Neuro Flashcards
1
Q
how many diseases affect the NS?
A
600
2
Q
Disorders of the NS may affect nutrition intake by affecting these 3 areas ?
A
- swalling/taste/smell
- fine motor skills
- strength and balance
3
Q
the brain makes up ____ % of body weight
A
2%
4
Q
the brain consumes ___ % of the body’s energy
A
20%
5
Q
the peaks and grooves of the brain
what % is visible
A
gyri and sulci
30%
6
Q
what is corpus callosum?
A
communication between hemispheres
7
Q
this hemisphere controls spatial ability, musicality, arts, creativity
A
right
8
Q
this lobe deals with pain, touch, taste, temp
A
parietal lobe
9
Q
this lobe processes visual info
A
occipital lobe
10
Q
this lobe controls hearing, auditory functions, memory, emotions
A
temporal lobe
11
Q
this lobe deals with thinking, planning, emotion
A
frontal
12
Q
what are the 2 classes of functional cells in the NS?
A
- neurons - deal with cell to cell transmission
- glial cells - surround neurons and provide support for and insulation between them
13
Q
these cells surround neurons and provide support for and insulation between them
A
glial cells
14
Q
these cells deal with cell to cell transmission
A
neurons
15
Q
most neurological disorders from damage of ______
A
neurons or glial cells
16
Q
what does the cascading effect refer to?
A
in traumatic brain injury, once one neuron dies, those around it may die as well
17
Q
what is brain plasticity?
A
the ability of other neurons to take on that function
18
Q
what are 3 classifications of brain injury?
A
- open v closed
- coup vs. countrecoup
- diffuse vs. focal
19
Q
shaken baby syndrome is an example of
A
diffuse brain injury - large section of the brain is impacted
20
Q
bullet penetration is an example of
A
focal brain injury - specific location in the brain is affected
21
Q
What is the primary pathophysiology of TBI?
secondary pathophysiology?
A
primary: lacerations, crushed tissue
secondary: edema, hemorrhage
22
Q
what are 5 clinical manifestations of TBI?
A
swelling
bleeding
seizure
stroke
coma
23
Q
what is the most common cause of TBI? 2nd most common?
A
- fall
- shaken baby syndrome
24
Q
what is the leading cause of seizure disorder in canada?
A
TBI
25
1 person is injured every ____ with TBI
3 minutes
26
TBI affects males by ____ %
60%
27
TBI is:
____ x more common than spinal injury
____ x more common than breast cancer
____ x more common than HIV
44x
30x
400x
28
what are 5 mild symptoms and 5 severe symptoms of TBI?
mild symptoms:
1. dizziness
2. blurred vision
3. headache
4. light headedness
5. mood changes
6. fatigue
severe symptoms:
1. concussion
2. headaches
3. seizures
4. confusion
5. slurred speech
6. dilated vision
29
What do we use to evaluate the severity of TBI?
the glasgow coma scale
29
according to the glasgow coma scale, a score of:
___ indicates severe head injury
___ indicates moderate head injury
___ indicates mild head injury
<8 = severe
9-12 = moderate
13-15 = mild
30
how do we diagnose TBI? 3 ways
1. CT scan
2. X-ray
3. GCS
31
Treatment of TBI focuses on these 6 things:
1. blood pressure regulation
2. mechanical ventilation
3. fluid resuscitation
4. stabilization in acute care
5. promote further rehab
6. stabilize weight
7. improve brain recovery
32
what are 6 nutritional implications of TBI?
1. hypermetabolism
2. hyperglycemia
3. insulin resistance
4. increased gluconeogenesis
5. lipolysis
6. protein wwasting
33
during TBI, nitrogen excretion peaks at _____
2 weeks
34
TBI patients need to be aggressively supported with nutrition, or they can lose 15% of UBW in 1 week.
If the patient is not fed by the end of the first week post injury, mortality rate increases
35
When should you attain full caloric requirements post TBI?
by day 7
36
When should you initiate EN for TBI?
24-48 hrs post injury, once the patient is hemodynamically stable
37
What are some barriers to beginning EN after TBI?
1. delayed gastric emptying with vagal nerve damage
2. narcotics and paralytics slow transit
may need post pyloric access
38
what are 3 examples of nutritional diagnoses related to TBI?
1. hypermetabolism
2. inadequate intake
3. motor and cognitive impairment
39
what are the caloric requirements for TBI?
highly variable (can be 200% higher) - do indirect calorimetry
40
what are the protein requirements for TBI?
