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Adult Neuro One > Acute Management of Stroke and TBI > Flashcards

Acute Management of Stroke and TBI Flashcards

1
Q

Goals for acute care management

A

1 - survival
2 - (ABC) airway, breathing, and circulation
3 - manage ICP/CCP and prevent 2nd injury
4 - hemodynamic stability

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2
Q

what is the gold standard to measure BP?

A

arterial line
*do NOT pull this out

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3
Q

when the brain swells, you have increased _______ which causes decreased __________

A

intracranial pressure
central perfusion pressure

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4
Q

when CPP decreases so does ________ which causes ischemia and more edema

A

cerebral blood flow

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5
Q

normal ICP

A

0-15 mmHg

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6
Q

ICP goal in acute

A

<20 mmHg

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7
Q

CPP goal

A

50-70 mmHg
*really above 60

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8
Q

medical procedures to decrease ICP

A

external ventricular drain
lumbar drain
craniotomy
craniectomy (removes portion of skull)

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9
Q

your patient has an external ventricular drain. what needs to be completed before getting your patient up

A

the ECD needs to be clamped

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10
Q

you patient had a craniectomy. what do you need to make sure of before getting them up

A

they have a helmet on

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11
Q

signs/symptoms of increased ICP

A

altered mental status
N/V
headache
pupillary changes
papilledema
motor function changes
respiratory changes
vital sign changes

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12
Q

would you treat a patient with acidosis

A

most likely not b/c you are pulling blood supply from the brain to the muscles

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13
Q

BUN and creatinine levels tell you about…

A

kidney function

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14
Q

INR and platelets are important with..

A

hemorrhage

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15
Q

spO2% should be at least ____ and systolic BP should be greater than ______ before you work with a patient

A

92 (94 now)
90 mmHG

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16
Q

to get adequate cerebral perfusion the mean arterial pressure has to be ______ than the intracranial pressure

A

greater

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17
Q

Cushing’s triad

A

1 - bradycardia
2 - bradypnea
3 - hypertension

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18
Q

T or F: cushing’s triad is a medical emergency

A

T: it is a sign of impending brainstem herniation
ICP is greater than MAP

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19
Q

your patient had an acute loss of consciousness, left pupillary dilation and weakness on his right side. what could be happening?

A

uncal herniation

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20
Q

thalamic storming (what is it? signs/symptoms?)

A
  • increase in sympathetic NS activity caused by severe brain damage
  • increased HR, BP, breathing rate, excessive sweating, posturing
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21
Q

you go into the ICU and notice your patient, who sustained a TBI, has an ICP of 30 mmHg. what would you do next?

A

notify the nurse immediately… ICP is too high

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22
Q

3 options for medical management of DVT

A

1 - IVC filter placement
2 - heparin
3 - compression stockings (this is to prevent DVT. don’t use after you already have one)

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23
Q

gold standard for DVT diagnosis

A

ultrasound

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24
Q

wells clinical prediction rule for DVT

A

“eat chips”

E = edema (3cm diff), entire leg edema, pitting edema
A = active cancer
T = tenderness along deep veins
C = collateral superficial veins
H = history of DVT
I = is another dx just as likely (-2 if so)
P = paralysis/paresis/ immobilization of LEs
S = surgery w/in past 12 weeks or immobilized >3 days

> 2 pts is high risk
1-2 pts mod risk
<1 pts low risk

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25
Q

Homan’s sign

A

pain incalf with forced DF, used to test DVT
*don’t use this, use well’s

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26
Q

moderate-severe TBI mortality is ______%

A

20-50

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27
Q

CSF is produced by

A

choroid plexus

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28
Q

common symptoms of CSF leak

A
  • headaches that feel worse when sitting up
  • N/V
  • neck pain and stiffness
  • ringing in ears
  • vision changes
  • Halo sign
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29
Q

decorticate posturing

A

flexion UE, ext/IR LE
damage to corticospinal tract

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30
Q

decerebrate posturing

A

extension UE/LE
damage to pons/midbrain

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31
Q

penumbra

A
  • the tissue that surrounds the necrotic core
  • it is affected by ischemia but the damage can be reversed if there isn’t further insults
32
Q

tissue plasminogen activator (tPA)

A

drug that breaks up blood clots (needs to be given within 3 hours)

33
Q

brfore a patient gets a tPA what should be performed

A

an MRI to ensure the stroke isn’t hemorrhagic

34
Q

MERCI retriever

A

is a medical device that removes blood clots in the brain

35
Q

for a hemorrhagic stroke the BP goal is less than _______- mmHg

A

140

36
Q

T or F: in ischemic stroke, permissive hypertension is ok

A

T, to help preserve the pneumbra

37
Q

in ischemic stroke, the BP goal w? tPA is less than ______. without tPA it is __________.

