Acute Care Exam 3 Flashcards by Marc Duke

How are patients with ICP managed/treated?

HOB > 30
Control fever/BP
- SBP < 140
Avoid hypotonics

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What are the symptoms/clinical features of a TIA and what are the risk for stroke after TIA?

onset of focal neuro Sx lasting < 24 hrs
no objective evidence on brain studies
risk of stroke after TIA is 2-17% w/in 90 days

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What are the diet recommendations for stroke prevention?

Mediterranean diet
DASH diet

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What are the effects of a PCA stroke?

Right/Left homonymous hemianopia
Alexia w/out agraphia
Possible aphasia
Contralateral hemisensory

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How is HLD and stroke related and what Rx/dose is used in prevention?

Stroke risk r/t LDL levels
Lipitor 80 mg

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What are the TPA contraindications r/t CT scans?

Blood on CT (light color)

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What are the stroke center levels and some key differences between them?

primary stroke center:
- most cases of ischemic stroke
- not req’d to have cath services
- not req’d to have a separate unit
- access to neurosurg w/in 2 hrs
comprehensive stroke center:
- all types of stroke
- 24/7 cath services
- have separate neuro ICU
- 24/7 on site neurosurg

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What are the AHA recommendations for exercise for stroke prevention?

any exercise reduces stroke risk
AHA:
- 30 mins mod activity 5 d/wk or
- 25 mins vigorous activity 3 d/wk

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What is the CURB-65 and what are its components?

Scoring system to help diagnose CAP
Components (1 pt each):
- C - confusion
- U - urea > 7 mmol/L
- R - RR > 30
- B - SBP < 90 mmHg or DBP < 60 mmHg
- 65 - age > 65
0-1 = low risk, 2 = probable, 3-5 = hosp visit

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What are the diagnostic features of a hemorrhagic stroke?

ICH score
CT (blood is light)
MRI (blood is dark)
Seizures
Neurosurgery:
- EVD
- evacuation of blood
- increased ICP (>20 mmHg)

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What are the cryptogenic stroke associated risk factors?

arterial dissection, arteriopathy
cerebral sinus venous thrombosis
autoimmune Dz and genetic factors
infxn
hypercoaguability Dz

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What are the effects of a Right MCA stroke?

Left sided deficits
- Left hemiplegia/sensory loss
- Left homonymous hemianopia
- Left hemi-neglect
Right gaze preference

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How is VAP prevented?

HOB elevated
handwashing
chlorhexidine gluconate oral rinse
cont removal of subglottic secretions

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What are the prevention protocols for CLABSI?

Hand hygiene
optimal insertion site
- prep skin w/ 2% CH or 70% isopropyl alcohol
maximal sterile barrier and intact dressing
daily review of necessity and early removal (5 day max)

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What are the risk factors for hemorrhagic stroke?

HTN
increased age
cerebral amyloid angiopathy
antithrombotic therapy
increased EtOH and/or drug abuse

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What differential diagnoses should be considered if CAUTI suspected?

pyelonephritis
sepsis
bactermia
PNA
skin/soft tissue infxn

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What are the Sx of a hemorrhagic stroke?

stroke Sx w/ HA
- HA usually intense, extremely painful
vomiting
decreased LOC

What are the TPA contraindications r/t Rx history and what Rxs are ok?

Currently on:
- Anticoags
  - Eliquis, Xeralto, Pradaxa, full dose LMWH or Heparin gtt
ASA and Plavix are ok

What is the treatment for VAP?

initially treated with broad specturm ABX
- specturm should be subsequently narrowed
- pathogen may influence treatment
usually 7 days

What neurotransmitters increase pain?

bradykinins and tacyhkinins (sub-P, neurokinin-A)
cations and free radicals
histamine and serotonin
prostanoids (PTG, leukotrienes)
purines (adenosine, ATP)

What are the characteristics and treatment of neuropathic pain?

characteristics:
- pain from dmg nerve endings that result in abnormal signal processing. Pain sensation serves to purpose
treatment:
- gabapentin 100 mg 1-3x/day, titrate up to 1800 mg/day
- lyrica 25-100 mg up to q 8hr
- cymbalta (duloxetine)
  - tapering req’d at end of treatment

What is the diagnostic criteria for HAP?

arises 48 hrs or more after hospital admission not incubating at time of admission

What is the treatment fo COVID-19?

no approved FDA treatment, get it and ur ded
supportive mgmt of complications

What is the A1c goal for stroke prevention?

