Module 7 Flashcards
The brain's blood dependence: brain cells depend on: blood supplies brain cells with: blood also removes ? from? the cells of the brain have no mechanism to ? they have complete dependence on
uninterrupted and oxygenated blood
nutrition
- glucose
- oxygen
metabolic waste (carbon dioxide) from nerve cells
-store glucose or oxygen for later consumption/ blood flow
brain blood flow and stroke
-without adequate blood supply, the brain can only function ? before the cell bodies are
interruption of blood flow for 4-6 minutes results in?
- damage occurs to the ?
- the area that surrounds the core infarct is called the
- neurons in the area of the prenumbra may survive for about ? without alternate circulation, and up to ? if there is some degree of collteral blood supply
for a few minutes/ cell bodies are irreversibly damaged
irreversible brain damage
- core cells that are the center of where the infarction occured
- ischemic penumbra
20 minutes/ 6-8 hours
Acute stroke:
two types
ischemic: inadequate blood flow to the brain results in ?
hemmorhagic:
- rupture of a blood vessel
- blood which is toxic to brain tissue
- blood also causes swelling of ? swelling can further restrict ?
- issue with tissue damage and potential increasedintra cranial pressure due to the ? as well as ?
damage to the brain tissue
causes bleeding in the brain
- collects in brain tissue
- brain tissue/ blood flow to other neighboring brain tissue
- bleed itself/ swelling as a reaction to the blood
Comprehensive Stroke Center:
hospital certified by the ?
Early management of acute ischemic stroke: a guideline for ?
this designation/certificated is given to center that are able to:
.. and… treat all strokes utilizing ?
-provide ? for blood clot removal
-provide
American Heart Association/american stroke association stroke leadership council
healthcare professionals from the american heart association/american stroke association
- quickly and effectively/ medications to resolve blood clots
- catheter based procedures
- neurosurgical services
Treatment for ischemia in the brain:
what restores blood flow:
-
-
tPA (tissue plasminogen activator) - drug
thrombectomy: procedure (vascular/neurosurgery) - larger clot in larger vessel
Tissue plasminogen activator: tPA (generic name is ? ) approved by FDA in ? -dissolves blood clots that are -given to patients via -administered within ? limits risk of ? .... consider timing of
alteplase/ 1996 blocking blood flow to the brain - IV -3 hours of symptoms onset -brain damage and functional impairment -hemorrhage (risk and contraindication) -SLP intervention
Thrombectomy:
in some hospitals can be completed up to? (if imaging shows ?)
-more typically, the window is … from symptom onset (with assumption that damage to neural tissue will not be improved by ?)
time of onset is tricky calculaton
-…. onset
-variation in ?
24 hours after onset of ischemic stroke ( there would be therapeutic benefit)
6 hours (intervention)
unwitnessed
A&P of individual patients
Thoughts about stroke and COVID-19:
risk of worse outcomes with COVID-19 patients with history of ?
risk of stroke with COVID:
-two studies ad meta-analysis suggests that stroke is associated with ?
covid-19 itself may contribute to development of?
-prevalence of ischemic stroke is ?
true association remains ?
further investigation and more consistent covid screening ?
consider the non-COVID patient: risk of greater ? lasting deficits from stroke as patients are less likely to ?
stroke
2.5 fold increase in likelihood of severe COVID-19 with a trend in increased mortality
vascular events
-1.6%
unclear
-needed
injury/ seek medical treatment due to COVID
Acute Ischemic Stroke and COVID-19 an analysis of 27, 676 patients:
investigated ?
patients with covid with or without ischemic stroke and
acute ischemic stroke patients with and without ?
risk factors, comorbidities and outcomes between
covid
total of 103 patients developed ? among 8136 patients with covid
among all patients with covid the proportion of patients with hypertension, diabetes, hyperlipidemia, atrial fib, and congestive heart failure ?
acute ischemic stroke was associated with discharge to ?
