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BSNC 2000 > CNS Regulation > Flashcards

CNS Regulation Flashcards

1
Q

Four functional brain areas

A

Cerebrum
Diencephalon
Brainstem
Cerebellum

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2
Q

Diencephalon components

A

Thalamus

Hypothalamus

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3
Q

Brainstem components

A

Midbrain
Pons
Medulla Oblongata

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4
Q

Cerebrum function

A

thinking, consciousness
sensory perception
movement, emotions, memory

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5
Q

Cerebellum function

A

balance, muscle coordination, posture

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6
Q

Diencephalon function

A

sensory relay, emotions, alert mechanism, regulation of body temp, fluid balance, sleep, appetite

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7
Q

Brainstem function

A

conduction pathway between PNS and CNS

cardiac, respiratory, vasomotor control (medulla/pons)

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8
Q

Intracranial Pressure

A

sum of pressure within the intracranial cavity

brain tissue + blood + CSF

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9
Q

Layers of the meninges

A

Dura mater
Arachnoid
Pia mater

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10
Q

Blood Brain Barrier components

A

endothelial cells with tight junctions

astrocytes

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11
Q

Where is CSF located

A

within the subarachnoid space

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12
Q

Normal ICP

A

0-15 mm Hg

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13
Q

Pathological ICP

A

sustained at > equal to 20 mm Hg

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14
Q

Anterior Cerebral Artery blood Supply

A

medial surface of cerebrum

frontal, parietal lobes + prefrontal cortex

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15
Q

Middle Cerebral Artery Blood Supply

A

lateral surface of cerebrum
frontal, parietal, temporal lobes + basal nuclei
broca’s & wernicke’s area
delivers 80% of blood to brain

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16
Q

Brain Cellular Metabolism

A

Brain cannot engage in anaerobic metabolism so it requires a constant supply of O2
otherwise, lactic acid/pyruvic acid builds up lowering pH

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17
Q

Factors causing cerebral vasodilation

A

Low O2
Decreased pH (increase in lactic/pyruvic acid)
Increased CO2

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18
Q

FAST

A 
F = facial droop
A = arm drift
S = slurred speech
T = time
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19
Q

Types of Stroke

A

Ischemic

Hemorrhagic

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20
Q

Hemiplegia

A

one sided paralysis

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21
Q

Posterior Cerebral Artery blood supply

A

posterior surface of cerebrum

occipital lobe + medial/inferior temporal lobe

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22
Q

Penumbra

A

ischemic brain tissue surrounding a central necrotic core

penumbra represents salvable brain tissue during the evolution of as stroke

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23
Q

Time period before infarction

A

3 minutes

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24
Q

Modifiable Risk Factors

A 
Hypertension
Diabetes
Hyperlipidemia / Dyslipidemia 
Heart conditions (dysrhythmia, inflammation, heart failure)
Atherosclerosis 
Obstructive sleep apnea 
Alcoholism
Cocaine 
Smoking
Hormone Replace Therapy
Oral contraceptives
Injury
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25
Q

Non-Modifiable Risk Factors

A 
Age
Gender
Race (African-Americans)
Family History/Genetics
Stroke History
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26
Q

Common vessels of ischemic stroke

A

internal carotid arteries
vertebral arteries
basilar artery

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27
Q

Conditions for Thrombosis

A 
Atrial fibrillation
Valvular disorders
Cardiogenic embolism
Dilated left ventricle
Atherosclerosis
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28
Q

Transient Ischemic Attacks

A

ischemic brain tissue without infarction
symptoms same as stroke without long-term damage
resolve within 24 hours
elevated risk of stroke for next 3 months

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29
Q

Agnosia

A

inability to recognize familiar persons/objects

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30
Q

Ataxia

A

uncoordinated muscle activity

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31
Q

Apraxia

A

inability to perform learned, motor tasks

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32
Q

Dysarthria

A

inarticulate/slurred speech due to neuromuscular impairment

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33
Q

Agraphria

A

inability to write

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34
Q

Alexia

A

inability to understand written words

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35
Q

Hemiplegia

A

one sided paralysis

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36
Q

Homonymous Hemianopia

A

loss of half of one’s vision field

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37
Q

Cerebral Perfusion Pressure equation

A

MAP - ICP

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38
Q

Medication management

A

anticoagulation
reperfusion
antiplatelet function
neuroprotective function

39
Q

Primary Motor Cortex location

A

Frontal Lobe before central sulcus

40
Q

Somatosensory Cortex Location

A

Parietal lobe behind central sulcus

41
Q

Broca’s area

A

located in frontal lobe on the left side near motor cortex

involved in speech formation/articulation

42
Q

Wernicke’s area

A

located in temporal lobe on left side near auditory cortex

involved in language comprehension

43
Q

Visual cortex location

A

located in occipital lobe

44
Q

Auditory cortex location

A

located in temporal lobe

45
Q

Gustatory cortex location

A

located in the insular lobe

46
Q

Middle Cerebral Artery Homunculus

A

hand, arm, face

47
Q

Anterior Cerebral Artery Homunculus

A

feet, legs

prefrontal cortex

48
Q

Prefrontal cortex Function

A

higher-order thinking

reasoning, planning, decision-making, problem-solving

49
Q

Hemiparesis

A

one-sided weakness

50
Q

Metabolic demand of brain

A

20% oxygen
15% CO
Adequate perfusion –> brain does not store glycogen or engage in anaerobic metabolism

