Neuro-sensory – Flashcards

Loss or dysfunction of memory, orientation, attention language, judgment, and reasoning Risk Factors: -Aging -family history Etiology: -neurodegenerative conditions (AD) -Alzheimers, down syndrome, parkinson's -vascular disorders -subarachnoid hemorrhage, subural hematoma -toxic, metabolic, or nutritional diseases -alcoholism, vitamin deficiency, hyper-hypothyroidism -immunologic disease/infection -MS, AIDS, meningitis, encephalitis -systemic disease -Wilson's disease, dialysis dementia -trauma -head injury -tumors -brain tumors, metastatic tumors -ventricular disorders -hydrocephalus -drugs -anticholinergics, Dilantin, opioids, hypnotics, tranquilizers, cocaine, heroin Pathophysiology: -vascular dementia (multiinfarct dementia): loss of cognitive function resulting from ischemic, ischemic-hypoxic, or hemorrhagic brain lesions caused by cardiovascular disease; may be caused by a single dtroke or decreased blood supply Signs and symptoms: Early (Mild): -forgetfulness -short-term memory impairment -difficulty recognizing what numbers mean -loss of initiative and interests -decreased judgment -geographic disorientation Middle (Moderate): -impaired ability to recognize close family/friends -agitation -wandering -loss of remote memory -confusion -impaired comprehension -forgets how to do simple tasks -expressive & receptive aphasia -insomnia -delusions -behavioral problems Late (Severe): -little memory, unable to process new info. -cannot understand words -difficulty eating/swallowing -repetitious sounds or words -unable to form self care -immobility -incontinence Complications: Diagnostic tests: focuses on determining cause (reversible or nonreversible) -thorough medical, neurological, & psychological history -screen for cobalamin (B12) deficiency for hypothyroidism -mental status test (Mini-Mental State Exam/MMSE): focuses on evaluating memory, ability to calculate, language, visual-spatial skills, and alertness *Vascular caused dementia: -CT scan -MRI -PET Nursing Care: -Tx of HTN, diabetes, smoking, hyperfibrinogenemia, & cardiac dysrhythmias -Drug therapy

Orientation to time -What is the date? Registration -Listen carefully, I am going to say three words. you say them back after I stop. Ready? Here they are... HOUSE....CAR.....LAKE..... Now repeat those words back to me. (Repeat up to 5 times but only record 1st trial). Naming -What is this? (point to pen or pencil) Reading -Please read this and do what it says. (Show the words "close your eyes")

A state of temporary but acute mental confusion Risk Factors: Precipitating -preexisting dementia -depression -pain -emotional stress -immobility -sensory overload/deprivation -drugs (opioids, hypnotics, withdrawal) Etiology: -cholinergic deficiency -excess release of dopamine -serotonergic activity -cytokines: interleukine 1, 2, & 6 -chronic stress Pathophysiology: -unknown Signs and symptoms: -hypoactivity -lethargy -hyperactivity -agitation -hallucination -inability to concentrate -irritability -insomnia -loss of appetite -restlessness Complications: Diagnostic tests: -medical, psychological and physical history 1st -Confusion Assessment Method Tool -potential causes are then explored -health history and medications -lab tests -ECG -drug and alcohol levels -CSF -CT & MRI Treatment: -drug therapy: antipsychotics or benzodiazepines -used only for severely agitated pts Nursing Care: -prevention -early recognition -treatment -pain mgmt. -safety

Chronic, progressive, degenerative disease of the brain Risk Factors: -age -genetics: overproduction of B-amyloid -cellular: inflammation, and formation of free radicals damage neurons -modifiable: diabetes, ApoE gene variation, smoking, depression Etiology: -exact is unknown -familial AD: people with clear pattern of inheritance within a family -sporadic: cases where no familial connection is made Pathophysiology: -people with AD contain more plaques and NF tangles -plaques contain B-amyloid protein which is cleaved from APP, associated with cell membrane -neurofibrillary tangles: abnormal collections of twisted proteins threads inside nerve cells -loss of connection between neurons--> brain atrophy Signs and symptoms: -(early warning signs slide) -similar to dementia -subtle deterioration of memory* -dysphasia -apraxia Diagnostic tests: -diagnosed by exclusion -complete health history -physical exam -neurological & mental status tests -lab tests -MRI/ CT -definite diagnosis requires presence of neurofibrillary tangles and plaques at autopsy Treatment: -Drug therapy: slows rate of decline of disease and worsening of symptoms; do not cure Dx Assessment: -health history -medications -health perception-mgmt. -nutrition/metabolic -activity/exercise -cognitive/perceptual -appearance -neurologic (mild, mod, severe) -diagnostic tests Nursing Care: -pt/family teaching -safety -home care -behavioral problems -pain mgmt. -eating and swallowing difficulties -oral care -infection prevention -skin care -elimination problems -caregiver support

