NR 283 Week 5 Quiz 4

7 Disorders Right Sided Stroke Pathophysiology Ischemic stroke Occurs suddenly within minutes of blood supply interruption to brain tissues Due to blockage of arteries Signs & symptoms Memory loss Facial weakness Paralysis on left side of body Diagnostic/labs CT scan CT angiogram angiogram MRI scan MRA Droppler ultrasound Treatment/medication TPA Alteplase (activase) Tenecteplase Blood thinners Nursing implications Monitor & assessment Mobility & safety Cognitive & perceptual deficits Nutritional support Patient teaching = FAST F ace = ask patient to smile. Face drop? A rm = ask patient to raise their arms. One arm down? S peech = ask patient to repeat a phrase. Slurred? T ime = time is brain. Call 9-1-1 Left Sided Stroke Pathophysiology (2 types) Ischmic Thrombotic Embolic Hemorrhagic Intracerebral Subarachnoid Signs & symptoms Weakness or paralysis Sensory changes (loss of function) Vision problems Speech & language difficulties Swallowing challenges Cognitive changes Behavioral changes Diagnosis/labs CT scan MRI scan Angiogram MRA Droppler ultrasound Treatment Medication Blood thinners Surgery Embolectomy Vertebrobasilar angioplasty & stenting Rehabilitation Physical therapy Occupational therapy Speech therapy Psychological therapy Nursing implication Supporting breathing, circulation, airway Monitoring vital signs Performing neurological assessment Providing a quiet environment Prevent constipation Patient teaching Manage/treat underlying condition Limit salt intake in diet Healthy diet Reduce alcohol intake Quit smoking Implement exercising Maintain or achieve a healthy weight Dementia / Alzheimer Pathophysiology Two main abnormalities Amyloid plaques – clumps of protein that form between nerve cells Neurofibrillary tangles – accumulation of protein that form inside neurons Signs & symptoms Memory loss Hard time thinking Hard time making decision/judgment Change in personality and behavior Diagnostic/labs Physical/neuro exams Blood test MRI/CT/PET scan Medication/treatment No cure Medications Can help with symptoms Cognition enhancing meds Improves mental function Balance mood Lower blood pressure Nursing implications Communicate step by step with patient Encourage routine with patient Creating care plan Mealtime Sleep pattern Continuous assessment Teaching patient Teaching family about the decline of health Provide resources Safety to avoid risk/injury Parkinsons Pathophysiology Degeneration of dopaminergic neurons in brain (substantia nigra) leads to disruption of the niagral-striatal pathway causing imbalances in dopamine levels Results in decreased excitation of motor cortex & increased inhibition Results in excess acetylcholine leading to over excitation of GABA-releasing neurons Signs & symptoms Tremors Bradykinesia Rigid muscles Impaired posture/balance Loss of auto movements Speech changes Writing changes Diagnostic/labs MRI of brain Bloodwork Dopamine transporter scan Treatment/medications Prescription medicines Physical, occupational and speech therapies Exercise diet Nursing implications Med plans Mobility assess before discharge Daily encourage of ADL’s Support groups eduation Patient teaching Better control symptoms How to make ADL’s easier to complete/modify Increased intercranial pressure Pathophysiology Fluid build up in brain Causes pressure against skull Head trauma Hemorrhage Stroke meningitis Signs & symptoms Headaches – LOC Vomiting Bradycardia Papilledema Dilated pupils Diagnosis/labs Spinal tap Lumbar puncture Neurological exam MRIs CTs Treatment/medication Medication to reduce swelling (osmotic diuretic) Surgery to drain CSF Nursing implications Monitor vitals Neuro exam Monitor LP site Pain assessment Bed raised 30 degrees Patient teaching Neck midline Complications – stroke