Neuro NP2

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Neuro NP2
2012-04-24 10:41:19

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  1. Left Brain duties
    • Language
    • Writing
    • Reading
    • Listening
    • Calculation
    • Logic
    • Analysis
    • Sequence
  2. Right Brain duties
    • Creativity
    • Conseptual
    • Inovation
    • Idea
    • Image
    • Color
    • Music/Art
    • Dimension
    • Emotion
    • Daydreaming
    • LONG-Term Memory
  3. _____ are now believed to play a key role in recurring seizures
  4. Chronic disorder of frequent seizure activity
  5. Prevention of seizures
    • Avoid stress, lack of sleep, emotional upset, and alcohol
    • avoid precipitating stimuli
    • comply with medication regimen
    • learn relaxation techniques
  6. Tonic Phase:
    • Muscles become rigid, stiffens arms and legs
    • Loss of consciousness, fall to ground
  7. Clonic Phase
    • Rhythmic jerking of extremities
    • Loss of bowel or bladder, frothing at mouth
  8. Post ictal phase:
    Wake up exhausted and don't know what is going on
  9. One thing to remember when patient starts to have a seizure:
    Time it!
  10. What should you have for patient with seziures
    • Side rail padded with pillows and blankets
    • Suction
    • Untie all restraints if they have them
  11. Absence seizure
    • Petite mal seizure: common in childern
    • Brief, only few seconds
    • Hard to catch
    • Typically seen as blank staring then return to baseline but no memory of this
    • Lip smack, tap hands
  12. Partial complex seizure
    • Loss of consciousness characteristic automatisms followed by amnesia when seizure is complete,
    • One arem, one leg, one hand all at once
  13. Simple Partial seziure
    • Remains conscious, reports an aura
    • Will have unilateral movement, odd sensations, autonomic or psychic symptoms
  14. Seizure diagnosic tests
    • Electrolyte panel
    • history and physical
    • mri and mra (inject dye, blood vessels)
    • EEG-neuron activity
    • Drug screens
    • spinal tap with CSF analysis
    • Skull xrays
    • ct scan
  15. Seizures: Medical Management
    • Antiepileptic drugs
    • Client and family education
    • seizure precautions
    • monitoring drug levels
    • surgical management: Vagal nerve stimulator or surgical excision of area
  16. Seizures Nursing Interventions
    • Injury prevention during seizure
    • Monitor thearpeutiv drug levels on meds
    • Maintain ABC's oxygen as need
    • Monitor start, duration, characteristic of seizure, and post
    • Note if aura or other circumstances lead to seizure
    • Protect patient by padded side rails, bed in low postiton
    • lossen clothing if possible
    • Monitor vitals post seizure including neurological
    • Maintain iv access
    • minimize stimuli that may trigger
    • Turn on side once done, suction out secretions, o2 sat
    • Padded tongue blade, suction, oral airway always bedside
    • Orient to surrounding post seizure
    • educate peers on seizure first aid
    • Monitor side effects on medication and compliance with meds
  17. Complications of seizures
    • Status epilepticus: Prolonged seizure activity over 5 minutes long or repeated seizure in short period of time with a few seconds in between
    • Neurological emergency: must be treated immediately
    • Monitor ABC's: will respiratory arrest
    • IV MEDICATIONS: Valium, Ativan, Dilantin
    • Diastat Gel: rectal gell
  18. Types of Ischemic strokes
    • Thrombotic
    • Embolic - clot in artery, usually carotid
  19. Types of hemmorhagic strokes
    • Hypertensive strokes
    • AVM ruptures-arterial venous malformation, asymptomatic
    • Aneurysm-subarchnoid hemmorage (3-5 ccs of blood)
  20. How many mins of no blood flow for brain tissue to die
  21. Watershed affect
    • Opposite side of the brain
    • Stroke on right side of the brain, symptoms on the left
  22. FAST
    • Facial weakness
    • Arm weakness
    • Speech difficulties
    • Time is brain
  23. Aphagia receptive
    Cant understand
  24. Aphagia expressive
    can understand but cant say it
  25. Eye problems with stroke
    • only part of your eye works, (eat outside food on plate)
    • abnormal pupil response or size in one eye
  26. Stroke: Right brain damage
    • Paralyzed left side: hemiplegia
    • Left-sided neglect
    • Spatial-perceptual defects
    • Tends to deny or minimize problems
    • Rapid performance, short attention span
    • Impulsive, safttey problems
    • impaired judgement
    • imparied time concepts
  27. Stroke: Left brain damage
    • Right sided hemiplegia
    • imparied speecch/language, aphagias
    • imparied right/left discrimination
    • slow performance, cautious
