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Stroke (brain attack)
Formally known as a cerebrovascular accident (CVA), is a sudden focal neurological deficit caused by cerebrovascular disease.
- ⁃ A stroke is a syndrome in which the cerebral circulation is interrupted, causing neurological deficits.
- Cerebral anoxia lasting longer than 10 minutes causes cerebral infarction with irreversible change.
- Cerebral edema and congestion cause further dysfunction.
- Diagnosis is determined by a CT scan, electroencephalography, cerebral arteriography, and MRI.
- Transient ischemic attack may be a warning sign of an impending stroke.
- Permanent disability cannot be determined until cerebral edema subsides.
- Order of function return: facial, swallowing, lower limb, speech, arms.
- Carotid endarterectomy is a surgical intervention used in stroke management; targeted at stroke prevention, especially in clients with symptomatic carotid stenosis.
The inability to recognize familiar objects or person.
Called dyspraxia if the condition is mide, characterized by loss of ability to execute or carry out skilled movements or gestures, despite having the desire and physical ability to perform them.
blindness in half the visual field
Loss of half of the field of view on the same side in both eyes.
Client unaware of existence of his paralyzed side
Altered position sense that places the client at increased risk of injury. Pyramid point: with visual problems, the client must turn the head to scan the complete range of vision.
is a chronic, progressive, non contagious, degenerative disease of the CNS characterized by demyelinization of the neurons.
- - Usually occurs between the ages of 20 to 40 years and consists of periods of remissions and exacerbations.
- - Causes unknown, but disease is thought to be the result of an autoimmune response or viral infection.
- - Percipitating factors include pregnancy, fatigue, stress, infection and trauma.
- - Electroencephalographic findings are abnormal. Increased gamma globulin level, but the serum globulin level is normal.
- A neuromuscular disease characterized by considerable weakness and abnormal fatigue of the voluntary muscles. A defect in the transmission of nerve impulses at the myoneural junction occurs.
- - Causes: insufficient secretion of acetylcholine, excessive secretion of cholinesterase, and unresponsivess of the muscle fiberes to acetylcholine.
a degenerative disease caused by the depletion of dopamine, which interferes with the inhibition of excitatory impulses, resulting in a dysfunction of the extrapyramidal system. A slow, progressive disease that results in a crippling disability.
Guillain- Barre syndrome
an acute infectious neuronitis of the cranial and peripheral nerves. The immune system overreacts to the infection and destroys the myelin sheath. Usually preceeded by a mild upper respiratory tract infection or gastroenteritis. Slow process recovery that can take years.
Inflammation of the brain parenchyma and often of the meninges. It affects the cerebrum, brainstem, and cerebellum.
West nile virus infection
a potentially serious illness that affects the CNS. Contracted primarily by the bite of an infected mosquito (mosquitos become carrieres when they feed on infected birds)
An inflammation of the arachnoid and pia mater of the brain and spinal cord. Caused by bacterial and viral organisms, although fungal and protozoal meningitis also occur.
predisposing factors include: skull fractures, brain or spinal injury, sinus or upper respiratory infections, the use of nasal sprays and compromised immune system.
Occurs when an artery to the brain is blocked. The brain depends on it's arteries to bring fresh blood from the heart and lungs. The blood carries oxygen and nutrients to the brain, and takes away co2 and cellular waste. If an artery is blocked, the brain cells (neurons) cannot make enough energy and will eventually stop working. If the artery remains blocked for more than a few minutes, the brain cells may die. Immediate medical treatment is critical. Most commonly caused by narrowing of arteries in the neck or head due to atherosclerosis (gradual cholesterol deposition)
Results from a weakened vessel that ruptures and bleeds into the surrounding brain. The blood accumulates and compresses the surrounding brain tissue. Two types: intracerebral (within the brain) and subarachnoid hemorrhage. Two types of weakened blood vessels sually cause hemorrhagic stroke: aneurysms and arteriovenous malformations.
less common and include menstrual and cluster migraines. Lasts longer than 72 hours.
- neurologic symptoms are not completely reversible w/in 7 days.
- Ischemic infarct is noted on neuroimaging.
- Headache is unclassified and does not fit all the criteria to be classified migraine.
Migraines w/o Aura
- (common migraine) migraine begins without an aura before the onset of the headache.
- - pain is aggravated by performing routine physical activities.
- - pain is unilateral and pulsating.
- - One of theses symptoms in present:
- -Nausea and/or vomiting
- headache lasts 4-72 hours
- migraine often occurs in the early morning during periods of stress, or in the premenstrual tension or fluid retention
Migraines with an aura- (classic migraine)
- 1st phase- develops over a period of several minutes and lasts no longer than 1 hour.
- - well defined transient focal neurologic dysfunction exists.
- - pain may be preceded by:
- visual disurbances, flashing lights, lines or spots, shimmering or zigzag lights
- - Pain may be preceded by a variety of neurologic changes, including:
- - numbness, tingling of the lips and tongue, acute confusional state, aphasia, vertigo, unilateral weakness, drowsiness
- - 2nd phase- headache is accompanied by nausea and vomiting.
- - usually begins in the temple and increases in intensity and becomes throbbing in 1 hour.
- - 3rd phase- pain changes from throbbing to dull.
manifested by brief 30 minutes to 2 hours, intense unilateral pain that generally occurs in the spring and fall without warning. Most common chronic short duration headache with pain lasting less than 4 hours. Far less common than migraines. typically develop in men 20 and 50 years old.
Skull and spinal radiography
radiographs of the skull reveal size and shape of the skull bones, suture separation in infants, fractures or bony defects, erosion, and calcification.
spinal radiographs identify fractures, dislocation, compression, curvature, erosion, narrowed spinal cord, and degenerative processes.
Priorities: always check with clinet about the possibility of pregnancy before any radiographic procedures are done.
preprocedure- provide nursing support for the confused, combative, or ventilator dependent client.
- maintain imobilization of the neck if spinal fracture is suspected.
- Post procedure: Maintain immobilization until results are known.
Computed tomography (CT)-
- - Computed tomography is a type of brain scanning that may or may not require injection of dye. Accurate, quick easy, non invasive, painless, and least expensive method of diagnosis neurologic problems.
- - It is used to detect intracranial bleeding, space occupying lesions, cerebral edema, infarctions, hydrocephalus, cerebral atrophy, and shifts in brain structures.
Magnetic Resonance imaging (MRI)
produces images better than CT scan. Does not use ionizing radiation and instead relies on magnetic fields. A noninvasive procedure that idetifies tissues, tumores, and vascular abnormalities.
Position Emission Tomography- (PET)
is a diagnostic tool that is not available in all medical centers. It's benefit over a CT scan or MRI is that it provides information about the function of the brain.
Insertion of a spinal needle through the L3-L4 interspace into the lumbar subarachnoid space to obtain cerebrospinal fluid, measure CSF fluid or pressure or instill air, dye, or medications.
injection of dye or air into the subarachnoid space to detect abnormalities of the spinal cord and vertebrae
Injection of contrast material usually through the femoral artery (or another artery) into the carotid ateries to visualize the cerebral arteries and assess for lesions
graphic recording of the electrical activity of the superficial layers of the cerebral cortex.