A
What diagnostic test is most helpful to diagnose seizures?
electroencephalogram (EEG)
What is an aura?
preictal (before seizure) - odors, visualizations, sense of butterflies
A patient suffers hemorrhagic stroke. What is the earliest sign of increased ICP?
Cushing's triad (widening PP, irreg resps, bradcardia) is a late sign!
When assessing the level of awareness the nurse notes the patient arouses, but not fully and simply moans. How should the nurse describe this level of consciousness?
•Stuporous
What is BE FAST stand for?
B - balance (loss of balance/coordination)
E - Eyes (vision disturbance)
F - Face (asymmetric)
A - Arms (drift)
S - Speech (slurred/abnormal/absent)
T - Time (3 hours! 4.5 max!)
The normal range for intracranial pressure in adults and the actionable abnormal reading.
What is 5–15 mm Hg and what is sustained greater than 20.
This doctrine explains the relationship between brain tissue, blood, and cerebrospinal fluid inside the skull.
What is monro-kellie
What is the term for a patient who has a weakness (not paralysis) of the Left side?
Left sided hemiparesis
The nurse assesses the plantar reflex (Babinski's sign) by taking the heel of the reflex hammer and stimulating the outside sole of the foot.
What is an abnormal finding? what does it indicate?
a positive Babinski sign happens when the big toe bends up and back to the top of the foot and the other toes fan out.
This can mean there is an underlying nervous system or brain condition causing reflexes to react abnormally.
What is the name of the scale used to assess stroke before and after thrombolytic therapy to evaluate progress of treatment?
NIHSS (National Institute of Health Stroke Scale)
What class of seizure is characterized by loss of consciousness followed by muscle tensing and then jerking movements all over.
generalized tonic-clonic
A patient with atrial fibrillation and is prescribed rivaroxaban.
A. What is rivaroxaban.
B. How will it help?
A. Factor Xa inhibitor and anticoagulant
B. Lengthens clotting time to prevent clots caused by pooling blood/sluggish flow due to the arrhythmia atrial fibrillation.
carbamazepine, phenytoin, and lamotrigine are all monotherapy antiepleptic drugs (AEDs) used to prevent seizures. Aside from monitoring for seizure activity, how will the nurse determine therapeutic effect?
Monitor serum levels
The patient returns post cerebral angiogram. What are three (3) interventions required post angiogram?
monitor site for hematoma,
neurovascular assess affected limb (5 Ps)
fluids to clear contrast,
VS to monitor for hemorrhage,
limb straight 4-6 hours,
HOB flat and progress to 90 over time
How will you explain to a patient with stroke symptoms why they need carotid dopplers and an echocardiogram? (they will ask..."Its my brain, not my heart - right?")
Carotid artery atherosclerosis can limit blood flow to the brain and cause stroke the carotid dopplers will detect this.
as can clots from the heart due to dysrhythmias such as atrial fibrillation and the echo will detect this.
This position promotes venous drainage and helps lower ICP.
What is head of bed elevated 30 degrees with midline alignment?
A patient with valvular disease is taking antiplatelet medications as well as warfarin to prevent embolism. Name at least three (3) interventions required to maintain "bleeding" precautions.
•Bleeding precautions (soft bristled toothbrush, electric razor, rotate bP cuff, avoid sticks, avoid injury)
•Alcohol (1 to 2 per day)
•Do not take with ASA or NSAIDs
•Emergency – Prothrombin Complex Concentrate, FFP, Vitamin K
What nutrition therapy is helpful to control seizures?
ketogenic diet (low carb, low protein, high fat)
ncreasing one component in the skull without compensation leads to this dangerous condition.
Name four (4) symptoms of stroke other than BEFAST.
Hemiparesis or hemiplegia
Heminopia
Dysphagia
Dysphasia/aphasia
Loss or decreased sensation one side of body
Facial asymmetry
Inability to manage oral secretions
Dizziness
Ataxia
Tinnitus
The primary goal of ICP management is to maintain this to ensure brain tissue oxygenation.
What is cerebral perfusion pressure (CPP)?
A patient begins to have a seizure.
a. What class of medication is administered first? and what is the common ending?
a. What is the reversal agent for benzodiazepine medications?
b. What safety measures are required for seizures (name 3)?
a. benzodiazepine - -pam is the common ending (lorazepam, diazepam are examples)
a. flumazenil
b. Safety measures (pad rails, bed in lowest position/locked, suction at the bedside, oral/nasal airway at the bedside)
For the patient experiencing a witnessed seizure:
a. loosening of restrictive clothing
B. turning the patient to the side (preferably to the left side to reduce the risk of aspiration).
c. clear area of any items that may injure (if in bed remove pillows)
d. If on floor clear away items and do not attempt to lift to bed, if in chair, lower to floor. If in bed raise rails and pad them
Name at least three causes of non-epileptic (secondary/provoked) seizures.
Nonepileptic (provoked, secondary) be caused by
•Trauma
•Surgery
•Tumors
•Stroke
•Meningitis
•Lack of sleep
•Flashing lights, moving patterns or other visual stimulants
•Hyponatremia
•Antidepressants and other medications
•Autoimmune disorders (SLE, MS)
•Amphetamines or cocaine
•Alcohol withdrawal or extreme intoxication
A. What is t-PA (alteplase)?
B. what is the expected outcome?
C. What is the time limit?
d. Most dangerous complication?
a. thrombolytic dissolves the clot at site and restores blood flow
b. improved stroke symptoms
c. Must present within 3 hours (4.5 of symptom onset).
d. ICH (Occurs in 6.7% of patients), for hemorrhage FFP, cryoprecipitate. Aminocaproic acid (Amicar) may be used as an antidote.
Nursing Considerations – NIHSS, frequent VS, Explain need for bedrest and minimal handling during therapy to avoid injury. Avoid all unnecessary procedures such as shaving, vigorous tooth brushing, IM injections or arterial punctures. Apply pressure to all arterial and venous puncture sites for at least 30 min.
The nurse is assessing a patient with massive stroke using the Glascow coma scale.
a. What is the maximum and minimum score?
b. When assessing the motor movement the nurse progresses from least to most noxious stimulus. There is no response until the nurse performs a nailbed pinch. In response the patient extends the arms toward the pain. What is this called? (
a. 3 is minimum; 15 is maximum - 8 indicates severe brain.
b. extension to pain - decerebrate posturing It is an ominous sign