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MedSurg:Chapter 48

Interventions for Critically Ill Clients with Neurologic Problems

QuestionAnswer
Stroke Disruption in the normal blood supply to the brain in the form of an interruption in blood flow to the brain(Ischemic) or bleeding within or around the brain(Hemorrhagic Stroke)*A stroke is a MEDICAL EMERGENCY that strikes suddenly;Treat Immediately
Types of Strokes Ischemic(occlusive)and Hemorrhagic
Ischemic Stroke- occur during sleep Caused by the occlusion of a cerebral artery by either a thrombus(Thrombotic Stroke) or an embolus (Embolic Stroke)
Thrombotic Stroke Associated with the developement of atherosclerosis
Atherosclerosis Altered function of the inner linning of arterical vessels, inflammation, and increased growth of vascular smooth muscles; Plaque develop on the inner wall of the affected arterial vessel
Atherosclerosis 2 Clot formation; artery becomes occluded; decreased blood flow causes transient ischemia, which progresses to complete ischemia and infarction of the brain tissue.Within 72 hours, area is edematous and necrotic and cavities develop
Lacunar stroke Type of thrombotic stroke- soft area or cavity develop in the white matter or deep gray matter of the brain; may result in significant neurologic dysfunction if it damages a critical area in the brain
Embolic Stroke Caused by an embolus or a group of emboli (clot) that break off from one area of the body and travel to the cerebral arteries via the carotid artery or vertebrobasilar system*Usual source is Cardiac
Emboli Can Occur in Clients With Nonvalvular atrial fibrillation, ischemic heart diseas, rheumatic heart disease, and mural thrombi following a myocardial infarction or insertion of a prosthetic heart valve
Transient Ischemic Attack(TIA)=silent stroke and Reversible Ischemic Neurologic Deficit(RIND) Precedes an ischemic stroke; both cause transient focal neurologic dysfunctionTIA last few minutes to fewer than 24 hoursRIND symptoms last longer than 24 hours but less than a week
Hemmorhagic Stroke Vessel integrity is interrupted, and bleeding occurs into the brain tissue or into the spaces surrounding the brain; results from a ruptured aneurysm, ruptured of an arteriovenous malformation, or severe hypertension
Aneurysm- Usually occur duing activity An abnormal ballooning or blister on the involved artery- weaken vessel wallContinued force on the weakened vessel wall from elevated blood pressure strtches and thins the vessel wall, causing the intimal or innermost vessel layer to protrude
Arteriovenous Malformation Occur during embryonic development; a tangled or spaghetti-like mass of malformed, thin-walled, dilated vesselsAbnormal communication between the arterial and venous system- vessels eventually rupture-bleeding in SA space or IC tissue
Hypertension Hemorrhagic stroke may be more likely with sudden, dramatic blood pressure elevations, such as those seen with cocaine intoxication
Manifestations of Stroke- Cognitive Changes Cognitive Changes-Changes in LOCRight cerebral hemisphere- visual and spatial awareness and proprioception- unaware of any deficits and may be disoriented to time and place, poor judgement,personality changes
Manifestations of Stroke- Cognitive Changes Left Cerebral Hemisphere- Center for language, mathematic skills, and analytic thinking; Results in aphasia (inability to use or comprehend language), alexia(reading problems), agraphia(difficulty with writing)- Persons are slow and cautious
Motor Changes-Right Side Hemiplegia(paralysis on one side of the body) or hemipareis(weakness on one side of the body)- stroke involving the left cerebral hemisphere because the motor nerve fibers cross in the medulla before the spinal cord and periphery.
Motor Changes-Left Side Left hemiplegia or hemiparesis indicates a stroke in the right cerebral hemisphere
Motor Changes Hypotonia or flaccid paralysis- unable to overcome the forces of gravity, and the extremities tend to fall to the side- feel heavy, and muscle tone is inadequate for balance, equilibrium, or protective mechanisms
Motor Changes Hypertonic (spastic paralysis)- cause fixed positions or contractures of the involved extremities
Sensory Changes Client maybe unable to write, comprehend reading material, use an object correctly(agnosia) or carry out of purposeful motor actvity(apraxia)
Sensory Changes- Neglect Syndrome-Stroke in Right Cerebral Hemisphere Client is unaware of the existence of his or her left paralyzed side- the client who washes or dressess only one side of the body
Neglect Syndrome Picture: Client sitting in a wheelchair, leaning to the left with the arm caught in the wheelchair, leaning to the left with the arm caught in the wheelchair wheel- Client believes that he or she is fine and believe that he or she is sitting up straight
Intracranial Pressure(ICP) Monitoring Most at risk for increased ICP resulting from edema during the first 72 hours after onset of the stroke. First sign of increased ICP is a declining level of consciousness (LOC)-Elevate HOB to 30 degrees- Head is midline, neutral position-venous drainage f
ICP Monitoring AVOID Extreme hip and neck flexion *AVOID clustering nursing procedures-Eg. giving a client a bath followed immediately by changing the bed linen *Hyperoxygenate Client before suctioning *Quiet Environment *Low lights
Management of Arteriovenous Malformation (AVM) Therapy to occlude abnormal arteries or veins and prevent bleeding from vascular lesion
Management of Cerebral Aneurysms Repaired via a craniotomy as soon as the client's condition is stabilized; During surgery, the aneurysm is clipped or a clamp is placed at the base, or neck, of the aneurysm to prevent blood from entering the area
Dysarthria Loss of motor function to the tongue or to the muscles of speech, causing slurred speech
Expresssive(Broca's or motor) aphasia Damage in Broca's area of the frontal lobeClient generally understand what is said but is unable to communicate verbally- difficulty writing- deficit and may become frustrated and angry
Receptive (Wernicke's or sensory) aphasia Temporoparietal areaClient unable to understandd the spoken and often the written wordClient is able to talk, language is often meaninglessNeologisms(made up words) are common parts of speech
Global(Mixed) Combination of difficulty understanding words and speechDifficulty with reading and writing.
Created by: keisha12_18
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