Decreased memory & cognition -Cholinesterase inhibitors: block cholinesterase which is responsible for breakdown of acetylcholine in synaptic cleft -donepezil (Aricept) -rivastigmine (Exelon) -galantamine (Razadyne) -N-methyl-D-aspartate receptor antagonist: protects brain's nerve cells against excessive amounts of glutamate which is released in large amounts in AD brains -Memantine (Namenda) Depression -Selective serotonin reuptake inhibitors (SSRI's) -sertraline (Zoloft) -fluvoxamine (Luvox) -citalopram (Celexa) -fluoxetine (Prozac) -Tricyclic antidepressant -nortriptyline (Aventyl Pamelor) -amitriptyline (Elavil) -imipramine (Tofranil) -Doxepin (Sinequan) -Atypical antidepressant -trazadone (Desyrel) Behavioral -Typical antipsychotics -haloperidol (Haldol) -loxapine (Loxitane) -Atypical antipsychotics -risperidone (Risperdal) -olanzapine (Zyprexa) -quetiapine (Seroquel) -aripiprazole (Abilify) -Benzodiazepines -lorazepam (Ativan) -temazepam (Restoril) -oxazepam (Serax) Sleep -zolpidem (Ambien)

1. Memory loss that affects job skills -unexplainable confusion or frequent forgetfulness at home or work -beyond forgetting assignment or colleague's name 2. difficulty performing familiar tasks -may forget to eat a meal they cooked AND that they made it 3. Problems with language -may forget simple words or misuse words making it difficult to understand 4. disorientation to time and place -get lost on their own street, not knowing where they are, how they got there, or how to get home 5. poor or decreased judgment -dressing inappropriately such as wearing a bathrobe to the store 6. Problems with abstract thinking -unable to recognize numbers or do basic calculations 7. Misplacing things -frequently misplaces or puts things in inappropriate places such as putting eating utensils in clothes drawer 8. Changes in mood or behavior -more rapid mood swings for no apparent reason 9. Changes in personality 10. Loss of initiative -may become uninterested in usual pursuits

Occurs when ischemia (inadequate blood flow) to a part of the brain or hemorrhage into the brain that results in dead brain cells Risk Factors: Modifiable: -HTN -heart disease -smoking -excessive alcohol consumption -obesity -sleep apnea -metabolic syndrome -lack of physical exercise -poor diet -drug use Non-modifiable: -age -gender -ethnicity/race -family history Etiology: -Factors affecting blood flow to brain: ---systemic BP ---cardiac output ---blood viscosity ---intracranial pressure: causes brain compression and reduced cerebral blood flow -atherosclerosis: hardening and thickening of arteries --can lead to thrombus formation and contribute to emboli Pathophysiology: -internal carotid artery & vertebral artery supply blood to brain -cerebral autoregulation: mechanism that protects brain from changes in mean systemic arterial blood pressure ---may be impaired following cerebral ischemia, and cerebral blood flow then changes directly in response to changes in BP -CO2 is a vasodilator; increased CO2 levels increase cerebral blood flow -in response to ischemia, a series of metabolic events occur called the ischemic cascade ---inadequate adenosine triphosphate (ATP) production ---loss of ion homeostasis ---release of excitatory amino acids (glutamate) ---free radical formation ---cell death ---around core area of ischemia is a border zone of decreased blood flow called penumbra, where ischemia is potentially reversible ---if adequate blood flow can be restored early (within 3hrs), and the ischemic cascade can be interrupted, there may be less brain damage and less neurological function lost Signs and symptoms: 1. Motor function: -mobility -respiratory function -swallowing and speech -gag reflex -self-care ability 2. Communication: -aphasia (total loss of comprehension and use of language or total inability to communicate) -dysphasia (impaired ability to communicate) -dysarthria (disturbance in muscular control of speech) 3. Affect -emotional responses may be exaggerated or unpredictable -frustration and depression due to inability to perform ADLs 4. Intellectual Function -impaired memory & judgment -left brain stroke: memory problems related to language; cautious in making judgments -right brain stroke: impulsive & move quickly 5. Spatial-Perceptual Alterations -usually from right brain damage -incorrect perception on self and illness -perception of self in space -agnosia: inability to recognize an object by sight, touch, or hearing -apraxia: inability to carry out learned sequential movements on command 6. Elimination: -initially & temporary -may initially experience frequency, urgency, & incontinence -constipation Diagnostic tests: -tests are done to: 1. confirm that it is a stroke and not a brain lesion 2. identify likely cause -non-contrast CT: distinguishes between ischemic and hemorrhagic stroke & helps determine size and location of stroke -CT angiography: provides visualization of cerebral blood vessels; can provide estimate of perfusion and detect filling defects in cerebral arteries -MRI: determine extent of brain injury; can detect vascular lesions and blockages -angiography: can identify cervical and cerebrovascular occlusion, atherosclerotic plaques, & malformation of vessels -intraarterial digital subtraction angiography (IDSA): reduces dose of contrast material, uses smaller catheter; visualizes blood vessels in neck -transcranial Doppler (TCD) ultrasonography: measures velocity of blood flow in the major cerebral arteries; effective in detecting microemboli and vasospasm -lumbar puncture: done to look for evidence of RBC in CSF if a subarachnoid hemorrhage is suspected Treatment: 1. Preventative: -control of HTN -control of DM -treatment of underlying cardiac problems -no smoking -limit alcohol intake 2. Drug therapy -Platelet inhibitors (e.g. aspirin) -anticoagulants for pts. with atrial fib. 3. Surgical therapy -carotid endarterectomy -stenting of carotid artery -transluminal angioplasty -extracranial-intracranial bypass -surgical interventions for aneurysms 4. Acute Care -maintenance of airway -fluid therapy -treatment of cerebral edema -prevention of secondary injury 5. Ischemic Stroke -tissue plasminogen activator (tPA) IV or intraarterial -MERCI retriever 6. Hemorrhagic Stroke -surgical decompression -clipping or coiling of aneurysm Nursing Care: -reduce secondary injury related to ICP

