Diagnostics
What is included in the BEFAST acronym for stroke symptoms?
B- Balance
E-Eyes
F-Face
A-Arms
S-Speech
T-Time
When do you want to begin rehabilitation therapy for a stroke patient?
The same day as the stroke.
What is the earliest indicator of ICP?
The earliest sign of increasing ICP is a change in LOC.
Slowing of speech and delay in response to verbal suggestions are other early indicators.
What must be ruled out before giving a patient a thrombolytic agent for a stroke?
A hemorrhagic stroke must first be ruled out.
This is also referred to as a "brain attack"
What is a stroke?
Bennett is suffering from a suspected stroke and is being scored on the NIH stroke scale. For section 1b, she is asked to verify her age and what month it is. She says she is 20 and that the month is October. However, she is actually 21. How would this be scored? Would there be partial credit given for being close?
The answer must be correct — there is no partial credit for being close.
So, she would get a one out of two for answering the month correctly.
What procedure involves removing plaque to prevent further TIA/stroke?
Carotid endarterectomy
Nicole had multiple seizures back to back with very little time in between. What is the term for this?
Status epilepticus
If a patient receives anticoagulant therapy for atrial fibrillation, what complication is this attempting to prevent?
Stroke
This is an autoimmune disorder with acute attack of peripheral nerve myelin.
What is Guillain–Barré Syndrome?
What screening test must be done to determine if a stroke patient can take medications orally?
The STAND test.
What emergency intervention is usually required for a patient with Guillain–Barré Syndrome?
Mechanical ventilation
Nicole suffered from a seizure and stated that before it occurred, there was a weird taste in her mouth. What is the term for what Nicole was experiencing?
An aura (a premonitory or warning sensation, which can be visual, auditory, or olfactory)
What are the first-line medications to stop seizures and by what route are they given?
lorazepam and midazolam via IV
Lenore often has trouble understanding what others are saying to her as well as forming sentences of her own. What condition (often caused by strokes) is this similar to?
Global aphasia
What is a positive Kernig's sign and what does it indicate?
When the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended. This is indicative of meningitis.
Nicole remains unconscious and unresponsive after a seizure. What intervention should the nurse prepare for?
Intubation
Lenore presents to the ER with a family member that claims she is having trouble recognizing objects that she is normally familiar with. What is the term for this?
Agnosia - Failure to recognize familiar objects perceived by the senses.
What is included in medication management of Myasthenia Gravis?
Anticholinesterase medications, immunosuppressive therapy, intravenous immune globulin (IVIG), therapeutic plasma exchange, thymectomy
Impulsive behavior and poor judgment result from a stroke in which hemisphere of the brain?
Right hemisphere
What test can be ordered if CT is negative and ICP is not elevated to confirm subarachnoid hemorrhage?
A lumbar puncture
A seizure patient is at risk for hypoxia, vomiting, and pulmonary aspiration. What are the interventions you can use to prevent these complications?
To prevent complications, the patient is placed in the side-lying position to facilitate drainage of oral secretions, and suctioning is performed, if needed, to maintain a patent airway and prevent aspiration.
Bennett presents at the hospital with what she describes as "the worst headache of her life." The nurses know that this is a cardinal symptom of what?
Hemorrhagic stroke.
What is included in the medical management of multiple sclerosis?
Disease-modifying therapies; interferon -1a and interferon -1b, glatiramer acetate, and IV methylprednisolone
How does the body typically compensate to maintain a normal ICP of 10-20 mmHg?
Bonus points if you can name the hypothesis that explains this.
Shifting or displacing CSF.
- Monro–Kellie hypothesis: because of limited space in the skull, an increase in any one of components of the skull (brain tissue, blood, CSF) will cause a change in the volume of the others.