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What's a TIA?
Neuroologic dysfunction that lasts for only a few minutes (7-14)
What's a CVA?
Stroke, blood flow impeded to the brain which causes oxygenation deprivation to cerebral tissues.
How do you get a TIA?
How do you get a CVA?
- Thrombus-plaque or clot
- Embolis-moving clot from carotid artery or heart
- Hypertensive or intracerebral hemorrhage
S/S of a carotid and cerebral artery TIA
- blind in one eye
- hemiplegia (one side paralyzed)
- hemianesthesias (one side decreased sensation)
- speech disturbance
S/S of vertebro basilar artery TIA
- visual defects in 1 or both fields
First sign of a CVA
altered level of consciousness
What will I see as a nurse that will initiate a "code stroke" call?
- slurred speech
- droopy face
- change in extremity strength
What are the changes in VS that confirm a stroke?
- Cushing Reflex:
- Elevated BP
- Widened pulse pressure
Ischemic neurons vs necrossed
If ischemic....they can be saved.
disturbance in language:
- Cant read:
- expressive language
- pt can understand, but cant talk
patient cant understand what you are saying
defects in articulation
brain damage causing a patient to not be able to read
difficulty in selecting appropriate words-particularly nouns
disturbance in ability to write
- inability to perform previously learned purposeful motor acts
- (wants a drink of water, picks up a pitcher and glass, then stops)
- failure to recognize familiar objects by the senses
- (close eyes, put keys in hand, dont know what it is)
damage to the occipital area leading to blindness of 1/2 of the body....and is the opposite side of the damaged brain
partial blindness when the vision is missing in the outer half of both visual fields
Nursing interventions for the client with aphasia
Nursing interventions for the stroke client with visual/perceptual problems
When do you notify the physician of a CVA pt. elevated blood pressure?
How do you have a CVA patient sit correctly?
- HOB 30 degrees
- head slightly flexed
- shoulders relaxed
- knees flexed
To maximize ventilation potential
Describe signs of ICP
- Behavior change
- Decreased LOC
- weakness/numbness/eye movement problems
Cardio signs of ICP
- carotid bruit
Urinary signs of ICP
Examples of behavior changes in a person with ICP
What is unilateral neglect?
related to visual field and a loss of one side of the body, (dont use it)
- Tell pt to:
- scan things from left to right-see everything
- position bed in room so I come at them from unaffected side
- put things in visual field of unaffected side...gradually moving things to affected side
- work on reintegration of the whole body
What is neglect syndrome?
Dont acknowledge the affected side of the body. Like it doesnt even exist
a wasting of a body part due to it not being used
What meds are given to a person who has had a stroke?
- antiplatelets....aspirin 81mg
What kind of stroke patient gets coumadin?
one with a-fib
BP medication that is effective for pt. who have had a stroke
Interventions for a CVA pt at risk for airway obstruction
- clear airway-TCDB or suction
- encourage slow deep breathing
- HOB at 30 degrees with ....etc
- IS to prevent atelectasis
- NPO till swallow eval is done to prevent aspiration
Interventions to assist the CVA pt to achieve urinary and bowel continence
- bladder retraining
- interval training
- positive reinforcement for making it to the toilet
What are important concepts related to patient teaching and stroke prevention:
- Call 911 if:
- sudden numbness/weakness/paralysis...especially on one side of body
- slurred speech
- sudden confusion/or trouble understanding
- trouble walking/dizzy/loss of balance
- sudden severe headache
What should be included in a home environment assessment for the CVA pt?
- assistive devices-utensils
- pillows to prop up pt so dont slump
- good lighting
- things placed in sight
- no skid surfaces-remove rugs
Describe resources the might be utilized in transitioning a CVA client from hospital or rehabilitation unit to home
- Home health aid
- bus or car service
- cognitive fxn
Where is brocas?
Where is the brain damage if you see a change in personality?
receives and interprets sensory stimuli
What part of the brain tells you if you are hot, cold or in pain?
interprets visual stimuli
- speech reception
What part of the brain has Wernikes?
What part of the brain controls long term memory?
What does the cerebellum do?
- coordinates muscle tone and fxn
- integrates proprioception and maintains balance and coordination
What makes up the brain stem?
- Pons and Medulla
- Reticular activation system
major receiving and communication center for sensory input
- supervises the ANS
relays impulses from the cerebellum to the cerebrum
Pons and Medulla
Repiration and VS
Reticular Activation system
controls wakefulness and arousal
What happens when you have thick blood?
it is harder to get blood up to the brain
3 metabolic factors important to regulation of ICP
3 areas Glascow coma scale checks:
- eyes opening
- motor response-obey commands?
- verbal response-tell to do something, do it
Person who has had a CVA should start PT when?
Immediately....I can do without a doctors order with ROM exercises
Golden test for CVA
CT scan....needs to be done within 30 minutes and labs need to be done within 45 min
Prior to do a CT scan what do you need to find out?
if the pt is allergice to seafood or iodine....use contrast
Treatment of thrombus CVA
- clot buster within 6 hours of onset of symptoms
- heparin to prevent further thrombi
Treatment of hemorrhagic CVA
control ICP and prevent further bleeding
Treatment of ICP
- admin of 02
- IV mannitol and lasix
Measures to prevent or control ICP
- HOB at 30
- prevent hyperextension, flexion or rotation of head
- prevent emotional upset
- prevent valsalva maneuver
- prevent constipation
- prevent sudden arousal from sleep
A person who has ICP....their CO2 should be kept under
The reason why rehab therapy is effective is cuz of Bobath principles. What are they?
- you can relearn things even after the brain is damaged cuz:
- level of excitability of nerve cells is changeable
- when neural conncections are impaired, there is a degeneration of inhibition that allow previously unused connections to be utilized
- collateral sprouting
What does it mean when you say the excitability of nerve cells is changeable?
if a cell dies, remaining cells can produce a better response to the lower input received from fewer cells
What is collateral sprouting?
when previously unconnected axons attached to dendrites of cells deprived of input cuz of cell deaths, provide new input
What does medicare type D cover?
medications up to $2800, then the pt pays 100% of drug charges
What is capitation?
accepting a fixed amount of money per enrolled person per enrollment period (1 year) and agreeing to provide certain healh care services to all plan members with no additional billing