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Acute Test #2 > Cerebrovascular Dysfunction > Flashcards

Cerebrovascular Dysfunction Flashcards

1
Q

physical exam findings

A
  • mental status - orientation (situation, person, place, time)
  • Glasgow coma scale (verbal, motor, eye, LOC)
  • cranial nerves (movement and pupils)
  • posturing (flexion/extension)
  • reflexes
  • intracranial pressure
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2
Q

signs of increased ICP (9)

A
  • headache
  • decreased LOC
  • seizure
  • vomiting w/ out nausea
  • papilledema
  • periorbital bruising
  • cranial nerve VI palsies (looking side to side)
  • cushing’s triad
  • peds = increasing agitation
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3
Q

Glasgow coma scale

A
  • eye opening
  • verbal response
  • motor response
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4
Q

Glasgow coma scale scores

A
  • 15-13 = mild head injury
  • 12-9 = moderate head injury
  • 8-0 = severe head injury (coma)
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5
Q

assessment of infant responsiveness

A
  • alert - responsive to parents, babbles, smiles
  • verbal - responsive to verbal stimuli
  • pain - responsive to painful stimuli only
  • unresponsive - to painful stimuli
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6
Q

diagnostic test for head injury

A
  • neuroimaging - MRI, CT
  • X-Ray
  • EEG = electro encephalogram - abnormal electrical impulses
  • biopsy
  • lumbar puncture
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7
Q

MRI for peds

A

need to be sedated which is bad for a head injury

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8
Q

EEG for kids

A
  • sleep deprived EEG

- kid has not slept so that they sleep through EEG

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9
Q

lumbar puncture

A
  • worried about how much increased ICP they have
  • if highly increased then LP can cause brain to shift down and put pressure on brain stem affecting autonomic functioning
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10
Q

tentorial herniation

A
  • when LP causes brain to shift down and put pressure on brain stem
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11
Q

LP for kids

A

roll on their side

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12
Q

concussion

A
  • the brain shakes in skull stretching fibres holding brain in place
  • stretch releases neurochemicals = symptoms
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13
Q

concussion symptoms

A
  • fog
  • headache
  • photosensitivity
  • nausea
  • confusion (short or long)
  • amnesia 5 mins before event
  • weird pupil response
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14
Q

concussion treatment

A
  • physio
  • gradually brought back to activities that increase HR
  • avoid weight training because of straining which increases ICP
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15
Q

meningitis

A

inflammation of the meninges

- less often now cause of vaccines

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16
Q

types of meningitis

A
  • bacterial = worse than viral, caused by bacteria

- viral = caused by a virus

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17
Q

meningitis symptoms (8)

A
  • stiff neck
  • headache
  • Kernig’s sign
  • Brudzinski’s sign
  • rash (red/purple pinpoint)
  • photosensitivity
  • high temp
  • lethargy/irritable
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18
Q

Kernig’s sign

A
  • to diagnose meningitis

- pain when knee bent

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19
Q

Brudzinski’s sign

A
  • to diagnose meningitis

- knees bend when head if lifted

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20
Q

3 main seizure types

A

1) partial seizures
2) generalized seizures
3) unclassified epileptic seizures

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21
Q

epilepsy

A
  • more than one seizure
  • a chronic disorder
  • no triggers
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22
Q

partial seizures

A
  • local onset
  • involve small location in brain
  • one hemisphere
  • no loss of consciousness
  • short lived
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23
Q

generalized seizures

A
  • initial discharge from both hemispheres
  • no focal onset
  • lose consciousness
24
Q

unclassified epileptic seizures

A
  • don’t fit into any other category

- generally associated with other syndromes

25
Q

febrile seizures

A
  • seizure associated with a febrile illness (upper resp or GI)
  • absence of CNS infection
  • no acute electrolyte imbalance
  • higher risk w seizure disorder
  • peds population
  • happens at initial spike in temperature once per illness
  • some kids are just more prone than others
  • treat infection in ER and educate
26
Q

status epilepticus management

A
  • medical emergency
  • ABC’s, vitals
  • O2 - not taking big breaths (100%)
  • IV access and IV or rectal antiepileptics
27
Q

status epilepticus

A
  • full blown seizure lasting at least 10 mins
28
Q

steps for seizure management (7)