acute ischemic stroke
was significantly higher among those with acute ischemic stroke
destination other than home or death
Acute ischemic stroke was infrequent in patients with ? and usually occurs in the presence of other ?
the risk of discharge to destination other than home or death increased 2-fold with occurence of ?
cardiovascular risk factors
acute ischemic stroke in patients with COVID 19
Stroke - intervention/facilities: ... care Subacute care: depends upon ? -consider -... patients sadly, can depend upon options: ... rehab -... rehab long-term ? home (... considerations) - -
acute care
level of function
- rehab needs
- ambulatory patients
finances
acute rehab (inpatient rehab) -sub-acute rehab (SNF) -care facility (frequently SNF first) (safety considerations) -home health -outpatient rehab services
Brain tumors:
a neoplasm is an area of uncontrolled ?
tumors result from an improper expression of ? and a decrease in expression of ?
-angiogenesis also promotes ? this is the formation of new blood vessels which promotes?
tumors in the brain can be ?
metastatic tumors in the brain are frequently metastasis of cancers including ?
they can also come from ? and from ?
spread results from cells traveling through the ?
growth of body tissue/ includes the glia
oncogenes (coding proteins involved with cellular growth) / tumor supressor genes
tumor growth / growth of tumor tissue
primary or metastatic
breast, lung, colon/ lymphomas and melanoma
lymphatic system or blood vessels
Neuroglial cells- functions astrocytes (CNS) -form a complete ? -contribute to the blood-brain barrier by restricting ? form ?
Oligodendrocytes:
form ? around axons in the CNS
microglia:
migrate to a site of ?
ependymal cells:
form the ?
Schwann cells (PNS) -form the ? constitute ... around fibers in the PNS
lining around the surface of the brain
- permeability of ionic substances across the blood vessels
- scars around a cerebral infarct
myelin sheaths
brain lesion and engulf cellular debris to remove it
membranous lining of the ventricular cavity
myelin sheath around axons in the PNS
fibrous connective tissue
Brain Tumors Can Be: are staged in grades (1-4) Grade 1: Grade II: Grade III: Grade 4:
non-cancerous or very slow growing
cancerous but slow growing (cells look closer to normal)
cancerous y grow faster than grade 1 and II (more cell abnormalities)
fast growing with greater cell abnormalities (may also have necrotic tissue; develop own blood vessels, spread to other parts of brain)
Brain Tumour Types:
astrocytoma:
arise from
the worst brain tumour is the ?
ependymoma:
arise from
oligodendroglioma:
arise from ? frequently found in ?
astrocytes Glioblastoma (GBM) - a type of astrocytoma
ependymal cells lining the ventricles
oligodendrocytes - frequently found in the frontal region of the adult brain
Brain Tumors (Non-malignant)
Meningioma: arises from ?
usually ?
Acoustic neuroma (vestibular ? ) arise from the ? and are typically located at the
symptoms can include: and can cause other ?
-…,…,…
cause ?
Pituitary adenomas:
cause ? and can produce ? due to ?
meninges
non-malignant
schwannoma
-nerve sheath/ cerebllopontine angle
impaired hearing acuity and equilibrium / other deficits (tumour and post-op)
-facial weakness, dysphagia, dysphonia
hydrocephalus (obstruct fourth ventricle)
hormonal dysfunction / visual deficits / compression of optic chiasm
Diagnosis and TX planning: ... planning is frequently completed at a ? typically conducted ? include: - - - - - - -
medical/surgical / neuro tumour board meeting
weekly
- neuroradiologist
- pathologist
- medical oncology
- radiation oncology
- neurosurgery
- neurology
- mid-level providers
- SLP
Treatment options:
medical ?
-
radiation?
- … therapy
- several ?
neuro?
all of the
what will?
… of the above
oncology
-chemotherapy
radiation oncology
- radiation therapy
- several types
neurosurgery
- all of the above
- timing be?
