1 / 86

NEUROLOGIC DEFICITS

NEUROLOGIC DEFICITS. Nur-224. OBJECTIVES. Identify the various types/causes of seizures. Identify clinical manifestations for clients experiencing neurologic deficits. Apply the principles of nursing management to care for the patient in the acute stage of ischemic stroke.

mardi
Télécharger la présentation

NEUROLOGIC DEFICITS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NEUROLOGIC DEFICITS Nur-224

  2. OBJECTIVES • Identify the various types/causes of seizures. • Identify clinical manifestations for clients experiencing neurologic deficits. • Apply the principles of nursing management to care for the patient in the acute stage of ischemic stroke. • Use the nursing process as a framework to develop a plan of care for the client with neurological deficits.

  3. CEREBROVASCULAR ACCIDENT • 3rd leading cause of death in the US • 800,000 people experience a stroke each year • An emergency condition in which neurologic deficits result from a sudden decrease in blood flow to a localized area of the brain. • Major loss of blood supply to the brain  severe disability or death Types of stroke • Ischemic (80–85%) • Hemorrhagic (15–20%)

  4. CEREBRAL VASCULAR ACCIDENT Risk Factors • Hypertension • Sickle cell anemia • Atrial fibrillation • Diabetes mellitus • Smoking • Hyperlipidemia • Obesity • Sedentary lifestyle • TIA or “little stroke”

  5. CVA • Characterized by a gradual/rapid onset of neurologic deficits  compromised cerebral blood flow • Stroke leads to a loss/impairment of sensorimotor functions on the opposite side the side of the brain that is damaged contralateral deficit. • Stroke in the (R) hemisphere of the brain is manifested by deficits in the (L) side of the body (and vice versa)

  6. CEREBROVASCULAR ACCIDENT

  7. ISCHEMIC STROKE • Disruption of the blood supply to the brain due to an obstruction  a thrombus or embolism, or from stenosis of a vessel resulting from a buildup of plaque Types • Large vessel stroke • Small vessel stroke • Cardiogenic embolism

  8. ISCHEMIC STROKE

  9. ISCHEMIC STROKEClinical Manifestations • Symptoms depend upon the location and size of the affected area • Numbness or weakness of face, arm, or leg, especially on one side • Confusion or change in mental status • Trouble speaking or understanding speech • Difficulty in walking, dizziness, or loss of balance or coordination • Sudden, severe headache • Perceptual disturbances

  10. (L)/( R) HEMISPHERIC STROKE • Paralysis/weakness on (R ) side of the body • (R ) visual field deficit • Aphasia • Altered intellectual ability • Paralysis/weakness on the (L) side of the body • (L) visual field deficit • Impulsive behavior and poor judgment • Lack of awareness of deficits L sided stroke R sided stroke

  11. COMPLICATIONS • Sensoriperceptual deficits • Cognitive and behavioral changes • Communication disorders • Motor deficits • Elimination disorders

  12. SENSIORIPERCEPTUAL DEFICITS Deficits may include • Hemianopia • Apraxia • Neglect syndrome

  13. COGNITIVE /BEHAVIORAL CHANGES Cognitive changes Behavioral changes • Emotional lability • Loss of self-control Intellectual changes

  14. COMMUNICATION DISORDERS • Usually a result of the stroke affecting the dominant hemisphere Aphasia • Expressive • Receptive • Global

  15. MOTOR DEFICITS Depending on the area of the brain involved strokes may cause: • Hemiplegia • Hemiparesis • Flaccidity • Spasticity

  16. ELIMINATION DISORDERS • Bladder elimination • Bowel elimination

  17. Transient Ischemic Attack (TIA) • Mini-stroke • Brief period of localized cerebral ischemia that causes neurologic deficit lasting less than 24 hours • Sudden loss of motor, sensory, or visual function • Serves as a warning for impending stroke