< 7%

What is important in a migraine assessment and what is included in prevention, workup, and treatment?

* most important: history, history, history * complicated Dx of exclusion * status migrainosus (HA \> 72 hrs) * Treatment: * NSAIDs, neuroleptics, triptans, ergot, alkaloids, opioids * PPX: * propranolol, topamax, TCA, depakote * Must treat in pregnancy * r/t eclampsia; magnesium used in Tx

What are the effects of an ACA stroke?

* Leg weakness * Leg sensory loss * Behavior abnormalities (Frontal Lobe) * Transcortical aphasia (Left ACA) * Left hemi-neglect (Right ACA)

How are obesity, smoking, and OSA r/t storke prevention?

* obesity and smoking increases risk for stroke * OSA is an independent risk factor for storke

What are the S/Sx of SIRS?

* Temp \> 38 or \< 36 * HR \> 90 * RR \> 20 or PaCO2 \< 32 * WBC \> 12 or \< 4 or bandemia present (\> 10%)

What is the most common CAUTI pathogen?

E. coli

What is the TOAST criteria and what is it comprised of?

* classification system for ischemic stroke into 5 subtypes * types: * large artery atherosclerosis * cardioembolism * small vessel occulusion * stroke of other determined etiology * stroke of undertermined etiology

What are the causes/contributing factors to an embolic stroke?

* embolism * atherosclerosis * inflammation

What is the general treatment for CAUTI?

ABX for 7-14 days

How do older patients present with CAUTI?

* AMS * altered appetite

What are the risk factors for developing VAP?

* duration of intubation or nasogatric intubation * large vol aspiration or chronic lung Dz * depressed LOC * supine * thoracoabdominal surgery * prior ABX

What are the clinical features of sepsis?

* mycardial depression * altered vasculature and organ perfusion * imbalance of O2 delivery and comsuption * metabolic (lactic) acidosis

What are the TPA contraindications r/t vital signs and lab values?

* glucose \< 50 or \> 400 * BP \> 185/110 * PLT \< 100,000 * INR \> 1.7 and on warfarin

What substances inhibit pain?

* endogenous opioid peptides * enkalphins - spinal cord/brainstem * triggered by serotinin * beta-endorphines - hypothalamus/pituitary * most like morphine * dynorphins - released by spinal cord/brainstem * 200x stronger vs morphine

What is the BP goal for stroke prevention with HTN?

* \<140/90 * w/ DM \<130/90

What are the TPA contraindications r/t history?

* Basically are you bleeding now or bled a lot before * Recent * acute stroke * major surgery (last 2 wks) * or current GI/GU bleed * major head trauma * Hx of intracranial hemorrhage

What are the effects of a Left MCA stroke?

* Right sided deficits and language impairments * Right hemiplegia/sensory loss * Expressive aphasia (Broca's) * Receptive aphasia (Wernicke's) * Right homonymous hemianopia

What the testing/lab abnormalities r/t SARS-CoV-2?

* lymphopenia (most common) * neutrophilia ↑ * serum alanine aminotransferase ↑ * aspartate aminotransferase ↑ * lactate dehydrogenase ↑ * CRP ↑ * ferritin ↑ * procalcitonin ↑ (in ICU usually) * elevated D-dimer * ↑ risk of mortality

What is included in the NIH stroke scale and what does the scoring mean?

* 11 components that grade stroke deficits * 0-42 points * Higher score = more stroke deficits