a taxia in the s troke p atient n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
A taxia in the S troke P atient PowerPoint Presentation
Download Presentation
A taxia in the S troke P atient

Loading in 2 Seconds...

play fullscreen
1 / 65

A taxia in the S troke P atient - PowerPoint PPT Presentation


  • 141 Views
  • Uploaded on

A taxia in the S troke P atient. Kelli Kulpa BSN, RN Alverno College MSN Student Neurosciences Department Froedtert Hospital. Objectives. Describe pathophysiology of cerebellum as it relates to smooth muscle movements Describe how ischemia to cerebellum causes ataxia in stroke patient

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'A taxia in the S troke P atient' - otto-kline


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
a taxia in the s troke p atient

Ataxiain the Stroke Patient

Kelli Kulpa BSN, RN

Alverno College MSN Student

Neurosciences Department

Froedtert Hospital

objectives
Objectives

Describe pathophysiology of cerebellum as it relates to smooth muscle movements

Describe how ischemia to cerebellum causes ataxia in stroke patient

Identify presence of ataxia in stroke patient

Identify appropriate nursing interventions and outcomes

topics to review
TOPICS TO REVIEW

STROKE

CEREBELLUM

ATAXIA

NIH STROKE SCALE

CARE OF THE PATIENT WITH ATAXIA

stroke
Stroke

(Porth, 2005)

“Syndrome of acute focal neurologic deficit from a vascular disorder that injures brain tissue” Porth (2005, p. 1245)

US leading cause of mortality & morbidity

About 700,000 Americans afflicted with stroke

Many survivors left with some degree of deficit

Image from Microsoft Clipart

risk factors for stroke
Risk Factors for Stroke
  • Controllable
    • Hypertension (HTN)
    • Atrial Fibrillation
    • High Cholesterol
    • Diabetes
    • Tobacco Use & Smoking
    • Alcohol Use
    • Physical Inactivity
    • Obesity
  • Uncontrollable
    • Age
    • Race
    • Gender
    • Family History
    • Previous Stroke or TIA
    • Fibromuscular Dysplasia
    • Patent Foramen Ovale

(National Stoke Association, 2009)

Image from Microsoft Clipart

uncontrollable risk factor
Uncontrollable Risk Factor
  • AGE:
    • Risk of stroke increases with age
    • After age 55, risk doubles for every decade that passes
    • Increased prevalence of controllable risk factors as age increases
      • Hypertension
      • High Cholesterol
      • Diabetes
  • RACE: AFRICAN-AMERICAN
    • Most impacted race in US
    • Twice as likely to die from stroke than Caucasians
      • Occur earlier in life
    • Reasons not fully understood, but have a higher rate of risk factors
      • ex: 41% have HTN

(National Stoke Association, 2009)

Image from Microsoft Clipart

uncontrollable risk factor1
Uncontrollable Risk Factor

(National Stoke Association, 2009)

  • GENDER: WOMEN
    • 55,000 more women than men experience stroke each year
    • Unique risk factors:
      • Oral Contraceptives
      • Pregnancy
      • Hormone replacement therapy
      • Post-menopausal with thick waist and high triglyceride levels
      • Suffer more migraines, increase risk 3-6 times

Image from Microsoft Clipart

uncontrollable risk factor2
Uncontrollable Risk Factor

(Morrison, Brown, Kardia, Turner, & Boerwinkle, 2003)

(Humphries & Morgan, 2004)

  • FAMILY HISTORY
    • Evidence suggests genes influence vulnerability to HTN & stroke
      • A region on:
        • Chromosome 13 in Caucasians
        • Chromosome 19 in African-Americans
    • Carotid intimalmedial wall thickness (IMT)
      • Surrogate measure of subclinical atherosclerosis
      • Strong predictor of future ischemic strokes
      • Homozygous for 6A genotype
        • Genetically predisposed to produce less stromelysin 1
        • High carotid artery wall thickness & greater risk of stroke

Image from Microsoft Clipart

controllable risk factor inflammation
Controllable Risk Factor & Inflammation

(Humphries & Morgan, 2004)

  • Inflammation can influence the development of atherosclerosis
    • Causes endothelial dysfunction
      • One of the earliest manifestations of atherosclerosis
    • Inflammatory markers associated:
      • Coronary disease development
      • Disease severity
      • Occurrence of coronary events
    • Progression of atherosclerosis may be associated with high concentrations of inflammatory markers
test your knowledge
TEST YOUR KNOWLEDGE

GOOD JOB!