  18. Ischemic Stroke -Assessment Acute phase • diagnosis the type/cause of the stroke • support cerebral circulation • control/prevent further deficits Focus • minimize brain injury • maximize patient recovery

  19. Ischemic Stroke – Diagnostic Findings • Complete history/careful physical assessment • CT scan • DWI test • PLAC tests

  20. MEDICATIONS Prevention • Antiplatelet- Aspirin, clopidogrel(Plavix), ticlopidine(Ticlid) Acute Stroke • fibrinolytic therapy-tissue plasminogen activator • anticoagulant therapy Antihypertensive medications

  21. Thrombolytic Therapy • Used to treat ischemic stroke by dissolving the blood clot that is blocking blood flow to the brain. • Recombinant t-PA • Rapid diagnosis of a stroke and initiation of therapy (within 3 hours) decrease the size of the stroke and may improve functional abilities after 3 months • Bleeding most common side effect

  22. TREATMENTS Surgery (Carotid Endarectomy) • Performed to prevent the occurrence of a stroke • Restore blood flow when a stroke has occurred • Repair vascular damage Rehabilitation • Physical therapy • Occupational therapy • Speech therapy

  23. Carotid Endarterectomy Postoperative Care • Position on the inoperative side – • Assess respirations/oxygen saturation - hemorrhage -respiratory distress - cranial nerve impairment -hypotension/hypertension

  24. HEALTH PROMOTION • Stroke prevention – esp known risk factors • Public awareness of signs of TIA/Stroke • Sudden – - weakness/numbness - confusion, trouble speaking - trouble walking, dizziness, loss of balance - trouble with vision - severe headache without a cause

  25. Nursing Diagnosis/Interventions • Risk for Ineffective Tissue Perfusion- Cerebral • Impaired Verbal Communication • Impaired Swallowing • Impaired Physical Mobility • Self-care deficits r/t (bathing, grooming, hygiene)

  26. Nursing Interventions -Mobility • Maintain correct position  good body alignment  avoid deformities • Change position every 2 hours – if sensation is impaired on one side – the amount of time spent on the affected should be limited. • Prevent pressure ulcers. • Affected extremities – ROM exercises • Prepare for ambulation ASAP/active rehabilitation program

  27. Nursing Interventions- Nutrition • May swallowing problems (dysphagia). • Swallowing difficulties place the patient at the risk for aspiration, pneumonia, dehydration, and malnutrition. • Start patient on thick liquid/pureed foods  easy to swallow • Patient unable to consume oral intake  enteral feedings • Long-termed feedings  gastrostomy tube

  28. Nursing Interventions-Communication • Aphasia –receptive/expressive • Face the patient and establish eye contact • Develop strategies to make the atmosphere conducive to communication • Speak in a normal manner and tone, speak slowly • Use gestures, pictures, objects, writing, • Use same words and gestures  be consistent

  29. Nursing Intervention – Skin Integrity • At risk for skin and tissue breakdown • Specialty bed • Regular turning schedule • Minimize shear/friction forces

  30. ISCHEMIC STROKE • Recovery/rehabilitation  may be prolonged and requires patience. • Community based support groups • Depression – common /serious problem • Caregivers need to be reminder to attend their own health concerns/well-being  respite care.

  31. Hemorrhagic Stroke • Intracranial hemorrhage • Cerebral blood vessel ruptures. May be due to: • Intracerebral hemorrhage • Intracranial aneurysm • AV malformation • Subarachnoid hemorrhage

  32. HEMORRHAGIC STROKE

  33. HEMORRHAGIC STROKE

  34. Hemorrhagic Stroke –Clinical Manifestations • Similar to ischemic stroke • Severe headache • Early and sudden changes in LOC • Vomiting

  35. HEMORRHAGIC STROKE Nursing Interventions • Maintain optimum tissue perfusion -aneurysm precautions • Manage potential complications - vasospasms - hyponatremia - seizures • Promote home and community-based care

