Medsurg 1 (CH 5) - neurological disorders PT 2

Hemorraghic stroke

ruptured blood vessel in the brain (usually aneurysm rupture) causing pool of blood in the brain to reduce O2 supply to brain tissue

ischemic stroke

thrombotic/embolic blockage in the brain constricts O2 supply causing brain tissue death

Hemorraghic stroke s/s

- HTN (BIG INDICATOR)

- N/V

- slurred speech

- facial drooping

- impaired movements

- confusion

ischemic stroke s/s

- slurred speech

- facial drooping

- impaired movements

- confusion

stroke risk factors

- high cholesterol

- HTN

- inactivity

- excessive alc use

- smoking

- cocaine

- hx TIA

- hx afib

- valve problems

- CVD

- diabetes

modifiable risk factors for stroke

- smoking

- cocaine

- alcohol abuse

- immobility

primary stroke preventions

GOAL: preventing a stroke in pts who have never had a stroke but are at risk

- control HTN/BP

- diabetes/cholesterol management

- increase activity/dietary education

- smoking secession

secondary stroke preventions

GOAL: preventing strokes in pts who have already had a stroke w/ preventative/palliative measures in a more aggressive way

- more agressive risk factor control

- agressive BP/cholesterol/diabetes monitoring

- invasive therapies (stents, BV filters)

- agressive modifiable/lifestyle changes

TIA

transient ischemic attack (mini stroke) w/ complete recovery

- temporary attach <24hrs

TIA risk factors

- same as stroke risk factors

- THROMBOEMBOLISM most common

- ulcerated plaque buildup

right sided TIA manifestations

The left side of the brain is affected

- spatial/perceptual deficit

- denies problems

- short attention span

- impulsive behaviors

- impaired judgements

left sided TIA manifestations

The right side of the brain is affected

- aphasia

- dysarthria (slurred speech, difficulty forming words)

- anxiety

- impaired comprehension

- memory problems w/ languages

- vision changes

TIA vision changes s/s and nursing priority

- homonymous --> loss of vision in half of the visual field in both eyes

- hemianopia --> vision loss

NURSING:

- RAPID neurological assessments

- determine baseline neurological functioning

- safety assessments

- time length of TIA

nursing care for TIA

- RAPID neurological assessments

"BE FAST"

- determine baseline neurological functioning

- safety assessments

- time length of TIA

- access the airway

- Post TIA, educate preventative/modifiable lifestyle changes

aphasia education

dependent on damaged area, brain loses cohesive speech functioning (w/ subclasses):

- werknies aphasia

- brocas aphasia

- global aphasia

werknies aphasia s/s

left-temporal damage:

- does not understand your speech/writing

- speaks cohesively but not appropriate to situation/ no meaning of words

- word salads/made up words

broca's aphasia s/s

frontal lobe damage:

- comprehends what is being said/wrote

- unable to properly say words/sentences

- non fluet speech

- frustrated and aware of broken speech

global aphasia

SEVERE DEFICIT:

- unable to understand speech/writing

- unable to properly say words/sentences

- facial expressions, gestures, vocal tone is completely impaired

global aphasia nursing priorties

- simplify speech

- visual aids

- safety assessments

- determine swallowing/aspiration risk

- create a system for emergency scenarios

post TIA/stroke nursing interventions

- ABCs --> ensure airway/ monitor O2

- CT scan STAT

- BP management

- thrombolytic therapy

- determine underlying causes (stroke, tissue damage, injury, meds)

- TIMING: CRUCIAL to determine cause of symptoms within 4.5 hrs of onset