AHN 2 Neuro Ch. 67 Neurovascular

Basalar fracture signs

-blood in nose, pharynx, ear -Battle sign -CSF leak

Battle sign

Bruising behind an ear over the mastoid process

neurogenic shock

Circulatory failure caused by paralysis of the nerves that control the size of the blood vessels, leading to widespread dilation; seen in patients with spinal cord injuries.

clopidogrel

Plavix

Plavix (clopidogrel)

antiplatelet

carotid stenosis

arteriosclerosis of the carotid artery

halo sign

blood stain surrounded by a yellowish stain; highly suggestive of a cerebrospinal fluid leak

plavix

clopidogrel

Dysarthria

difficulty forming words

Levadopa side effects

extrapyramidal signs

Hydralazine (Apresoline)

ganglionic blocker

anasocoria

unequal pupils

impaired cerebral circulation

A 64-year-old client reports symptoms consistent with a transient ischemic attack (TIA) to the physician in the emergency department. What is the origin of the client's symptoms? impaired cerebral circulation cardiac disease diabetes insipidus hypertension

Restrict fluids before surgery.

A client on your unit is scheduled to have intracranial surgery in the morning. Which nursing intervention helps to avoid intraoperative complications, reduce cerebral edema, and prevent postoperative vomiting? Administer an osmotic diuretic. Administer prescribed medications. Restrict fluids before surgery. Administer preoperative sedation.

Autonomic Dysreflexia

(potentially life threatening emergency!) HOB elevate 90 degrees, loosen constrictive clothing, assess for full bladder or bowel impaction, (trigger) administer antihypertensives (may cause stroke, MI, seizure)

Persantine

Dipyridamole

Dipyridamole

Persantine

Intracranial hemorrhage

Which is a contraindication for the administration of tissue plasminogen activator (t-PA)? Ischemic stroke Age 18 years or older Systolic blood pressure less than or equal to 185 mm Hg Intracranial hemorrhage

Levadopa

precursor of dopamine used to treat parkinsons

tPA contraindications

- Acute ICH - History of ICH - BP above 185/110 - Unknown time of onset - Stroke/Trauma in past 3 months - Thrombocytopenia/Coagulopathy - Anticoagulation if INR>1.7

Parkinson dx

2/4 cardinal signs present confirmed with pos levadopa trial

Auditory agnosia

A client has experienced an ischemic stroke that has damaged the temporal (lateral and superior portions) lobe. Which of the following deficits would the nurse expect during assessment of this client? Lack of deep tendon reflexes Auditory agnosia Limited attention span and forgetfulness Hemiplegia or hemiparesis

Left-sided cerebrovascular accident (CVA)

A client is admitted with weakness, expressive aphasia, and right hemianopia. The brain MRI reveals an infarct. The nurse understands these symptoms to be suggestive of which of the following findings? Completed Stroke Transient ischemic attack (TIA) Right-sided cerebrovascular accident (CVA) Left-sided cerebrovascular accident (CVA)

Increased urine output

A client is receiving an IV infusion of mannitol (Osmitrol) after undergoing intracranial surgery to remove a brain tumor. To confirm that this drug is producing its therapeutic effect, the nurse should consider which finding most significant? Increased urine output Elevated blood pressure Decreased heart rate Decreased level of consciousness (LOC)

"The client is unaware of his left side. You should approach him on the right side."

A client recently experienced a stroke with accompanying left-sided paralysis. His family voices concerns about how to best interact with him. They report the client doesn't seem aware of their presence when they approach him on his left side. What advice should the nurse give the family? "The client is unaware of his left side. You should approach him on the right side." "This condition is temporary." "The client is unaware of his left side. You need to encourage him to interact from this side." "The client is feeling an emotional loss. He'll eventually start acknowledging you on his left side."

Anticoagulant therapy

A client with a history of atrial fibrillation has experienced a TIA. In an effort to reduce the risk of cerebrovascular accident (CVA), the nurse anticipates the priority medical treatment to include which of the following? Anticoagulant therapy Cholesterol-lowering drugs Carotid endarterectomy Monthly prothrombin levels

cardio embolic

A nurse is reading a journal article about stroke and the underlying causes associated with this condition. The nurse demonstrates understanding of the information when identifying which subtype of stroke as being due to atrial fibrillation? cryptogenic large-artery thrombotic small, penetrating artery thrombotic cardio embolic

Three hours

An emergency department nurse is awaiting the arrival of a client with signs of an ischemic stroke that began 1 hour ago, as reported by emergency medical personnel. The treatment window for thrombolytic therapy is which of the following? One hour Six hours Three hours Two hours

International normalized ratio greater than 2

An emergency department nurse is interviewing a client who is presenting with signs of an ischemic stroke that began 2 hours ago. The client reports a history of a cholecystectomy 6 weeks ago and is taking digoxin, warfarin, and labetalol. What factor poses a threat to the client for thrombolytic therapy? International normalized ratio greater than 2 Two hour time period of the stroke Surgery 6 weeks ago Taking digoxin

Persantine (dipyridamole)

Antiplatelet

Ticlid (ticlopidine)

Antiplatelet

balance, eyes, face, arms, speech, time

BEFAST

carbidopa

Give with levodopa Inhibits DOPA-decarboxylase in periphery-->increased levodopa in CNS

apresoline

Given with meals (antihypertensive)

global aphasia

Nonfluent aphasia w/ impaired comprehension. Both Broca's and Wernicke's areas affected.

