Ch 17 Flashcards
1
Q
What is the 5th leading cause of death and adult disability?
A
Stroke
2
Q
What ethnicities have an increased risk of stroke?
A
African Americans, Hispanics, and Asians.
3
Q
Seizures may occur in patients:
A
Brain disorders Recent or prior head injury Brain tumor Metabolic disease Fever Genetic disposition (genetic variations often inherited from a parent)
4
Q
What are the 3 major parts the brain is divided into?
A
Brain stem
Cerebellum
Cerebrum
5
Q
What is the largest part of the 3 major parts of the brain?
A
Cerebrum
6
Q
What does the brain stem control?
A
Breathing
BP
Swallowing
Pupil constriction
7
Q
Where is the cerebrum located?
A
Behind the brain stem
8
Q
What is the cerebellum responsible for?
A
Coordinating complex tasks that involve muscles
Ex. Standing on one foot wtout falling
Walking
Writing
Picking up a coin
Playing the piano
9
Q
Where is the cerebrum located?
A
Above the cerebellum
10
Q
The cerebrum is divided down the middle into?
A
Right and left cerebral hemispheres
11
Q
What does the front part of the cerebrum control?
A
Emotion & Thought
12
Q
What does the middle part of the cerebrum control?
A
Sensation and movement
13
Q
What does the back part of the cerebrum process?
A
Sight
14
Q
Where is speech controlled in most people?
A
Left side of the brain near the middle of the cerebrum
15
Q
12 cranial nerves run directly from the brain to various parts of the head such as:
A
Eyes
Ears
Nose
Face
Remaining nerves join in spinal cord & exit brain through large opening in the base of the skull called foramen magnum
16
Q
What is the large opening in the base of the skull called?
A
Foramen Magnum
17
Q
What do the spinal nerves in the neck and back do?
A
Branch out from spinal cord and carry signals to and from the body
18
Q
The brain is most sensitive to changes in:
A
Oxygen
Glucose
Temperature levels
19
Q
What is a coma?
A
A state of profound unconsciousness and permanent brain damage can result within minutes.
20
Q
Why do the brain and skull not actually sense pain?
A
Neither contains pain receptors
21
Q
The pain associated with headaches is felt from?
A
Surrounding areas of the face: Scalp Meninges (membranes cover brain &a spinal cord); Larger blood vessels Muscles of the head, neck, and face
22
Q
Tension headaches are caused by:
A
Contractions in head & neck and are attributed to stress
23
Q
How are tension headache pain described as?
A
Squeezing, dull, or an ache
24
Q
Migraine headaches are thought to be caused by?
A
Changes in blood vessel size in the base of the brain.
25
Migraine headache pain is described as:
Pounding
Throbbing
Or pulsating
26
Sinus headaches are caused by:
Pressure that is the result of fluid accumulation in the sinus cavities
27
When dealing with sinus headaches pts they will often report increased pain when:
They bend over or heads moved forward
28
What are some serious neurological conditions that include headache as a symptom?
Hemorrhagic stroke (bleeding in brain)
Brain tumor
Meningitis
29
Incident with multiple patients reporting headache may indicate:
Carbon monoxide poisoning
30
Headache red flags are:
- sudden onset of symptoms
- explosive/thunderclap pain
- altered mental status
- age>50
- depressed immune system (known to be at higher risk for infection)
- neurological deficits
- neck stiffness/pain
- fever
- changes in vision
- one sided paralysis or weakness
31
What happens in a hemorrhagic stroke?
Blood from a ruptured blood vessel irritates the tissues of the brain and can cause increased intracranial pressure
32
What are early signs of increased intracranial pressure?
Headache
Seizures
AMS
Vomiting
33
A pt. with bacterial meningitis will often complain of?
Headache
Stiff neck
Fever
Sensitivity to light
34
What is bacterial meningitis?
An inflammation of the meninges caused by bacterial infection // central nervous system infection
35
What is a cerebrovascular accident (CVA) or stroke?
Interruption of blood flow to an area within the brain that results in loss of brain function
36
What does it mean when brain cells will develop ischemia?
Reduction of blood supply that results in inadequate O2 being supplied to the brain cells
37
What are the two main types of stroke?
Ischemic and hemorrhagic
38
An ischemic stroke occurs when:
Blood flow through cerebral arteries are blocked
39
What occurs in a hemorrhagic stroke?
Blood vessel ruptures and the accumulated blood causes increased pressure in the brain
40
Blood flow to a particular part of the brain is stopped by a blockage (blood clot) inside of a brain results in:
Ischemic stroke
41
What is thrombosis?
Where a clot forms at the site of blockage
42
Oxygen is rapidly consumed by the body during seizure activity. What should you do?
