Neuro Quiz #4 PDF

Michael Elkin Quiz #4 Neuro CVA – A stroke in the leading cause of a CVA HTN, Trauma, Illicit Drug use, Obesity, smoking, drinking can all cause strokes All strokes can lead to Seizures Primary prevention is the key to stroke prevention...

Michael Elkin Quiz #4 Neuro CVA – A stroke in the leading cause of a CVA HTN, Trauma, Illicit Drug use, Obesity, smoking, drinking can all cause strokes All strokes can lead to Seizures Primary prevention is the key to stroke prevention Ischemic Stoke Disruption of blood supply by obstruction Large artery thrombosis A-fib – pooling of blood causes clot formation though carotids Cryptogenic – unkown Illicit drug use – cocaine S&S Severe headache Numbness or weakness of face, arms or legs on one side Change in mental status Ataxia Hemiplegia – complete weakness Hemiparesis – partial weakness Dysarthria – weak speech muscles Aphasia BEFAST quick assessment tool Balance Eyes Facial dropping Arm weakness Speech diSiculties Time Treatment for Ischemic Strokes We will give tPA therapy also known as thrombolytic therapy (clot busters)  tPA is given within 3-4.5 hours after the onset of stroke symptoms tPA Guidelines are as followed DO NOT USE IF: CT scan showing signs of a hemorrhagic stroke History of intercranial hemorrhaging Seizure at stroke onset GI or UT hemorrhage less than 3 weeks ago USE IF Over the age of 18 Clinical diagnosis of ischemic stroke Baseline Ct scan showing no evidence of hemorrhage Transient Ischemic Stroke (Mini Stroke) Stroke that goes away on its own Temporary neurological deficits Warning sign of an impending stroke Plaque buildup or stenosis of carotids Prevention Treatments Anticoagulant therapy Antiplatelet therapy – ( clopidogrel and aspirin) Statins – decrease plaque formation Antihypertensives May need to do a carotid endarterectomy Hemorrhagic Stroke Sudden LOC Severe Headache ICP Low systemic BP Bleeding – hemorrhage shock Vomiting Causes HTN  Trauma Blood tinning drugs Diagnostic tests CT scan of the Brain Cerebral angiography Lumbar puncture (Spinal Tap)- to check if blood is in the CSF Care Morphine sulfate for headache Nitroprusside or labetalol Mannitol for ICP Fluids May need surgical procedure to drain or craneotomy Acute phase of stroke NIHSS Scale 0-42 ranking stroke severity The higher the score the more severe Monitor for bleeding: Monro-Kellie doctrine: the sudden increase in blood volume within the skull due to bleeding will cause a compensatory decrease in the volume of either cerebrospinal fluid (CSF) or brain tissue, aiming to maintain a constant intracranial pressure within the rigid cranial vault Low BP Tachycardia Low Cardiac Output Low Urine Output – Check BUN And Creatinine; increased levels mean you need to give isotonic fluids ICP Interventions: OXYGENTATE Monitor VS Elevate the HOB 30 degrees to drain blood by gravity  Maintain airway and ventilation Check Motor function, Speech, Pupil changes, I & Os, O2% Patients recovering from Stroke Assess: Mental Status Perception Motor control Swallowing ability Skin integrity – check sacrum Nutritional status – thickened foods or purred diet; may need TPN if not tolerated No straws Elevated be to 90 degrees when feeding and have them tuck in chin At risk for aspiration pneumonia Activity tolerance – turn and position patient as one, using support if indicated Use pillows to prop up patient Align all limbs Bowel and bladder function – look for fecal impaction or bladder distension Give laxatives May have to catheterize Have a bathroom schedule Concussion Vs Contusion Concussion – temporary neurological impairment Contusion – Bruising of the brain tissue Hematomas Epidural hematoma – between the skull and dura Subdural hematoma – between the dura and tissue Intradural hematoma – in the brain tissue Primary Prevention vs Secondary Prevention Primary – the main cause such as skull lacerations, fracture, contusions Secondary – issues overtime such as ICP, hypoxia, hypotension, hyperthermia and then turns into