1.2-2.5 g/kg/d
41
what are some 90 nutrition needs the brain needs post TBI?
1. amino acids
2. protein
3. omega 3 - help improve neuron function
enough
4. glucose
5. vitamin E
5. curcumin
6. F&V
7. whole grains
8. choline
9. glutamine
42
what is the difference between paraplegia and quadriplegia?
paraplegia = full or partial paralysis of the lower body
43
how many SCHO are there in ontario each year? canada?
ontario - 600
canada = 1500
44
how do people get SCI?
trauma and accidents
45
what are 2 complications of SCI?
1. autonomic dysreflexia (overreaction of autonomic nervous system)
2. spasticity (stiff or rigid muscles, hyperactive reflexes). affects 65-78% of people
46
how do you treat SCI?
1. treat underlying cause
2. corticosteroids
3. stabilization
47
nutrition needs for TBI are similar to SCI. this trauma also triggers a systemic inflammatory response
48
what are the protein requirements for SCI?
2 g/kg/day
49
what are the energy requirements for SCI?
we feed 10% below estimate, due to reduced metabolic activity in denervated muscle
50
what is the AF and SF for SCI?
AF = 1.1
SF = 1.2
51
what are 5 long term implications of SCI?
1. obesity
2. cardiovascular disease
3. digestive issues/fecal incontinence
4. osteoporosis
5. pressure ulcers
6. higher risk of malnutrition and food insecurity
52
who is at increased risk of pressure ulcers?
malnourished people
immunocompromised people
smoking
alcohol use
high/low body weight
53
what are common sites for pressure ulcers?
where bone is close to skin
side of thigh
heels
butt
54
What are the 4 stages of pressure ulcers?
1. skin is unbroken but inflamed
2. skin is broken to the epidermis or dermis
3. ulcer extends to the subcutaneous layer
4. ulcer extends to muscle or bone
55
what are 5 things to cosnider when considering nutrition for pressure ulcers?
1. size
2. healing
3. age
4. clinical issues
5. nutritional status
56
what are caloric requirements for pressure ulcers?
30-40 cals/day
57
what are protein requirements for pressure ulcers?
1.25-3 g/kg/d
58
what are some nutrient recommendations for PU?
1. replace micronutrients as needed
2. protein supplement (need more arginine and glutamine)
3. healing vitamins and minerals: vitamin A, C, K, zin, selenium (only do these if defficient)
59
what are 3 nutrition interventions for SCI?
1. get enough energy via indirect calorimetry
2. rehab concerns
3. prevent excessive weight gain
60
how to monitor nutrition therapy for SCI?
1. prevent PU
2. keep energy needs in mind
3. weight management
61
In canada, a stroke happens every ____ minutes
10 minutes
62
what is the difference between:
1. ischemic stroke
2. hemorrhagic stroke
3. TIA
4. aneurysm
1. ischemic stroke = blood vessel that supplies blood to the brain is blocked by a blood clot. MOST COMMON
2. hemorrhagic stroke = blood vessel in the brain ruptures. Happens when blood vessel wall is weak from hypertension or aneurysm
3. TIA = a transient epsiode of ischemia with momentary symptoms consistent with loss of oxygen
4. = dilation and bulging of smooth muschle in the brain
63
What are 5 moifiable risk factors for stroke and aneurism?
5 non modifiable risk factors?
modifiable risk factors:
1. age
2. sex
3. ethnicity
4. genetics
5. previous stroke
nonmodifable risk factors:
1. hypertension
2. CVD
3. DM
4. cigarettes
5. alcohol
6. birth control
7. exercise
8. carotid stenosis
9. hyperlipidemia
64
What impacts HTN the most?
1. diet and waist circumference control
2. DASH diet
65
What are 4 warning signs of stroke?
F = face droop
A = arm weakness
S = speech difficulty
T = time to call 911
66
How do you diagnose a stroke?
1. national instititues of health stroke scale
2. CT
3. MRI
4. PET
67
how do you acutely and chronically treat stroke
acutely:
- eliminate clot and restore blood flow
- IV injection of recombinant tissue plasminogen activator release
Chronic measures:
- rehab
68
what are some nutrition implications of strokes?