- none of the above
SLP role: Communication ? and swallowing ? pre-treatment ? post-surgery intervention during ? as needed post-treatment ? -treatment as -... participation in ?
function baseline measures functional measures medical and radiation oncology treatment, as needed functional meaurements -appropriate -education awake craniotomy
Dementia: an ? term a group of disorders that affect affects: - - -
2 types:
… dementia
… dementia
…
umbrella term
brain function
- thinking
- behavior
- ability to complete ADL
cortical dementia (alzheimers)
sub-cortical dementia (Parkinsons dementia)
combo
Types of dementia:
alzheimers:
- the most common
- accounts for ?
.. dementia:
second most
-accounts for
Lewy body:
accounts for
frontotemporal:
accounts for
other
form of dementia
40-70%
vascular dementia
- common from
- 15-25%
2-20%
2-4%
brain injury ETOH HIV PD HD creutzfeldt jakob
Role of SLP:
communication:
assessment of
educate?
-to maximize
intervention with SLP should be ?
Swallowing: assessment of ? -may be best to ask what will be -establish consider treatment may be ? due to ?
current function
-medical professionals and family members
strategies
-environmental
-comm. function
relatively short in duration
- current function
- done regarding results
- least restrictive PO diet
- patient and family wishes
- limited / cognitive comm. dysfunction
Tube feeding in severe dementia: main results: -no .. trials identified -seven -six assessed ? -the other study assessed ? there's was no evidence of increased ? none of these studies examined ? and there was no evidence of benefit in terms of ?
authors conclusions:
despite the very large number of patients receiving this intervention there is insufficient evidence to suggest that enteral tube feeding is ?
data are lacking on adverse effects of ?
randomised controlled trials identified
- observational controlled studies identified
- mortality
- nutritional outcomes
- survival in patients receiving enteral tube feeding
- QoL nutritional status or prevalence of pressure ulcers
beneficial in patients with advanced dementia
-this intervention
What is delirium: a state of characteristics of delirium include: difficulty difficulty confused about hallucinations - ... that are not develops over a short has ?
severe confusion -thinking clearly -to attend -situation/circumstances hearing or seeing things not present
period of time
fluctuating symptoms
ICU Delirium:
approx. … patients in the ICU experience delirium
approx. ona. ventilator experience delirium (while on or immediately following)
linked to negative ? increased? decreased ? and greater ?
2/3
7/10
medical outcomes n(increases LOS in ICU and Hospital) , costs, survival, long-term cognitive dysfunction
Advice for PT and family/friends speak? use ? remind patient of talk about bring ? decorate room with provide patient with if your loved one has delirium you might be asked to ?
calmly/simple words or phrases day and date family and friends glasses/hearing aids calendars, posters, family pictures favorite music/tv delirium/ sit and help calm them
Delirium prevention and Management:
delirium is one area that is part of a larger
there are specific components of care that include
care programs include:
-.. assessment and management
-reducing ? to allow for
electing the best … for individual pt’s
delirium?
early
engaging with
overall care plan in ICU
delirium in plan of care implemented
pain sedatives/ awakening and spontaneous breathing -analgesics/pain meds -prevention, assessment, mgmt mobility/exercise family members
Post intensive care syndrome: physical, psychological, and cognitive symptoms that persist ? physical symptoms include: - -.. difficulty -... and ...
psychological symptoms can include: - - - -
after critical illness
- weakness and balance issues
- breathing difficulty
- pain and numbness
anxiety
depression
PTSD
Sleep disturbance
Cog. Symptoms of PICS:
difficulty w/
memory
increased
concentration.attention
deficits
processing time
Traumatic Injury:
Traumatic injury is a term which refers to ? which require ? the insult may cause system shock called ? may require immediate ?
physical injuries of sudden onset and severity/ immediate medical attention/ shock trauma/ resuscitation and interventions to save life and limb
Metabolic, endocrine and immunologic response to trauma: body response to trauma includes: ... an increase in use of increased increased development of -higher blood glucose levels have been found to be associated with ?
