Stroke 1
What effect does "fibrinolytic therapy" using recombinant tissue plasminogen activator alteplase (Activase) have?
Administered to dissolve clots occluding cerebral circulation.
what is a contradiction for the use of tissue plasminogen activator (tPA)
intracranial hemorrhage, Why? Let's discuss
HIV has progressed to AIDS when.....
CD$+ count is <200 cells/mL OR there is the presence of an opportunistic infection.
A nurse is stuck with stylet used to start an IV on a patient with HIV. What intervention should the nurse implement first?
Flush skin with water and try to get the area to bleed. (Hopes of getting out the contaminated blood)
What is the expected action of Mannitol?
Decrease fluid in cerebral tissue.
Mannitol is a diuretic so an increase in urine output is expected as well.
What is the greatest risk factor for stroke?
HTN
What are some effects of alteplase (Activase), given for stroke, that a nurse should educate the patient of?
Bruising and epistaxis
Modes of HIV transmission are: (2 parts)
1) Body fluids with infected cells (blood, blood precuts, seminal fluid, vag secretions)
2) mother to child (amniotic fluid, breast milk)
Interventions for AIDS patient with white patchy lesions on hard and soft palate and R inner cheek complaining of sore mouth and tongue.
Notify HCP for an order of antifungal swish and swallow meds. Why?
Patient presents with a head injury and loss of consciousness with a low HR, slightly elevated BP, normal and irregular RR. This is indicative of?
ICP
Client presents with R-sided weakness, that started 1 hour ago. Which diagnostic test should the nurse expect first?
Non-contrast computed tomography (CT) scan. Why? Let's discuss
What is a carotid endarterectomy
surgical removal of plaque from an artery in the neck
Antiretroviral medications given as a post exposure prophylaxis for health care workers are started within how many hours of exposure.
72 hours 2-3 drugs may be prescribed for 28 days. Use standard precautions and hand hygiene to decrease the risk of transmission to HCP.
Client presents with a body temp of 104oF. Name some interventions the nurse should do? (3 parts)
1) cover client with fluid circulating blanket
2) ensure a cool environment
3) Monitor I&O
Nurse adminsters O2 to a client experiencing a stroke in order to prevent hypoxia and hypercapnia. This intervention will also lessen the risk for which complication?
^ ICP
What needs to be understood about taking Warfarin (Coumadin)
You need to have the same amount of Vit K intake that you had before taking the medicine.
What is an appropriate nursing diagnosis for R. sided stroke.
risk for injury r/t denial of deficient & impulsiveness
Clinical syndrome characterized by decrease in cognitive, behavioral, and motor functions as a direct result of HIV infection.
HIV encephalopathy
Elderly client admitted with pnuemonia has a normal body temp. Nurse realizes the reason for this inconsistency is?
Temp not a reliable indicator. Why?
Food volume advice after stroke
Thickened commercial beverages and fortified cooked cereals.
What are interventions for dysphagia? (5 parts)
1) Assist with meals as needed
2) test gag reflux before offering food or fluids
3) allow ample time to eat
4) offer thickened liquids
5) DON'T PLACE FOOD ON AFFECTED SIDE OF MOUTH
R-sided CVA interventions? (4 parts)
1) Position client to prevent shoulder adduction
2) OT referral
3) Encourage movement of affected side
4) Quadricep exercise 5 times daily
Name the client problem that is a priority in a patient diagnosed with HIV encephalopathy.
Risk for injury. Why? Let's discuss
Preschool child has a fever and the mother states this happens often. What response should the nurse give her?
Fevers are seen more in children due to developing immunity.
Patient with Hx of TIAs presents to ER with hemiparesis and dysarthria starting 2 hours ago. Nurse anticipates the need to prepare client for which procedure.
Tissue plasminogen activator (tPA) infusion