Neurological System

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  • Sx Tx Carotid endarterectomy – removal of atherosclerotic plaque in the internal carotid artery to improve blood flow and prevent impending cerebral infarction – no brain sx for pt’s who’ve had TIA Transluminal angioplasty – inserting a balloon to open up an stenosed or narrowed artery to improve blood flow. Last-resort – surgiclaly connecting a brach of extracranial artery to an intracranial artery beyond area of obstruction to improve cerebrla blood flow If your carotid arteries are significantly blocked, you may need surgery to reopen the narrowed arteries (carotid endarterectomy). Endarterectomy surgery also may be appropriate for some people who have not had a TIA but who have significant narrowing in an artery. Another option to reopen narrowed carotid arteries is angioplasty with stenting . This procedure is much like the one used to open up clogged heart arteries. A doctor threads a thin tube called a catheter through an artery and up to the carotid arteries in your neck, and then he or she inflates a tiny balloon to enlarge the narrowed artery. The doctor places a wire mesh device called a stent in the artery to keep it open. Carotid artery stenting is not as common as endarterectomy.
  • Passive ROM – begin first day of hosp.(to prevent contractures, limbs need to be exercised every 4 hours) hemorrhagic stroke- limit mvmt to extremities only – not to ambulate pt Teach active exercise ASAP if not contraindicated Position joints higher than joint proximal to it – prevents dependent edema Deformities of the weak or paralyzed side – hip-external rotation: trochanter roll prevent hand contractures with- hand cones Shoulder frozen Pain due to contraction of soft tissue and immobilization It is a thickening or contraction of soft tissue and structures surrounding the shoulder complex, which causes pain and restricted motion. Who is likely to get adhesive capsulitis? Unfortunately, anyone can have it, but it is seen most commonly in females between the ages of 40-65 years old. What are the symptoms of adhesive capsulitis? Diffuse shoulder pain often radiating to the lateral arm, forearm, or neck. Most people won't seek professional help until there is a significant decrease or restriction of functional activities. For men, this usually comes when there is difficulty putting on a shirt and tucking it into the pants; for women, it is when they have trouble hooking their bra. How does someone get adhesive capsulitis? Often, symptoms have a spontaneous onset and the cause may be difficult to pinpoint.  Listed are the most common causes, however, sometimes the cause may remain unknown.  Result of a previous trauma or immobilization of the shoulder (i.e. stroke, heart attack, cervical disorder, fracture, rotator cuff tendinitis, arthritis, inflammation of shoulder joint) Systemic disorders can also cause it (i.e. Diabetes, Hypo- or Hyperthyroidism)
  • Ignore affected side due to altered perception and vision Nursing Interventions: Teach client to touch and use both sides Remind client to dress and bath both sides Place objects within patients field of vision Approach patient from unaffected side Teach patient to scan their environment A person may be unfortunate enough to have both homonymous hemianopsia and a neglect syndrome, which increases the inattention to the weak or paralyzed side. A neglect syndrome results in decreased safety awareness and places the patient at high risk for injury. Immediately after the stroke, the nurse must anticipate potential safety hazards and provide protection from injury.
  • Management: Strict Bedrest & supportive care Minimize stimulation to patient Maintain normal BP Hourly neuro checks Patients in ICU Subarachnoid and intracerebral hemorrhage treatment of aneurysm to prevent rebleeding bleeding into brain produces hydrocephalus – increased fluid volume in the cranial vault – which increases ICP – ventriculostomy - -----promotes cerebrospinal drainage
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