Cranial Nerves

affected in headaches

venous sinuses, dura, cranial blood vessels

*headache can arise from intracranial and extracranial sources

when the cause is not another disease or med condition

*Tension

*Migraine

*Cluster

*most common vascular headache

*changes in CV blood flow and serotonin

*unilateral usually

*3:1 women

*family history, low educ and socioecon status,high workload,and frequent tension type headaches, foods, hormonal changes

*

*Slow onset

* Preceded by AURA(10-30min)Visual sensory, and motor phenomenon{least common}

*pr preceded by Prodrome(hrs-days neurologic, psychologic manifestations.hyperactivity, food cravings,photophobia

*4-72hr

*try to hibernate form noise light odor people

*

*predominantly in men 20-40

*2-3hrs after falling asleep

*no prodromal signs

*intense unilateral pain behind one eye

*minutes to hrs

* swelling around eye

Most common

*bilateral

*muscle contraction headache, poorly localized

*stressdul situations

*constant sqeezing tightness, palpable neck and shoulder muscles, stiff neck, tenderness

Care for headaches

Drugs=

Nonopoid(apspirin, ibprophen) for Tension type and Migrain

*Oxygen and prophylactic drugs

*identify stressful situations,foods, relaxation,exercise

*HEADACHE DIARY

MRI, CT scan, magnetic resonance, angiography

to rule out eneurysm, tumor or infection

Headaches

NURSING diagnoses

ineffective individual coping

sensory/perceptual alterations

knowledge deficit

fear

sleep pattern disturbance

altered role performance

Disorder of cerbral blood flow

*blood supply: internal carotids and vertebral arteries. connect at Circle of Willis

Veins: internal Jugular

Arm/leg weakness/numbness

speech

time

Cerebral Vascular Accident

3rd leading cause of death

related to Atrial Fibrillation

Result of VTE

embolism lodges where branches are

length of time flow is decreased or stopped

area of brain involved

extent of involvement

Hypertension

diabetes

sickle cell

substance abuse

atherosclerosis

obesity

sedentary lifestyle

high lipids

oral contraceptive use congential cerebrovascular abnormalities

Brief period of localized cerbral ischemia

lasts less than 24 hrs warning signs of impending stroke

Signs and symptoms<1hr

*occlusion of a vessel by a thrombus

*usually during sleep or rest

*slow progression 1-2day period

Traveling clot becomes lodged in a narrowed area

*men more than women

*awake

*symptoms may disappear as it breaks up

*cerebral blood vessel rupture

*engaged in some activity

*LONG STANDING HYPERTENSION,aneurysms, malformations,anticoagulant therapy,liver disease,brain tumor

*15% of all strokes

Blood in brain tissue, ventricles, or subarachnoid space causign cerebral edema

*Loss of consiousness

motor deficits

elimination disorders

sensory-perceptual deficits

language disorder

behavioral changes

motor deficits

weakness, paralysis , or spasticity

Hemiparesis-weakness on 1 side of body

Flaccidity, Splasticity

Rigidity

Hemiplegia-1 side paralysis

Hemianopia-blindness in half of visual field

agnosia-inabilty to recognise object

apraxia-inability to carry out motor function

*aphasia-expressive,receptive,mixed, global

*cognitive and behavioral changes

Lab tests-mri, ct scan

TPA- tissue clot busters(not for hemorrhagic stroke

aspirin

bladder and bowel complications are common

urinary frequency, urgency, or incontinence

constipation stool impaction

*active ROM for unaffected extremities

*passive for affected

*turn and reposition

*Watch for VTE(DVT)

*splints as ordered

*collaborate with PT about mobility

Holistic and individualized

*altered cerebral tissue perfusion

-monitor= respiratory status and airway patency, neurological status,cardiac status,body temperature,  for seizures

-accurate I&O

-use unaffected arm for ADLs

Dress affected extremities first

use assistive devices

-sitting upright

-neck slightly flexed

-puree or soft food

-food in the unaffected side of the mouth

-check mouth for the pocketing of food

-have suction equipment at bedside

ineffective airway clearance

impaired skin integrity

altered thought processes

risk for injury

self esteem disturbance

ineffective individual coping

social isolation

powerlessness