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semester 2 2019 > neuro disorders > Flashcards

neuro disorders Flashcards

1
Q

common causes of stroke?

A 
HTN
atherosclerosis
CAD, hyperlipidemia
diabetes
consequence of AF (ischaemic)
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2
Q

modifiable risk factors for stroke?

A

hypertension

hyperlipidemia

smoking

obesity

inactive lifestyle

excessive alcohol intake

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3
Q

non-modifiable risk factors for stroke?

A

age

previous history including TIAs

male

family history

ethnicity - African- American, Hispanic, and Asian-Pacific Islander population

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4
Q

what is ischaemic stroke caused by?

A

blocked artery from an emboli or thrombus

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5
Q

pathophysiology of ischaemic strokes?

A
  1. vascular occlusion secondary to thromboembolic disease
  2. ischaemia causes cell hypoxia and depletion ATP → ion channels are impaired→K+ leaves the cells and Na+ and Ca2+ enter→cerebral oedema
  3. overwhelming inflammatory response leads to further damage
  4. further neuronal cell death and irreversible damage
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6
Q

pathophysiology of haemorrhagic strokes?

A

rupture of blood vessels

bleeding occurs directly into brain parenchyma

damage in surrounding area due to increased
intracranial pressure

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7
Q

types of haemorrhagic strokes?

A
  • Subarachnoid: bleeding occurs under the thin, delicate arachnoid membrane surrounding the brain
  • Intracerebral: bleeding within brain itself
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8
Q

difference between TIA and ischaemic stroke?

A

in TIA, interruption of blood flow temporary (<24 hours) and thrombus/emboli resolves spontaneously

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9
Q

clinical manifestations of stroke in occipital lobe?

A

vision issues

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10
Q

clinical manifestations of stroke in parietal lobe?

A

loss of sensation

issues with spatial tasks, reading or maths

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11
Q

clinical manifestations of stroke in frontal lobe?

A

loss of emotional control, social skills

speech issues

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12
Q

clinical manifestations of stroke in temporal lobe?

A

issues with understanding and remembering language

issues with understanding and remembering non-verbal information

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13
Q

clinical manifestations of stroke in brain stem?

A

Physical and sensory problems

Autonomic regulation of BP/Resp control

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14
Q

clinical manifestations of stroke in cerebellum?

A

Physical and sensory problems

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15
Q

acronym associated with recognising stroke?

A

FAST

face, arms, speech, time

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16
Q

common tests for Ax and Dx of stroke?

A
  • Brain scans: CT scan & MRI
  • ECG & echocardiogram
  • Transcranial Doppler
  • Cerebral angiogram
  • Carotid duplex
  • Blood tests: international normalised ratio or INR
  • Urine tests or chest X-rays
17
Q

drug therapy for haemorrhagic stroke?

A

anticonvulsants

anti-hypertensives

osmotic diuretics

18
Q

what is epilepsy?

A

a chronic neurological disorder characterised by recurrent seizures

19
Q

increase in risk of death in epilepsy?

A

up to 2-3 times higher than general population

20
Q

common causes of epilepsy?

A

stroke
head injury
genetics
infections

21
Q

two main types of seizures?

A

focal - one side of brain, +/- impaired conscious state

generalised - both hemispheres affected, always impaired consciousness

22
Q

what is a seizure?

A

abnormal electrical activity in the brain causes an involuntary change in body movement, sensation, awareness, or behavior

23
Q

what causes a seizure?

A

a momentary ‘imbalance’ within electrical and chemical circuits in the brain; excitatory neurotransmitters > inhibitory neurotransmitters.

24
Q

triggers for seizures?

A

stress

lack of sleep/fatigue

alcohol

diet and caffeine

infections and illness

febrile illness

menstruation/hormonal changes

missed medications

N+V and diarrhoea can lead to poor drug absorption

illegal drugs

photosensitivity

N+V and diarrhoea can lead to poor drug absorption

25
Q

subtypes of generalised seizures?

A

absence - LOC sudden but transient, unresponsive, often with automa lip smacking, blank state, eyelids fluttering

tonic clonic - collapse and rigidity → violent convulsions→ unconscious and deep sleep (postictal), +/- vomiting and incontinence

26
Q

manifestations of focal seizures without impaired consciousness?

A

variable according to affected area of brain

experiencing auras

confusion

vagueness

repetitive actions such as uttering unusual sounds or chewing movements

muscle spasms

tingling

visual, olfactory, aural without a stimulus

27
Q

manifestations of focal seizures with impaired consciousness?

A

variable according to affected area of brain

TEMPORAL LOBE– staring

FRONTAL LOBE – impaired memory, alterations in mood (laughing, swearing)

28
Q

first seizure phase?

A

seizure initiation

Increased AP → Persistent Na+ channels opening →Prolonged depolarisation

29
Q

second seizure phase?

A

seizure phase

spread of AP causing associated signs and symptoms

this is dependent on the type and origin of the seizure
activity

Inhibitory neurons release to inhibit excitatory actions

30
Q

third phase of seizures?

A

postictal phase (in tonic clonic only)

use of O2, glucose and ATP leads to deficiency Can lead to exhaustion and sleep

31
Q

what is the main complication of epilepsy?

A

status epilepticus

generalised recurrent seizures lasting > 30 minutes without pt regaining consciousness

medical emergency → during seizures, cerebral demands increase by 200%. → if demands not met this results in a lack of O2 and glucose to brain cells → ischaemia,
hypoxia, cell death

32
Q

nursing considerations during a seizure?

A
  1. keep pts afe→remove objects which can harm
  2. place in a recovery position
  3. supplemental oxygen
  4. suction to prevent aspiration
  5. time seizures
  6. pharmacological agents to stop seizure activity
33
Q

three main ways antiepileptic drugs work?

A
  1. increase release of GABA
  2. decrease action of glutamate
  3. inhibit Na+ movement/close ion channels
34
Q

general adverse effects + nursing considerations around antiepileptic drugs?

A

these drugs are able to cross the BBB, therefore have many CNS adverse effects

require frequent plasma level monitoring to control seizures while reducing adverse effects - constant titration!

35
Q

antiepileptic drugs that inhibit the opening of Na+ channels?

A

phenytoin

carbamezapine

36
Q

antiepileptic drugs that enhance GABA inhibitory action?

A

barbituates

37
Q

other drug classes used to treat epilepsy?

A

sodium valproate (epilim)

semester 2 2019 (16 decks)

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