NR325 Exam 2 Study Guide / NR 325 Exam 2 Study Guide (Latest update, ): Chamberlain College of Nursing

NR 325 Exam 2 Material
Neurology:
 Brain required continuous blood supply, needs perfusion
 Blood flow has to be at 750-1000 mls or 20% of cardiac output for
optimal brain functioning
 Amount of blood that passes through the brain in 1 minute – cerebral
BF
o Regulated by metabolic needs
 MAP – normal is 70-110, number can be used to tell us if the body is
perfusing well or not
o Below 70 – not adequately perfusing to the brain
 Brain is not getting enough oxygen and glucose
 Levels need to be at 60 or above to prevent tissue death
 50 and below – ischemia occurs
 Calculation – (systolic BP + 2(Diastolic BP))/3)
 Stroke
o Risk factors
 Modifiable
 Hypertension
 Obesity
 Sedentary lifestyle
 Alcohol consumption
 Smoking
 Poor diet
 Discontinuation of BP medications
 Non-modifiable
 Aging - 65+
 Gender – male
 Family history
 Face
o Co-morbidities
 Atrial fibrillation
 Atherosclerosis
 Diabetes
 High cholesterol
 TIA
o What happens during a stroke
 Brain is deprived of oxygen and glucose
 Total interruption of BF, neurological status is altered in 20
seconds, brain death occurs in 5 minutes of not receiving
oxygen
o BEFAST – balance, eyes, facial drooping, arm weakness, speech
difficulty, time
o TIA
 Lasts one hour or less

,  Increased risk for a stroke
 If carotid is involved, loss of vision in one eye
 Brief interruption of cerebral BF
 Symptoms depend on the blood vessel involved
 Always seek treatment for any stroke symptoms, even if
they stop
 1/3 have a stroke, 1/3 never have another TIA, 1/3 have
more TIAs
o Ischemic stroke
 Thrombotic
 Most common cause of stroke
 Usually has a warning TIA
 Usually occurs before or after sleep
 Slower onset of symptoms
o Symptoms increase in the first 72 hours
 Risk factors – things that will damage the vessels
o hypertension, high cholesterol, atherosclerosis,
DM, more common in men
 Embolic
 Embolus lodges and occludes an area of the brain
 2nd most common cause of stroke
 Sudden symptoms**
 Warning signs are less common
 Usually originates from the heart
 Need to aggressively treat the underlying cause
o Hemorrhagic
 Bleeding into the brain tissue itself
 Intracerebral hemorrhage
 Caused by a vessel rupture
 Basal ganglia
 Sudden onset of S/S with quick progression
 Poor prognosis
 Most common cause - Hypertension
 Clinical manifestations
o Headache
o Nausea
o Decreased LOC
o Hypertension
 Subarachnoid hemorrhage
 Rupture of cerebral aneurysm
 No warnings
 Can be completely aware during the stroke or
comatose
 Risk factors
o Trauma

, o Drug abuse
o “silent killer” – you don’t know you have it until
it ruptures
 Clinical manifestations
o N&V
o Seizures
o Stiff neck
o Cranial nerve defects
 Atrial venous malformation
 Abnormal tangle of BVs
o Disrupts normal BF – oxygen and BF to the
brain is impacted
o Affected arteries can weaken and rupture
 Hemorrhagic stroke
 Cerebral vasospasm
 Complication of hemorrhagic stroke
 Narrowing of the vessels causing infarction
 Subarachnoid blood clots break down and release
components that cause endothelial damage
 Peak is 6-10 days following hemorrhagic stroke
 Keep in ICU 14 days if at risk
 S/S
o Increased BP, more/increase in pain, new
symptoms of stroke
 Drugs
o Nimodipine***
 Calcium channel blocker
 Neuroprotection and vasodilation
 other treatments
o control HTN
o decrease ICP
o craniotomy
o Emergency care
 Single most important assessment – time and onset of
symptoms*
 Goals
 Preserve life
 Prevent further damage
 Reduce disability
 Need to be seen within 5 minutes of arrival
 TPA protocol
 Hypertension needs to be lower than 220/120 or give
antihypertensive medication
 Ask questions – bleeding and anti-coagulant therapy
will exclude them from getting TPA therapy