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Care of the client with alterations in neurological integrity

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TIA antiplatelet aggregation agents and anticoagulant drugs Slide 15 Carotid endarterectomy. Carotid endarterectomy. Slide 18 CVA/Stroke Stroke Stroke killed ... – PowerPoint PPT presentation

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Title: Care of the client with alterations in neurological integrity


1
The NCLEX questions will be taken from
  • B CVA DBears
  • A AD DBears
  • D All of the above
  • C CVA AD

2
The NCLEX questions will be taken from
  • B
  • A
  • D
  • C CVA AD

3
Care of the client with alterations in
neurological integrity
  • NUR 108
  • Spring 2007

4
Pathophysiology of the CNS
  • Constant blood flow is required to provide the
    brain with
  • Oxygen
  • Glucose
  • Metabolism The chemical processes occurring
    within a living cell or organism that are
    necessary for the maintenance of life.
  • Complete interruption of blood flow
  • Metabolism change in 30 seconds
  • Cessation of metabolism in 2 minutes
  • Cellular death in 4-5 minutes
  • Protection
  • Cerebral autoregulation processes that maintain
    a generally constant physiological state in a
    cell or organism

5
Causes of altered cognitive function
  • Inadequate blood flow
  • Altered nutrition
  • Fluid/electrolyte imbalance
  • Infectious process
  • Inadequate sleep and rest
  • Environmental stress
  • Pharmacological agents

6
Effects of aging on the Nervous System
  • CNS
  • Loss of neurons
  • ? of cerebral blood flow
  • ? in CSF production
  • PNS
  • Degenerative changes in myelin ??in nerve
    conduction
  • Cellular degeneration ?death of neurons
  • Neurons are electrically excitable cells in the
    nervous system that function to process and
    transmit information.

7
Acute Neurological Alterations
  • Transient Ischemic Attack (TIA)
  • Cerebrovascular Disease (Stroke)
  • Amyotropic Lateral Sclerosis (ALS)

8
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9
Mini Strokes
10
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11
TIA Transient Ischemic Attack
  • Definition temporary focal loss of neurological
    function caused by ischemia to one vascular area
    of the brain
  • Lasts lt 24 hours
  • Most resolve in 3 hours
  • Warning sign of progressive cerebrovascular
    disease

12
What causes a transient ischemic attack?
  • TIAs occur when a blood clot temporarily clogs an
    artery, and part of the brain doesn't get the
    blood it needs. The symptoms occur rapidly and
    last a relatively short time. Most TIAs last less
    than five minutes. The average is about a minute.
    Unlike stroke, when a TIA is over, there's no
    injury to the brain.

13
TIA
  • Signs and symptoms are dependent on which area of
    the brain was affected
  • Sudden numbness or weakness of the face, arm or
    leg, especially on one side of the body
  • Sudden confusion, trouble speaking or
    understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of
    balance or coordination
  • Sudden, severe headache with no known cause
  • CT scan is the most important initial diagnostic
    tool
  • Rx antiplatelet aggregation agents and
    anticoagulant drugs

14
antiplatelet aggregation agents
and anticoagulant drugs
15
  • Plavix

16
Carotid endarterectomy.
17
Carotid endarterectomy.
18
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19
CVA/Stroke
  • Definition ischemia to a portion of the brain OR
    bleeding into the brain both of which causes
    cellular death
  • most common cause of death
  • Approx 25 die within one year
  • Incidence increases with age
  • Doubling each decade after age 55

20
StrokeStroke killed 157,804 people in
2003.One of the largest cause of death, ranking
behind "diseases of the heart" and all forms of
cancer. Stroke is a leading cause of serious,
long-term disability in the United States.
21
Classification
  • Thrombotic
  • Ischemic
  • Embolic
  • Intracerebral
  • Hemorrhagic
  • Subarachnoid