A
  • safety (move objects) & help
  • time
  • place on side
  • O2 sat & monitor
  • call doc for stat med orders
  • if 10+ mins get BP (manual) and BG
  • admin anti epileptics
29
Q

antiepileptics

A
  • lorazepam (Ativan) is drug of choice = shorter 1/2 life and less risk of resp depression
  • can give IV or rectally, kept in fridge, cant draw up in advance
  • dilantin (Phenytoin) - filtered when IV
  • not diazepam
30
Q

management of seizures

A
  • drug therapy
  • ketogenic diet
  • vagus nerve stimulation
  • surgical
31
Q

ketogenic diet

A
  • high fat no sugar

- lowers seizure threshold

32
Q

vagus nerve stimulation

A
  • implanted
33
Q

seizure surgery

A
  • cut corpus callosum
34
Q

Cushing’s triad

A
  • requires intubation
  • widened pulse pressure (systolic rises but not diastolic)
  • bradycardia
  • irregular respirations
35
Q

interventions to lower ICP

A
  • airway management
  • hyperventilation
  • activity management
  • positioning (45 degree angle)
  • bowel management (no straining)
36
Q

airway management to lower ICP

A
  • hyperoxygenation

- open airways

37
Q

activity management to lower ICP

A
  • cluster interventions so not bugging all the time

- quiet calm environment to decrease brain stimuli

38
Q

stroke

A
  • ischemia or hemorrhage results in death of brain cells

- severity based on location and extent of brain involved

39
Q

2 types of stroke

A
  • ischemic - blocking flow

- hemorrhagic - bleeding

40
Q

ischemic stroke

A
  • 87% of all strokes
  • thrombotic or embolic
  • TIA usually precursor
41
Q

transient ischemic attack

A
  • TIA
  • resolves, lasts ~1hr
  • may be residual effects
  • increases risk of stroke
42
Q

thrombotic stroke

A
  • thrombosis from injury to blood vessel wall and formation of clot or narrowing of blood vessel
  • most common cause of stroke
43
Q

embolic stroke

A
  • embolus lodges and occludes a cerebral artery
  • infarction and edema of area supplied by artery
  • rapid severe clinical symptoms
  • sudden onset as immediate blockage
  • may or may not be r/t activity
  • usually conscious with headache
44
Q

carotid endarterectomy

A
  • surgery for stroke

- shunt placed to re-route BF around blockage

45
Q

brain stent

A
  • placed in clogged artery to open in
46
Q

edovascular treatment in cerebral ischemic stroke

A
  • removal of clot with wire and balloon
47
Q

hemorrhagic stroke

A
  • 15% of all strokes
  • bleeding into brain tissue or subarachnoid space
  • from ruptured vessel
  • HTN is most important cause
  • occurs during period of activity
48
Q

why does hemorrhage occur during activity

A
  • increased BP

- can sometimes also happen first thing in AM as BP is higher in AM

49
Q

intracerebral hemorrhage

A
  • sudden onset of symptoms with progression over minutes to hours
  • neuro deficits
  • headache
  • N & V
  • decreased LOC
  • HTN
50
Q

subarachnoid hemorrhage

A
  • commonly cause by ruptures of a cerebral aneurysm
  • majority of aneurysms are in circle of Willis
  • “worst headache of life”
51
Q

GDC coil

A
  • coiling an aneurysm

- slow blood through it decreasing BF and rupture potential

52
Q

clipping and wrapping of aneurysm

A
  • clip aneurysm so blood doesn’t flow into it causing rupture
53
Q

signs of stroke

A
  • face = drooping
  • arms = cant raise both
  • speech = slurred/jumbled
  • time = brain tissue
54
Q

treatment of bacterial meningitis

A
  • anitpyretics

- antibiotics

55
Q

treatment of viral meningitis

A
  • symptom management

- self-limiting disease

56
Q

CSF bacterial meningitis

A
  • increased pressure
  • increased protein (5+)
  • low glucose
  • thick, cloudy
57
Q

CSF viral meningitis

A
  • increased pressure
  • increased protein (0.5-5)
  • normal or low glucose
  • clear or cloudy

Acute Test #2 (4 decks)

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