NR 330 -Neurologic Problems Assignment

NR 330 -Neurologic Problems Assignment

NR 330 -Neurologic Problems Assignment

Chapter 45: Neurologic Problems

 

Transient Ischemic Attack

 

• TIAà temporary neurologic dysfunction resulting from a brief interruption in cerebral blood flow
  • WARNING SIGN for a stroke
• Symptoms typically resolve in 30 to 60 minutes

• NO BRAIN DAMAGE OCCURS WITH TIA
• Neurologic assessment, labs, EKG, and HCT done
  • Possible admission to look at risk factors for stroke
• Treatment focused on PREVENTING TIA or stroke
  • Reducing BP
    • Most common RF!
  • Aspirin or antiplatelet drugs
  • Controlling DM and keeping BGL 100-180 mg/dL
  • Lifestyle changes
    • Smoking cessation
    • Healthy diet
    • Physical activity

Stroke (Brain Attack)

• Strokeà any interruption of PERFUSION to the brain
  • “Brain Attack”
• MEDICAL EMERGENCY!!
  • Treated promptly to reduce disability
• Pathophysiologic Changes in the Brain
  • Brain needs glucose and oxygen!!
    • Through cerebral blood flow
      • Also removes waste
    • Without blood flow à infarction (tissue death)
    • Brain metabolism and blood flow are affected around the infarction site and the contralateral hemisphere
    • Brain edema à ­ ICP and secondary brain damage
  • Types of Stroke
    • Ischemicà occlusive
      • MORE COMMON!
      • Caused by the blockage of a cerebral artery by a thrombus or embolus
        • Thrombotic stroke
          • Associated with atherosclerosis in the cranial arteries
            • Carotid arteries and vertebral arteries with the basilar artery are the most common sites
          • The rupture of plaques promotes clot formation
          • Slow onset
            • Minutes to hours
          • Embolic stroke
            • Caused by a thrombus or group of thrombi that break off from one area of the body and travel to the cerebral arteries
              • Source is usually the heart
                • A-fib, MI, prosthetic heart valves
              • Middle cerebral artery is the most common site
              • Sudden development with rapid neurologic deficits
                • May resolve over several hours or a few days
              • Can progress to hemorrhagic strokeà brain bleed
            • Hemorrhagic Stroke
              • Vessel integrity is interrupted, and bleeding occurs into the brain tissue or into the subarachnoid space
              • Intracerebral Hemorrhageà bleeding into the brain tissue
                • Results from severe HTN
                • Brain damage occurs from bleeding, causing edema, distortion, and displacement
              • Subarachnoid Hemorrhageà bleeding into the subarachnoid space
                • Usually caused by ruptured aneurysm or arteriovenous malformation
                  • Aneurysmà abnormal ballooning or blister of artery
                  • AVMà tangled, weak vessels without capillary network
                    • Subject to rupture and bleeding
                  • Vasospasmà constriction of a cerebral artery that allows bleeding from another source
                • Etiology
                  • Major RF include family history, HTN, atherosclerotic disease, and aneurysm

NR 330 -Neurologic Problems Assignment

Traumatic Brain Injury

 

• Pathophysiology
  • TBIà damage to the brain from an external force
  • Can lead to temporary or permanent impairment of cognitive, physical, or psychosocial functions
  • Types:
    • Direct injuryà blow to the head
    • Indirect injuryà force to another part of body that rebounds to the brain
      • Movement within the skull
      • Shearing injuries
      • Contusions
      • Lacerations
    • Brain injury occurs from forces on the head and brain and a result of secondary derangements of physiologic stability
    • Types of Force and Mechanisms:
      • Acceleration Injury
        • Caused by external force
        • Contacts the head
        • Places the head in motion
      • Deceleration Injury
        • When the moving head is suddenly stopped
        • Results in shearing, straining, and distortion of brain tissue

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