Ischemic: Transient Thrombotic, Embolic 1. Transient Ischemic Attack: -transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, but without acute infarction of brain -Sx usually last <1hr; include temporary vision loss, transient hemiparesis, numbness or loss of sensation, or sudden inability to speak; may be due to microemboli that temporarily blocked blood flow; 2. Thrombotic Stroke: -occurs from injury to a blood vessel wall and formation of a blood clot -infarction and cell death occur -Sx may progress in the 1st 72 hours as infarction and cerebral edema 3. Embolic Stroke: -occurs when embolus lodges in and occludes a cerebral artery, resulting in infarction and edema in the area supplied by the involved vessel -Sx appear rapidly: headache Hemorrhagic Stroke: 1. Intracerebral Hemorrhage: -bleeding within the brain caused by a rupture of a blood vessel -Sx: weakness on one side of body, severe headache, NV, slurred speech, deviation of eyes 2. Subarachnoid Hemorrhage: -occurs when there is intracranial bleeding into the cerebrospinal fluid-filled space between the arachnoid and pia mater membranes on the surface of the brain -Sx: cranial nerve deficits, NV, seizures, stiff neck

Right -left hemiplegia -left-sided neglect -spatial-perceptual deficits -tends to deny or minimize problems -rapid performance, short attention span -impulsive, safety problems -impaired judgment -impaired time concepts Left -right hemiplegia -impaired speech/language aphasias -impaired right/left discrimination -slow performance, cautious -aware of deficits: depression, anxiety -impaired comprehension related to language and math

a. Glascow coma scale b. Analysis of any symptoms c. Related History d. Physical exam: mental status exam, neuro checks, cranial nerve assessment

a. stages of Alzheimer's Disease b. Ischemic Stroke c. TIA

a. Electroencephalogram or EEG b. CT scan/CTA c. Magnetic Resonance Imaging or MRI /MRA d. cerebral angiogram e. TCD (transcranial doppler) f. Blood tests: serum glucose, BUN, liver function, lipid profile, platelets, PT, PTT g. Cerebrospinal fluid analysis

a. Disturbed thought processes r/t effects of dementia b. Self-care deficit r/t memory deficit & neuromuscular impairment c. HRF Injury r/t impaired judgment, gait instability, weakness, sensory perceptual alteration d. Wandering r/t disease process

a. Medications: i. Dementia: benzodiazepines (diazepam, alprazolam), cholinesterase inhibitors (donepezil HCl, memantine HCl), antipsychotics (risperidone, olanzapine) ii. antidepressants iii. Stroke: tPA, ASA, clopidogrel bisulfate, warfarin, ticlopidine HCl b. Patient teaching for Alzheimer's disease c. Nursing Implementation for Alzheimer's d. Collaborative interventions: Identify other health care team members involved in the care of the patient with the disorder i. Managing confusion and anxiety in Alzheimer's disease ii. Communication with the Alzheimer's patient. e. Consider efficient use of human and material resources. f. Preventive Care - Stroke