Chapter 18 Flashcards
two functioning components for remaining conscious
intact reticular activating system and at least one cerebral hemisphere
Reticular activating system
a network of nerve cells in the brainstem that constantly transmit environmental and sensory stimuli to and from the cerebrum.
coma
An unconscious state in which the patient does not respond to painful stimuli
structural causes of AMS
Brain tumor
Hemorrhage in the cranium but outside of the brain
Hemorrhage in the brain tissue
Direct brain tissue damage from trauma to the brain
Degenerative disease of the brain
Brain abscess or infection
toxic metabolic causes of AMS
Severe hypoxia or anoxia (reduced oxygen or no oxygen)
Abnormal blood glucose conditions (high blood glucose or low blood glucose)
Liver failure
Kidney failure
Poisoning (e.g., carbon monoxide, cyanide)
other cause of AMS
shock
drugs that depress CNS
Post Seizure
infection
Cardiac rhythm disturbance
stroke
s/s of ams associated with trauma
obvious signs of trauma
Abnormal respiratory pattern
Increased or decreased heart rate
Unequal pupils
High or low blood pressure
Battle’s Sign (discoloration behind the ears—late sign)
Raccoon eyes (discoloration around the eyes—late sign)
Pale, cool, moist skin
decorticate posturing or decerebate posturing
s/s of AMS with non trauma
Abnormal respiratory pattern
Dry or moist skin
Cool or hot skin
Pinpoint, midsize, dilated, or unequal pupils
Stiff neck
Lacerations to the tongue indicating seizure activity
High systolic blood pressure and low heart rate
Loss of bowel or bladder control
Abnormally high or abnormally low blood glucose reading
what is AEIOU-TIPPS used for?
used to easily recall possible causes of altered mental status
AEIOU-TIPPS
alcohol intoxication
epilepsy (seizure)
insulin (diabetic)
oxygen (hypoxia)
Uremia (kidney failure)
Trauma
Infection
Psychiatric
Poisoning
Shock
neurologic deficit
any deficiency in the functioning of the brain or nervous system. Altered mental status, slurred or absent speech, paralysis, weakness, and numbness are all signs and symptoms of neurologic deficit.
stroke
sudden disruption in blood flow to the brain that results in brain cell damage
FAST is used for?
identifying stroke
FAST
Facial Droop
Arm weakness
Speech difficulty
Time last known to be well
LAMS (los angeles motor Scale)
Facial Droop 0-1
arm drift 0-2
speech 0-1
grip 0-2
total 0-6, 4 or above needs more advanced treatment
ischemic penumbra
The area of ischemia during the stroke, where the brain cells are electrically silent from a lack of ATP but are still alive
infarct zone
area of dead tissue caused by absence of blood flow
ischemic stroke
stroke caused by clot blocking blood to brain most common 87 percent of all strokes
hemorrhagic stroke
caused by rupture of blood vessel in the brain that allows blood to leak and collect in/around brain tissue
responsible for 13 percent of strokes
thrombotic stroke
caused by stationary clot that forms in and blocks cerebral artery
cerebral embolism
embolus lodges in cerebral artery
embolic stroke
stroke caused from embolus lodging in cerebral artery
atrial fibrillation
irregularly irregular heart rhythm highly associated with cerebral embolism
hemorrhagic stroke two types of weakened vessels
aneurysm, AVM
arteriovenous malformation
tangle of abnormally formed blood vessels in the brain or on its surface, which divert blood directly from the artery to the vein, bypassing the capillaries
Hemorrhagic Stroke with Bleeding in Brain Tissue (Intracerebral) s/s
Headache
Nausea and vomiting
Weakness to one side of the body
Decreased level of consciousness
Hemorrhagic Stroke with Bleeding in the Subarachnoid Space (Subarachnoid)
Worst headache
Intolerance to light
Vomiting
Decreased level of consciousness
categories of stroke
anterior circulation
posterior circulation
anterior circulation stroke
occurs from the blockage of a cerebral artery that perfuses the cerebrum and cerebral cortex. The cerebrum is composed of the right and left hemispheres of the brain. The anterior circulation vessels perfuse approximately four-fifths of the brain.
anterior circulation stroke s/s
Weakness, clumsiness, heaviness, or complete paralysis of the hand, arm, leg or face on one side of the body (unilateral)
numbness tingling, loss of sensation on one side of the body
language disturbance: aphasia
Total or partial loss of vision in one eye (monocular blindness) might occur. The patient might also describe his vision disturbance as a dropped curtain, fog, or a grayout or blackout.
eye gaze, eye looks toward side of stroke
aphasia
difficulty speaking/understanding speech
expressive aphasia
knowledge of what you want to say, but cant say it
receptive aphasia
difficulty understanding what is said to you
global aphasia
cant understand or speak, most severe form of aphasia
posterior circulation stroke s/s
Weakness, clumsiness, heaviness, or complete paralysis of the hand, arm, leg, or face on one (unilateral) or both (bilateral) sides
numbness, tingling, or loss of sensation can occur to the hand, arm, leg, or face on the right, left, or both sides of the body
language disturbance: dysarthria
might complain of double vision (diplopia) or bouncing or moving visual objects
vertigo or ataxia
dysarthria
slurred or difficult-to-understand speech caused by weakness or paralysis of the muscles used to form words.
posterior circulation stroke
one-fifth of the brain; however, it is responsible for supplying blood to the brainstem and cerebellum.
ataxia
loss of coordination
vertigo
spinning sensation
Transient Ischemic Attack (TIA)
“mini Stroke”
brief episode of stroke like symptoms typically disappears with in minutes but can last up to an hour,
cryptogenic stroke
one that cannot be conclusively attributed to an embolism originating from the heart, thrombosis in an artery, or small artery disease despite extensive medical diagnostic testing.
vascular headache
occur because of dilation or distention of vessels or inflammation within the cranium
migraine
thought to be caused by spasm of vessels followed by vasodilation and a change in the chemicals that transmit nervous impulses in the brain. Migraines are often described as throbbing and can be generalized or localized to one side of the head.
commonly experiences sensitivity to light (photosensitivity), nausea, vomiting, and sweating
cluster headache
occur repetitively, in clusters. They are similar to migraines because they are believed to have a vascular origin. The pain is usually found on only one side of the head or face in the temporal region or around the eye and is excruciating.
might also complain of excessive tear production on the side of the pain, nasal congestion or runny nose (rhinorrhea), and nausea
tension headaches
thought to be caused by contraction of the muscles of the neck and scalp. The pain is usually described as “tight” or “viselike.” This is the most common type of recurring headache found in children, adolescents, and adults
organic headaches
Also called traction or inflammatory headaches, these are not simply headache conditions but rather are symptoms of another condition. They may be a result of tumors, infection, stroke, or inflammatory disorders within the cranium such as a hemorrhage or meningitis.
A&O x0-4
Alert to self, place, time and event
