Neuro 2

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Thenordski
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194730
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Neuro 2
Updated:
2013-01-23 17:43:56
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nursing nurse neurology neuro
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Nursing Neuro 2 exam
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  1. Types of CVA
    • - Transient ischemic attack (TIA)
    • - Hemorrhagic
    • - Ischemic
  2. 3 Types of Ischemic attacks
    • - Embolic
    • - Thrombotic
    • - Lacunar
  3. Embolic ischemic attacks
    Clot, plaque, or debris that travels through the blood vessel and lodges in a cerebral artery
  4. Thrombotic ischemic attacks
    • - obstructions that form in an artery (does not travel)
    • - becomes an emboli if it dislodges
  5. Lacunar ischemic attacks
    • - caused by small penetrating vessels deep within brain
    • - symptoms and neuro changes less severe
  6. Hemorrhagic CVA
    • - rupture of vessels
    • - caused by trauma, aneursym, uncontrolled HTN
  7. Modifiable CVA Risk factors
    • - HTN, smoking, diabetus, cardiovascular disease
    • - A-fib, carotid stenosis, TIA, sickle-cell, dyslipidemia
  8. Non-modifiable CVA Risk factors
    - Age, gender, heredity, prior CVA/MI
  9. S/Sx of CVA
    • - Numbnes/weakness to face, arms, or legs
    • - Sudden severe headache, visual difficulty, trouble speaking/walking, dizziness
  10. Rx Treatments for CVA
    - Thrombolytics, anti-coag, anti-platelet, corticosteroids, mannitol, calcium channel blockers
  11. Thrombolytic (CVA Rx)
    • - TPA (Tissue-type plasminogen activator)
    • - only be used within 3 hours of onset
    • - contraindicated in hemorrhagic stroke, bleeding/clotting disorders, ...
  12. Anticoagulant (CVA Rx)
    • - Prevents formation of new clot
    • - does not dissolve existing clots
    • - ie: Warfarin, heparin
  13. Antiplatelet (CVA Rx)
    • - platelet aggregation inhibitors
    • - aspirin/ticlid: prolongs bleeding time (decreases risk for stroke)
    • - plavix: inhibits clotting
  14. Corticosteroid (CVA Rx)
    Dexamethasone: reduces ICP by reducing inflamm in brain after stroke
  15. Mannitol (CVA Rx)
    - Osmolytic diuretic
  16. Calcium channel blockers (CVA Rx)
    • - Prevents spasms in cerebral blood vessels after a hemorrhagic stroke
    • - Nifedipine, nimodipine
  17. CVA complications
    - Immobility, increased ICP, pneumonia, dysphasia, dysphagia, emotional/behavioral changes
  18. Immobility (CVA comp.)
    • - Contractures, skin breakdown, DVT
    • - Provide gentle ROM
    • - Provide support and alignment
  19. Increased ICP (CVA comp.)
    - Avoid any noxious stim that could increase ICP
  20. Pneumonia (CVA comp.)
    • - Prevention methods: positioning and prevention of aspiration r/t dysphagia
    • - Avoid noxious stim (cough/deep breathe, suctioning, chest PT)
  21. Expressive Dysphagia (CVA comp.)
    - Difficulty speaking, producing speech
  22. Receptive Dysphagia (CVA comp.)
    - Difficulty understanding words
  23. Dysphagia (CVA comp.)
    - Difficulty swallowing
  24. TIA: Transient ischemic atk
    • - temporary (few minutes - 24 hours)
    • - neuro deficit caused by impaired perfusion to brain
    • - patient at risk for full CVA
  25. S/Sx of TIA
    • - Dizziness, momentary confusion, dysphasia, dysarthria, loss of balance, weakness/tingling on one side of body, ptosis, visual disturbances
    • - Can resolve once perfusion returns
  26. Parkinson's disease
    • - Idiopathic (genetic?)
