ICP
What is the Monroe Kelly Theory? Describe what you can do to increase or decrease BP
Monroe Kelly Theory: brain made up of brain matter, CSF, and blood: want equilibrium
Vasoconstrict: increase BP
Vasodilate: decrease BP
Decrease CO2: hyperventilate
Increase CO2: dilate vessels
- rest
- low impact continuous constant exercise
- cool down
- balanced diet: fiber
- relieve stress
What are 2 preventions
Aerobic exercise
limit caffeine intake
What orders do you question for a hemorrhagic stroke?
anticoagulants: heparin, aspirin, warfarin
What is difference between focal and generalized seizures?
Focal:
- 1 region
- progress
- symptoms related to that area: twitching, confusion, sensations
- focal aware and focal impaired
Generalized:
- both regions
- widespread symptoms
- convulsions, LOC, muscle stiffness
What are nursing interventions for ICP?
- CPP wnl
- neutral position: HOB 0-60 degrees
- avoid hip flexion, valsalva maneuver, abdominal distention, excessive suction
- calm, quiet environment
- aseptic technique
- surgery
Describe the 4 stages
CIS: first episode of symptoms
RRMS: periods of exacerbations and go back to baseline neuro after
SPMS: RRMS leads to this, steady decline, will start with exacerbations and lead to steady decline
PPMS: no exacerbations, progressive decline, Ocrevus
What is Parkinsons
Deficiency of dopamine- extrapyramidal disorder
What are some risk factors?
- age 55 yrs
- family hx
- increased cholesterol
- smoking
- increased BP: control HTN
- diabetes
- obesity
- loosen restrictive clothing
- patent airway
- suction and O2
- pad rails
- bed lowest position
- document thorough assessment
- vitals, O2, glucose
- nothing in mouth
What are the early and late signs and symptoms?
Early:
- change in loc
- pupillary changes
- weakness
- headache
Late:
- cushing triad: increase BP, decrease HR and RR
- projectile vomit
- decorticate or deceberate
- cheyne stokes
- loss of brainstem reflexes: C/G/C
What are some signs and symptoms?
- blurred vision
- weakness
- intentional tremor
- slurred speech
- numbness/ tingling
- mood swings
- motor incoordination
- bowel/ bladder incontinence
- impaired judgement
- nystagmus
What are the main symptoms?
- uncontrolled tremor: sleeping
- slowed movements: bradykinesia
- difficulty with balance
- muscle stiffness
- shuffling gait
- Decrease ROM
- Decrease autoimmune response
- drooling
What are some diagnostics for strokes?
- CT scan: gold standard: tells you what kind
- auscultate the carotid: bruit
- ultrasound: shows blockage
- carotid angiogram: visualize artery
- MRI
- angiogram
Describe what happens in the aura :pre ictal, during: ictal, post ictal phases
Aura: warning
- smells, sounds, flash light
- tingling
- strange behavior
- intense feelings
During:
- will depend on seizure
- jerky movements
Post ictal:
- drowsy
- headache
- confused
- amnesia
- assess for injuries
What do you monitor for when giving mannitol?
I and O, serum electrolytes: diuretic
What is multiple sclerosis?
demyelinating disease: causes permanent degeneration and destruction of myelin sheath
Medications and teaching
Dopamine agonist:
- mimics effect of dopamine
- can be added with other drugs
- Mirapex, Requip
- s/e: hallucinations, impulsive, increased eating
MAO B inhibitors:
- inhibits breakdown of dopamine
- Zelapar, Azilect
- s/e: hallucinations, impulsive, increased eating
Carbidopa- Levodopa:
- converted to dopamine
- s/e: orthostatic hypotension: fall risk
- longer used: more it wares off
- max dose: watch dyskinesia, lip smacking
What does BEFAST stand for and how to test them
B: balance: rhomberg test: see if sway or fall
E: eyes: blurred vision, diplopia
F: face: asymmetry: smile
A: arm weakness: pronator drift
S: speech: slurred, aphagia
T: time to call 911, time when they were well
What is gold standard diagnostic for seizures?
EEG: active only
What are the 3 complications and decrease what you would see
- herniation: fixed and dilated pupils
- Diabetes Insipidus: dry inside, clear urine, increased sodium, decrease BP and urine output
- SIADH: soaked inside, concentrated urine, decrease sodium, increase BP and urine output, seizure precautions
Treatments and patient education
Corticosteroids: inflammation
- s/e: increase glucose, PUD, insomnia, hyperactive, HTN
Plasma exchange: exchange in plasma
- tx in 5-7 days
- removes antibodies
- uses a line: infection risk
Ocrevus: PPMS
- FDA approved
- IV infusion
- 1st time, 2 weeks 2nd time, 6 months 3rd time
- doesn't cure: lessen symptoms
- man made antibodies
Paresthesia:
- Gabapentin
- Lyrica
- Neurontin
Spasms:
- baclofen
- balanced diet
- exercise: low aerobic
- alternative medicine
- coping
- fall risk: education
- PT/OT
What treatment can you do for an ischemic stroke and tell when you shouldn't give it
Thrombolytic therapy: TPA
criteria:
- minor or rapidly improving symptoms
- seizure
- stroke/ trauma in 3 months
- major surgery within 14 days
- hx of hemorrhage
- sustained BP 185/110
- arterial puncture in 7 days
- heparin within 48 hours
- INR > 1.7
- platelets <100,000
- Glucose <50 >400
What are the medications given and education for patient
Phenytoin: lab draws every month
Phenobarbital: bone health
Carbamazepine (Tegretol): toxic for fetus
IV: active seizures