LPN 132 Chapter 23 Student.pptx - Chapter 23 Care of Patients with Disorders of the Brain Learning Objectives Theory 1 Describe the appropriate nursing

LPN 132 Chapter 23 Student.pptx - Chapter 23 Care of...

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Unformatted text preview: Chapter 23 Care of Patients with Disorders of the Brain Learning Objectives Theory 1. Describe the appropriate nursing actions and observations to be carried out for a patient experiencing a seizure. 2. Explain why seizure may be a consequence of a stroke, tumor, or infection in the brain. 3. Compare the subjective and objective findings of thrombotic stroke and intercerebral bleed. 4. Devise a nursing care plan for the patient who has had a cerebrovascular accident (CVA, stroke). 5. Discuss nursing actions to assist the patient who has developed a complication after a CVA. 6. Describe subjective and objective findings indicative of a brain tumor. 7. Explain the pathophysiology behind the symptoms of a brain tumor. 8. Diagram the mechanism by which infection in the brain may cause increased intracranial pressure. 9. Recall the signs of increasing intracranial pressure from early to late signs. 10. Compare and contrast symptoms of meningitis and encephalitis. 11. Explain the assessment data that differentiate migraine headaches from cluster headaches. 12. Compare the signs, symptoms, and treatment of trigeminal neuralgia and Bell’s palsy. Clinical Practice 13. Teach a teenage patient recently diagnosed with epilepsy what she needs to know about her disorder and care. 14. Perform neurologic checks on a patient who is admitted with a suspected CVA. 15. Assist with the care of a patient who has had intracranial surgery. 16. Devise a teaching plan for the patient who has had a CVA and has right-sided hemiplegia. Seizure Disorders and Epilepsy Epilepsy: chronic disturbance of nervous system characterized by recurrent, spontaneous seizures Etiology Pathophysiology Symptomatic of large number of disorders Also can occur any time brain is deprived of oxygen Abnormal electrical activity of the brain Classified as partial or general Seizure Disorders and Epilepsy Signs and symptoms based on different types of seizures: Automatisms: repetitive, automatic actions like lipsmaking Aura: preceding sensation Postictal: after seizure Partial seizures – can be unilateral (one-sided) Generalized seizures – bilaterally symmetrical Simple: consciousness not impaired Complex: Some impairment of consciousness Partial seizures that become generalized Whole brain affected and there is no aura Unclassified seizures – pt doesn’t have enough data Status epilepticus can lead to irreversible brain damage Classification of Seizures Partial seizures: previous slide Generalized seizures: Absence seizures (petit mal) (short, no aura, no postictal period, or loss of consciousness) Tonic seizures Contraction of all muscles, body becomes rigid Tonic-clonic seizures (grand mal) last a few seconds, no aura, no postictal period Bilateral jerks of the extremities Loss of consciousness and possible incontinence Worried about patient biting tongue Postictal phase very drowsy and confused Atonic seizures – “drop attacks” Remain conscious, but lose muscle tone causing the patient to fall Seizure Disorders and Epilepsy Diagnosis: History and the actual signs and symptoms observed during a seizure Electroencephalogram (EEG) or MRI to locate the site or locus of seizure Treatment: Antiepileptic/anticonvulsant drugs All are CNS depressants – watch for those side effects Phenytoin (dilantin) causes liver damage, arrhythmias, hypotension Periodic blood work needed q 1-3 months to check levels Must infuse no faster than 50 mg/min d/t potential cardiac dysrhythmias Surgical treatment Risk for Injury Related to Seizure Activity Immediate care during the seizure Maintain safety! Long‑term management Know triggers and try to avoid them Take meds as prescribed Patient education: Self‑care Seizure‑triggering mechanisms Alcohol interferes with effectiveness of meds, causes excessive sedation, and may trigger seizures Fatigue, stress, bright lights, especially bright flashing lights All other possible factors