PNH301 Neuro Content Review: Stroke, TBI, Seizure, AD

Embolic Stroke Thrombotic Stroke Ischemic Stroke

Risk Atrial fibrillation (irregular heart Atherosclerosis Hypertension
Factors/Cause rhythm) Hypertension Vascular disorders
Coagulation disorders
Hypertension

Onset Sudden May be gradual over several hours Sudden

May have transient ischemic attacks in days
prior to stroke (symptoms of stroke that
resolve within 24 hours)

Manifestations Sudden headache

Assessment Monitor for elevated ICP

Nursing
Diagnoses
PNH301 Neuro Content Review: Stroke, TBI, Seizure, AD

Interventions

Patient/Family
Teaching
PNH301 Neuro Content Review: Stroke, TBI, Seizure, AD

Concussion Basal Skull Fracture Subdural Hematoma

Risk
Factors/Cause/
Characteristics

Onset

Manifestations

Assessment

Nursing
Diagnoses
PNH301 Neuro Content Review: Stroke, TBI, Seizure, AD

Interventions

Patient/Family
Teaching

Identify Key Features of Traumatic Brain Injury

PNH301 Neuro Content Review: Stroke, TBI, Seizure, AD

Increased Intracranial Pressure

Principles of  Cranial contents include brain tissue, blood and cerebrospinal fluid (CSF)
ICP  An increase in volume of one component must be compensated for by a decrease in the volume of one of
the other components
 Normal ICP is 10-15 mmHg
 Periodically increases with straining to defecate, sneezing and coughing
Manifestations
of Increased
ICP

Interventions
to prevent
inreased ICP
PNH301 Neuro Content Review: Stroke, TBI, Seizure, AD

Early Alzheimer’s Mid-Alzheimer’s Late Alzheimer’s

Risk Factors/Cause/
Characteristics

Onset

Manifestations

Assessment

Nursing Diagnoses
PNH301 Neuro Content Review: Stroke, TBI, Seizure, AD

Interventions

Patient/Family Teaching
PNH301 Neuro Content Review: Stroke, TBI, Seizure, AD

Generalized Seizures
 6 types
 Loss of consciousness common to all, may involve both cerebral hemispheres

Tonic-Clonic, Tonic, Clonic Absence Seizure Myoclonic Atonic (Akinetic)

 Immediate loss of  More common in children  Brief stiffening and jerking of  Sudden loss of muscle tone
consciousness  Runs in families extremities lasting a few seconds
 Lasts 2-5 minutes  Brief loss of consciousness  May be one or both sides  Followed by postictal
 Starts with the tonic  Blank staring involved confusion
phase (stiffening and  May look like they are  Lasts just a few seconds  Likely to fall, result in injury
rigidity of muscles) daydreaming   Also called a Drop Seizure
 Followed by clonic  May have automatisms  Most resistant to drug
phase (rhythmic jerking (involuntary behaviours eg: treatment
of all extremites) lip smacking, picking at
 May bite tongue clothes)
 May be incontinent of  Returns to baseline
urine or feces immediately after seizure
 Fatigue, acute  May occur multiple times
confusion and lethargy per day
may last up to an hour  Interferes with
afterwards school/activities
 May need to sleep  May not get diagnosed-
afterwards missed because student
 Two other types: 1. thought to just be not
Tonic-only tonic paying attention
presentation
 2. Clonic – only clonic
movements
PNH301 Neuro Content Review: Stroke, TBI, Seizure, AD

Partial Seizures

 Also called focal or local seizures

 Begin in one part of cerebral hemisphere
 Sub-divided into two main classes: Complex Partial Seizures and Simple Complex Seizures
 Some partial seizures may evolve into a generalized tonic-clonic, tonic or clonic seizure
 Usually in adults
 Difficult to treat

Complex Partial Seizure Simple Partial Seizure

 May cause loss of consciousness (syncope) or ‘blackout’  Remains conscious throughout
for 1-3 minutes  May report an aura preceding the seizure (eg: sense of
 May have automatisms “déjà vu” (already experienced event) or perception of
 Unaware of environment and may wander at the sudden pain or offensive smell)
beginning of the seizure  May have one sided movement of extremity
 May have postictal amnesia  May experience unusual sensations
 Often call psychomotor or temporal seizures because  May have autonomic changes: change in heart rate, skin-
temporal lobe usually involved flushing, epigastric discomfort
 Most common in older adults
 Difficult to diagnose-*may be confused with dementia
due to presentation of seizure (wandering, unaware) and
postictal amnesia
PNH301 Neuro Content Review: Stroke, TBI, Seizure, AD

Terms

Aura:

Automatisms:

Preictal Phase:

Postictal Phase:

1. List the care of the patient during and immediately following a tonic-clonic or complex partial seizure

2. Describe the assessments and documentation required.

PNH301 Neuro Content Review: Stroke, TBI, Seizure, AD

3. Describe status epilepticus. Briefly list the interventions.

4. Identify key nursing diagnoses for the patient with a seizure disorder and appropriate interventions.