Monitor the patient's O2 saturation level with a pulse oximeter & apply high flow O2 even if you are unable to get an accurate pulse oximeter reading
43
Why does brain deterioration increase the risk of brain injury from minor forces?
Because the brain can more readily impact the inside of the skull as a result of the increased space and the veins that connect the brain to the dura are stretched.
44
A reduced brain mass may also reduce:
The patient's mental status and capacity
45
What is thrombolytic therapy?
Blood clot dissolving drugs and methods to mechanically remove blood clots
46
Thrombolytic therapy will reverse symptoms and even stop the stroke if:
Given within 3 hours (drugs) or 6 hours (mechanical methods) of the onset of symptoms.
47
Thrombolytic therapies should not be given to:
Pts with bleeding (hemorrhagic) strokes
48
Management of a patient having a stroke in the field is based on:
Supporting ABC's and providing rapid transport to stroke center
49
What is the only reliable way to tell whether there is bleeding in the brain?
Computed tomography (CT) scan
50
What is very important to the notify the hospital?
Regarding the last time the patient was known to be well (without their current signs and symptoms of stroke)
51
What should you do for pts who are having a seizure?
Protect them from harm
Maintain a clear airway by suctioning as necessary &
Administer O2 as quickly as possible
52
What should you do for pts who continue to have a seizure as in status of epilepticus?
Suction the airway
Provide positive pressure ventilation (BVM)
Transport quickly to hospital
53
What can help you differentiate if a pt is experiencing an transient ischemic attack (TIA) or a stroke?
S&S can last from minutes to 24 hours // signs of stroke that you note on arrival may gradually disappear
54
What is the most significant difference between a pt with AMS and other emergencies?
Pts with AMS cannot reliably tell you what is wrong, and there may be more than one cause.
55
What special considerations should be taken for a pt with suspected neurological emergency?
Evaluation of pt's environment
Assessing for any signs of potential trauma (mechanism of injury)
Indications of medical conditions such as diabetic supplies, medical alert tags, and evidence of seizure
56
What are some questions you can ask to determine nature of illness?
- did anyone witness what happened?
- when was the last time the patient appeared normal?
- is the pt's bed or furniture in array?
57
What approach should you do to assess ABC's to see how well these systems respond to care & treatment?
Sound approach
58
If pt is in postictal stage he/she may be:
Unresponsive
| Starting to regain awareness of the surroundings
59
How do you asses the patient's level of consciousness?
Use the AVPU scale
60
What does AVPU stand for?
Alert
Voice
Pain
Unresponsive
61
What should you do when you have determined that the patient cannot protect his/her airway?
Place the patient in recovery position to help prevent secretions from entering the airway
62
All patients with AMS regardless of cause should:
Receive high flow oxygen
63
Seizures cause patients to:
Use oxygen quickly resulting in hypoxia
64
In the immediate postictal state following a seizure you should:
Anticipate rapid, deep respirations, fast heart rate result of stress of severe convulsions
65
Ventilate pt at rate of:
10-12 breaths per minute a period of 1 second
66
Hyperventilation can cause:
Over inflation of lungs=can impair blood return to right atrium and cause decrease in cardiac output
Risk of regurgitation & aspiration
67
Hyperventilation may cause injury severe injury in patients with intracerebral bleeding & intracranial pressure:
Causes cerebral vasoconstriction which shunts blood and O2 away from brain
68
Pt more likely to sustain trauma:
Pt who has a seizure than a stroke
69
What are two evidence of a seizure?
Icontinence
| Bitten tongue
70
Why is it important to pinpoint when the symptoms first started?
Typically there is a 3 hour window in which outcomes are greatly improved if pt receives treatment
71
What indicates significant bleeding and pressure on the brain?
Unequal pupil size & reactivity
Slowing pulse and respiratjkns
BP very high to compensate poor perfusion
72
What is the name of the blood glucose monitor?
Glucometer
73
How does the portable blood glucose monitor measure glucose level in whole blood?
Using capillary or venous samples
74
To test speech ask the pt to repeat:
The sky is blue in Cincinnati
75
How do you test facial movement?
Ask pt to smile to show teeth //
| No teeth ask to see gums
76
How do you test arm movement?
Ask pt hold both arms in front of body, palms up toward the sky, with eyes closed and without moving. // next 10 sec watch pts hand. If you see one side drift toward the ground you know that side is affected
77
What does the 3 item stroke severity scale (LAG scale) look for specifically?
LOC
Arm drift (motor function)
Gaze
78
What does the mnemonic FAST stand for?
Facial droop (smile)
Arm drift (arms held out)
Speech (listen for slurred speech)
Time ( pt was last seen normal)
79
What is key info to document for a pt who may have had a stroke?
- time of onset of the S&S
- score of Glasgow Coma Scale
- results of a stroke assessment took (LAG, FAST, Cincinnati, Los Angeles)
- changes noted in reassessment
80
What should you document?
