symptoms: o Early Signs: Restlessness, headache, vomiting. o Late Signs: Cushing’s Triad (bradycardia, hypertension, irregular breathing), fixed pupils, posturing. Management: o Elevate HOB 30°. o Maintain normothermia. o Osmotic diuretics (Mannitol). o Monitor for herniation (fixed pupils, posturing). 4. Seizures & Epilepsy Seizure Phases: o Prodromal – Warning signs (hours/days before). o Aural – Sensory disturbances. o Ictal – Seizure activity. o Postictal – Recovery phase. Status Epilepticus: Continuous seizure activity >5 min; requires emergency treatment (IV lorazepam/diazepam). Nursing Interventions During a Seizure Maintain airway, turn patient to the side. Do not restrain or place objects in the mouth. Monitor duration & characteristics. 5. Nursing Priorities in Stroke & Neuro Disorders Ineffective airway clearance Risk for aspiration Impaired physical mobility Risk for skin breakdown Ineffective cerebral tissue perfusion Impaired swallowing Impaired communication 35 Multiple-Choice Questions with Answers 1. What is the most important initial assessment in a stroke patient? A) Blood glucose level B) Blood pressure C) Airway, breathing, circulation (ABCs) D) Oxygen saturation 2. What diagnostic test is performed first in a suspected stroke? A) MRI B) CT scan C) EEG D) Cerebral angiography 3. What medication is used for ischemic stroke within 4.5 hours of symptom onset? A) Heparin B) Tissue plasminogen activator (tPA) C) Warfarin D) Aspirin 4. Which symptom is more common in a right-brain stroke? A) Aphasia B) Impulsivity C) Cautious behavior D) Slow speech 5. What is the priority intervention for a patient with increased ICP? A) Lay the patient flat B) Elevate HOB to 30 degrees C) Give fluids rapidly D) Perform deep suctioning frequently 6. Which is an early sign of increased ICP? A) Cushing’s triad B) Fixed pupils C) Altered level of consciousness D) Bradycardia 7. What is the hallmark of Cushing’s triad? A) Hypotension, tachycardia, irregular breathing B) Hypertension, bradycardia, irregular breathing C) Tachycardia, hypertension, increased temperature D) Decreased ICP, increased temperature, confusion 8. Which intervention is important in a seizure patient? A) Restrain the patient B) Turn the patient on their side C) Insert a tongue blade D) Give oral medication immediately 9. What is the priority in a hemorrhagic stroke? A) Give tPA B) Control blood pressure C) Encourage oral fluids D) Administer anticoagulants 10. What is the best way to prevent aspiration in a stroke patient? A) Elevate HOB 90 degrees while eating B) Give thin liquids C) Encourage large bites D) Lay the patient flat 11. What is a major risk factor for stroke? A) Hypotension B) Hypertension C) High HDL D) Low cholesterol 12. What is the first intervention for status epilepticus? A) Restrain the patient B) Administer IV lorazepam C) Encourage oral fluids D) Wait for the seizure to end 13. Which stroke symptom requires immediate action? A) Gradual onset of confusion B) Sudden facial droop C) Chronic dizziness D) Mild headache 14. What diet is recommended for stroke prevention? A) High sodium B) DASH diet C) Low-fiber diet D) Keto diet 15. What is the purpose of Mannitol in increased ICP? A) Decrease CSF production B) Reduce brain swelling C) Increase blood pressure D) Treat infection 16. What position should a patient with increased ICP be in? A) Trendelenburg B) Supine C) HOB 30 degrees D) Prone 17. What should be avoided in patients with increased ICP? A) Clustered nursing care B) Quiet environment C) Low-stimulation D) Maintaining head midline 18. What is a postictal phase? A) Seizure warning phase B) Recovery phase C) Seizure itself D) Period before a seizure 19. What is a key intervention after a stroke? A) Keep NPO until swallow reflex is evaluated B) Give food immediately C) Encourage thick liquids only D) Lay patient flat 20. What is a major concern in a hemorrhagic stroke? A) Clot formation B) Rebleeding C) Hypotension D) High cholesterol 36. What is the main purpose of a lumbar puncture in neurological assessment? A) Detect increased intracranial pressure B) Evaluate cerebrospinal fluid (CSF) for infection C) Diagnose stroke D) Assess muscle strength 37. Which symptom is most concerning for a patient with a head injury? A) Mild headache B) Nausea C) Sudden decrease in level of consciousness D) Bruising at the site of impact 38. Which medication should be avoided in hemorrhagic stroke? A) Labetalol B) Aspirin C) Nicardipine D) Mannitol 39. A patient presents with sudden unilateral facial droop and slurred speech. What is the priority action? A) Administer IV fluids B) Obtain a stat CT scan C) Start anticoagulation therapy D) Elevate HOB to 90 degrees 40. What intervention helps prevent deep vein thrombosis (DVT) in stroke patients? A) Keeping the patient on bed rest B) Applying SCDs (Sequential Compression Devices) C) Providing a high-sodium diet D) Increasing fluid restrictions Week 6: 1. Overview of Diabetes Mellitus Type 1 Diabetes (T1DM): o Autoimmune destruction of beta cells in the pancreas. o Absolute insulin deficiency. o Requires lifelong insulin therapy. o Symptoms: Polyuria, polydipsia, polyphagia, weight loss, fatigue, nausea. Type 2 Diabetes (T2DM): o Insulin resistance + relative insulin deficiency. o Strongly associated with obesity, sedentary lifestyle. o Symptoms: Recurrent infections, prolonged wound healing, vision changes, fatigue. 