Spatial-perceptual deficits

The nurse has just received report on a client in the ED being transferred to the acute stroke unit with a diagnosis of a right hemispheric stroke. Which findings does the nurse understand is indicative of a right hemispheric stroke? Spatial-perceptual deficits Aphasia Altered intellectual ability Slow, cautious behavior

Provide a dimly lit environment. Administer docusate per order. Elevate the head of bed 30 degrees.

The nurse is caring for a client diagnosed with a subarachnoid hemorrhage resulting from a leaking aneurysm. The client is awaiting surgery. Which nursing interventions would be appropriate for the nurse to implement? Select all that apply. Provide a dimly lit environment. Permit friends to visit often. Ambulate the client every hour. Administer docusate per order. Elevate the head of bed 30 degrees.

Establishing eye contact

The nurse is caring for a client with aphasia. Which strategy will the nurse use to facilitate communication with the client? Avoiding the use of hand gestures Speaking in complete sentences Establishing eye contact Speaking loudly

Ticlopidine

Ticlid

Ticlid

Ticlopidine

Perform stretching exercises and frequent position change.

When providing teaching to a client who reports tension headaches, which of the following instructions would be most beneficial to prevent onset of symptoms? Avoid certain foods. Apply cool or warm cloth to head or eyes. Eliminate use of bright lights when working. Perform stretching exercises and frequent position change.

Homonymous hemianopsia

Which disturbance results in loss of half of the visual field? Nystagmus Anisocoria Homonymous hemianopsia Diplopia

Main presenting symptom is an "exploding headache."

Which of the following is accurate regarding a hemorrhagic stroke? It is caused by a large-artery thrombosis. Functional recovery usually plateaus at 6 months. One of the main presenting symptoms is numbness or weakness of the face. Main presenting symptom is an "exploding headache."

Bleeding

Which of the following is the most common side effect of tissue plasminogen activator (tPA)? Headache Increased intracranial pressure (ICP) Bleeding Hypertension

Atrial fibrillation

Which of the following, if left untreated, can lead to an ischemic stroke? Cerebral aneurysm Ruptured cerebral arteries Arteriovenous malformation (AVM) Atrial fibrillation

diffuse axonal injury

involves stretching, shearing, or tearing of the extension of the neuron that conducts electrical impulses away from the cell body.

Parkinson's disease

neurologic movement disorder linked to decreased dopamine levels

spinal shock

physiologic response that occurs between 30 and 60 minutes after trauma to the spinal cord and can last up to several weeks. presents with total flaccid paralysis and loss of all reflexes below the level of injury.

anticoag

stroke prevention r/t A-fib

cardio embolic stroke:

stroke resulting from a source of the heart. (a-fib)

endarterectomy

surgical removal of plaque from the inner layer of an artery

heat

tension headache tx

tPA

tissue plasminogen activator

Parkinson cardinal features

tremor, rigidity, bradykinesia/akinesia, postural instability

Botulinum Toxin A

tx of choice for spasticity of extremities r/t CVA

aphasia

impairment of language, usually caused by left hemisphere damage either to Broca's area (impairing speaking) or to Wernicke's area (impairing understanding).

apraxia

inability to perform particular purposive actions, as a result of brain damage.

Ask the client if he has trouble breathing.

A nurse is caring for a client who has returned to his room after a carotid endarterectomy. Which action should the nurse take first? Take the client's blood pressure. Ask the client if he has trouble breathing. Ask the client if he has a headache. Place antiembolism stockings on the client.

Lioresal (Baclofen)

A patient who has suffered a stroke begins having complications regarding spasticity in the lower extremity. What ordered medication does the nurse administer to help alleviate this problem? Diphenhydramine (Benadryl) Lioresal (Baclofen) Pregabalin (Lyrica) Heparin

Frontal

A stroke victim is experiencing memory loss and impaired learning capacity. The nurse knows that brain damage has most likely occurred in which lobe? Temporal Frontal Occipital Parietal

Psychosis, disorientation, delirium, insomnia, and hallucinations

The nurse is caring for a client following an aneurysm coiling procedure. The nurse documents that the client is experiencing Korsakoff syndrome. Which set of symptoms characterizes Korsakoff syndrome? Severe dementia and myoclonus Tremor, rigidity, and bradykinesia Choreiform movement and dementia Psychosis, disorientation, delirium, insomnia, and hallucinations

Difficulty swallowing

The nurse is caring for a client with a history of transient ischemic attacks (TIAs) and moderate carotid stenosis who has undergone a carotid endarterectomy. Which postoperative finding would cause the nurse the most concern? Neck pain rated 3 of 10 (on a 0 to 10 pain scale) Difficulty swallowing Mild neck edema Blood pressure 128/86 mm Hg

Sinimet

carbidopa/levodopa