must be ruled out for epilepsy diagnosis Transient Ischemic Attack (TIA) Causes – brief disruption in blood to the brain Emboli and brain blood vessel rupture Recreational drugs Symptoms similar to CVA last a few minutes to 24 hours Completely resolve without residual deficits Further diagnostic testing to determine stroke risk Carotid doppler Stroke) Etiology Atherosclerosis main cause, but also HTN, diabetes, excessive alcohol intake, and lack of exercise African Americans 50% more likely than Caucasians Pathophysiology Interruption (lack) of blood flow to the brain -> cerebral ischemia -> necrosis/infarct Ischemia caused by: Thrombus or embolus Intracerebral hemorrhage Pressure on blood vessel (tumor) Stroke) Cerebral Aneurysm Abnormal ballooning of the artery either congenital or weakening of arterial wall from chronic HTN. Leads to subarachnoid hemorrhage Arteriovenous Malformation Congenital abnormality Tangled mass of malformed, thin walled, dilated vessels Often leak causing intracerebral hemorrhage S/S: sudden onset headache (worst headache they’ve ever had), blurred vision, neurologic impairment Risk Factors for Stroke Risk factors that can be treated: Cigarette smoking, drugs, alcohol Heart disease, diabetes, high blood pressure, high cholesterol Polycythemia, transient ischemic attacks (blood is very thick, clots) Sedentary lifestyle, use of oral contraceptives, hormone replacement therapy Risk factors that cannot be changed: Age, heredity, race, sex Asymptomatic carotid bruit Diabetes mellitus Prior stroke (Also refer to Health Promotion Points pg 529.) Stroke) Stroke prevention: Eliminate or manage conditions that lead to stroke Carotid endarterectomy Only if 60-99% occluded, otherwise medical management Removal of plaque deposited on inner wall of carotid artery (angioplasty) Signs/symptoms – what side is affected??? Weakness (hemiparesis) or paralysis (hemiplegia) Difficulty/inability to speak or understand (dysarthria (difficulty forming words) or aphasia Difficulty with vision – especially peripheral Loss of balance or poor coordination (ataxia) Decreased LOC with confusion Cerebrovascular Accident S/S cont Signs and symptoms continued Motor function deficits affecting mobility, respiratory function, swallowing, gag reflex, and self care abilities. Frustration from not being able to perform a function that has been easy for them in the past Memory and judgement may be impaired Neglect from the affected side of the body Incontinence Agnosia –inability to recognize object Show object, say what it is, and demonstrate Warning Signs of Stroke Sudden weakness, numbness, tingling, or loss of feeling in the face, arm, or leg Sudden trouble seeing in one or both eyes; double vision Sudden confusion, slurred speech, trouble talking, or difficulty understanding what others are saying A sudden, severe headache for no known reason Sudden trouble walking, dizziness, or a feeling of spinning around Loss of balance or coordination Blackouts (More information can be found in Patient Teaching pg 531.) Immediate assessment acronym – FAST Stroke) Diagnosis: Complete physical and neurologic examination CT scan, cerebral angiogram, MRI, EEG, Carotid dopplers Treatment: Emergency care – ABC’s Systemic tissue plasminogen activator (t-PA) “clot buster” – dissolves clots and emboli in non-hemorrhagic stroke Cannot give any other anticoagulants or antiplatelets for 24 hrs Never given to pt with known risk of bleeding Must be given within 3 – 6 hours (4 hours on test) from ONSET of symptoms Surgery 1/3 of strokes from obstruction to 1 of 4 arteries in neck Mechanical Embolus Removal in Cerebral Ischemia (MERCI) Retriever Cerebrovascular Accidents Complications of cerebrovascular accidents: Extension of hemorrhage or rebleed Seizures Hydrocephalus Nursing management: Phase 1: initial care – ABC’s and stabilize patient Phase 2: Rehabilitation efforts Phase 3: Continuity of care Basically watch for any S/S and treat them accordingly while promoting independence/rehab Review patients with dysphagia pg 540 Brain Tumor Etiology and pathophysiology Neoplasms in the skull increase ICP Many are benign, and rarely metastasize out But frequently