Hypertension

SORRY!

Cannot control if you have a history of stroke

Previous Stroke

OPPS!

Cannot control age

Age

GREAT!

Hyperlipidemia

Select the controllable risk factors for stroke (Multiple answers)

test your knowledge1
TEST YOUR KNOWLEDGE

Sorry!

Women are at higher risk of stroke & also have increased mortality.

TRUE

Yes!

Women are at higher risk of stroke & also have increased mortality.

FALSE

Men are at higher risk of stroke

types of stroke
Types of Stroke
  • ISCHEMIC
    • Interruption of blood flow in a cerebral vessel
    • Most common type
    • Account for 70-80% of strokes
  • HEMORRHAGIC
    • Bleeding into the brain tissue, from blood vessel rupture
    • Caused by:
      • HTN
      • Aneurysms
      • AVM
      • Head injury
    • Much higher fatality rate
      • 37-38% of occurrence results in death

(American Heart Association, 2010)

(Porth, 2005)

Image from Microsoft Clipart

cell ischemia
Cell Ischemia

(Porth, 2005)

  • Reduced or absent blood flow deprives cell of needed nutrients
  • Effects occur quickly
    • No stored glucose in brain
    • Incapable of anaerobic metabolism
neuronal injury excitotoxicity
Neuronal Injury: Excitotoxicity

(Porth, 2005)

  • Ischemia depletes neuronal energy stores causing energy dependent membrane ion pumps to fail
  • Results in increased extracellular glutamate concentration
  • Release of excitotoxic glutamate & aspartate open up calcium channels
    • Influx of calcium, sodium and chloride
      • Intracellular calcium responsible for activation of a series of destructive enzymes
    • Out flux of potassium
    • Resulting in irreversible neuronal damage
      • Results in release of cytokines and other mediators
inflammation following ischemia
Inflammation Following Ischemia

(Porth, 2005)

Image used with permission from http://images.wellcome.ac.uk/

Rapid production of inflammatory mediators

White blood cell (WBC) recruitment to ischemic area as early as 30 minutes

Capillary endothelium produces adhesive proteins causing WBCs to adhere to capillary lining

WBCs move into injured tissue

Phagocytize injured cells

Extent of inflammation can be determined by C-reactive protein levels

test your knowledge2
TEST YOUR KNOWLEDGE

Try again

If the cell is not getting adequate blood flow, there is not enough energy available.

Too much energy available to the cell

GOOD JOB!

No energy is getting to the cell.

Energy dependent membrane ion

pumps fail

Try again

Phosphorus is not directly related to this process

Lack of phosphorus available

Try again

There are increased levels of glutamate.

Decreased levels

of glutamate

Neural cell ischemia is caused from:

cerebellum
Cerebellum
  • Stores learned sequences of movements
  • Fine tuning & coordination of movement produced elsewhere in brain
  • Integrates all information to produce fluid movements

(Dubuc, 2002)

Image used with permission from http://thebrain.mcgill.ca/flash/i/i_06/i_06_cr/i_06_cr_mou/i_06_cr_mou.html#3

movement
Movement
  • Motor cortex:
    • Sends signals to cerebellum
    • Communicates movement to make
  • Cerebellum:
    • Makes continuous adjustments
  • Final result:
    • Smooth movement, key with delicate maneuvers

(Porth, 2005)

Hover over the highlighted words for definition

Cerebellum

Image used with permission from http://thebrain.mcgill.ca/flash/i/i_06/i_06_cr/i_06_cr_mou/i_06_cr_mou.html

cerebellum involvement
Cerebellum Involvement
  • Receives proprioceptor input from vestibular system
  • Feedback from muscles, tendons, & joints
  • Indirect signals from somesthetic, visual, & auditory systems to provide background info for ongoing movement

(Porth, 2005)

  • Can continuously assess status of each body part
    • Position
    • Rate of movement
    • Forces, such as gravity, opposing it