  36. SEIZURE DISORDERS • A single event of abnormal, sudden, electrical discharge in the brain resulting in an abrupt and temporary altered state of cerebral function. • Epilepsy (seizure disorder) – - chronic disorder of abnormal, recurring excessive electrical discharges - recurring seizures accompanied by some type of behavioral change

  37. SEIZURE DISORDERS • affect more than 3 million people • strong genetic component Precipitating factors • birth defects • head injury/trauma • metabolic disorders/renal failure hyponatremia, • IICP • The cause is unknown in 70% of all cases

  38. Seizures • All people with epilepsy have seizures, but not all people who have a seizure have epilepsy. • Only after a person has two seizures  dx. of epilepsy is made Classification of seizures • Partial seizures: begin in one part of the brain • Generalized seizures: involve both hemispheres of the brain

  39. SEIZURE DISORDERS/Pathophysiology • Messages from the body are carried by the neurons (nerve cells) by electrical discharges. • Impulses occur when a nerve cell has a task to perform. • Sometimes there is an excessive imbalance and the cell continues to fire after the task is completed. • Unwanted discharges cause the body to respond erratically.

  40. Generalized Seizures • Consciousness is always impaired • Absence seizures (petit mal) -sudden brief cessation of all motor activity accompanied by a blank stare and unresponsiveness. • Tonic-clonic seizures (grand mal) - common type of seizures in adults - warning aura may precede generalized seizure activity

  41. TONIC-CLONIC SEIZURE Tonic Phase • Begins with a sudden loss of consciousness, sharp muscle contractions • Patient may fall to the floor • Urinary incontinence is common • Breathing ceases and cyanosis develops • Pupils are fixed and dilated • Tonic phase may lasts – 15 seconds – 1 minute

  42. TONIC-CLONIC SEIZURE Clonic Phase • Alternating contraction/relaxation of the muscles in all extremities • Eyes roll back and the patient froths at the mouth • Phase varies in duration and subsides gradually • Entire seizure generally lasts no more than 60-90 seconds

  43. Tonic – Clonic Seizures

  44. TONIC-CLONIC SEIZURES • Following clonic phase (postictal phase) • Person remains unconscious /unresponsive to stimuli • Person is relaxed and breathes quietly • Regains consciousness gradually • May be confused/disoriented • Headache muscle ache and fatigue may follow • Amnesia of the seizure may follow • Because of lack of warning with tonic-clonic seizures, head injury, fractures, burns may occur secondary to seizure activity

  45. Status Epilepticus • Can develop during seizure activity • Seizure becomes continuous– with only short periods of calm between intense and persistent seizures • Cumulative effect  muscular contractions that interfere with respirations • Hypoxia, acidosis, hypoglycemia, hyperthermia and exhaustion may occur if the convulsive activity is not stoped. • medical emergency • Goal – stop the seizure (ASAP) • Establish and maintain airway is priority

  46. SEIZURE DISORDERS/Assessment Diagnostic Assessment • Confirm the diagnosis, determine any treatable causes and precipitating factors Diagnostic Testing • MRI/CT Scan • EEG • Lab data – CBC, biochemistry

  47. SEIZURE DISORDERS/Medical Management • Pharmacologic therapy ( AEDs) controls rather than cures seizures • Medication blood levels should be monitored • Antiseizure drugs should not be discontinued abruptly because it can precipitate seizures • Protect the patient from harm, reduce/ prevent seizures activity without impairing cognitive function or producing undesirable side effects

  48. SEIZURE DISORDERS/Medications • Phenytoin (Dilantin) • Caramazepine ( Tegretol) • Gabapentin (Neurotonin) • Topiramate (Topamax) • Valproate (Depakote,Depakene) • Clonazepam (Klonopin) see page 1885

  49. Antiepileptic Drugs • Note CNS side effects: blurred vision, slurred speech, confusion • Patients on prolonged therapy may need a diet rich in Vitamin D • Maintain good oral hygiene – phenytoin • Obtain liver functions • Carry identification indicating type of seizure -- being treated for

More Related