CVA
What is a Transient ischemic attack (TIA)?
A brief episode of neurological dysfunction caused by a temporary blockage of blood flow to the brain, often referred to as a "mini-stroke." Symptoms, such as weakness, numbness, or speech difficulties, resolve within 24 hours without permanent damage.
- TIA's are a warning sign that a real stroke could happen soon (1/3 people have a stroke after a TIA)
What is a normal ICP?
What is a normal CPP?
How are they different?
Normal ICP: 5 - 15 mmHg
Normal CPP: 60 - 100 mmHg
ICP measures the pressure inside the skull, while CPP represents the pressure driving blood flow to the brain.
Seizure vs Epilepsy
A seizure is a single abnormal electrical event in the brain.
Epilepsy is a chronic neurological disorder marked by recurrent, unprovoked seizures.
What is ALS?
Be sure to include ... Patho, Signs/symptoms, treatment, nursing considerations.
- ALS is a progressive neurodegenerative disease that destroys motor neurons in the brain and spinal cord.
- Muscle weakness, atrophy, spasticity, dysphagia, dysarthria, and respiratory decline.
- No cure; riluzole and edaravone may slow progression. Focus on symptom management and supportive care.
- Nursing considerations: Airway/respiratory support, aspiration precautions, nutrition, communication aids, psychosocial support.
1. Injuries at _____ level often result in impaired diaphragm function.
2. Injuries at _____ level, may increase the risk of the client developing ______ and/or ________
1. C3-C5
2. T6, Autonomic dysreflexia, Neurogenic shock
Ischemic vs Hemorrhagic strokes
Ischemic Stroke = Blockage or narrowing of an artery that supplies blood to the brain, often due to a clot or atherosclerosis.
- Symptoms: Numbness or weakness, difficulty speaking or understanding speech, loss of vision, balance issues etc.
- Treatment: Thrombolytic therapy to dissolve the clot, antiplatelet medications, mechanical thrombectomy possibly
Hemorrhagic Stroke = Rupture of a blood vessel in the brain, leading to bleeding and increased intracranial pressure. Can be caused by high blood pressure, aneurysms, or arteriovenous malformations.
- Symptoms: Sudden severe headache, nausea, vomiting, loss of consciousness, and neurological deficits like weakness or vision changes.
- Treatment: Surgery to repair the rupture, controlling bleeding, and managing intracranial pressure. Medications to control blood pressure.
Decorticate vs Decerebrate posturing.
Decorticate posturing: Arms flexed towards the chest, legs extended — indicates damage to the cerebral cortex.
Decerebrate posturing: Arms and legs extended outward, wrists rotated — indicates damage to the brainstem (worse, associated with poor prognosis)
Describe what occurs during a tonic-clonic seizure.
A seizure with two phases: the tonic phase causes stiffening of muscles and loss of consciousness; the clonic phase follows with rhythmic jerking of limbs.
May include cyanosis, incontinence, and postictal confusion.
What is Guillain-Barré Syndrome (GBS)?
Be sure to include ... Patho, Signs/symptoms, treatment, nursing considerations.
GBS is an autoimmune disorder where the body attacks peripheral nerve myelin, causing acute demyelination.
Signs/Symptoms: Ascending weakness/paralysis, areflexia, paresthesia, autonomic instability, respiratory compromise.
Treatment: IVIG or plasmapheresis to remove antibodies.
Nursing Considerations: Monitor respiratory status, manage pain, prevent complications, support mobility, and address anxiety.
What is Autonomic Dysreflexia?
(who is at risk, s/s, treatment?)
- Life-threatening!
- AD results from noxious stimuli (bowel/bladder most commonly)
S/s: severe hypertension SBP>200, pounding headache, bradycardia, warm/flushed skin above injury
- Injuries at T6 or above have increased risk
- Sit patient upright, attempt to find trigger and resolve asap, lower BP
Risk factors for CVA
Hypertension, Smoking, Diabetes mellitus, High cholesterol, Heart disease (atrial fibrillation), Obesity, Physical inactivity, Excessive alcohol consumption,
Age (risk increases with age, especially over 55), Gender (men are at higher risk, but women have a higher risk of death from stroke)
Family history of stroke, Previous TIA, Certain medical conditions (sickle cell disease, carotid artery disease)
Drug use (cocaine or methamphetamine use)
What is Cushing's Triad?