    • Aware of deficits, depression, anxiety
    • Imparied comprehension related to language, math
  28. Diagnostic testing for strokes
    • history and physical
    • mri and mra
    • ct scan
    • carotid doppler
    • arteriography and angiography
    • ultrasound: heart and carotid, legs
    • CBC- wont show alot
    • chemistery and lipid profiles
    • bleeding studies- pt, ptt, inr ( if increased bleed into brain)
    • blood glucose
    • CSF tests- lumbar puncture
  29. Strokes Medical Mangement
    • Heparin
    • Plavix
    • Aspririn
    • Coumadin
    • Lovanox
  30. Strokes medical management
    Antiseizure medications
    Dilantin, Kepra
  31. Strokes medical management
    Hyperosmolar medications
    • Manitol- iv
    • reduces swelling in brain
  32. Thrombolytic therapy: for acute ischemic stroke
    • Should be in the first 90min of stroke to up to 3 hours of onset
    • Rt-PA Retavase (streptokinase)
    • Must be watched carefully
    • Must have bleeding stidies monitored
    • Watch for bleeding, bruising, changes in neurological status (better or worse)
  33. Strokes medical management
    • Reduce platelet adhesions
    • Plavix
    • Persantine
    • Ticlid
  34. Strokes medical management
    • Surgical clipping an avm or putting a coil graft in the weak vessel, AV bypass
    • Surgical embolectomy or evacuation of crainal bleed
    • Carotid endarterectomy- thromblic, routo-router the carotid
    • then graft it , can stroke out! Watch BP
    • If Bleed- Burr hole to decrease pressure
  35. Early signs of increasing intercrainal pressure
    • The patient may become lethargic, talkative or quiet, or restless and irritable.
    • trouble remembering things, experience a change in personality, or complain of nausea and vomiting. Symptoms may progress to confusion or diminished responsiveness. hemiparesis or new-onset seizures.altered respiratory pattern, unequal pupils, and sluggish pupillary response to light (early signs
  36. Late signs of increased intercrainail pressure
    • fixed, dilated pupils;
    • decorticate or decerebrate posturing;
    • loss of gag reflex;
    • loss of corneal reflex;
    • bradycardia
    • increased systolic blood pressure,
    • widened pulse pressure,
    • and slowed heart rate.
    • Irregular respiratory patterns may develop, and the patient's temperature may rise.
  37. Stroke
    Nursing interventions
    • Frequent Neurological Assessment- note any motor changes, glasgow coma scal, progression or improvement in cognitive deficit, paralysis or blindness
    • Assess for Neglect or hemianopsia
    • Montitor labs, PT, PTT, INR, and CBC if on blood thinners
    • Vital sign monitoring (BP key)
    • AFib
    • Dysphagia precautions
    • monitor for aspiration (if do, modified barium swallow)
    • ability to do adls
    • Monitor for signs of increased intracranial pressure (ICP) for 72 hours ( highest time of risk)
    • Seizure precautions
    • Assess ability to speak or comprehend
    • Sensory disturbances
    • Coping mechanisms
  38. Health teaching
    • Medications, side effects, BP meds, and monitoring
    • Home health needs and referals
    • physical therapy assessment
    • psychosocial -assess for depression
    • Occupational therapy assessment
    • safety assessment
  39. Complications of stroke
    • Aspirations
    • increases intercrainal pressure
    • seizures
    • coma
    • death
  40. Signs and symptoms of TIA
    • blurred vision
    • diplopia (double vision)
    • Blindness unilaterally
    • Transient weakness/numbness of extremities
    • Ataxia
    • vertigo
    • aphasia
    • dysarthria - cant move
    • Can last only a few min -24 hours
  41. Preventive therapy and drug therapy for migraines
    • Ha at least 2-3 montths
    • NSAID: Naproxen
    • Beta-adrenergic blocker: propanolol (inderal)
    • Tricyclic or ssri: Imitrex
    • Antiepileptic drugs: Depakene
  42. Migrane Abortive therapy
    • Alleviating pain in aura phase
    • asa and acetaminophen
    • ERGOTAMIN derivatives
    • Nsaids
    • triptans-
  43. What should people with Migrains avoid eating
    • Eliminate tyramine- containing product:
    • -chocolate
    • Nuts
    • alcoholic bevv
    • aged cheeses
    • beveragaes with caffine
  44. Cluster headache S&S
    • Facial swelling
    • miosis
    • pallor
    • increased IOP
    • Increased temp
  45. drug therpay for cluster headaches
    • Same for migranes
    • 100% o2 in a sitting position for 15 min
  46. Nursing management for headaches
    • history and physical
    • bed time and waking time
    • lifestyle changes
    • wear sunglassess
    • sit away from windows: reduces glare
    • pain assesssments
    • education on sleep-wake cycle