Care of the Patient Exam Review Solution 2024 A+

Care of the Patient Exam Review Solution 2024 A+ stoke - ANSWER-Most effective way to decrease the burden of stroke is prevention. Risk factors can be divided into nonmodifiable (age, gender, race) and modifiable risks (bp). Our biggest role is prevention types of stroke - ANSWER-Ischemic -Thrombotic -Embolic Hemorrhagic -Intracerebral -Subarachnoid ischemic stroke - ANSWER-Thrombotic stroke -Thrombosis occurs in relation to injury to a -blood vessel wall and formation of a blood clot. -Result of thrombosis or narrowing of the blood vessel -Most common cause of stroke -Lacunar strokes are typically asymptomatic:A lacunar stroke refers to a stroke from occlusion of a small penetrating artery with development of a cavity in the place of the infarcted brain tissue. This most commonly occurs in the basal ganglia, thalamus, internal capsule, or pons. ischemic stroke - ANSWER-Embolic stroke: -Patient with an embolic stroke commonly has a rapid occurrence of severe clinical symptoms. -Onset of embolic stroke is usually sudden and may or may not be related to activity. -Patient usually remains conscious, although he may have a headache. *Warning signs are less common with embolic than with thrombotic stroke. hemorrhagic stroke - ANSWER-Intracerebral hemorrhage -Bleeding within the brain caused by rupture of a vessel -Hypertension is the most important cause. -Hemorrhage commonly occurs during periods of activity. pre-hospital assmesnt - ANSWER-Face Arm Speech Time transient ischemic attack - ANSWER-Temporary focal loss of function d/t ischemia secondary to microemboli Manifestions 24 hours: -Onset considered time from when last seen symptom-free or asks when it started, you have to say exactly when sypmtoms started -Symptoms typically last 1 hour without visual evidence of infarction with diagnostic imaging (CT scan or MRI) -Brain attack: 911! Treat within 60 minutes -Inpatient treatment is controversial: treat in outpatient -What is the cause: brain injury, overdose, ischemia *Changes in pupil reaction is NOT a manifestation of a stroke Nursing Assessment of Stable Patient: primary assessment - ANSWER-Primary assessment: -History of current illness (symptoms, onset, duration, nature, changes in S/S) Past medical illnesses, particularly -Previous stroke -Hypertension -Atrial fibrillation Family history of stroke Nursing Assessment of Stable Patient: secondary assessment - ANSWER--Level of consciousness -Cognition (orientation person place time) -Motor function -Cranial nerve function -Sensation-qtip cotton ball don't let them watch where your touching, sharp vs. dull -Proprioception-pt eyes closed, ask her to tell you the position of her toes/fingers in space (towards/away from head). -Cerebellar function: balance, heal to toe, walk a line. -DTRs (deep tendon reflex) -Stroke Scale (NIHSS) National Institutes of Health Stroke Scale (NIHSS): 0-42 - ANSWER--Level of consciousness (alert-reflex only-unresponsive CEA post-op care - ANSWER-Cranial Nerve Assessment (tend to have problems bc edema or bleeding) VII: symmetry of face when smiling and showing teeth X: swallowing, gag reflex, phonation "say ah". (vagus) XI: shrug shoulders, rotate head side to side. (spinal accessory nerve) XII: tongue control and movement. (hypoglossal) Horner's Syndrome from sympathetic nerve fiber edema/damage: ipsilateral eyelid ptosis, pupillary constriction, and lack of facial sweating neuro check every hour -Pupils, Glasgow Coma Scale - know baseline! -Cardiac Assessment - watch for bradycardia -Maintenance of BP too htn can bust suture line, too low could mean bleeding from suture line. -Bleeding - neck swelling, VS changes (HR inc, BP dec), respiratory difficulties (if bleeding) if constantly changing bandage that's a problem let dr. know, little edema not a lot. post stenting care - ANSWER-Femoral sheath stays in place about 1 hour post- procedure (larger diameter catheter-incase they reooclude keep in place change in loc, act like having a stroke again) Once sheath is removed, pressure applied to site until bleeding stops (up to 2 hours). -- Plug it synthetically or put pressure Patient lies flat with HOB 30 degrees and affected leg straight to prevent bleeding or hematoma for 4- 6 hours.- don't want them to move leg a lot. Monitor site & perform neurovascular assessment with VS. Vital signs every 15 minutes for 2 hours post-procedure. stenting - ANSWER-majority of patients discharged the day following the procedure on clopidogrel (Plavix) for at least 6 weeks and aspirin indefinitely Acute Care - ANSWER--ABCs! Pulse ox -Oxygen, intubation, and mechanical ventilation if necessary -Call Stroke Team -Perform baseline neuro assessment -IV access, EKG -Monitor VS, particularly BP: Oral antiHTN prn if very high. -CT scan and baseline labs: have 60 minutes to treat -Proper positioning: put them upright hob elevated, gravity help dec htn, dec IICP -Seizure precautions/meds -Thrombolytic - tPA Common Assessment findings & baseline labs - ANSWER-Common Assessment findings -Altered level of consciousness (neuro check) -Weakness, numbness, or paralysis -Speech or visual disturbances -Severe headache CONTINUES...