(McGill University, 2002)

dampening muscle movement
Dampening Muscle Movement
  • All body movements are pendular
  • Intact cerebellum analyzes proprioceptive information to predict:
    • Future position of moving parts
    • Speed of movement
    • Projected time course of movement
  • As movement approaches target, Cerebellum will:
    • Inhibit agonist muscles
    • Excite antagonist muscles

(Porth, 2005)

(Porth, 2005)

Image from Microsoft Clipart

type of movement
Type of Movement

“Require a burst of energy from an agonist muscle group; the movement is programmed from the start, so the movement proceeds from start to finish without modification”

Simple Movement

Self-terminating Movement: require smooth muscle sequence of coordinated agonist & antagonist movements programmed by higher brain centers to start, then are modified as the movement proceeds

Complex Movement

Click for Explanation

Click for Explanation

Porth (2005, p. 1194)

Image from Microsoft Clipart

test your knowledge3
TEST YOUR KNOWLEDGE

Try again;

This is part of the somesthetic system.

Meaningfulness of integrated sensory information from various sensory systems

GOOD JOB!

Any sensory nerve ending responding to stimuli from within body related to movement & spatial position

OPPS!

Vestibular apparatus, try again.

The inner ear structures that are associated with balance and position sense

Try again;

This is part of the somesthetic system.

Concerning perceptions of ‘where’ the stimulus is in space and in relation to body parts

Proprioreceptor input is:

test your knowledge4
TEST YOUR KNOWLEDGE

Yes!

Movement is pendulous, so muscles have

to be stopped.

Inhibit agonist muscles & Excite antagonist muscles

Opps!

Think this through again. Movement is pendulous.

Excite agonist muscles & Inhibit antagonist muscles

As movement approaches a target, the cerebellum will:

ataxia
Ataxia

(National Institute Of Neurological Disorders And Stroke, 2010)

  • People with ataxia experience
    • Failure of muscle control in arms and legs
    • Results in:
      • Lack of balance & coordination
      • Disturbance in gait

Image from Microsoft Clipart

acquired non genetic ataxia
Acquired (non-genetic) Ataxia

(National Institute Of Neurological Disorders And Stroke, 2010)

Image from Microsoft Clipart

  • Conditions that can cause acquired ataxia
    • Stroke
    • Multiple Sclerosis
    • Tumors
    • Alcoholism
    • Peripheral neuropathy
    • Metabolic disorders
    • Vitamin deficiencies
ataxia after stroke
Ataxia after Stroke

(Mayo Clinic Staff, 2009)

  • Right side of cerebellum controls coordination on right side of body, left side controls left
  • When nerve cells are lost or damaged:
    • Provide less control to muscles
    • Resulting in: loss of coordination
  • During a stroke:
    • Blood supply is interrupted or severely reduced
    • Deprivation of oxygen and nutrients to brain tissue
    • Brain cells begin to die

Image from Microsoft Clipart

recent findings
Recent Findings

Image from Microsoft Clipart

  • 15% of all cerebral strokes involve the cerebellum

(Timmann et al., 2009)

  • Anterior lobe of cerebellum is involved in motor control
    • Concluded from a study containing 34 patients with cerebellar infarcts

(Schmahmann, Macmore, & Vangel, 2009)

cerebellar ataxia
Cerebellar Ataxia

How does alcohol relate?

Select the beer for the answer!

  • Decomposition of movement
  • Each component of the movement occurs separately instead of being blended into a smooth action

(Porth, 2005)

“Ethanol specifically affects cerebellar function, persons who are inebriated often walk with a staggering and unsteady gait”

Porth (2005, p. 1213)

(Porth, 2005)

Image from Microsoft Clipart

ataxia1
Ataxia
  • Rapid alternating movements are performed slowly and jerky
    • Such as pronation-supination-pronation of hands
  • Touching a target:
    • Movements broken down into small steps
    • Each movement goes too far, then overcompensated
    • DYSMETRIA

SELECT THE TARGET TO SEE AN ANIMATION OF DYSMETRIA

(Porth, 2005)

Image from Microsoft Clipart

clinical pearl
Clinical Pearl

Image from Microsoft Clipart

Read the CT or MRI reports to identify where the infarct is located in the brain. If the cerebellum is involved, chances are ATAXIA will be exhibited in the patient

test your knowledge5
TEST YOUR KNOWLEDGE

Try again

Weakness

GOOD JOB!