tachycardia
use of oxygen
respiratory rate
insulin resistance
fatal outcomes in trauma patients
Trauma statistics:
center for disease control
10 leading causes of death in 2017 ?
in groups from ages 1 to 44 unintentional injury is ranked
for persons from 45-64 years unintentional injury is ranked
1st
3rd
History of Care for traumatic injury:
care and transportation build from medical lessons learned from ?
legislation in 1966:
accidental death and disability: the neglected disease of modern society - advocated for strong govt. leadership to develop
national highway safety act: provided funding from congress to reduce mortality from
Illinois developed the first statewide ? which extended the knowledge gained at Cook county hospital in Chicago which was one o the first
1st and 2nd world wars
trauma care as well as funding for research
motor vehicular accidents
trauma system/ first true trauma centre in the US
The American Trauma System:
designed to provide an ?
Run at the state and local level with guidance by ?
-geographic distribution of trauma system resources correlates with ? lower fatality rates seen in areas with more?
care begins in the field with ?
4 levels of trauma center
-level I trauma center: comprehensive regional resource providing ? typically located in ?
organized response to injury
- national societies
- outcomes/ clustered trauma centers
emergency medical services personel
I-IV
-total care for every aspect of injury/large cities or densely populated areas
Air Care:
modern air medical transport began in ? with what program ? the first hospital-based air medical transport in US
by 1990 there were more than ? in operation
air care reduces the amount of ? to expidiate evacuation within?
it is estimated that there are nearly ? annually with an additional 150,000 patient flown by ? each year in the US
1972/ Flight for life program at Anthony’s hospital in Denver
170 air transport programs
pre-hospital time / golden hour
400,000 helicopter transports /by fixed wing aircraft
Air care flight physiology:
oxygenation changes during ? (consideration for … levels, which may result in need for ? prior to flight)
a pneumothorax should be addressed prior to flight because of risk of ?
penetrating ocular injuries should be transported at the ? due to the impact of intraocular pressure on the retina
expansion and contraction of gasses also have painful ? sites impacted include the ? Gas within the body expands during? patients with abdominal trauma should have a ? in place to avoid any mechanical effects
Temperature ? aircraft temperature is controlled but if there is failure of that system, a plan must be inplace as hypothermia has been found to dramatically increase ? also must consider the concern of the temperature of ? within aircraft
ascent from ground to higher altitudes/ hemoglobin levels/ blood transfusion
expansion or development of a tension pneumothorax during flight
lowest possible altitude
mechanical effects on the body/ middle ear, teeth, sinuses, and GI tract / ascent/ NGT
decreases with ascent/ mortality in trauma patients/ medications and supplies
At the hospital: injuries include: known unknown -... issues that result from ? - other considerations: patient's
known injury
unknown injury
-fistulas
life-saving treatment
-intubation/extubation/tracheostomy
patients past emdical and surgical hx
impact of traumatic injury: patients require family academic / occupational need for
contiuum of care
family impact
impact of injuries
ongoing support services
Other factors:
I…
location of
family
insurance injury (out of town, state, international travel) dynamics: discharge panning - need for 24 hour care
SLP evaluation and intervention: deficits including: -disorders of -...impairment ...impairment
consciousness
comm. impairment
swallowing impairment
Dysphagia assessment decision making: special considerations for this patient population: patient positioning: -unstable -external
aility to safely ?
-… deficits
…fixators
-…
type and timing of ?
restrictions and limitations
- spine
- external ventricular drain (EVD)
transport to radiology
-cognitive comm. deficits
external fixators
-IVs and chest tubes
dysphagia assessment
Swan-Ganz Catheter:
inserted into the right side of ?
can measure ?
measures pressure in the
heart to monitor heart functions
- blood flow in the right atrium and right ventricle
- pulmonary artery
Dysphagia assessment decision making in trauma: what is the appropriate timing of the eval: -time of -medication -... factors -NGT to Small and large Ileus: obstruction of -post-surgical /?