1. impaired chewing, swallowing, self-feeding
2. dysphasia
3. individualized nutrition support (texture mod, EN, PN)
maximum nutrition support should begin immediately after admission and then continue through rehab because post stroke is a hypermetabolic phase
69
potential nutrition diagnoses for stroke:
1. inadequate oral intake
2. inadequate energy intake
3. inadequate fluid intake
4. inadequate protein intake
5. swallowing difficulty
5. self feeding difficulty
70
what interventions will you do with stroke?
EN support if PO is not possible
modify consistency
modify positioning of patient
manage dysphasia
71
when to start EN with stroke?
24-48 hours
72
what type of formula should be used for EN with patients with TBI
formula with EPA and DHA
73
Why does parkinsons occur?
etiology isnt clear BUT
is the result of decreased dopamine producing cells in the substantia nigra of the brain
74
what are 3 things dopamine is responsible for?
1. movement
2. mood/motivation
3. learning/memory
Parkinsons
75
____ affects 1% of the population over 70 yrs old
parkinsons disease
76
what are 5 contributing factors to parkinsons disease?
1. genetics
2. oxidative stress
3. environmental stress
4. abnormal inflammatory response
5. protein malformations
77
what is the pathophysiology of parkinsons?
we are able to get balanced and coordinated movements with a perfect balance of dopamine (excitory) and gaba (inhibitory). When you lose dopamine
78
What are 5 symptoms of parkinsons?
1. resting tumor
2. rigidity
3. bradykinesia or full akinesia (slowness of movement)
4. shuffling gate
5. posture instability
6. depression
7. anxiety
79
what is the gold standard treatment for PD?
levodopa (a dopamine precursor)
80
what do we need to be careful of when taking levodopa (meds for parkinsons)
they compete with amino acids at receptor sites and amino acids win. so if we eat protein, levodopa wont get absorbed as well
to stabilize drug effect, have ratio of 5:1 or 7:1 carbs to protein
81
What are 5 nutrition related concerns in parkinsons?
1. dehydration
2. constipation
3. gastoparesis
4. GERD
5. dysphagia
6. unintentional weight loss
decreased functional capacity to self feed
82
A spontaneous, disordered electrical discharge of cerebral neurons is called:
seizure
83
What is epilepsy?
diagnosed upon 2 or more unprovoked seizures
84
___- % of the population will have a seizure at some time in their life
10%
85
what is the etiology of epilepsy?
1. head trauma
2. CNS infection
3. drug and alcohol use
4. CNS tumors
but majority have no known precipitating event
86
what is the difference between a generalized and partial seizure?
generalized = both hemispheres of brain
87
what are 3 common medications for epilepsy?
1. gabapentin (neurontin)
2. valproic acid (depakote)
3. zonisamide (zonegran)
88
when doing the ketogenic diet, ratio of fat to carbs/protein should be:
4:1
or
3:1
89
what % of calories should be from fat?
80-90%
90
What are 4 common keto diets?
1. classic ketogenic diet
2. medium-chain trigs diet (MCT)
3. low-glycemic index treatment
4. modified atkins diet (MAD)
91
what is the classic ketogenic diet like?
3-4 fat: 1 pro/carb (but start at 1:1 --> 2:1 --> 3:1 --> 4:1)
90% cals from fat
no starchy foods
92
what is the MCT diet like?
MCT oil allows for more protein and carbs
only 73% of cals from fat
pros: good for picky eaters, allows for more carbs/proteins
cons: cant use on valproate, expensibe
17% carbs
93
for low glycemic indext treatment, how much fat?
60%
94
for MAD ketogenic diet, how many cals from fat?
65% (no more than 10% carbs from start)
very restricted carb intake
95
What type of supplementation do you need if on ketogenic diet? 5 things:
1. fibre
2. multivitamins
3. calcium
4. vitamin D
5. carnitine
96
what are some drug-nutrient interactions with epilepsy drugs?
1. vitamin D
2. calcium
3. folate
4. thiamine
5. folate
97
what are 3 examples of epilepsy diagnosis?
1. inadequate intake
2. excessive intake
3. malnutrition
4. food-medication interaction
98
what types of labs to look at for epilepsy?
1. lipid profile
2. liver profile
3. blood glucose - avoid hypoglycemia
4. beta-hydroxybutyrate (BHB) - should be > 4 mmol/L
5. fluid intake
look at growth, anthropometrics, seizure frequency records
99
What is the RD role in initiating keto diet for epilepsy?
1. nutrition education
2. vitamin/supplement support
3. grocery shopping/labeling
4. formula administration