Lack of coordination

OPPS!

Impaired speech

Try again

No need to pay taxes

Ataxia is:

test your knowledge6
TEST YOUR KNOWLEDGE

AWESOME!

Cerebellum

Motor Cortex

Think again,

motor cortex is involved in movement, but not directly related to ataxia.

Try again;

not related to movement

Parietal Lobe

Almost there…

look closer at the options.

Cerebrum

What part of the brain was infarcted if the patient has ataxia?

test your knowledge7
TEST YOUR KNOWLEDGE

Yes!

Acquired ataxia is non-genetic.

True

Opps!

Ataxia after a stroke is not a genetic cause of ataxia.

Genetic ataxia is caused from mutations in genes.

False

Ataxia in stroke is acquired ataxia.

national institute of health stroke scale nihss
National Institute of Health Stroke Scale (NIHSS)

(Jensen & Lyden, 2006)

  • Stroke scale functions:
    • Document and communicate
      • Baseline deficits
      • Changes over time
  • First used in 1989
  • Administered in mean time of 6.6 minutes
  • Interrater and intrarater agreement is good

Image from Microsoft Clipart

national institute of health stroke scale nihss1
National Institute of Health Stroke Scale (NIHSS)

(Duncan et al., 2005)

  • Strongly predicts the likelihood of recovery after stroke
    • Total score
      • > 16 high probability of death or severe disability
      • <6 predicts a good recovery

Image from Microsoft Clipart

national institute of health stroke scale nihss2
National Institute of Health Stroke Scale (NIHSS)
  • 15 Item Clinical Deficit Scale
    • Assess:
      • Level of Consciousness
      • Gaze
      • Vision
      • Facial Palsy
      • Arm & Leg Strength
      • Limb Ataxia
      • Neglect
      • Dysarthria
      • Aphasia

REMEMBER:

MUST BE ASSESSED

IN ORDER LISTED

(Jensen & Lyden, 2006)

Image from Microsoft Clipart

nihss limb ataxia
NIHSSLimb Ataxia

YOU’RE NOT THE ONLY ONE WHO MAY MAKE AN ERROR SCORING ATAXIA!!!

“A few items consistently show poor

agreement, notably ataxia,

dysarthria, and facial weakness”

Jensen & Lyden (2006, p. 2)

nihss limb ataxia1
NIHSSLimb Ataxia

Assesses evidence of a unilateral cerebellar lesion

Assesses incoordination from weakness

Test with eyes open, in intact visual field

Test on bilateral extremities

(NIH Stroke Scale International, 2001)

(National Institute Of Neurological Disorders And Stroke, 2001)

evaluating limb ataxia
Evaluating Limb Ataxia
  • Scored if present out of proportionto weakness
  • Two instances when ataxia would not be assessed
    • Absent in patients who do not understand or are paralyzed
    • Untestable (UN) if amputation or joint fusion present

(NIH Stroke Scale International, 2001)

(National Institute Of Neurological Disorders And Stroke, 2001)

finger nose finger test
Finger-Nose-Finger Test

Click on picture of face to view example of finger-nose-finger test with ataxia present

(NIH Stroke Scale International, 2001)

Ask patient to touch your index finger with his index finger and then back to his nose

Repeat enough times to fully assess for ataxia, moving your index finger each time to make a new target

Then repeat using other extremity

Image from Microsoft Clipart

heel shin test
Heel-Shin Test

Click on picture to view example of heel-shin test with ataxia present

(NIH Stroke Scale International, 2001)

  • Ask patient to move right heel up and down the left shin
  • Repeat enough times fully assess for ataxia
  • Then repeat using other extremity

Image from Microsoft Clipart

limb ataxia
Limb Ataxia

(NIH Stroke Scale International, 2001)

Video used with permission from NIHSS English Training Campus

  • SCALE DEFINITION
    • 0 Absent (Not present or paralyzed)
    • 1 Present in 1 limb (an arm or a leg)
    • 2 Present in 2 limbs (both arms, both legs, or arm and leg on same side of body)
    • UN Amputation or joint fusion (explain)
  • The link below will take you to the National Institute of Health Stroke Scale Training Video
    • Assessment #7 Limb Ataxia http://www.youtube.com/watch?v=8AXtl3QPH7Y&feature=related
test your knowledge8
TEST YOUR KNOWLEDGE

False:

Ataxia is incoordination, not weakness!

