Chapter 17 Flashcards

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1
Q

… is the fifth leading cause of death and the leading cause of adult disability in the US
common in geriatric patients

A

stroke

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2
Q

… and … are other common neurological emergencies

A

seizures; altered mental status

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3
Q

the brain controls …, …, and all other body functions

three major parts: …, …, and ..–> … is the largest part

A

breathing; speech; brain stem; cerebellum; cerebrum; cerebrum

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4
Q

the … controls the most basic functions

the cerebellum controls … and … coordination

A

brain stem; muscle; body

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5
Q

messages sent to and from the brain travel through nerves:
… nerves run directly from the brain to parts of the head
the rest of the nerves join in the … and exit the brain through the foramen magnum
at each vertebra in the neck and back, two nerves branch out from the …and carry signals to and from the body

A

twelve cranial nerves; spinal cord; spinal cord

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6
Q

many different disorders can cause brain dysfunction: can affect the patient’s …, …, and …
the brain is sensitive to changes in oxygen, glucose, and …–> significant change in any one of these levels will result in a neurologic change

A

level of consciousness; speech; voluntary muscle control; temperature

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7
Q

headache is one of the most common complaints and can be a symptom of another condition or a … on its own
only a small percentage of headaches are caused by a serious med condition

A

neurologic condition

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8
Q

tension headaches: caused by … in the head and neck
attributed to …
pain is usually described as squeezing, dull, or as an ache
usually do not require med attention

A

muscle contractions; stress

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9
Q

migraine headaches:
thought to be caused by changes in the … size in the base of the brain
pain is usually described as pounding, throbbing, and pulsating
often associated with … and … and may be preceded by … changes
can last for several hours or days

A

blood vessel; nausea; vomiting; visual

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10
Q

sinus headaches: caused by pressure that results from … in the sinuses

A

accumulated fluid

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11
Q

serious conditions that include headache as a symptom are …, .., and …

A

hemorrhagic stroke; brain tumors; meningitis

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12
Q

stroke: also called a …
interruption of .. to an area within the brain
results in the loss of …

A

cerebrovascular accident (CVA); blood flow; brain function

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13
Q

ischemic stroke:
most common, accounting for more than 80% of strokes
results from … or an …
symptoms may range form nothing to complete ..
… in the blood vessels is often the cause

A

thrombosis; embolus; paralysis; atherosclerosis

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14
Q

hemorrhagic stroke accounts for 13% of strokes
cerebral hemorrhages are often ..
… are a common cause of hemorrhagic strokes in healthy, young people–> presents as the “worst headache of their life” and causes a … hemorrhage

A

fatal; berry aneurysms; subarachnoid

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15
Q

transient ischemic attack (TIA): when stroke-like symptoms go away on their own in less than … hrs, the event is called a TIA
may be a warning sign of a … to come and is considered an emergency–> about one third of patients who have a TIA will experience a stroke soon after
all patients with a TIA should be evaluated by a physician

A

24; larger stroke

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16
Q

signs and symptoms of stroke:

sudden … or … in the face, arm, leg, or one side of body
decreased/absent … and … on one side of the body
lack of … (ataxia) or loss of …
sudden … in one eye, blurred or double vision

A
facial drooping;
weakness; numbness; 
movement; sensation
muscle coordination; balance
vision loss
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17
Q
signs and symptoms of stroke: 
difficulty … 
decreased level of … 
… disorders
difficulty expressing … or inability to use the right … 
… speech (dysarthria)
… and … headache
A

swallowing; responsiveness; speech; thoughts; words; slurred; sudden; severe

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18
Q
signs and symptoms of stroke cont: 
..
…
…
…
…
..
...
A
confusion
dizziness
weakness
combativeness
restlessness
tongue deviation
coma
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19
Q

stroke in the left cerebral hemisphere may cause …–> inability to produce/understand speech
strokes that affect the left side of the brain can also cause paralysis of the … side of the body

A

aphasia; right

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20
Q

strokes that affect the right side of the brain cause paralysis of the … side of the body. patients can … language and speak, but their words may be …
patients may be oblivious to their problem; this symptom is called …
patients with a problem affecting the back part of the cerebrum may neglect certain parts of their …
neglect and lack of pain cause many patients to delay seeking help

A

left; understand; slurred; neglect; vision

21
Q

bleeding in the brain:
patients may have …–> may be the cause of the bleeding or may be caused by the bleeding as a compensatory response
a trend of an … is an important sign
significant drops may occur as the patient’s condition worsens

A

high blood pressure; increasing blood pressure

22
Q

conditions that may mimic stroke:


… or … bleeding

A

hypoglycemia
postictal state
subdural; epidural

23
Q

a seizure is a neurologic episode caused by a sure of … activity in the brain
in the US it is estimated that 2 to 3 million people have epilepsy

A

electrical

24
Q

generalized (tonic-clonic) seizure: this type of seizure results from abnormal … from large areas of the brain, usually involving both hemispheres
characterized by … and a generalized severe … of all muscles that lasts several mins or longer

