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Neurology

Neurology. Cerebrovascular Accident Brunner’s Ch. 62 pg 1887. Breaking down in tears. I’m a nursing student who’s never seen a person die. When the time comes, I’m afraid I’ll lose it and upset the patient or family. How do you do this work all the time and not break down in tears?.

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Neurology

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  1. Neurology Cerebrovascular Accident Brunner’s Ch. 62 pg 1887

  2. Breaking down in tears • I’m a nursing student who’s never seen a person die. When the time comes, I’m afraid I’ll lose it and upset the patient or family. How do you do this work all the time and not break down in tears?

  3. Cerebrovascular accident AKA • CVA • Stroke • Brain attack

  4. CVA: Pathophysiology • Disruption of blood flow to part of the brain  • Ischemia  • Tissue Anoxia  • i PaO2 & h PaCO2  • Acidosis  • Infarction  • Edema  • h ICP

  5. CVA: Etiology • Ischemic • Thrombosis • __?__  thrombosis • Arteriosclerosis • Common site • Carotid artery • Embolism • Atrial fib or HTN • Plaque breaking off and becoming an emboli • d/t Long standing cardio-vascular disease

  6. CVA: Etiology • Hemorrhage • Rupture of the cerebral blood vessel • Commonly caused by poor control of HTN

  7. CVA: Etiology • Hemorrhage • This type of CVA results in: • Slow recovery • h probability of neurological deficits • No meds to reverse the effects

  8. CVA: Etiology • Other causes • Syphilis • Trauma • Hypertension • Hypoxia • ***Anything the i blood flow

  9. CVA: Risk Factors Changeable • Smoking • Obesity • HTN • Sedentary life • Stress • h fat diet • h Na diet • Substance abuse • Oral contraceptives • Diabetes mellitus Non-changeable • Age • Gender • Family history • Race

  10. CVA: Risk Factors Which is the most important risk factor for a stroke? • Smoking • Weight • Diet • HTN • Stress • Substance Abuse

  11. CVA: Risk Factors What is the number one cause of CVA in a younger patient? • Smoking • Weight • Diet • HTN • Stress • Substance Abuse

  12. CVA: Pathophysiology substance abuse • Substance (PCP, crack)  • h Blood pressure  • h ICP  • Subarachnoid & intracerebral hemorrhage  • Interrupt blood flow  • i O2 & i glucose  • Depressed neurons 

  13. CVA: Pathophysiology • ** Vessels involved determine the area of the brain involved • ***Area affected determines the S&S

  14. CVA: Clinical manifestations S&S depend on: • Location • Size • Amount

  15. CVA: Clinical ManifestationsCommon clinical manifestations • Syncope • Alt. LOC • Paresthesia • H/A • Aphasia • Seizures • Vision disturb • Difficulty walking • Labile emotion • Hemiparesis/hemiplegia

  16. Left vs. Right Hemispheric CVA

  17. Left vs. Right Hemispheric CVA

  18. CVA: diagnostic findings • LP • h pressure • Blood • CT / MRI • Bleeding • Infarction • Shift • Angiography • Occlusion

  19. CVA: Medical Management Focus on Cause & Control • #1 cause = • Hypertension • Medications

  20. CVA: Rx - HTN • Beta-blockers • Action • Block sympathetic response • Example • Propranolol hydrochloride

  21. CVA: Rx - HTN • Central acting Anti-hypertensive • Action • i Cardiac output • i Heart rate • Example • Catapres

  22. CVA: Rx - HTN • Vasodilators • Action • Relax smooth muscles • Example • Apresoline • Emergency • Hyperstat • Nipride

  23. CVA: Medical Management • Diet • Sodium • i • Fat • i • Potassium • h • Stimulants • i • Fluids • i

  24. CVA: Medical Management • Prevent clot formation • Meds / anticoagulants • Coumadin • Antidote? • Vit K • Heparin • ASA

  25. CVA: Medical Management • Prevent clot formation • Non-Rx • Ted hose • ROM • Isometric exercise

  26. CVA: Medical Management • Surgery • Endarterectomy • Carotid stenosis • Craniotomy • Evacuate clot

  27. CVA: Medical Management • Thrombolytic agents • Action • Break down thrombi • S/E • Hemorrhage • Streptokinase • Urokinase • Tissue-type prasminogen activator (tPA)