True

Great job!

Ataxia is incoordination, not weakness!

False

Ataxia occurs because of muscle weakness after a stroke.

test your knowledge9
TEST YOUR KNOWLEDGE

Think about the order of the exam.

Ataxia is assessed after weakness!

True

Great job!

Ataxia is assessed after weakness!

False

Ataxia needs to be assessed prior to weakness in the NIH Stroke Scale.

test your knowledge10
TEST YOUR KNOWLEDGE

No, ataxia is not present because the patient is

unable to perform the test.

The score would be absent or 0 due to paralysis.

Yes

Great job!

Ataxia is not present because the patient is

unable to perform the test.

The score would be absent due to paralysis.

No

If the patient has weakness in the right arm and is unable to lift the arm off the bed, would ataxia be present?

test your knowledge11
TEST YOUR KNOWLEDGE

Try again!

Ataxia is present in R arm.

0

GREAT JOB!

1

Try again!

Ataxia is only present in the R arm.

2

Try again!

Only score UN if amputation or joint fusion present.

UN

The patient exhibits some weakness in the right arm and is able to perform the finger-nose-finger test. The patient misses the assessors finger. The patient completes test on left arm without difficulty. What score would be given for the upper extremity test?

treatment
Treatment

(National Institute Of Neurological Disorders And Stroke, 2010)

  • There is no current cure of ataxia following a cerebellar stroke
  • Physical & Occupational Therapy
    • Strengthen muscles
    • Assistive devices
      • Assist in walking and other activities of daily living (ADLs)

Image from Microsoft Clipart

nurse sensitive outcomes
Nurse Sensitive Outcomes

(Bader & Littlejohns, 2004)

  • Impaired Mobility
    • Mobilize early to prevent complications
      • Active & Passive range of motion (ROM)
      • Participate in self-care & activities frequently
    • Teach safe use of assistive devices
    • Educate & Facilitate adaptation of home/work environment for maximal independence
    • Teach safety precautions
    • Expected outcomes:
      • Optimal independence with ADLs & mobility
      • Maintain safety precautions
nurse sensitive outcomes1
Nurse Sensitive Outcomes

(Bader & Littlejohns, 2004)

Self-Care Deficit

  • Evaluate ability to perform ADLs
  • Consult occupational therapy (OT)
  • Assess for risk of falls
  • Expected outcomes:
    • Functional abilities recognized & advanced
nurse sensitive outcomes2
Nurse Sensitive Outcomes

(Summers et al., 2009)

Safety

  • Identify Fall Risk
    • Implement fall prevention strategies
      • Universal Fall Risk Interventions
      • Fall Precautions due to activity impairment
    • Expected outcome:
      • Effective in decreasing vulnerability to falls and related injury
nurse sensitive outcomes3
Nurse Sensitive Outcomes

(Bader & Littlejohns, 2004)

Anticipatory grieving related to loss of functional abilities

  • Facilitate discussions to allow patient/family to voice concerns
  • Neuropsychiatry consult to evaluate cognitive vs. depressive issues
  • Rehabilitation consult to evaluate needs
  • Support Groups
  • Expected outcomes:
    • Supported & given resources to assist with coping
coping
Coping
  • (Porth, 2005)
    • (Mayo Clinic Staff, 2009)
  • Challenges:
    • Loss of independence
      • May feel alone
      • Lead to depression & anxiety
    • Therapy or counseling may lessen sense of isolation and help cope
  • Can lead to increased stress on the patient
    • Habitual Stress
      • The physiologic & behavioral changes induced by generalized stress response can threaten homeostasis
generalized stress response
Generalized Stress Response
  • Stroke is a life changing event people do not have time to prepare for
  • Stress can impact controllable risk factors for stroke
    • Hypertension
    • High cholesterol
    • Tobacco use
    • Alcohol use
    • Physical Inactivity
    • Obesity
generalized stress response gsr
Generalized Stress Response (GSR)