metastasize in – about 130,000/yr in US Signs, symptoms, and diagnosis Again depends on location Personality changes, memory and judgement disturbances, loss of muscle strength and coordination, difficulty speaking, seizures Headache awakening a key sign Treatment: Surgery Radiation therapy Chemotherapy Complications of a Brain Tumor Hydrocephalus Obstruction of CSF flow -> increased ICP Ventriculoperitoneal (VP) shunt placed to drain excess CSF into peritoneal cavity where it is absorbed Intercerebral hemorrhage Tumor erodes blood vessels Bacterial Meningitis Etiology and pathophysiology: Virus, bacteria, or fungi enter into the cranial vault Via the bloodstream from another location Through an opening in the skull or infection from spinal procedure Can cause permanent neurologic damage d/t severe vasoconstriction or hydrocephalus Signs and symptoms: Sudden onset fever and severe headache aggravated by moving Nuchal rigidity – stiffness of neck when head bent forward Brudzinski’s sign – place hand behind head, other hand on chest, flex neck forward. (+) if flexion of knees or hips Kernig’s sign – supine with knee flexed 90 degrees, slowly extend knee. (+) if PAIN behind knee Figure 23-10 Brudzinski’s sign Kernig’s sign Bacterial Meningitis Diagnosis: Spinal tap with Gram staining Treatment: Early recognition and prompt treatment Antibiotics Will even start them prophylactically to people in close contact with pt Anticonvulsants and non-narcotic pain meds…why? Mortality in 25% of cases Nursing management Keep room quiet and dimly lit = minimal stimulation Often produces confusion, delirium, and seizures Fluid volume deficit often a problem Decreases peristaltic action of intestines Encourage rest Health Promotion Points pg 543: Meningitis Immunization Meningitis vaccine is available and is required for all students entering college. It should be encouraged for adults living in a communal situation. Meningitis can spread quickly when people are in proximity, such as in classrooms or dormitory rooms. Viral Meningitis Tends to be milder s/s: headache, fever, photophobia, stiff neck Cerebrospinal fluid (CSF) examination Self-limiting Full recovery in 7-10 days Symptomatic management May have some residual effects such as persistent headaches, mild mental impairment, and lack of coordination Encephalitis Etiology and pathophysiology Less common than meningitis Typically comes from a vector: tic, mosquito Acute inflammation of the brain, can be fatal Numerous viruses known to cause, i.e. Herpes simplex 1, chickenpox, measles, mumps, and vector transmitted viruses like west nile virus, Enters neural cells and disrupts normal neural functioning Signs and symptoms Stiff neck, photophobia, and lethargy classic signs Seizures, acute confusion, and flaccid paralysis also Unlike meningitis, encephalitis causes altered mental status, motor or sensory deficits, and speech and movement disorders Migraine Headaches Signs and symptoms: Aura – Prodromal period of visual disturbances like scotoma (“spots before the eyes”) Whatever the aura, usually happens 1hr prior One-sided throbbing headache Nausea, vomiting, irritation from light Treatment: Darkened, quiet room and odor-free environment Meds (box 23-2) and also meds for nausea Migraine Triggers Alcohol Caffeine Chocolate Artificial sweeteners Monosodium glutamate (MSG)(soy sauce) Citrus fruits Meats with nitrites Salt Foods containing tyramines: peanuts, raisins, aged cheese, yogurt, sour cream, chicken livers, sausages, bananas, avocados, freshly baked breads, pork, beans. Cranial Nerve Disorders Bell’s palsy Weakness or paralysis of the muscles supplied by facial nerve Risk factors: herpes simplex, stress, exposure to cold S/S: partial or total paralysis of the facial muscles suddenly or over a few days, taste disturbances, eyelid on affected side loses blink reflex and mouth droops, causing drooling Diagnosis: H/P, smile, move eyebrow Treatment: Closing and patching eye if loses blink reflex, artificial tears to prevent dryness 80-90% recover within 6wks-3mo, but recurs in 10-15% ...
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  • Fall '19
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