22
Definitions
  • Ischemia
  • Thrombotic or embolic occlusion of cerebral
    vessels
  • Progresses over hours to days
  • Hemorrhage
  • Bleeding into the brain
  • Abrupt onset of headache
  • High mortality rate

23
Major types of Stroke
  • Thrombus - atherosclerosis of carotids/brain
    gradual, during sleep or early am, preceded by
    TIAs
  • Embolus - cardiac clot, rapid onset, during day
    activity, falling
  • Hemorrhage - intracerebral or subarachnoid worse
    headache of my life lose consciousness

24
Subarachnoid Hemorrhage
Intracerebral Hemorrhage
Hemorrhage either within the brain itself
(intracerebral) or in the space surrounding the
brain (subarachnoid) is a cause of
cerebrovascular accident or brain attack.
25
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26
Coil is used to occlude an aneurysmal sac
27
Manifestation of R-brain L-BrainStroke
28
Spatial and Perceptual deficits in
Stroke Homonymous
hemianopsia
29
Risk Factors
  • MODIFIABLE
  • Diabetes
  • Heavy alcohol
  • Hypercoagulability
  • Hyperlipidemia
  • HTN
  • Obesity
  • Sedentary lifestyle
  • smoking
  • NONMODIFIABLE
  • Age
  • Gender
  • Ethnicity
  • Heredity

30
Diagnostic Tests
  • History and neuro exam
  • Blood tests
  • CT scan
  • doppler studies
  • EKG
  • MRI
  • Angiography/DSA (digital subtraction angiography)
  • PET Positron emission tomography
  • TCD Transcranial Doppler ultrasonography
  • Lumbar Puncture
  • CXR

31
Warning signs of stroke
  • Sudden weakness, paralysis, or numbness of face,
    arm or leg
  • Especially on one side of the body
  • Sudden dimness or loss of vision
  • Sudden loss of speech, confusion or difficulty
    speaking
  • Unexplained sudden dizziness, loss of balance or
    coordination
  • Sudden severe headache

32
Goals of acute care following CVA
  • Preserve life
  • Prevent further damage
  • ?disability

33
Anticoagulant therapy Acute phase
  • Treat aggressively - Clot Busters
    Thrombolitic Drug tissue plasminogen activator
    (tPA)
  • Window of opportunity is 3 hours Timing
  • Only for Ischemic Stroke
  • Heparin is initiated immediately IV with goal to
    be 2 -2 1/2 times the control
  • Can not use if cause is hemorrhage
  • Coumadin 1 1/2 times for 3 months
  • After 3 months - Platelet antiaggregation therapy
    - ASA or Persantine

34
tissue plasminogen activator (tPA)
  • is a fibrin specific thrombolytic agent for the
    therapy of thromboembolic diseases such as
    myocardial infarction, pulmonary embolism, stroke
    and deep venous thrombosis.
  • Naturally occurring substance in the body tissues
    that activates the enzyme plasmin that is able to
    dissolve blood clots

35
Medical Management
  • Treatment of predisposing conditions
  • Control of hypertension
  • Anticoagulant therapy
  • Surgical Intervention - Carotid endarterectomy

36
Rehabilitation
  • Following stabilization, goal of care shifts from
    preservation of life to ?disability and attaining
    optimal function

37
Rehabilitation Team
  • Multidisciplinary approachindividual /
    familynurse / physicianphysical / occupational
    registered dietitiansocial worker / vocational
    counselorrecreation therapist / speech therapy
    clergy

38
Recovery
  • Most significant recovery from a CVA occurs
    during the first 6 weeks after the event

39
Nursing Diagnosis
  • Impaired physical mobility
  • Impaired verbal communication
  • Unilateral neglect
  • Ineffective health maintenance
  • Altered nutrition
  • Self-esteem

40
Amyotrophic Lateral Sclerosis
  • Lou Gehrigs Disease

41
amyotrophic lateral sclerosis
  • The official name comes from these
  • Greek words
  • "a" for without
  • "myo" for muscle
  • "trophic" for nourishment
  • "lateral" for side (of the spinal cord)
  • "sclerosis" for hardening or scarring