(Porth, 2005)

  • Sympathetic Nervous System (SNS)
    • “Fight or Flight Response”
      • Increased heart rate and strength of contraction
      • Increased metabolic rate, stored fat released into circulation
      • Bronchodilation in lungs
      • Vasoconstriction of:
          • Skin
          • Gut
            • Decreased motility
            • Less insulin secreted
          • Kidneys
      • Pupils Dilate
hormone involvement in gsr
Hormone Involvement in GSR

(Porth, 2005)

  • Corticotropin-releasing Factor (CRF)
    • Released by the hypothalamus
    • Stimulates ACTH release
  • Adrenocorticotropic hormone (ACTH)
    • Released from the anterior pituitary gland
    • Stimulates synthesis and release of cortisol
  • Cortisol
    • Released from adrenal cortex
    • Affects many systems and processing in the body
effects of cortisol
Effects of Cortisol
  • Cardiovascular
    •  arterioles more responsive to sns
    •  increased contractility
  •  Liver
    • stored glucose released into blood
  • Pancreas
    • decreased insulin release
  • Adipose tissue
    • lipids released from periphery, redeposited in trunk
  • Skeletal
    • decreased bone deposition
  • Renal
    •  calcium lost in urine
    • Na+/K+ pump reabsorbs Na+ and H2O into blood, secretes K+ into urine
  • Muscular
    • actin and myosin break down
  • Immune
    • production of prostaglandins blocked
    • thymus atrophies
    • neutrophils can't leave blood
    • monocytes and macrophages less active

(Porth, 2005)

test your knowledge12
TEST YOUR KNOWLEDGE

Try again;

Ataxia does not affect breathing in the stroke patient.

Impaired gas exchange

Try again;

Ataxia does not affect breathing in the stroke patient.

Ineffective breathing pattern

Great job!

Very important to also consider fall risk!

Impaired physical mobility

Try again!

Ataxia affects movement, not tissue perfusion.

Impaired tissue perfusion

Identify the most appropriate nursing diagnosis in terms of special needs when ataxia is present.

test your knowledge13
TEST YOUR KNOWLEDGE

Try again;

Used for stroke treatment, but not for treating ataxia.

TPA

Try again;

Not used for treating ataxia.

Heparin

Try again;

Movements are impaired because of communication error in the brain.

Muscle Relaxers

GREAT!

Currently no treatment available. PT & OT to help with function.

No Treatment Available

Treatment for ataxia in the stroke patient is:

case study
Case Study

A 67 year old male with a history of afib and prior stroke (with no deficits) was admitted from home with acute onset of nausea, generalized weakness, ataxia, and left sided weakness. Initial MRI noted a large acute ischemic infarct within the left cerebellum and smaller infarcted areas within the cerebellar vermis and right cerebellum with occlusion of the right internal carotid artery.

case study1
Case Study

GREAT!!!

Cerebellar Stroke

Try again;

Be more specific

Stroke

Try again;

Be more specific.

Weakness

What is the anticipated medical diagnosis of the patient?

case study2
Case Study

Opps!

Ataxia is present, therefore, 0 cannot be the score.

0

Try again;

Ataxia is present in both upper extremities.

1

GREAT!

Score 2 if present in bilateral upper or lower extremities, or an arm and leg on the same side of the body.

2

When tested for ataxia, it was present on the bilateral upper extremities. What score would be given according to the NIHSS?

case study3
Case Study

Sorry,

This would be appropriate, but not specific to the symptom of ataxia.

Impair tissue perfusion

Great!

Think safety with patients experiencing ataxia!

This patient has left sided weakness, plus BUE ataxia. This could make using mobility devices harder.

Risk for injury: falls

Try again,

This could be present in the patient, but does not relate to ataxia.