day (alertness) delivery (pain and level of alertness) factors (is it safe to assess/safety for PO intake) -suction bowel issues -part of intestine opioid use
Dysphagia Assessment decision making: which test provides the best ? FEES: contraindications include: ... fractures ability to ... (risk of bleeding)
fluoroscopy tower versus C-arm -. - -transfer -
If MBS which contrast to utilize (whose decision)
-…
…
assessment
nasal/facial
participate/cooperate
anticoagulation
weight
positioning
transfer constraints
cognition (Ranchos IV or lower-likely not)
radiologist decision
water-soluble
barium
Covid consideration:
trauma is typically not an
anecdotally a large number of patients have been admitted to the hospital status post fall/trauma have been found to be
elective hospitalization
COVID positive
Assessment: limited in acute care due to level of formal assessment may not be ? -length of time to -higher level tasks on
formal assessments include:
SCATBI:
CLQT:
RBANS:
function/severity of injury
possible
- assess
- assessment
scales of cognitive ability in traumatic brain injury
cognitive linguistic quick test
repeatable battery for the assessment of neuropsychological status
The montreal cognitive assessment
a brief 30 question test that helps healthcare professionals detect ? allowing faster ? and patient ?
MoCA is the most ? available for detecting ? measuring ? and multiple ? which are important components not measured by ?
COGNITIVE IMPAIRMENTS VERY EARLY ON / diagnosis/care
sensitive test / alzheimers disease/ executive functions / cognitive domains/MMSE
In 2003, after analysis of the 2000 study results, a few elements of the test were optimized and a new validation study was copleted in 2003-2004 which confirmed the test’s discirminatory ability to distinguish ?
normal controls from subjects with mild cognitive impairment or mild alzheimers disease
Cognistat: Standardized for ? -..,...,... how long to administer or less with?
evaluates: - -..skills - - -
adolescents and adults
stroke, TBI, dementia
15-20 or less with screening
language spatial skills reasoning memory calculations
Mild TBI/Concussion identification of patient's who have potentially -nursing ? -may or may not involve imaging may be
mechanism to educate patients and families about
mechanism to see these patients for
athletes versus ?
- different
- pre-testing for athletes mayhave been
sustained a concussion
-identifiers
-loss of consciousness
normal
potential issues that may arise
outpatient follow up
non-athletes
-referrals for outpatient
completed
Signs and symptoms of Mild TBI: social: interactions with maintaining difficulty with participating in -engaging in -difficulty taking perspective of
others a topic in convo word-finding in convo social roles as a spuse, parent, friend activities like work and school others
Signs and symptoms of mild TBI: mental difficulty feeling difficulty with difficulty with difficulty with difficulty wih
concentrating slowed down or sluggish memory problem solving decision making multi-tasking and completing daily activities
Signs and symptoms of mild TBI emotional: change in changes in - -emotional -easily -...
personality mood/sadness irritability outbursts overwhelmed nervousness
Sign and symptoms of Mild TBI: physical ... loss of impaired slower .. or... blurry sleeping
headache balance coordintion/dizziness reaction time nausea or vomiting blurry vision difficulty
The 3 ounce water test/challenge:
initially information for swallow screening published in
several other publications followed by ? lacked adequate ?
debra suiter Ph.D. and steven leder Ph.D. completed further investigation of this screening and there is now a great deal of ?
use by use by initially used with ? subsequent investigations included varied ? not just ? includes other ?
1992
different authors/ sample size and lacked statistical power
evidence available
slps nurses stroke patients populations stroke/ neurological and pulmonary disorder and specific surgeries
Yale swallow protocol:
brief
… exam
.. water challenge
cognitive assessment
oral mechanism exam
3 oz
3 oz water test: SLP involvement in developing and or maintaining typically completed by assess patient for ? - - administer ? -...sips
this screening program nursing appropriateness to administer PO -alertness intubation
3 oz of water
consecutive sips
Performing RN stroke swallow screen:
step 1
step 2
step 3
initial assessment
swallow challenge
documentation
