Stroke
Name 3 modifiable risk factors for stroke
Heart disease: Atrial Fibrillation, DM
Hypertension
Metabolic syndrome
Homocysteine (found in red meat, dairy)
B6, B12 & folic acid vitamins may be protective
Poor diet, heavy alcohol consumption
Drug abuse/Smoking
Sleep apnea
Physical inactivity, obesity
Which cranial nerve is associated with Bell's palsy?
CN VII
What medication is commonly used to treat Parkinson's disease?
Carbidopa-levodopa
Name one example of primary prevention
Preventing the cancer before it occurs by modifying risk factors such as avoiding implementing good diet, quitting smoking, etc
What is normal ICP?
5-15 mmHg
How are strokes assessed?
Bedside assessment (NIHSS)
CT - determine if hemorrhagic or ischemic
MRI - show areas of ischemia or other pathologic changes
Which cranial nerve is associated with trigeminal neuralgia?
CN V
Describe migraine aura
Positive and negative focal neurologic symptoms that precede or accompany an attack such as tingling in the face or spotty vision
Name 2 recommendations for a patient receiving radiation therapy
Cleanse skin with mild soap and lukewarm water
Apply moisturizing cream and medicated creams as directed. Some common ones you may see used are:
Topical corticosteroids
Topical 1% atorvastatin
Silver sulfadiazine
Silicone-based creams
Avoid the use of heating pads and ice
Use paper tape to secure any bandages, if used.
What is Cushing's Triad?
Widening pulse pressure
Bradycardia
Decreased, irregular respirations
What are the symptoms of stroke?
(Hint: BE FAST acronym)
B - balance
E - eyes
F - facial droop
A - arm weakness
S - slurred speech
T - time to call 911
What is CN III and how do you assess it?
Oculomotor
Use penlight to check for PERRLA
What are the stages of Alzheimer's disease?
Asymptomatic preclinical phase
Symptomatic predementia phase (mild impaired cognition)
Dementia phase
Name 3 risk factors for prostate cancer
Age
Family history including first-degree relative with the disease
African-American race - risk of mortality 2x than any other group
Other factors may include diet (high saturated fat, low fiber) and exposure to environmental agents such as arsenic
What are late signs of increased ICP? (3 total)
Cushing's Triad (Widening pulse pressure, Bradycardia, Decreased/irregular respirations)
Pupillary changes
Vision abnormalities
What medications should be held 24 hours before a CT scan if possible?
Metformin
NSAIDS
(interfere with kidney perfusion)
What is CN VIII and how do you assess it?
Vestibulocochlear
Whisper test
Gait assessment
Name 3 goals of care for the patient with Parkinson's disease.
Improving mobility
Prevent falls
Encourage self-management of ADLs
Evaluate need for adaptive devices
Healthy sleeping patterns
Improve nutrition
Prevent aspiration
Name 5 risks for breast cancer
Female
Age
Genetic factors (BRCA1, BRCA2)
Hx of previous breast cancer
Family hx (two first-degree relatives with breast cancer)
Ionizing radiation to the chest
Breast density
Atypical hyperplasia
High postmenopausal bone density (high estrogen levels over time strengthen bone and ↑ breast cancer risk)
ETOH use (3-14 drinks/week increase)
No or late child-bearing
Many years of menstruation
Recent OC use (slight increase – risk is removed with 10 years of no use)
HRT use.
Obesity
What are early signs of increased ICP? (5 total)
Headache
Decreased LOC
Nausea and vomiting
Restlessness
What are some nursing considerations for a patient with hemiplegia?
Mobility - fall risk
Skin - pressure ulcer/skin breakdown risk
Contractures - need to perform passive ROM
Inability to perform ADLs independently
Poor self image
What is CN XII and how do you assess it?
Hypoglossal
Ask patient to stick out tongue and move side to side
What are the 5 stages of Parkinson's disease?
Initial stage
Mild stage
Moderate disease
Severe disability
Complete ADL dependence
What is the pancytopenic patient at risk for?
↓ RBCs – fatigue, doe, headache, ↑ HR, palpitations; pallor on the conjunctiva, nail beds or palmar creases
↓ WBCs – risk for infection, fever, dysuria, cough, enlarged spleen
↓platelets – ecchymoses, petechial, bleeding gums, hematuria, joint pain
Name 3 interventions to decrease ICP
Fluid restriction]
Raise HOB
Refrain from coughing
Refrain from suctioning if able
Provide non-stimulating environment
Avoid neck/hip flexion
Therapeutic cooling