Cushing's Triad is indeed a late sign of increased intracranial pressure (ICP). It indicates that ICP has risen to a critical level and the patient could be at risk for brain herniation.
- Characterized by: wide pulse pressure, bradycardia, irregular breathing pattern
List the stages of seizures.
Prodromal Stage: Early signs or symptoms before the seizure (days/hours before, mood changes, irritability).
Aura: A warning sensation (smell, visual changes) that precedes the seizure.
Ictal Stage: The actual seizure event.
Postictal Stage: Recovery phase after the seizure, with confusion, fatigue, or headache.
What is Parkinson's Disease?
Be sure to include ... Patho, Signs/symptoms, treatment, nursing considerations.
Patho: A progressive neurodegenerative disorder caused by loss of dopamine-producing neurons in the substantia nigra.
Signs/Symptoms: Resting tremor, bradykinesia/akinesia, rigidity, postural instability, shuffling gait, stooped posture, mask-like face.
Treatment: Levodopa-carbidopa is first-line
Nursing Considerations: Fall prevention, assist with ADLs, promote mobility, assess swallowing/nutrition.
What is the difference between Spinal Shock and Neurogenic Shock?
Spinal Shock: Occurs immediately (temporary), Loss of all spinal reflexes, motor function, and autonomic activity below level of injury due to sudden disruption of nerve signals. Symptoms include flaccid paralysis, areflexia, absent sensation below injury, impaired thermoregulation, absent bowel/bladder control.
Neurogenic Shock: Can occur 30 mins after injury, typically occurs with SCI at T6 or above causing a loss of sympathetic nervous system control. PNS overpowers causing widespread vasodilation, hypotension, bradycardia, warm skin.
Treatment options for CVA
Ischemic Stroke:
tPA – Clot-busting drug given within 3–4.5 hours of symptom onset.
Mechanical thrombectomy – Surgical removal of the clot.
Antiplatelet therapy – Aspirin or clopidogrel to prevent further clot formation.
Anticoagulants – (warfarin, apixaban) especially for atrial fibrillation-related strokes.
Hemorrhagic Stroke:
Surgical intervention – To repair aneurysm or remove hematoma (ex: craniotomy).
Blood pressure management – To prevent further bleeding.
Medications – To reverse anticoagulation or reduce ICP (kcentra, mannitol).
Seizure prevention meds – As bleeding can irritate brain tissue.
Monitoring and managing ICP – May include an external ventricular drain (EVD).
Nursing interventions for increased ICP
- HOB 30 degree's, neutral position
- Avoid excess stimulation, control pain/agitation
- Monitor neuro status and VS frequently
- Prevent fever and hypercapnia, avoid suction
- Administer fluids to decrease ICP (3%, mannitol)
Pharmacology for seizures:
Benzodiazepines, Phenytoin, Levetiracetam, Lamotrigine, Topiramate, Valproic acid
Benzodiazepines
- Used for: Emergency seizure control (status epilepticus). Increases GABA to calm brain activity
Examples: Lorazepam, Diazepam
Phenytoin (Dilantin)
- Used for: Tonic-clonic and focal seizures
Watch for: Gingival hyperplasia, rash, narrow therapeutic range
Levetiracetam (Keppra)
- Used for: Broad-spectrum seizures
Perks: Fewer drug interactions, well tolerated. Monitor for SI/personality changes.
Lamotrigine (Lamictal)
- Used for: Focal and generalized seizures,
Watch for: Stevens-Johnson Syndrome (rash risk)
Topiramate (Topamax)
- Used for: Seizures and migraine prevention
Watch for: Cognitive issues, weight loss, kidney stones
Valproic Acid (Depakote)
- Used for: Many types of seizures and mood stabilization. Increases GABA
Watch for: Liver toxicity, pancreatitis, not safe in pregnancy
What is Myasthenia Gravis?
