Neuro_Lecture-3.ppt

Neurological Disorders Dr. Rita A. Dello Stritto, Nurs. 4043 Texas Woman's Universtiy Cerebrovascular Disease  Most frequent neurological disorder of adults.  3rd leading cause of morbidity and mortality in US 1st heart disease 2nd Cancer  Any phathological d...

Neurological Disorders Dr. Rita A. Dello Stritto, Nurs. 4043 Texas Woman's Universtiy Cerebrovascular Disease  Most frequent neurological disorder of adults.  3rd leading cause of morbidity and mortality in US 1st heart disease 2nd Cancer  Any phathological disorder that involves the bloeed vessels of the brain. Thrombosis, embolism, hemorrhage Texas Woman's Universtiy 2 Brain Attack http://www.uab.edu/images/uabmagazine/soph_briefs/stroke/stroke_02.jpg Texas Woman's Universtiy 3 Stroke  National Stroke Association Stroke is leading cause of permanent disability 15% are institutionalized 30% dependent on activities of daily living 60% decreased socialization outside home  American Heart Association $15-20 billion spent annually on stroke and stroke related disorders. Texas Woman's Universtiy 4 Texas Woman's Universtiy 5 Stroke Etiology  Vascular Obstruction ¾ (thrombi or emboli)  Ischemia and infarction  Hemorrhagic ¼ (hypertensive vascular disease)  Ruptured aneurysm  Arteriovenous malformation  Subarachnoid or intracerebral Bleeds Texas Woman's Universtiy 6  http://www.med.umich.edu/1libr/wha/wha_stroke_art.htm Texas Woman's Universtiy 7 Stroke Etiology Texas Woman's Universtiy 8 Stroke Epidemiology  750,000 strokes annually  Men > Women  Risk Factors Smoking Hypertension Obesity Cardiac Disease ↑ Cholesterol DM Birth control pills Texas Woman's Universtiy 9 Stroke Epidemiology  Prevention Lifestyle changes Warfarin or aspirin  A. Fib Texas Woman's Universtiy 10 Infarct vs Ischemic Stroke  Infarct Results of thrombus or embolus Oxygen deprivation of cerebral tissue  Microscopic necrosis of neuron  Necrotic area is infarcted.  Ischemic Decline in cerebral blood flow  Zone of irreversible infarction  Surrounded by potentially salvageable area  Ischemic penumbra Texas Woman's Universtiy 11 Clinical Manifestations  Sudden onset of neurological impairment Focal  Weakness  Dyphagia  Aphasia Resolves within 24 hours  TIA  Usually last minutes to < 1 hour Texas Woman's Universtiy 12 Diagnosis  Must be Rapid Identify patients who can receive thrombolytic therapy.  3 hour from time of symptom onset to Thrombolytics  “time to needle”  Goal Save damaged brain tissue and minimize permanent deficits. Texas Woman's Universtiy 13 Diagnostic Tests  CT scan without contrast  Neurological Exam National Institutes of Health Stroke Scale  Score gives severity of stroke  LOC, gaze, visual, motor, sensory language Texas Woman's Universtiy 14 CT Ischemic Stroke http://medicine.ucsd.edu/peds/Pediatric%20Links/Links/Neurology/Etiology%20of%20Pediatric%20Ischemic %20Stroke%20Am%20Jour%20of%20EM%20Nov%201997_files/image005.jpg Texas Woman's Universtiy 15 Cerebral Angiography www.theuniversityhospital.com/ stroke/ischemic.htm Texas Woman's Universtiy 16 3-D Angiography www.theuniversityhospital.com/ stroke/ischemic.htm Texas Woman's Universtiy 17 Intracerebral Bleed www.drmikemerrill.com/ students/brain-images.html Texas Woman's Universtiy 18  Subarachnoid Hemorrhage http://images.google.com/imgres?imgurl=http://www.chall.com/Chall1/nl/images_091503/Subarachnoid_Hemorrhage1.jpg&imgrefurl=http:// www.chall.com/newsletter_091503.htm&h=800&w=656&sz=81&tbnid=eRL9KkufiXYJ:&tbnh=142&tbnw=116&hl=en&start=7&prev=/images%3Fq %3Dsubarachnoid%26svnum%3D10%26hl%3Den%26lr%3D%26rls%3DGGLG,GGLG:2005-28,GGLG:en%26sa%3DG Texas Woman's Universtiy 19 Texas Woman's Universtiy 20 Clinical Management  Four Primary Goals Restoration of Cerebral blood flow Prevention of recurrent thrombosis Neuroprotection Supportive care Texas Woman's Universtiy 21 Clinical Management  Save as much ischemic area as possible: Oxygen Glucose Blood flow Texas Woman's Universtiy 22 Pharmacological Management  t-PA Should be started within 3 hours of onset of symptoms  When the patient was last seen symptom free Older then 18 years NIHSS score – deficits CT negative for bleeds or tumors Texas Woman's Universtiy 23 Texas Woman's Universtiy 24 Pharmacological Management  Anti-platelet  Anti-coagulants  Anti-hypertension Lower BP gradually  In acute stroke brain is accustomed to higher BP  Lower BP too fast leads to decreased cerebral perfusion. Texas Woman's Universtiy 25 Nursing  Assessment Neurologic changes  Administer t-PA  Monitor oxygen and glucose levels  Prevention UTI, Bedsores, aspiration, contractures, thrombophlebitis.  Collaborative Care Social workers; PT/OT; Nutrition; Spiritual Care; etc Texas Woman's Universtiy 26 Intracranial Pressure Monitoring (ICP)  Monitors the pressures within the skull Measurements allow for decisions to be made as to what interventions should occur in order to prevent further cerebral ischemia. Help to prevent herniation of the brain stem. Texas Woman's Universtiy 27 Intracranial Pressure Monitoring Intraventricular Subarachnoid Epidural Subdural Texas Woman's Universtiy 28 ICP Monitoring  Intraventricular Catheter (IVC) most common type of ICP monitoring Texas Woman's Universtiy 29 ICP Monitoring  Normal measurements 0 – 10 mmHg Upper limits 15 mmHg May increase to 100 mmHg coughing or straining episodes Symptomatic 20 – 25 mmHg  Monitor for obstruction of the catheter Texas Woman's Universtiy 30 Indications for ICP  Head injury – GCS