RECOGNIZING THE SIGNS OF A NEURO EMERGENCY

Transcription

1 RECOGNIZING THE SIGNS OF A NEURO EMERGENCY Noorin Darvesh BScN, RN, CNN (C) Clinical Nurse Educator, Unit 58 South Health Campus Department of Clinical Neurosciences

2 None DISCLOSURES

3 WHO AM I?

4 WHO ARE YOU? Source: Retrived from URL. m=isch&sa=x&ved=0ahukewizy72kvbteahujhoakhtbndqaq_auidigb&biw=1440&bih=721#imgrc= 1aRj08uriEj0lM:

5 OUTLINE Case Objectives Discussion

6 CASE STUDY On January 26 th, 2018, a 76-year-old male patient was admitted to the inpatient neurology ward with a diagnosis of an ischemic posterior inferior cerebellar artery (PICA) stroke. His primary deficit was ataxia, but could still ambulate with stand-by assistance to the bathroom. Source: Retrived from URL.

7 On the night of January 27 th at approximately 0200, the patient s daughter rang the patient s call bell, as her father verbalized that he needed to go to the bathroom. As the primary nurse was ambulating the patient, she noticed an increase in his gait disturbance, and he required the assistance of 2 nurses to go to the bathroom. The patient reported unspecific visual disturbances, a low-grade headache, and appeared more confused in conversation.

8 As the primary nurse, what would be your intervention for this patient? a) Let the patient sleep. He s probably just tired. b) Nothing. It is normal to have worsening of symptoms after an acute stroke due to cerebral edema. c) Phone the on-call physician. Something is not right.

9 OBJECTIVES Analyze the anatomy and pathophysiology of the signs and symptoms present Identify the signs and symptoms of increased intracranial pressure (ICP) following a PICA stroke Outline the most anticipated nursing interventions utilized Hopefully influence your decision to choose C in the future

10 ANATOMY Posterior Circulation Diagram. Retrieved from URL: =isch&sa=x&ved=0ahukewi44oqb_bdeahvzkh0khxbkdwwq_auidigb&biw=1440&bih=721#imgrc=hlewarlgbnhtm:

11 Headache Nausea/Vomiting COMMON SYMPTOMS Dysphagia/Dysarthria Horizontal Nystagmus Ataxia Vertigo (Nouh, A., Remke, J., Ruland, S. (2014).

12 WHY ARE WE WORRIED?

13 MONROE-KELLIE HYPOTHESIS Source:Retrieved from URL: Source:Retrieved from URL:

14 HEADACHE When the full PICA cerebellar territory is involved, headache is usually present in the occiput or high neck on the ipsilateral side. (Caplan, L.R. (2018). Source:(2016). Retrieved from URL:

15 PUPILLARY & OCULAR ABNORMALITIES CN III originates from the midbrain CN IV originates from the pons CN V1 originates from the pons Cerebellum Source:Retrieved from URL:

16 EMESIS Fourth ventricle located in the medulla Source: (2011). Retrieved from URL:

17 DETERIORATION IN LOC Source: Retrieved from URL:

18 POSTURING Source: Retrieved from URL:

19 NURSING INTERVENTIONS Notify MRHP: Patient may require transfer to a hyper-acute neurological unit for further monitoring or surgical intervention Source: Retrieved from URL:

20 OUTCOME Source: Retrived from URL.

21 QUESTIONS? Source:Retrieved from URL: nds+up

22 REFERENCES Caplan, L.R. (2018). Posterior circulation cerebrovascular syndromes. UpToDate, Inc. Hickey, J.V. (2014). The clinical practice of neurological and neurosurgical nursing. Philadelphia, PA: Lippincott Williams & Wilkins. Majid, A., Kassab, M. (2018). Pathophysiology of ischemic stroke. UpToDate, Inc. Nouh, A., Remke, J., Ruland, S. (2014). Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management. Frontiers in Neurology, 5(30) Sharifi, M., Cisczek, B. (2013). Bilaterally absent posterior inferior cerebellar artery: case report. Surgical and Radiologic Anatomy (2013). 35 (7)