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Neuro Study Guide-1

NUR 3225
Study Guide
1. What are the modifiable and nonmodifiable risk factors for stroke? What health promotion
strategies can the nurse implement to improve a patient’s chance of having a stroke? What are
the strategies available to prevent a stroke?
 Nonmodifiable Risk Factors = Age (older than 65), gender (male), race (black),
heredity/family history
 Modifiable Risk Factors = Hypertension, heart disease, diabetes mellitus, smoking, elevated
cholesterol, excessive alcohol intake, obesity, lack of physical exercise, poor diet, female
with migraine aura
 Antiplatelet drugs (aspirin most frequently used) are usually the chosen treatment to
prevent further stroke in patients who have had a TIA = 81 to 325 mg/day
 Preventing Stroke = Slide 31 and 32; pretty much just stay healthy
2. What are the major types of stroke? Ischemic (87%) or Hemorrhagic (13%)
 Thrombotic Stroke (Ischemic) = Clot forms and results in narrowing of blood vessel
 Embolic Stroke (Ischemic) = An embolus/foreign object dislodged, circulates in the blood,
and then occludes a cerebral artery
 Hemorrhagic Stroke = Results from bleeding into the brain tissue itself (intracerebral) or into
the subarachnoid space
o Intracerebral = Bleeding within brain caused by rupture of vessel; HTN is biggest
cause; poor prognosis
o Subarachnoid = Intracranial bleeding into cerebrospinal fluid-filled space between
the arachnoid and pia mater; commonly a rupture of a cerebral aneurysm (saccular
or fusiform); majority in circle of Willis; “Worst headache of one’s life”
3. How is a stroke diagnosed?
 CT or MRI are primary diagnostic tests = rapidly determine hemorrhage vs. ischemic and the
size and location
 Time is brain = test must be done rapidly to determine treatment options
4. What are the manifestations of a stroke?
 Intracerebral Hemorrhage = Neurologic deficits, headache, N/V, decreased LOC, HTN
 Clinical Manifestations = Motor activity (mobility, respiratory, swallowing/speech, gag
reflex, self-care ability), Communication (aphasia, dysphasia, dysarthria), Affect, Intellectual
Function, Spatial-perceptual alterations, elimination
 Motor Function = Most obvious effect of a stroke
o Loss of skilled voluntary movement (akinesia)
o Impairment of integration of movements
o Alterations in muscle tone
 Communication = Aphasia when stroke damages language dominant hemisphere of brain
Dysarthria – Different from aphasia since it’s just a disturbance in the muscular
control of speech, not meaning or comprehension (pronunciation, articulation, etc.)
 Affect = May have difficulty controlling emotions, may be exaggerated or unpredictable
 Intellectual Function = Both memory and judgment may be impaired; left-brain stroke
causes memory problems related to language
 Spatial-Perceptual Alterations = Right-brain stroke causes this more
 Elimination = Occur initially and is temporary, if only one hemisphere is affected then
prognosis for normal bladder function is exxcelelnt
5. What treatments are available for those with hemorrhagic stroke?
 Surgical = Immediate evacuation of aneurysm-induced hematomas or cerebellar hematomas
greater than 3 cm; or Clip/Coil the aneurysm to prevent re-bleeding
 Drug therapy = Medications typically manage HTN; contraindications are anticoagulants and
platelet inhibitors
6. What treatments are available for those with an embolic stroke? What are the nursing
implications of tPA?
 Surgical = Stent retrievers (opening blocked arteries)
 Anticipate thrombolytic therapy for ischemic strokes (tPA and platelet inhibitors like aspirin)
 tPA = Tissue Plasminogen Activator reestablishes blood flow through a blocked artery to
prevent cell death, must be used within 4.5 hours of onset of symptoms
o R/O hemorrhagic stroke; Blood tests for coagulation disorders; Screen for GI
bleeding/stroke/head trauma within 14 days or recent internal bleeding; Recent
trauma is a contraindication
o During infusion, monitor vital signs and neuro status; SBP <185 is critical during
infusion and 24 hours after
7. What are nursing interventions related to stroke in emergency care? In acute care? In
rehabilitation? At home?
Emergency Care
 Within 10 Minutes: NIH Stroke scale to determine stroke and stroke severity; Order head CT
scan asap; Assess and treat ABC’s; 12 lead ECG to r/o MI and arrhythmias; Call stroke
team/experts; Blood glucose r/o hypoglycemia
 Within 25 Minutes: Full neuro assessment and stroke team evaluation; Head CT scan should
take place within 25 minutes of patient’s arrival!!!!!!!
 Within 45 Minutes: CT scan should be read by physician within 45 minutes to determine if
there is any intracranial hemorrhage present
o Do not give anticoagulants before r/o intracranial bleeding (aspirin, heparin, any
o If NO hemorrhage = may qualify for fibrinolytic therapy; tPA should be started
within 60 minutes of arrival to any treatment facility!!!!
 After stroke stabilized for 12-24 hours, care shifts from preserving life to lessening disability and
attaining optimal functioning
8. Review the NIH Stroke Scale posted and concentrate on the first page. What I want you to see is
how very specific the directions are for scoring. This is typical for scoring assessments – I want
you to be aware 
9. Review the Adult Suspected Stoke algorithm posted in the course. Notice the timing on the side
– within 25-30 minutes the CT is done and results are available so decisions about care can be
made. Look at the options for care based on the results of the CT. This should be what you also
remember from class, but this is slightly condensed 
10. What are the clinical presentations of tension, migraine, and cluster headaches? What nursing
interventions are appropriate for patients with these headaches?
11. Describe generalized and focal seizures. What are the nursing interventions for someone having
a seizure?
12. What is RLS, how is it diagnosed, and how does a patient with this condition describe their
condition? Other than medication, how can it be treated?
13. How do patients with MS present? What are the nursing interventions for multiple sclerosis?
14. What are the hallmark findings in Parkinson’s disease? What is the primary treatment for PD &
nursing assessment for this treatment?
15. What is ALS and how is it treated? What are the clinical manifestations? What are the nursing
interventions associated with it?
16. What is myasthenia gravis and how is it treated? How will the patient present? What role does a
thymectomy play in MG?
17. What is Huntington ’s disease and how will the patient present?
18. What are the differences between delirium and dementia? Know approaches to prevent
19. What are the clinical manifestations of Alzheimer’s disease?