Pt's S&S
Findings of stroke scales
Airway managements & interventions performed // position pt was placed
Give description of seizure
Include bystander comments if witnessed seizure
Onset and duration of seizure
Pt mention notice an aura?
Evidence of trauma and interventions performed
If it's pts first seizure it has history of them
How often they occur & of history of status epilepticus
Record time intervention was performed // pts response to it // findings of continued reassessments
81
What might a person with chronic alcoholism have?
Decreased liver function
Blood clotting
Immune system abnormalities // can cause predisposition to intracranial bleeding, brain and blood stream infections, and hypoglycemia
82
What might be causes of AMS?
```
Unrecognized head injury
Psychological disorders
Infections (particularly involving brain and blood stream)
Hypoglycemia
Hypoxemia
Intoxication
Body temp abnormalities
Brain tumors
Overdoses// poisonings
```
83
What is delirium?
A symptom not a disease
84
What are symptoms of delirium?
Temporary change in mental status ( lethargy and agitation)
characterized by disorganized thoughts, inattention, memory loss, disorientation, striking changes in personality and affect, hallucinations, delusions, decreased LOC
85
Delirium presents itself as:
New complaint
| Temporary state often has physical or mental cause and may be reversed with proper treatment
86
Symptoms of delirium may mimic?
Intoxication
Drug abuse
Severe psychological disorders (ex. Schizophrenia)
87
What is a helpful mnemonic to use when reviewing possible causes of AMS?
```
Alcohol
Epilepsy, endocrine, electrolytes
I insulin
O opiates & other drugs
U remia (kidney failure)
```
Trauma, temp
Infection
Poinsoning, psychogenic causes
S shock, stroke, seizure, syncope, space occupying lesion, subarachnoid hemorrhage
88
Remember:
AMS symptom not disease
89
Hypoglycemia can mimic?
Conditions in brain associated with stroke
90
What's the principal difference between a stroke and hypoglycemia?
Pt has stroke may be alert and attempting to communicate normally
Pt with hypoglycemia almost always have AMS or decreased LOC
91
Seizures are often mistaken:
For syncope (fainting)
92
What's a difference between a seizure and syncope (fainting)?
Seizures may occur in any position // fainting typically occurs while standing
93
Geriatric patient's are at greater risk of:
Hypoxia
Hypotension
And/or cardiac dysrhythmias
94
What happens when a seizure has stopped?
Pt's muscles relax // become flaccid, floppy
| Breathing becomes labored (fast and deep) in attempt to compensate buildup of acids in blood stream
95
What happens to the blood stream during a seizure?
There's a buildup of acids
| Pt may turn cyanotic (lips,tongue, and skin)
96
During postictal state patients:
May be unable to maintain open airway bc of relaxed and exhausted state
97
What are critical steps during postictal state for achieving best pt outcomes?
Patient positioning
Clearing airway of secretions
Preventing aspiration
98
What is hemiparesis?
Weakness on one side of body resembling stroke
99
What happens to pts with diabetes during a seizure?
Blood glucose level may decrease due to excessive muscular contraction
100
What is incontinence?
Loss of bowel or bladder control
101
What's one clue that unresponsive or confused pts may have had a seizure is to find?
Incontinence // although seen with other medical conditions.. sudden incontinence likely sign of seizure
102
epilepsy is:
Congenital
103
What is the name for a seizure which a cause cannot be determined?
Idiopathic
104
Medications used most often to treat seizures include:
```
Levetiracetum (Keppra)
Phenytoin ( Dilantin)
Phenobarbital
Carbamazepine (tegretol)
Valproate (depakote)
Topiramate (topamax)
Clonazepam (klonopin)
```
105
What is the cause of structural seizures?
```
Tumor (benign or cancerous)
Infection (brain abscess)
Scar tissue from injury
Head trauma
Stroke
```
106
What is the cause of metabolic seizures?
```
Hypoxia
Abnormal blood chemical values
Hypoglycemia
Poisoning
Drug overdose
Sudden withdrawal from alcohol or meds
```
107
What is the cause of febrile seizures?
Sudden high fever
108
What drug that controls seizures may itself cause seizures of the person takes too much?
Phenytoin
109
What is a seizure?
Neurological episode caused by surge of electrical activity in brain
110
How many people in the US have epilepsy?
2 to 3 million
111
Seizures is classified into two basic groups:
Generalized & partial (focal)
112
Generalized (tonic-clonic) seizure results from:
Abnormal electrical discharges from large areas of the brain usually involving both hemispheres
113
What is another name for generalized seizure?
Petit mal or absence seizure
114
A partial (focal) seizure begins in:
One part of the brain
115
Partial seizures are classified as:
Simple or complex
116
What changes occur in a simple partial seizure?