Be sure to include ... Patho, Signs/symptoms, treatment, nursing considerations.
Patho: An autoimmune disorder where antibodies block or destroy acetylcholine receptors at the neuromuscular junction.
Signs/Symptoms: Fluctuating muscle weakness that usually begins in face, ptosis, diplopia, difficulty swallowing, and fatigue that worsens with activity.
Treatment: Pyridostigmine, corticosteroids, immunosuppressants, IVIG/plasmapheresis for crises, possible thymectomy, Tensilon test.
Nursing Considerations: Monitor respiratory status, schedule meds before meals, prevent aspiration, reduce fatigue, and avoid triggers for myasthenic crisis and cholinergic crisis.
SCI Pharmacology --> compare/contrast:
1. Norepinephrine
2. Dopamine
3. Phenylephrine
4. Baclofen
5. Oxybutynin
Norepinephrine vs Dopamine:
Both treat neurogenic shock, but Norepi is preferred for pure vasoconstriction, while dopamine also boosts heart rate (esp. helpful in bradycardia).
Phenylephrine:
Doesn’t increase HR — great for hypotension with tachycardia or normal HR.
Baclofen:
Used long-term for spasticity.
Oxybutynin:
Reduces bladder spasms and incontinence, common with neurogenic bladder.
Complications associated with strokes.
Hemiparesis or Hemiplegia, Dysphagia, Aphasia, Dysarthria, Cognitive Impairment – Memory loss, poor concentration, or confusion, Vision Problems, Neglect
Urinary Incontinence, Bowel Incontinence or Constipation, Seizures, Pressure Injuries, Deep Vein Thrombosis (DVT), Pneumonia
ICP monitoring - nursing considerations for EVD.
- Keep EVD at level of tragus
- Slow position changes, EVD clamped first, monitor CSF drainage hourly
Nursing interventions/considerations for a client having seizures.
ABC's, protect airway, turn patient on side to prevent aspiration, move objects away, cushion head, nothing in the mouth, don't restrain, record timing of events, administer emergency medications, monitor during post-ictal period.
What is Multiple Sclerosis?
Be sure to include ... Patho, Signs/symptoms, treatment, nursing considerations.
Patho: A chronic autoimmune disease causing demyelination of CNS neurons and plaque formation in the brain and spinal cord.
Signs/Symptoms: Vision problems, fatigue, muscle weakness, spasticity, numbness, balance issues, bladder/bowel dysfunction. Periods of remission and periods of exacerbation occur.
Treatment: Immunomodulators (e.g., interferons), corticosteroids for flares, symptom-specific meds, physical therapy.
Nursing Considerations: Promote mobility, manage fatigue, monitor for complications, prevent infection, support coping and safety, prevent exacerbation/manage triggers.
Discuss 4 complications of SCIs and nursing interventions.
1. Autonomic Dysreflexia
- Sit up, Address cause/trigger, Lower BP
2. VTE Risk
-Prophylaxis with Low molecular weight heparin, SCD's, TED stockings, encourage ROM and early movement, monitor for s/s of PE.
3. Bowel and Bladder Dysfunction
- SCI can lead to neurogenic bladder, where pts can't empty bladder voluntarily. Increased risk of urinary retention, infections, kidney damage. Encourage toileting schedule/diary, straight cath preferred over foley to reduce CAUTI risk. Meds to improve urine flow (example: tamsulosin), or to promote bowel evacuation (example: docusate). Encourage high fiber diet, increased fluid intake if able, use numbing gel for invasive measures to prevent AD.
4. Respiratory Complications
- C3, C4, C5 keep the diaphragm alive, due to impairment of phrenic nerve. Phrenic nerve controls the diaphragm (main muscle for breathing), can lead to hypoventilation, weak cough, difficulty clearing secretions, increased risk of atelectasis and aspiration pneumonia. Suction, monitor resp status, prepare for mechanical ventilation, if breathing independently encourage deep breathing/incentive spirometer, pulmonary toileting.