A

185/105
220/110

38
Q

hypotension and tachycardia together could be indicative of…

A

occult internal hemorrhage

39
Q

cerebral aneurysm rupture

A

subarachnoid hemorrhagic stroke
symptoms = severe sudden HA, N/V

40
Q

acute care exam/eval components

A
  • arousal, attention, cog
  • integumentary status
  • sensory
  • motor
    -ROM
  • reflex integrity
  • vitals
  • functional activities
41
Q

pts should be turned every _____ hrs

A

2

42
Q

after a severe CVA, what are some goals of acute PT

A
  • increase voluntary movement and alertness
    reduce risk of 2nd impairments
  • manage tone
  • improve postural control
  • increase tolerance to activities
  • maintain joint integrity/ mobility
  • educate family
43
Q

T or F: evidence shows that pt’s reduced consciousness is a reason for bed rest

A

F: early mobilization is important

44
Q

are the rancho los amigos scale levels of assistance related to mobility

A

NO, they are related to cognition

45
Q

RLAS level one

A

no response, total assistance

46
Q

RLAS level two

A

generalized response, total assist

47
Q

RLAS level three

A

localized response, total assit

48
Q

RLAS level 4

A

confused/agitated, max assist

49
Q

RLAS level 5

A

confused, inappropriate max assist

50
Q

RLAS level 6

A

confused, appropriate, mod assist

51
Q

RLAS level 7

A

automatic appropriate min assist for ADL

52
Q

RLAS level 8

A

purposeful, appropriate stand by assist

53
Q

RLAS level 9

A

purposeful appropriate stand by assist on request

54
Q

RLAS level 10

A

purposeful appropriate modified independent

55
Q

pt’s in brain death, coma, veg state, or minimally conscious state are in RLA level ___ - ____

A

1-3

56
Q

RLA level 1-3 interventions

A
  • progress from PROM to AROM
  • skin checks
  • stimulation to upright positions
  • talk to pt, try to tap into automatic movements
57
Q

how many times a week would you most likely see a pt in levels 1-3?

A

3-5
*if they are there for a long time you may decrease to 1-3

58
Q

sensory stimulation

A

stimulating an unconscious person’s senses of hearing, touch, smell, taste, and vision to help recover
*careful to avoid sensory overload

59
Q

warning signs of sensory overload

A
  • flushing
  • sweat
  • prolonged increases respiration
  • agitation
  • closing eyes
  • sudden decreased arousal
  • increase in muscle tone
60
Q

dyskinesia

A

involuntary movement

61
Q

tardive dyskinesias

A
  • rapid, rhythmic, automatic
  • chewing, tongue protrusion
62
Q

chorea, ballism

A

jerky, random, un-sustained

63
Q

akathisia

A

repetitive, restless movements that cannot be inhibited

64
Q

your pt s/p stroke is agitated and they are performing repetitive movements. they are talking but it is incoherent. they can sit and reach but not complete a task. they require max assist due to cog. what level are they

A

4

65
Q

pulling out tubes, screaming, and throwing objects is most common in what 2 levels

A

4-5

66
Q

your patient becomes very agitated and starts screaming. what should you do

A
  • use a soothing tone of voice
  • make sure not to trap yourself in a room
  • make eye contact, but don’t sustain
  • give pt options
  • know when to ask for help
67
Q

a thrombotic stroke is what kind of stroke? ischemic or hemorrhagic

A

ischemic

68
Q

an arteriovenous malformation can cause what kind of stroke? ischemic or hemorrhagic

A

hemorrhagic

69
Q

Your pt s/p stroke is alert but not oriented x3. They have some attention to the environment but are highly distractible. They can follow very simple commands and complete previously learned task as long as they have structure. They require maximal assistance for cognition. What level are they?

A

5

70
Q

Your pt is sometimes oriented x3 but not all the time. They follow simple commands consistently but need maximal assistance with new learning. Their memory of old events is starting to return but they are unaware of impairments and are a safety concern. What level are they?

A

6

71
Q

Your pt is consistently oriented x2 but not time. They show some carryover with new tasks you taught them last session. They can somewhat remember new events and completes tasks automatically. They still need help w/ problem solving and overestimates their abilities. What level are they?

A

7

72
Q

Your patient is consistently oriented x3. They recall new and old memories and can carryover learning to similar tasks. They can correct inappropriate behaviors but require stand by assistance for safety. What level are they?

A

8

73
Q

at level 7 and above the primary deficit is…

A

social appropriateness

74
Q

you see a purple butterfly posted on a pt’s room door. what does this mean

A

palliative care

75
Q

what are the 2 requirements for inpatient rehab

A
  • must be able to tolerate 3 hours of therapy 5 days a week
  • must need more than 1 discipline
76
Q

ideally, all patients with CVA would be treated in a level _____ stroke center

A

1
*but if there isn’t one w/in 2 hours they are treated at a level 2

Adult Neuro One (10 decks)

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