```
No change in LOC
Pt may report:
Numbness
Weakness
Dizziness
Visual changes
Unusual smells or tastes
Twitching of muscles & extremities spreads slowly from one part to the other ( no severe twitching)
Brief paralysis
```
117
A complex partial seizure results from:
Abnormal discharges from the temporal lobe of the brain
118
What occurs during a complex partial seizure?
AMS
Not interact normally with his or her environment
Lip smacking
Eye blinking
Isolated convulsions
Jerking of the body or one part of body ex. One arm
Experience unpleasant smells
Visual hallucinations
Uncontrollable fear
Exhibit repetitive physical behavior ex. Constant sitting and standing
119
Generalized seizures affect the:
Entire body
120
What is an aura?
Pt may experience a warning sign prior to the event
121
A generalized seizure is characterized by:
```
Sudden LOC
Chaotic muscle movement and tone
Apnea
Experience tonic phase lasting sec where period of muscle contraction & trembling
TONGUE biting
Bladder/bowel incontinence
May exhibit bilateral movement by a cycle of muscle rigidity & relaxation lasting 1 to 3 minutes
Tachycardia
Hyperventilation
Sweating
Intense salivation
```
122
A generalized seizure lasts followed by postictal state that lasts?
3-5 min
| Postictal state: 15-30 minutes
123
The postictal state is over when?
Pt regains complete return of his or her normal LOC
124
Seizures lasting more than 5 minutes are likely to progress to:
Status epilepticus
125
What is status epilepticus?
Describes seizures that continue every few minutes without the person regaining consciousness or last longer than 30 minutes.
126
Which conditions may appear to be a stroke?
Hypoglycemia
A postictal state (period following a seizure that lasts between 5 and 30 minutes characterized by labored respirations and some degree of AMS)
Subdural or epidural bleeding (a collection of blood near the skull that presses on the brain)
127
Subdural and epidural bleeding usually occurs as:
Result of trauma
128
What is the dura?
The leathery covering of the brain that lies next to the skull.
129
A fracture near the temples may cause:
Artery bleed on top of the dura resulting in pressure on the brain
130
Subdural bleeding is:
Slower than epidural bleeding
131
What is epidural bleeding?
Bleeding outside of aura and under skull
132
What is it called when patients with bleeding in the brain?
Cerebral hemorrhage
133
Patients who have cerebral hemorrhage may have?
HIGH BP
134
BP increases as:
The body attempts to force more O2 to the area of the brain located inside a box (skull) with only a few openings
135
What happens if the right cerebral hemisphere of the brain is not getting enough blood?
The pt will have trouble moving the muscles on the left side of the body
136
What is interesting in patients with right hemisphere strokes?
Oblivious to their probs
Ex. May ask pt to lift left arm and they cannot, will lift their right arms instead // pts will seem to forgotten their left arm even exists.
137
Pts with conditions affecting back part of cerebrum may:
Neglect certain parts of their vision
138
What's another word for lack of muscle coordination?
Ataxia
139
What's another word for slurred speech?
Dysarthria
140
If the left cerebral hemisphere has been affected by a stroke may:
Exhibit a speech disorder called aphasia
141
What is aphasia?
Inability to produce or understand speech
142
What is a transient ischemic attack (TIA)?
When stroke like symptoms resolve on their own in less than 24 hours
143
A transient ischemic attack may also be called?
Mini strokes
144
In a transient ischemic attack there is:
No actual death of tissue (infarction)
145
What results in ischemic stroke?
When blood flow to particular part of brain is stopped by blockage (blood clot) inside a blood vessel
146
What is thrombosis?
A blood lot either in arterial or venous system.
147
What is an embolus?
Blood clot or other substance in the circulatory system that travels to blood vessel where it causes a blockage
148
What is atherosclerosis?
Disorder in which calcium and cholesterol build up forming plaque inside walls of blood vessels
149
The cholesterol may:
Obstruct blood flow and interfere with the vessels' ability to dilate
150
Hemorrhagic stroke results of?
Bleeding inside the brain
151
What happens in a hemorrhagic stroke?
Blood vessel ruptures and accumulated blood then forms a blood clot which compresses brain tissue next to it
152
Cerebral hemorrhage are often:
Fatal
153
Hemorrhagic stroke commonly occurs in:
People experiencing stress or exertion
154
What is an aneurysm?
A swelling or enlargement of the wall of an artery resulting from a defect or weakening of arterial wall
155
What is a berry aneurysm?
A hemorrhagic stroke in healthy young person often caused by a weakness in a blood vessel
156
What is a subarachnoid hemorrhage?
When aneurysm is over stretched and ruptures, blood spurts into an area between two of the coverings of the brain called subarachnoid space
