Data Collection
What is the name of scale that is used if a patient is suspected of having a stroke that identifies the severity of the stroke?
NIH stroke scale
Name 3 nonmodifiable stroke risk factors
1. Age
2. Gender (females > males)
3. Ethnicity (Hispanics, Blacks, Native Americans Indians, Alaskan Indians) higher incidence
4. Prior stroke or heart attack
What is a hemorrhagic stroke? (In addition please give 1 example)
E.G. Subarachnoid hemorrhage, rupture of cerebral aneurysm, rupture of arteriovenous malformation
What is multiple sclerosis?
A neuromuscular disorder that causes the breakdown of the myelin sheath therefore delay or interrupting neuronal transmission
What is amytrophic lateral sclerosis (ALS)?
Degeneration of upper and lower motor neurons in the brain and spinal cord that leads to muscle weakness. This only affects voluntary muscles
If a patient is suspected of having a thrombotic stroke this test will be done to see if there is plaque build up in the carotid arteries
Carotid doppler
What is the difference between a embolic ischemic stroke and a thrombotic ischemic stroke?
Embolic=blood clot that is created somewhere in the body travels and gets trapped in a smaller artery that supplies blood to the brain.
Thrombotic= Occlusion builds up in an artery significantly reducing blood flow.
If a patient has a left sided cerebral infarct what are the symptoms you would expect to see?
Right side of the body will be affected
Aphasia
Depression
Name 5 symptoms that maybe seen with multiple sclerosis
1. Muscle weakness 6. Slurred speech
2. Spasticity 7. Vision disturbances
3. Sexual dysfunction 8. Ataxia
4. Numbness 9. Dysphagia
5. Fatigue 10. Bowel/bladder alterations
11. Mood disturbance
What is trigeminal neuralgia?
Inflammation or irritation of the sensory portion of the trigeminal nerve (CN V)
What is a cerebral angiogram? Include what the test is and the purpose
A catheter is inserted into the femoral artery into cerebral arteries in the brain. This may be used to find and/or treat a ruptured cerebral aneurysm/AVM
What is a transient ischemic attack (TIA)?
Temporary impairment of cerebral blood flow. Symptoms resolve within 24 hours
If a patient suffered a hemorrhagic stroke due to a ruptured cerebral aneurysm and they are not a candidate for this to be repaired via a cerebral angiogram what procedure can be done?
Craniotomy to clamp or clip the aneurysm
Name two diagnostic tests that maybe used to diagnose multiple sclerosis
1. CSF fluid analysis (Increase in immunoglobulin G antibodies)
2. History and physical
3. MRI of brain and spinal cord shows demylelination
4. Blood tests to rule out other diseases
What is cholinergic crisis? Name at least 3 symptoms
This occurs when a patient received to much of a anticholinesterase aka cholinesterase inhibitor.
Salivation, Lacrimation, Urination, Diarrhea, GI cramping, Emesis
Pupil constriction, increased bronchial secretions, bradycardia, dyspnea, increasing muscle weakness
What is the Tensillon( Edrophonium test) that is used to diagnose myasthenia gravis?
A anticholinesterase drug is injected in a patient with myasthenia gravis this will cause a temporary improvement in strength that then goes away as the medication wears off
If a patient has received alteplase (tpa) what is blood pressure parameter than needs to be followed?
SBP < 185
DBP <110
Name 3 complications of a hemorrhagic stroke
1. Rebleed
2. Hydrocephalus
3. Vasospasm
What is myasthenia gravis?
Antibodies destroy acetylcholine receptors resulting in not enough acetylcholine to stimulate muscle contraction.
Name 3 therapeutic interventions that maybe used in trigeminal neuralgia
1. Anticonvulsants
2. Nerve block
3. Surgery to destroy sensory portion of the trigeminal nerve
What is the name of the medication that is used in ALS to reduce glutamate in the body?
Edaravone (Radicava)
If a patient has suffered a stroke what is the goal for where their blood glucose should be kept?
BG 140-180 mg/dl
Name two nursing diagnoses that you may use if a patient has suffered a stroke, and two interventions that go along with your diagnosis.
1. Risk for ineffective cerebral perfusion
2. Ineffective airway clearance
3. Risk for injury
4. Impaired mobility
5. Altered nutrition
6. Disturbed sensory perception
7. Risk for impaired skin integrity
Give an example of anticholinesterase drug aka cholinesterase inhibitor and discuss how it works.
E.G. Neostigmine (Prostigmin), Pyridostigmine (Mestinon)
These medications work be blocking the enzyme cholinesterase therefore leaving more acetylcholine around.
What is Guillan Barre Syndrome?
Inflammation of the cranial and spinal nerves, that causes demyelination in an ascending pattern. Causes an influx of leukocytes in the peripheral nerves resulting in edema and inflammation.
Typically triggered by a virus or vaccine