42
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43
Lou Gehrig's Farewell Speech
  • Lou Gehrig's Farewell Speech
  • "Fans, for the past two weeks you have been
    reading about the bad break I got. Yet today I
    consider myself the luckiest man on the face of
    the earth. I have been in ballparks for 17 years
    and have never received anything but kindness and
    encouragement from you fans. Look at these grand
    men. Which of you wouldn't consider it the
    highlight of his career just to associate with
    them for even one day? Sure I'm lucky. Who
    wouldn't consider it an honor to have known Jacob
    Ruppert? Also, the builder of baseball's greatest
    empire, Ed Barrow? To have spent six years with
    that wonderful little fellow, Miller Huggins?
    Then to have spent the next nine years with the
    best manager in baseball today, Joe McCarthy?
    Sure I'm lucky. When the New York Giants, a team
    you would give your right arm to beat, and vice
    versa, sends you a gift - that's something. When
    everybody down to the groundskeepers and those
    boys in white coats remember you with trophies -
    that's something. When you have a wonderful
    mother-in-law who takes sides with you in
    squabbles with her own daughter - that's
    something. When you have a father and a mother
    who work all their lives so you can have an
    education and build your body - it's a blessing.
    When you have a wife who has been a tower of
    strength and shown more courage than you dreamed
    existed - that's the finest I know. So I close in
    saying that I may have had a tough break, but I
    have an awful lot to live for.
  • --Lou GehrigGehrig's immortal words of
    thanks on July 4, 1939, Lou Gehrig Appreciation
    Day at Yankee Stadium

44
ALS
  • Definition rare, progressive neurological
    disorder characterized by loss of motor neurons
  • Motor neurons in brain and spinal cord gradually
    degenerate
  • Leads to death within 2-6yrs of diagnosis
  • More common in men than women by ratio of 21

45
Clinical Manifestations
  • Typical initial symptoms
  • Upper extremity weakness
  • Dysarthria difficulty is speech
  • Dysphagia
  • Death is usually the result of respiratory
    infection secondary to compromised respiratory
    status

46
Collaborative Care
  • There is no cure for ALS
  • Treating signs and symptoms
  • Riluzole (Rilutek)
  • Slows the progression of ALS increases life by a
    few months
  • Cognition is intact with physical wasting
  • Support the patients cognitive emotional
    functions

47
Definitions
  • agnosia - inability to recognize familiar
    objects
  • alexia - inability to read or word blindness
  • anosognosia - denial and inattention of affected
    side. May harm self by not protecting affected
    side
  • aphasia - absence or impairment of the ability to
    communicate through speech, writing, or signs
  • apraxia - inability to perform a learned movement
    voluntarily - put toothpaste on a comb
  • ataxia - defective muscular coordination esp that
    manifested when voluntary muscle movements are
    attempted
  • diplopia - double vision
  • dysarthria - difficulty in speech due to motor
    function of the tongue
  • dyskinesia - inability to perform voluntary
    movements
  • paresis - partial or incomplete paralysis

48
Definitions
  • dysnomia - condition in which the patient forgets
    words or has difficulty finding words for written
    or oral expression
  • dysopia - defective vision
  • dysphagia - inability to swallow or difficulty in
    swallowing
  • dysphasia - impairment of speech resulting from a
    brain lesion
  • hemianopia - blindness in one half of the visual
    field
  • hemianosmia - loss of sense of smell in one
    nostril
  • hemiapraxia - incapacity to exercise purposeful
    movements on one side of the body
  • hemiataxia - impaired muscular coordination
    causing awkward movements of the affected side of
    the body.
  • hemiparesis - paralysis
  • hemiparesthia - numbness of one side of the body
  • hemiplegia - paralysis of only one side of the
    body

49
Any Questions ????
50
Any Questions !!!
By Leandro A. Resurreccion
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