Disorders of Circulation in CNS Flashcards

Question

Increased ICP Effects

Answer 1

impeded circulation to brain impeded absorption of CSF impacts fx of nerve cells leads to brainstem compression/deat

Answer 2

``` Altered level of consciousness (earliest sign of increased ICP) pupillary changes fever headache nausea vomitting abnormal respirations ```

Answer 3

``` elevated SBP widened pulse pressure bradycardia LATE changes in motor function positive babinski (toes extended) decorticate (Cs inward) decerebrate(Es outward) seizures ```

Answer 4

``` gauge impact of acute brain trauma vascular injury/infection hepatic/renal failure hypoglycemia diabetic ketoacidosis ```

Answer 5

<8 9-12 13-15

Answer 6

``` avoid increasing intra pressure (straining/coughing/blowing nose) head of bed 30-40 degrees head in neutral position avoid flexion of neck/hips minimal stimuli bring items closer to prevent reaching ```

Answer 7

``` imbalance of I/O CSF flow blockage of CSF through ventricles Inhereted genetic abnormalities/developmental disorders (ex spina bifida) complications of premie birth intraventricular hemorrhage meningitis tumors traumatic head injury subarachnoid hemorrhage ```

Answer 8

``` rapid increase of head circumference unusually large head size vomiting sleepiness irritability downward deviation of eyes (sun setting) seizures ```

Answer 9

``` skulls cannot expand headache w/ vomiting nausea blurred/double vision sun setting balance issues poor coordination gait disturbance urinary incontinence slow/loss of development lethargy drowsiness irritability personality/cognition changes memory loss ```

Answer 10

``` Ventriculoperitoneal (VP) shunt placed CT scan for FX/malfunction medication (controversal) only temporary acetazolamide furosemide ```

Answer 11

anticonvulsant acetazolamide inhibits carbonic anhydrase from catalyzing hydration/de of CO2 to carbonic acid controls fluid secretions promotes diuresis in abnormal fluid retention used in glaucoma tx

Answer 12

``` Stevens-Johnson syndrome toxic epidermalnecrolysis (TEN) acidosis agranulocytosis hepatic necrosis NONE cirrhosis, hypokalemia, hyponatremia, renal dysfunction, suprarenal gland failure can inhibit renal excretion of basic drugs/promote acidic drug release, increase salicylate toxicity (acidosis) C ```

Answer 13

Cerebral Vascular Resistance (CVR) x Cerebral Perfusion Pressure (CPP)

Answer 14

leads to infarction/tissue death | anaerobic glycolytic pathways initiated

Answer 15

cells can't maintain negative membrane potential excitatory amino acids in extracellular space glutamate/influx of CA ions apoptosis

Answer 16

immune cells activated leukocytes enter brain inflammatory agents contribute to brain inflammation nitric oxide/nitric oxide synthetase pathway mitochondrial dysfunction/apoptosis

Answer 17

interruption in blood supply to region of the brain or bleeding in vessel resulting in tissue damage or infarction 87% vs 13%

Answer 18

sudden onset of focal neurologic deficit persisting for at least 24 hours depend on area affected

Answer 19

partial or complete occlusion of cerebral blood flow due to thrombus/embolus atherosclerosis cardiac disorders thrombotic strokes (internal carotid artery, middle cerebral artery, basilar artery)

Answer 20

``` burst blodo vessel (intracerebral/intraventricular/extracerebral) subarachnoid hemorrhage cerebral aneurysm ischemic conversion arteriovenous malformations (aVMs) ```

Answer 21

``` restoration of blood flow/reduce area effected supplemental o2 glycemic control fibrinolytic therapy antihypertensive therapy aspirin 325 mg hypothermia blood pressure control ```

Answer 22

``` osmotic diuretics blood pressure control surgical evacuation craniotomy w/ aneurysm clipping endovascular therapy w/ coil embolization delayed cerebral ischemia (DCI) ```

Answer 23

tissue surrounding infartction

Answer 24

``` Diuretic mannitol promotes diuresis by increase ECF osomolarity tx cerebral edema/acute glaucoma increase in plasma oncotic pressure ```

Answer 25