Impaired memory

What appropriate nursing diagnosis would be given to this patient related to the presences of ataxia?

the end
The End
  • With the completion of the tutorial, you are now able to:
    • Describe pathophysiology of cerebellum as it relates to smooth muscle movements
    • Describe how ischemia to cerebellum causes ataxia in stroke patient
    • Identify presence of ataxia in stroke patient
    • Identify appropriate nursing interventions and outcomes
slide65

References

American Association Of Neuroscience Nurses. (2008). Guide to the care of the hospitalized patient with ischemic stroke. 2nd ed. Retrieved February 10, 2010, from http://www.guideline.gov/

American Heart Association. (2010). Heart disease and stroke statistics - 2010 update. Retrieved from http://www.americanheart.org

Bader, M., & Littlejohns, L. R. (2004). AANN core curriculum for neuroscience nursing (4th ed.). St. Louis, MO: Saunders.

Duncan, P. W., Zorowitz, R., Bates, B., Choi, J. Y., Glasberg, J. J., Graham, G. D.,...Reker, D. (2005). Management of adult stroke rehabilitation care: a clinical practice guideline. Stroke, 36, e100-e143. doi:10.1161/01.STR.0000180861.54180.FF

Humphries, S., & Morgan, L. (2004). Genetic risk factors for stroke and carotid atherosclerosis: insights into pathophysiology from candidate gene approaches. The Lancet Neurology, April (3) 227-236.

Jensen, M. B., & Lyden, P. (2006). Stroke scales: an update. Stroke Clinical Updates, XVI(1), 1-7. Retrieved from http://www.stroke.org/site/DocServer/SCU_-_Jan-Feb_2006.pdf?docID=5166

Mayo Clinic Staff. (2009). Ataxia. Retrieved from http://www.mayocliMayo Clinic Staff (2009) nic.com/health/ataxia/DS00910/DSECTION%3Dcauses

McGill University. (2002). The brain from top to bottom. Retrieved March 12, 2010, from http://thebrain.mcgill.ca/flash/index_d.html

Morrison, A. C., Brown, A., Kardia, S. L., Turner, S. T., & Boerwinkle, E. (2003). Evaluating the context-dependent effect of family history of stroke in a genome scan for hypertension. Stroke, 34, 1170-1175. doi:10.1161/01.STR.0000068780.47411.16

Mosby (2002). Mosby's pocket dictionary of medicine, nursing, & allied health (4th ed.). St. Louis, MO: Mosby, Inc.

National Institute Of Neurological Disorders And Stroke. (2010). NINDS ataxias and cerebellar or spinocerebellar degeneration information page. Retrieved from http://www.ninds.nih.gov/disorders/ataxia/ataxia.htm

National Institute Of Neurological Disorders And Stroke. (2001). NIH stroke scale. Retrieved from http://stroke.nih.gov

National Stoke Association. (2009). Stroke risk factors am I at risk for a stroke? Retrieved from http://www.stroke.org/site/PageServer?pagename=RISK

NIH Stroke Scale International. (2001). NIH stroke scale (NIHSS) in English. Retrieved from http://www.nihstrokescale.org/

NIHSS English Training Campus. (21). 2 9 7 limb ataxia. Retrieved April 1, 2010, from http://www.youtube.com/watch?v=8AXtl3QPH7Y&feature=related

Porth, C. M. (2005). Pathophysiology: concepts of altered health states (7th ed.) Lippincott.

Schmahmann, J. D., Macmore, J., & Vangel, M. (2009). Cerebellar stroke without motor deficit: clinical evidence for motor and non- motor domains within the human cerebellum. Neuroscience, 162, 852-861.

Shah, S. (n.d.). Pathophysiology of stroke. Retrieved March 12, 2010, from http://www.ferne.org/

Summers, D., Leonard, A., Wentworth, D., Saver, J. L., Simpson, J., Spilker, J. A.,...Mitchell, P. H. (2009). Comprehensive overview of nursing and interdisciplinary care of the acute ischemic stroke patient. A scientific statement from the American Heart Association. Stroke, 40. doi:10.1161/STROKEAHA.109.192362

Timmann, D., Konczak, J., Ilg, W., Donchin, O., Hermsdorfer, J., Gizewski, E. R., Schoch, B. (2009). Review: current advances in lesion-symptom mapping of the human cerebellum. Neuroscience, 162, 836-851.

Wellcome Images. (n.d.). Wellcome Images. Retrieved February 12, 2010, from http://images.wellcome.ac.uk/