  28. CVA: Medical Management • Thrombolytic agents • Tissue-type prasminogen activator (tPA) • Take in 3 hrs of CVA

  29. CVA: Medical Management • Airway • Patent • P reflex • O2 • Suction • Mech vent

  30. CVA: Medical Management • Prevent Seizures • Precaution • Meds • i stimuli

  31. CVA: Medical Management • i ICP • O2 • Mech vent • Position • HOB h • Activity • Rest • Meds • Diuretics • Glucocorticoids • Monitor • BP • Systolic < 180 • Diastolic < 100

  32. CVA: Medical Management • Nutrition • NGT

  33. CVA: Medical Management • Monitor for trouble • VS • Rectal temp • NO • I&O • Labs • Na • K • Glucose • ABG’s • PT/PTT • Pulse oximetry

  34. CVA: Medical Management Prevent complications • ROM • PT/SLP • Isometric exercise • Antacids • Maalox • Tums • Histamine antagonist • Tagamet • Zantac • Pain • Codeine

  35. CVA: NRS management Alt. tissue perfusion • r/t h ICP • Monitor ICP • Avoid act that h ICP

  36. CVA: NRS management Risk for injury • r/t seizures • r/t repeat CVA • r/t unilateral neglect • r/t falls • Padded side rails • Call light • Assist w. amb. • Suction • BR assist • Items w/in reach • Clear path • H2O temps • Turn & position

  37. CVA: NRS management Alt. nutrition • r/t impaired swallowing • Motor deficits • Impaired judgment • SLP • Swallow eval • HOB high fowlers • Straws – no • Thick liquids • Swallow twice • P pocketing food • Talk & eat – NO • Easy chew • Head position • Unaffected side of tongue • P gag • P choking • Small meals • High texture food

  38. CVA: NRS management Alt. Mobility • r/t neuro deficits • Begin on admit • Turn q2hr • Pillows • P skin • ROM • Splints • Hand & fingers • Arm • Legs • Footboards • Built-up utensils • Raised toilet • W/in reach • Pt. to do exercises

  39. CVA: NRS management Impaired Communication • r/t aphasia • SLP • Time • Anticipate • Call bell • Slow & clear • Face patient • Eye contact • Yes/No ? • ID methods • Gestures • Visual aids

  40. CVA: NRS management Knowledge Deficit • r/t new diagnosis • Orient • Explain • K.I.S.S. • Written, verbal & picture • Little at a time • Meds • Safety

  41. CVA: NRS management Self-Care Deficit • Eating • Non-skid mats • Stabilizer plates • Plate guards • Wide grip utensils

  42. CVA: NRS management Self-Care Deficit • Bathing & Grooming • Long handle sponge • Grab bars • Non-skid mats • Hand held showers • Electric razor • Shower seat

  43. CVA: NRS management Self-Care Deficit • Toileting • Raised seat • Grab bars

  44. CVA: NRS management Self-Care Deficit • Dressing • Velcro • Elastic shoelaces • Long-handle shoehorn

  45. CVA: NRS management Self-Care Deficit • Mobility • Canes • Walkers • Wheelchair • Transfer devices

  46. CVA: NRS management • Risk of care-giver role strain • Support systems

  47. CVA: NRS management Unilateral neglect • Unaffected side • Personal items • Approach • Door face • Cue • Scan environment • Sling

  48. CVA: NRS management Impaired thought processes • Family • KISS • SS&TTP • i distractions • Repeat • Visual reminders • Time • Simple  complex • Positive feedback • Non-judgmental

  49. Hemorrhagic Stroke • Usually more severe with a longer recovery period than ischemic stroke • Caused by bleeding into: • Brain • Ventricles • Subarachnoid space

  50. Hemorrhagic Stroke • Cerebral aneurysm • Dilitation, bulging or ballooning out of part of the wall of a vein or artery in the brain • When they enlarge and press upon cranial nerves or tissue  • Symptoms

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