51
Q

Types of Ischemic Stroke

A

Thrombotic
Embolus (fat, air bubble, traveling blood clot)
Lacunar (very small strokes, small arteries)
Watershed

52
Q

Stroke Medication Treatment

A

thrombolytics

antithrombotics

53
Q

tPA

A

thrombolytic
aka tissue plasminogen activator
dissolves fibrin fibers of blood clots
used to treat ischemic strokes –> DO NOT USE for hemorrhagic stroke

54
Q

tPA criteria

A 
> 18 years old 
onset of stroke <4.5 hours 
ischemic stroke 
no bleeding conditions
controlled HTN <185/110
normal glucose >50 mg/dL
55
Q

Common causes of thrombi/emboli

A 
cardiogenic emboli
atrial fibrillation
mitral valvular disease
left ventricular thrombi 
carotid plaque 
right-left shunting 
polycythemia
sickle cell disease
56
Q

Alcohol and blood

A

risk factor for HTN
hypercoaguability of blood
decrease cerebral blood flow
increase risk of atrial fibrillation

57
Q

Lacunar Stroke

A

<15 mm wide
affects smaller arteries
located in the subcortical region

58
Q

Types of Hemorrhagic Stroke

A

Intracerebral

Subarachnoid

59
Q

Hemostasis Stages

A

1) Vascular Spasm
2) Platelet plug
3) Coagulation

60
Q

Plasmin

A

enzyme that dissolves blood clots by breaking up fibrin

61
Q

Plasmin chemical equation

A

tissue plasminogen activator (tPA) + plasminogen –> plasmin

62
Q

Antithrombotic classes

A

anticoagulants

antiplatelet

63
Q

Factors increasing ICP

A

increase in SpCO2 (causes vasodilation)

64
Q

Dysphagia Liquid Thickening

A

Thin
Mild (Nectar)
Moderate (Honey)
Extremely thick (Spoon)

65
Q

Cushing’s Triad

A

late signs of ICP
bradycardia
decreased respiratory rate
increasing blood pressure

66
Q

Frontal lobe function

A

emotional control center
personality
executive function, problem-solving, planning, behavior

67
Q

Temporal lobe function

A

memory (hippocampus)
learning
hearing
managing emotions, recognizing faces

68
Q

Parietal lobe function

A

somatosensory sensation
visuospatial processing
math, spelling, hand-eye coordination, fine motor movement

69
Q

Occipital lobe function

A

vision

70
Q

S/S of Increased ICP

A 
nausea/vomiting
headache
blurred vision 
cushing's triad
widened pulse pressure
71
Q

Ischemic Stroke Treatment

A

thrombolytics

endovascular thrombectomy

72
Q

Hemorrhage Stroke Treatment

A

surgery

manage ICP

73
Q

NIHSS Stroke

A

lower the score the better

national stroke assessment tool

74
Q

tPA drug info

A

Onset: 30 min
Peak: 60 min
Half life: 35 min
initial bolus dose then infusion

75
Q

Hemorrhagic Stroke S/S

A

headache
vomiting d/t increased ICP
rapid onset

76
Q

BP Management

A

extreme BP >220/120 should be treated by lowering 15% but not more than 25% over 24 hours

77
Q

Hemorrhagic Stroke Diagnosis

A

CT scan

blood in CSF

78
Q

How long can you prescribe antiplatelet and anticoagulants together

A

30 days

79
Q

Antiplatelet drugs

A

aspirin

clopidogrel

80
Q

Anticoagulant drugs

A

warfarin
apixaban (XA drugs)
heparin (prodrug)

81
Q

Warfarin

A

anticoagulant
mechanism: interferes with vitamin K synthesis, interrupt clotting cascade
monitor for blooding
frequent INR checks

82
Q

Ischemic Stroke & A-fib

A

Anticoagulant

83
Q

Ischemic Stroke & No A-fib

A

Antiplatelet

84
Q

Anticoagulant mechanism

A

interrupts the coagulation cascade to prevent the formation of clotting factors

85
Q

Antiplatelet mechanism

A

prevents platelet aggregation by interrupting the enzymatic cascade

86
Q

Coagulation pathways

A

intrinsic (ends at factor 10)
extrinsic (ends at factor 10)
common (factor 10 –> thrombin)

87
Q

Impaired CNS Regulation Mechanisms

A 
Reduced Perfusion
Altered Neurotransmission
Insufficient Glucose
Infection
Degeneration
Neoplasm
Developmental defects
88
Q

Arteriovenous malformation

A

capillary bed fails to form between arterioles and venules

blood shunts from arteries (high pressure) –> venules (low pressure) causing venules to expand/weaken

89
Q

Somatic Sensation

A

touch
pain
temperature
proprioception

90
Q

Stroke Definition

A

brain tissue infarction secondary to ischemic or hemorrhagic damage. results in focal neurological deficits.

91
Q

Virchow’s Triad

A

three factors that predispose clot formation

1) hypercoagulability
2) blood stasis
3) endothelial injury

92
Q

INR

A

used to monitor anticoagulant therapy
measures intrinsic & common pathway of vitamin-k clotting factors
therapeutic range = 1.5-2.5x normal

93
Q

Origin of Embolic Stroke

A

atherosclerotic plaques in the internal carotid artery

left side of heart

94
Q

GCS Scores

A

Mild 13-14
Moderate 6-12
Severe 5-8

BSNC 2000 (9 decks)

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