A

electrical discharges; unconsciousness; twitching

25
Q

absence seizure:
does not involve any changes in .. activity
characterized by a brief … in which the patient seems to … and not respond

A

motor; lapse of consciousness; stare

26
Q

partial (focal) seizure:
simple partial seizure: no change in the patient’s level of …
may have .., .., …, … changes, or unusual … and …
may cause some .. or brief …

A

consciousness; numbness; weakness; dizziness; visual; smells; tastes; twitching; paralysis

27
Q

partial (focal) seizure
complex partial seizure:
altered …
results from abnormal discharges from the … of the brain
characterized by …, …, …
patients also may experience unpleasant .. or visual …, exhibit … or perform … physical behavior

A

mental status; temporal lobe; lip smacking; eye blinking; isolated jerking; smells; hallucinations; uncontrolled fear; repetitive

28
Q

patients may experience an .. prior to a seizure

A

aura

29
Q

generalized seizure:
characterized by sudden …, chaotic muscle … and … and …
most seizures last 3 to 5 mins
followed by a … state

A

loss of consciousness; movement; tone; apnea; postictal

30
Q

absence seizure:
formerly called petit mal
lasts for …
patient fully recovers with a brief … of the event

A

seconds; lapse of memory

31
Q

status epilepticus: seizures that continue every .. without the person regaining … or last longer than .. mins

A

few minutes; consciousness; 30

32
Q
causes of seizures: 
… 
… 
… 
… 
epileptic seizure can usually be controlled with meds
A

congenital
structural
metabolic
febrile

33
Q

recognize when a seizure is occurring and whether this episode differs from ..
identify other problems associated with the seizure

A

previous ones

34
Q

postictal state:
following the seizure, a patient’s muscles … and the breathing becomes ..
patients may be present with …, …, or …
if the patient’s condition does not improve, consider other problems such as infection/hypoglycemia

A

relax; labored; hemiparesis; lethargy; confusion

35
Q

seizures are often mistaken for …

A

syncope

36
Q
aside from stroke and seizures, the most common type of neurologic emergency that you will encounter is a patient with an altered mental status. causes include: 
… 
… 
… 
.. 
… 
unrecognized … injury
.. infection
… abnormality
.. 
…
A
hypoglycemia
hypoxemia
intoxication
delirium 
drug overdose
head
brain
body temp
brain tumor 
poisoning
37
Q

causes of AMS (altered mental status):
…: patients can have signs and symptoms that mimic stroke and seizures
…: a symptom, not a disease; presents as a new complaint; temporary state often with a physical or mental cause; can be reversed with proper treatment

A

hypoglycemia; delirium

38
Q
other causes of AMS: 
unrecognized … injury
severe … 
… disorders
… complications
.., particularly those involving the brain/bloodstream
A

head; intoxication; psychological; medication; infections

39
Q

all patients with an altered mental status should receive …
hyperventilation may have several negative consequences–> overinflates the lungs, which can impair … to the right atrium and cause a decrease in …

A

high-flow oxygen; blood return; cardiac output

40
Q

hyperventilation also increases the risk of … and … and may cause severe injury in patients with … and increased … causing cerebral vasoconstriction, which shunts blood (and oxygen) away from the brain causing further injury to the brain

A

regurgitation; aspiration; intracerebral bleeding; intracranial pressure

41
Q

secondary assessment: patients with intracranial bleeding may have increased … compressing the brain
can slow the … and cause … respirations
blood pressure is usually … to compensate for poor perfusion in the brain
changes in … size and reactivity indicate significant bleeding nd pressure on the brain. check … levels

A

pressure; pulse; erratic; high; pupil; blood glucose

42
Q
secondary assessment cont: 
stroke assessment: Cincinnati prehospital stroke scale 
los angeles prehospital stroke screen
… 
… mnemonic
… score
A

3-item stroke severity scale (LAG)
FAST
Glasgow Coma Scale (GCS)

43
Q

for suspected stroke patients, physicians in the ED need to determine whether there is … in the brain–> if there isn’t, the patient may be a candidate for … medication
notify the hospital regarding the last time the patient was known to be without their current signs and symptoms of stroke q

A

bleeding; blood clot-dissolving

44
Q

patients who have had a seizure require definitive eval and treatment in the hospital
for patients having a seizure:
protect them from harm
maintain a clear airway by ..
provide … as quickly as possible
if head or neck trauma is suspected, provide spinal immobilization

A

suctioning; oxygen

45
Q

headache–> you should be concerned if the patient complains of:
a …, severe headache
a sudden headache with .., …, …, or following …

A

sudden onset; fever; seizures; AMS; trauma

46
Q

stroke:
support the … and provide rapid transport to a stroke center
maintain a SPO2 level of at least 94%
oxygen therapy is not recommended unless the patient is experiencing … or is showing signs of …

A

ABCs; resp distress; hypoxia

47
Q

.. therapy and methods to mechanically remove the blood clot may reverse stroke symptoms and even stop the stroke if given within 3-6 hrs
transport to a designated stroke center

A

thrombolytic

48
Q

Seizure and AMS–> the patient may be in a … state on your arrival; care for patients actively seizing

A

postictal