nr325 exam 2 study guide nr 325 exam 2 study guide latest 2021 chamberlain college of nursing
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NR325
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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
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