hypothermia, electrolyte disturbances Skull Fractures  Increased risk of infection CSF can leak into the nose and ears – Halo ring can appear around blood stain Classic signs of Basal Fracture (Base of the Skull) Raccoon Sign – Bruising around the eyes Battle Sign – Ecchymosis around the ears Glasgow Coma Scale 3 categories it tests Motor function Eye opening Verbal function The lower the score the more severe state of coma Herniation of the Brain Compression of Cranial Nerve III Cushing’s Triad High BP Low heart rate (Bradycardia) Irregular Respirations Other S & S Deteriorating LOC Dilated and fixed pupils Erratic breathing patterns Severe headaches, vomiting, seizures Ventilation and Perfusion and the most important These patients may need to be intubated – we will give sedation first be for paralytic agent Seizure can happen We will give Ativan first to sedate first Then give anticonvulsants – Keppra, Dilantin (Phenytoin) EEG for monitoring of brain conductivity Seizure Precautions  Padding on bed rails Suction and oxygen Side lying Grip socks Side rails up Neurogenic Shock Low BP Decreased respirations Tachycardia Decreased Cardiac Output Venous Pooling Pounding Headaches Autonomic dysreflexia Autonomic dysreflexia (AD) is a life-threatening medical emergency that occurs when the autonomic nervous system overreacts to stimulation AD is most common in people who have had a spinal cord injury above the T6 level. It's usually triggered by a noxious stimulus below the level of the injury, such as bladder distention or a urinary tract infection Uncontrolled hypertension and cardiac dysrhythmias Monitor respiratory depression – the diaphragm can be paralyzed Diaphoresis above paralyzed area Impaction of feces- give laxatives Abdominal dissension – catheterize Many have paralytic ileus Risk for DVT and Orthostatic Hypotension Check Skin When documenting, write potential for AD in chart Meningitis Inflammation of the meninge membranes (Dura mater, Arachnoid mater, Subarachnoid space, pia mater) 2 types: Bacterial and Viral Septic caused by bacteria- Strep pneumoniae, Neisseria meningitidis  Aseptic caused by viral infection such as herpes or HIV Bacterial Infection Antibiotics – Penicillin G and Cephalosporin Dexamethasone Fluids Viral infection Acyclovir NSAIDS Fluids S&S Nuchal Rigidity (StiS neck) Kernig Sign – knee if flexed, and their pain when extending it Brudzinski’s Sign – neck flexed; legs straighten out Photophobia Fever Headache 2 vaccines one at 11 and the other before college Multiple Sclerosis Demyelination disease of the CNS Autoimmune disorder: body destroys itself S&S Numbness & Weakness Ataxia Visual disturbances Meds We will give Interferon and IV Methyl prednisone (steroids) They can have lapses but may dormant Management May lose bladder and bowel control Neurological deficits (GSC)  Secondary complications can be relapse of MS Myasthenia Gravis Autoimmune disorder that aSects myoneural junction (Destruction of muscle endplates) Acetylcholine isn’t getting through to help the muscles contract S&S Diplopia - (Double vison or awareness of two images in both eyes) Ptosis – droopy eyelids Dysphonia – diSiculty speaking, hoarseness, abnormal voice Bulbar weakness - (Facial muscle weakness) Medical Management We will give Mestinon (Pyridostigmine) and steroids Immunosuppressants IVIG – immune globulin Plasmapheresis – plasma transfusion Thymectomy Guillen’s syndrome Autoimmune : attacks the peripheral nervous myelin (similar to MS) Usually start low at the legs and works its way up S&S Absent reflexes, starting with lower extremities and progressing upwards Bulbar weakness Weakness Meds Medical Emergency with intensive care and continuous monitoring Plasmapheresis IVIG Parkinson’s Slow progressive neurological movement disorder overtime associated with low levels of dopamine S&S Slow tremors Bradykinesia/akinesia Drooling Urinary retention Decreased peristalsis Depression Dysphagia Meds Levodopa – Dopamine replacement Cogentin for tremors