``` GI symptoms Dizziness CHF Compartment Syndrome injection site extravasation Fluid/Elec Imbalance Acute injury of Kidneys Pulmonary Edma Coma Seizures ^ Dose = ^ risk of kidney disease/fluid overload (life-threatening pulmonary edema) [Severe Bronchospasms] anuria/aortic&cerebral aneurysm/uncontrolled HTN/recent MI or CVA/severe hypovolemia/dehydration/active intracranial bleed/pulmonary edema Tobramycin = ototoxicity fetal risk can't be ruled out ```

Answer 26

clot removal w/in 24-48 hrs of formation

Answer 27

TPA converts plasminogen to plasmin Plasmin digests fibrin strands restoring circulation regulates unwanted clots, fibrin remains

Answer 28

Tissue plasminogen activator alteplase enhances conversion of plasminogen to plasmin biding to fibrin (initiating fibrinolysis) TX acute MI/ischemic, acute CVA/pulmonary embolism/central venous catheter occlusion

Answer 29

Can Cause intercranial Hemorrhage (frequent neuro checks 15 min/signs of increased ICP like headache) Angioedema/allergic rx Once started do not insert additional IV/catheter NONE active internal bleeding/intracranial hemorrhage, AVM, bleeding diathesis, severe uncontrolled HTN/subarachnoid hemorrhage/within 3 months of cranial or spinal surgery or serious head trauma anticoagulants/antiplatlets = increased risk of bleeding ace-inhibitor = angioedma fetal risk cannot be ruled out

Answer 30

alters plasma membrane of platelets so they cannot aggregate prevent thrombi formation after stroke of MI aspirin clopidogrel monitor for bleeding/prolonged pressure needed w/ puncture sites

Answer 31

inhibits platelet aggregation by selectively bonding to receptors on platelets prevents thrombi formation after stroke or MI

Answer 32

bleeding (can be fatal) epistaxis hematuria bruising ulcers TTP [diminished antiplatelet effect if 2 loss of function alleles of CYP2C19 gene] active bleeding, peptic ulcer, intracrainial hemorrhage omeprazole (cyp2c19 inhibitors), NSAIDs/warfarin/SSRIs/SNRIs Fetal risk can't be ruled out

Answer 33

temporary episodes of neurologic dysfunction | focal brain/spinal cord/retinal ischemia wout acute infarction

Answer 34

``` facial dropping arm/leg weakness on one side of body speech difficulty sudden trouble seeing in one or both eyes difficulty walking w/ dizziness lack of balance/coordination severe headaches ```

Answer 35

``` age family prior TIA/stroke race sex sickle cell MODIFIABLE: cardiovascular disease carotid artery disease diabetes excess weight high blood pressure high cholesterol smoking heavy drinking physical inactivity poor nutrition use of birth control pills ```

Answer 36

``` exclusion of conditions that mimic TIA BG/blood tests to rule out electrocardiography noncontrast CT MRI w/ diffusion-weighted imaging CT angiogrpahy/magnetic resonance angiography carotid doppler ```

Answer 37

bleeding from bridging veins between dura mater/arachnoid membrane

Answer 38

trauma from high-speed impact to skull spontaneous acute (bleeding identified immediately after injury) chronic (brain atrophy)

Answer 39

``` headache confusion changes in behavior dizziness nausea vomiting lethargy excessive drowsiness weakness apathy seizures ```

Answer 40

``` rare trauma vascular malformation bleeding disorders epidural/subdural/subarachnoid/intramedullary ```

Answer 41

sudden/severe back pain w/ or w/out radiculopathy headache neck stiffness photosensitivity irreversible sensory loss below level of bleed

Answer 42

subdural: surgical decompression subarachnoid: surgical resection catheter-based interventional techniques focal radiation w/ gamma knife/cold photon knife

Answer 43

When was the last well?

Answer 44

Mimic the s/s of a stroke

Answer 45

TPA cannot be used for fear of causing a hemorrhagic stroke