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Brain attack, cerebrovascular accident (CVA) - Age: older at greater risk - Gender: men at greater risk than women (women - more than half of deaths from brain attacks) - Pregnant women at higher risk than nonpregnant women who take birth control pills and smoke or have hypertension - Family history: risk greater if parent, grandparent, or sibling had a brain attack.
Brain attack, cerebrovascular accident (CVA) - Age: older at greater risk - Gender: men at greater risk than women (women - more than half of deaths from brain attacks) - Pregnant women at higher risk than nonpregnant women who take birth control pills and smoke or have hypertension - Family history: risk greater if parent, grandparent, or sibling had a brain attack.
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Brain attack, cerebrovascular accident (CVA) - Age: older at greater risk - Gender: men at greater risk than women (women - more than half of deaths from brain attacks) - Pregnant women at higher risk than nonpregnant women who take birth control pills and smoke or have hypertension - Family history: risk greater if parent, grandparent, or sibling had a brain attack.
Copyright:
Attribution Non-Commercial (BY-NC)
Formati disponibili
Scarica in formato PPT, PDF, TXT o leggi online su Scribd
Health History: Past Medical History • Injury to head/spinal cord? Describe. Changes since injury? • Surgery on brain, spinal cord, or nerves? When? Outcome? • Stroke? Describe. When? Changes resulting from stroke? • Seizure disorder? Describe kind and how often. What prevents seizures?
Problem Based History Dizziness- TIA • How do you feel when dizzy or lightheaded? Feel as if you can’t keep balance or may fall? How often? Is the dizziness associated with change in position/activity? What makes it worse? What relieves it? • Ever feel like room is spinning (objective vertigo) or that you are spinning (subjective vertigo)? Suddenly or gradually? What makes it worse? What relieves it?
Problem Based History Changes in Movement • How long have you had a change in your mobility? Describe. Continuous or intermittent? • Noticed tremors/shaking of hands/face? When started?? • Noted any twitches or sudden jerks? • Felt any weakness in or difficulty moving body parts? Confined to one area? Associated with any particular activity? • Problems with coordination? Difficulty keeping balance when walking? Lean to one side/fall?
Examination Procedures and Techniques • Evaluate speech • Test eyes—visual acuity (CN II)/peripheral vision – Snellen chart – Confrontation test – Give them something to read • Observe eyes for extra ocular movement • Observe eyes—pupillary size, shape, equality, constriction, accommodation – PERRLA
Examination Procedures and Techniques • Inspect tongue—movement, symmetry, strength, absence of tumors – Have client protrude tongue, move toward nose, chin, side to side • Test shoulder/neck muscles— strength/movement – Have client shrug shoulders; turn head to side against hands
– General observation—observe walking – Balance • Romberg test (client standing)—feet together, arms at side, eyes open/closed • Alternately touch nose with index fingers (eyes closed) • Touch each finger to thumb in rapid sequence
– + Babinski’s is when the foot is stroked and the great toe dorsalflexes with fanning of the toes– pyramidal signs— – Achilles tendon – pull up on ankle– this response may be diminished in older adult.
Additional Assessment for Special Cases • Orientation – If orientation a concern during history, determine if oriented to time, place, person • Date/time—first orientation to disappear – Only a problem if remains disoriented after being reoriented • Place—2nd orientation to disappear • Person—last orientation to disappear – Orientation returns in opposite order in which is lost
Additional Assessment for Special Cases • When client’s awareness can’t be assessed because of unconscious, awakening is assessed – Glasgow Coma Scale—assess LOC using 15-point scale – Assess for best response to eye opening, motor response, and verbal response – Pain—1 descriptor used in assessment of best eye/motor response
range is from 3 to 15. The higher the score the better the response. • Decorticate posturing- rigid flexion • Decerebrate posturing- rigid extension– hands and forearms pronate (turn out).
Age-Related Variations: Infants/Children: Examination/Findings • Infants/Children- Ask parents for information about birth, cry, seizures – Birth trauma may lead to cerebral palsy – Shrill cry and sunset eyes may indicate hydrocephalus – Seizures may indicate high fever or a neurological disorder – ADHD – Neurologic Soft signs– pg 638
Age-Related Variations: Older Adults: Examination Normal and abnormal findings • Indicators of ability to perform activities of daily living— personal hygiene, appearance, and dress • Some older adults have slowed responses, move more slowly, or show decline in function (e.g., sense of taste) • Other aging changes—deviation of gait from midline; difficulty with rapidly alternating movements; some loss of reflexes and sensations (e.g., knee/ankle jerk reflexes, light touch/pain sensations)