    • - progressive degen disease
    • - lack of dopamine production
  27. Dopamine
    • - neurotransmitter
    • - facilitates transmission of impulses from 1 neuron to another
  28. S/Sx of Parkinson's
    • - tremors, rigidity, bradykinesia
    • - loss of dex, aching, monotone voice, drooling, mask face, shuffling gait, slumped posture
  29. Rx for Parkinson's
    - Symmetrel, Artane, L-Dopa, Carbidopa, Sinemet
  30. Symmetrel (Parkinson's Rx)
    - facilitates the release of dopamine
  31. Artane (Parkinson's Rx)
    • - blocks action of acetylcholine
    • - controls tremors and drooling
  32. L-Dopa (Parkinson's Rx)
    - converts into dopamine in brain
  33. Carbidopa (Parkinson's Rx)
    - prevents peripheral breakdown of levodopa so more is available in CNS
  34. Sinemet (Parkinson's Rx)
    - combo of levodopa/carbidopa
  35. Huntington's disease
    • - progressive degen disease
    • - autosomal domninant
    • - no cure
    • - involuntary choreiform mvmts (dancing, twisting), personality changes, depression, emotional instability
  36. Autosomal Dominant
    - 50% chance of inheriting from parent with the disease
  37. Multiple Sclerosis
    • - Idiopathic (possible autoimmune/viral; genetic)
    • - Degen of myelin sheath (neuron insulation)
    • - Inflamed nerves
    • - Periods of remission and exacerbation
  38. S/Sx of MS
    muscle weakness, fatigue, visual disturbances, vertigo, mood alt, dysphagia, ataxia, sexual dysfunction, bowel/bladder problems
  39. Tx for MS
    • - Rx
    • - Prevent exacerbation
    • - Plasmapheresis
  40. Prevention of exacerbation (MS)
    - Minimize stress, avoid illness, rest
  41. Rx for MS
    - Steroids (methylprednisone), Interferon, muscle relaxants, Immunosuppressive (Novantrone), Copaxone
  42. Plasmapheresis
    • - similiar to dialysis
    • - removal of anitbodies improve b/c idea of MS is autoimmune
  43. Myasthenia Gravis
    • - Defect at neuromuscular junction (insuff receptor sites)
    • - exhausted muscles that improve with rest (church example)
    • - Difficulty breathing, ptosis, diplopia, muscle spams
  44. Myasthenia Gravis diagnosis
    - Tensilon test
  45. Tensilon Test
    • - tensilon is administered, muscles improve greatly within 1 min and last 4-5 mins
    • - used to distinguish between myasthenic/cholinergic crisis
    • - rapid mvmt = myasthenic
    • - no improvement = cholinergic
  46. Treatment for myasthenia gravis
    • - Rx
    • - patient teaching on s/sx of crisis
    • - avoid infection
    • - patient teaching on energy conservation
  47. Cholinergic crisis
    • - caused by over-Rx
    • - Flaccid paralysis leading to resp. failure
    • - SLUDGE
    • - Tx = atropine
  48. Myasthenic Crisis
    • - Sudden exaggeration of symptoms
    • - often caused by by stress, fever, or infection
    • - paralysis of resp. muscles (requires vent)
  49. Rx for Myasthenia gravis
    • - Baclofen, Valium, Quinine¬†(muscle cramps)
    • - Prostigmin (anticholinesterase agent): improves transmission of nerve impulses in muscles
  50. ALS (Lou Ghrig's disease)
    • - idiopathic
    • - rapid progessive degen neuro disease (death 2-5 years)
    • - Cognition intact
  51. S/Sx of ALS
    • - Weakness of upper extremities, hands
    • - Emotional instability
    • - Difficulty swallowing/speaking
    • - Excessive secretions (infection=most common cause of death)
  52. Guillain-Barre Syndrome
    • - idiopathic, possible autoimmune
    • - reversible (may require intubation)
    • - destruction of myelin ; slows conduction
    • - symmetical, ascending muscle weakness
    • - ABG's and resp. status closely monitored
  53. Tx for Guillain-Barre Syndrome
    • - Plasmapheresis (removes antibodies)
    • - Steroids (reduces inflamm)
    • - Emotional support
  54. 3 phases of Guillain-Barre Syndrome
    Inital phase, plateau phase, recovery phase
  55. Trigeminal Neuralgia
    • - Irritation of the trigeminal nerve (5th cranial nerve)
    • - Sudden, intense unilateral pain triggered by hot/cold, chewing, shaving, brushing teeth, talking, touch
  56. Patient teaching with Trigeminal Neuralgia
    • - chew on unaffected side
    • - minimize painful stim
    • - each/drink foods at room/body temp
  57. Bell's Palsy
    • - Acute paralysis of 7th cranial nerve
    • - Pain behind ear or on face
    • - Speech difficulty, drooling, tearing of eye, inability to blink
  58. Tx for Bell's Palsy
    • - Protection to eye whos eyelid does not close
    • - prednisone, analgesics, antiviral rx, moist heat, gentle massage, facial sling

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