Chapter 17 Flashcards by Gail I

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

stroke

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… and … are other common neurological emergencies

seizures; altered mental status

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

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

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

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the … controls the most basic functions

the cerebellum controls … and … coordination

brain stem; muscle; body

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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

twelve cranial nerves; spinal cord; spinal cord

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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

level of consciousness; speech; voluntary muscle control; temperature

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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

neurologic condition

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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

muscle contractions; stress

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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

blood vessel; nausea; vomiting; visual

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

accumulated fluid

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

hemorrhagic stroke; brain tumors; meningitis

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

cerebrovascular accident (CVA); blood flow; brain function

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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

thrombosis; embolus; paralysis; atherosclerosis

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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

fatal; berry aneurysms; subarachnoid

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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

24; larger stroke

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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

facial drooping;
weakness; numbness; 
movement; sensation
muscle coordination; balance
vision loss

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signs and symptoms of stroke: 
difficulty … 
decreased level of … 
… disorders
difficulty expressing … or inability to use the right … 
… speech (dysarthria)
… and … headache

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

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signs and symptoms of stroke cont: 
..
…
…
…
…
..
...

confusion
dizziness
weakness
combativeness
restlessness
tongue deviation
coma

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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

aphasia; right

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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

left; understand; slurred; neglect; vision

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

high blood pressure; increasing blood pressure

conditions that may mimic stroke:
…
…
… or … bleeding

hypoglycemia
postictal state
subdural; epidural

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

electrical

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

electrical discharges; unconsciousness; twitching

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

motor; lapse of consciousness; stare

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 …

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

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

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

patients may experience an .. prior to a seizure

aura

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

loss of consciousness; movement; tone; apnea; postictal

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

seconds; lapse of memory

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

few minutes; consciousness; 30

``` causes of seizures: … … … … epileptic seizure can usually be controlled with meds ```

congenital structural metabolic febrile

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

previous ones

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

relax; labored; hemiparesis; lethargy; confusion

seizures are often mistaken for ...

syncope

``` 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 .. … ```

``` hypoglycemia hypoxemia intoxication delirium drug overdose head brain body temp brain tumor poisoning ```

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

hypoglycemia; delirium

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

head; intoxication; psychological; medication; infections

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 ...

high-flow oxygen; blood return; cardiac output

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

regurgitation; aspiration; intracerebral bleeding; intracranial pressure

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

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

``` secondary assessment cont: stroke assessment: Cincinnati prehospital stroke scale los angeles prehospital stroke screen … … mnemonic … score ```

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

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

bleeding; blood clot-dissolving

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

suctioning; oxygen

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

sudden onset; fever; seizures; AMS; trauma

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 …

ABCs; resp distress; hypoxia

.. 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

thrombolytic

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

postictal