NR 325 Exam 2 Study Guide

Neurology:

NR 325 Exam 2 Study Guide Latest 2023 / 2024

• Brain required continuous blood supply, needs perfusion • Blood flow has to be at 750-1000 mls or 20% of cardiac output for optimal brain functioning • Amount of blood that passes through the brain in 1 minute – cerebral BF

• Regulated by metabolic needs

• MAP – normal is 70-110, number can be used to tell us if the body is perfusing well or not

• Below 70 – not adequately perfusing to the brain

▪ Brain is not getting enough oxygen and glucose ▪ Levels need to be at 60 or above to prevent tissue death ▪ 50 and below – ischemia occurs ▪ Calculation – (systolic BP + 2(Diastolic BP))/3) • Stroke

• Risk factors

▪ Modifiable • Hypertension • Obesity • Sedentary lifestyle • Alcohol consumption • Smoking • Poor diet • Discontinuation of BP medications ▪ Non-modifiable • Aging - 65+ • Gender – male • Family history • Face

• Co-morbidities

▪ Atrial fibrillation ▪ Atherosclerosis ▪ Diabetes ▪ High cholesterol

▪ TIA

• What happens during a stroke

▪ Brain is deprived of oxygen and glucose ▪ Total interruption of BF, neurological status is altered in 20 seconds, brain death occurs in 5 minutes of not receiving oxygen

• BEFAST – balance, eyes, facial drooping, arm weakness, speech

difficulty, time

• TIA

▪ Lasts one hour or less 1 / 3

▪ Increased risk for a stroke ▪ If carotid is involved, loss of vision in one eye ▪ Brief interruption of cerebral BF ▪ Symptoms depend on the blood vessel involved ▪ Always seek treatment for any stroke symptoms, even if they stop ▪ 1/3 have a stroke, 1/3 never have another TIA, 1/3 have more TIAs

• Ischemic stroke

▪ Thrombotic • Most common cause of stroke • Usually has a warning TIA • Usually occurs before or after sleep • Slower onset of symptoms

• Symptoms increase in the first 72 hours

• Risk factors – things that will damage the vessels

• hypertension, high cholesterol, atherosclerosis,

DM, more common in men ▪ Embolic • Embolus lodges and occludes an area of the brain • 2 nd most common cause of stroke • Sudden symptoms** • Warning signs are less common • Usually originates from the heart • Need to aggressively treat the underlying cause

• Hemorrhagic

▪ Bleeding into the brain tissue itself ▪ Intracerebral hemorrhage • Caused by a vessel rupture • Basal ganglia • Sudden onset of S/S with quick progression • Poor prognosis • Most common cause - Hypertension • Clinical manifestations

• Headache
• Nausea
• Decreased LOC
• Hypertension

▪ Subarachnoid hemorrhage • Rupture of cerebral aneurysm • No warnings • Can be completely aware during the stroke or comatose • Risk factors

• Trauma 2 / 3

• Drug abuse
• “silent killer” – you don’t know you have it until

it ruptures • Clinical manifestations

• N&V
• Seizures
• Stiff neck
• Cranial nerve defects

▪ Atrial venous malformation • Abnormal tangle of BVs

• Disrupts normal BF – oxygen and BF to the

brain is impacted

• Affected arteries can weaken and rupture

▪ Hemorrhagic stroke ▪ Cerebral vasospasm • Complication of hemorrhagic stroke • Narrowing of the vessels causing infarction • Subarachnoid blood clots break down and release components that cause endothelial damage • Peak is 6-10 days following hemorrhagic stroke • Keep in ICU 14 days if at risk

• S/S

• Increased BP, more/increase in pain, new

symptoms of stroke • Drugs

• Nimodipine***

▪ Calcium channel blocker ▪ Neuroprotection and vasodilation • other treatments

• control HTN
• decrease ICP
• craniotomy
• Emergency care

▪ Single most important assessment – time and onset of symptoms* ▪ Goals • Preserve life • Prevent further damage • Reduce disability ▪ Need to be seen within 5 minutes of arrival ▪ TPA protocol • Hypertension needs to be lower than 220/120 or give antihypertensive medication • Ask questions – bleeding and anti-coagulant therapy will exclude them from getting TPA therapy

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