2. Diagnosis of Diabetes A1C ≥ 6.5% Fasting Plasma Glucose (FPG) ≥ 7.0 mmol/L Random Blood Glucose ≥ 11.1 mmol/L with symptoms Oral Glucose Tolerance Test (OGTT) ≥ 11.1 mmol/L 3. Acute Complications Diabetic Ketoacidosis (DKA) - Type 1 DM Causes: Illness, infection, missed insulin, stress. Symptoms: Hyperglycemia, Kussmaul respirations, fruity breath, dehydration, abdominal pain, nausea. Management: o IV fluids (NS → D5 when BG 34 mmol/L), dehydration, no ketones.  Management: o Similar to DKA, but no need for acidosis correction. Hypoglycemia (BG < 4 mmol/L) Causes: Too much insulin, missed meals, excessive exercise. Symptoms: Anxiety, tremors, diaphoresis, palpitations, confusion. Treatment: o Conscious patient: 15g glucose (juice, candy), recheck BG in 15 minutes. o Unconscious patient: IM glucagon or IV D50. 4. Chronic Complications Macrovascular: Heart disease, stroke, peripheral artery disease. Microvascular: Retinopathy, nephropathy, neuropathy. 5. Diabetes Management Lifestyle Modifications Nutrition: o Carb counting. o Glycemic Index (GI). o Balanced meal planning. Exercise: o Lowers blood glucose, increases insulin sensitivity. o Snack if exercising >30 min. Medications Insulin Therapy: o Rapid-acting (Lispro, Aspart) – given at meals. o Short-acting (Regular insulin) – IV use in emergencies. o Intermediate (NPH) – basal insulin. o Long-acting (Glargine, Detemir) – no peak, given once daily. Oral Antidiabetic Agents (Type 2 DM): o Metformin: 1st-line; hold before surgery due to contrast risk. o Sulfonylureas (Glipizide, Glyburide): Stimulate insulin release. o SGLT2 Inhibitors: Increase glucose excretion via urine. 6. Special Conditions Somogyi Effect vs. Dawn Phenomenon Condition Cause Treatment Somogyi Nocturnal hypoglycemia → rebound Lower night insulin Effect hyperglycemia in AM dose Dawn Morning hyperglycemia due to hormones (GH, Increase night Phenomenon cortisol) insulin dose 7. Nursing Priorities Monitor blood glucose. Prevent complications (infection, skin breakdown). Teach self-care (diet, exercise, medication compliance). Assess for signs of DKA, HHS, and hypoglycemia. 25 Multiple-Choice Questions with Answers 1. What is the hallmark symptom of Type 1 diabetes? A) Recurrent infections B) Obesity C) Polyuria, polydipsia, polyphagia D) Slow wound healing 2. Which blood test is most useful for long-term diabetes control? A) Fasting blood glucose B) Random blood glucose C) A1C D) CBC 3. Which of the following blood glucose levels confirms diabetes? A) FPG 5.5 mmol/L B) A1C 5.9% C) Random glucose 12.5 mmol/L D) OGTT 8 mmol/L 4. What is the first-line medication for Type 2 diabetes? A) Insulin B) Metformin C) Glipizide D) Prednisone 5. What is a key symptom of diabetic ketoacidosis (DKA)? A) Bradycardia B) Kussmaul respirations C) Peripheral edema D) Decreased urine output 6. What is a major difference between DKA and HHS? A) HHS has ketones in urine B) DKA occurs in Type 2 DM C) HHS does not have ketoacidosis D) DKA does not cause dehydration 7. What is the treatment for a conscious hypoglycemic patient? A) IV insulin B) IM glucagon C) 15g glucose, recheck in 15 min D) IV fluids 8. What is the primary complication of diabetes affecting the kidneys? A) Neuropathy B) Nephropathy C) Retinopathy D) Stroke 9. What insulin should be given at mealtime? A) NPH B) Lispro C) Glargine D) Detemir 10. How does exercise affect blood glucose? A) Increases blood glucose B) Decreases insulin sensitivity C) Lowers blood glucose D) Increases insulin resistance 11. What is the first intervention in a patient with HHS? A) IV insulin B) IV fluids C) Potassium replacement D) Give glucagon 12. What is the risk of metformin in hospitalized patients? A) High blood glucose B) Liver failure C) Lactic acidosis D) Severe hypoglycemia 13. What is the Somogyi Effect? A) Hyperglycemia due to stress B) Nocturnal hypoglycemia → rebound hyperglycemia C) Morning hyperglycemia from hormones D) Post-meal glucose spike 14. Which insulin has no peak and lasts 24 hours? A) NPH B) Lispro C) Glargine D) Regular 15. What is the best way to prevent diabetes complications? A) Ignore symptoms B) Monitor blood glucose regularly C) Increase fat intake D) Avoid exercise 16. What is a sign of hypoglycemia? A) Polyuria B) Bradycardia C) Sweating and tremors D) Kussmaul respirations 17. What diet is best for diabetes? A) High sodium B) Low-fat, balanced meals C) High sugar D) No carbs 18. What should be avoided in diabetic foot care? A) Daily inspection B) Walking barefoot C) Moisturizing D) Wearing closed-toe shoes 19. Which lab test is most specific for diabetic nephropathy? A) A1C B) Urine microalbumin C) CBC D) Potassium 20. What is the primary function of sulfonylureas? A) Stimulate insulin release B) Reduce liver glucose production C) Increase glucose excretion D) Prevent DKA