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Nursing 102 > Nevous System Exam #3 > Flashcards

Nevous System Exam #3 Flashcards

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1
Q

What is a CVA?

A

cerebral vascular accident

abrupt onset of neurological deficit from lack of blood supply to a specific part of the brain

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2
Q

What are 5 non-modifiable risk factors for CVA?

A 
gender (females)
age (increased age = increased risk)
race (AA, Hispanic, American Indian)
Family Hx
Personal Hx
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3
Q

What is the #1 modifiable risk factor for CVA?

A

HTN (control)

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4
Q

What are 5 lifestyle habits that increase ur risk of CVA?

A 
smoking
ETOH
poor diet
stress
sedentary lifestyle
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5
Q

Which arteries supple anterior brain circulation? posterior?

A 
anterior = internal carotids
posterior= vertebral arteries join to form basilar artery
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6
Q

What is cerebral autoregulation?

A

ability of cerebral blood vessels to change diameter independently from systemic BP to regulate cerebral blood flow

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7
Q

is CO2 a vasodilator or vasoconstrictor?

A

vasodilator = increased blood flow

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8
Q

What stimulates ischemic cascade?

A

decreased blood flow (= inadequate ATP)

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9
Q

What is a penumbra?

A

surrounds core ischemic area

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10
Q

What are 2 classifications of CVA?

A

Ischemic & hemorrhagic

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11
Q

What usually precedes an ischemic stroke?

A

TIA

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12
Q

What is an ischemic stroke?

A

decreased blood flow to brain secondary to partial or complete occlusion of a vessel

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13
Q

Which type of CVA is most common?

A

ischemic

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14
Q

what are 2 subdivisions of ischemic strokes?

A

Thrombotic & embolic stroke

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15
Q

What is a warning sign that a TIA may happen?

A

athersclerosis

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16
Q

What is true of Sx of TIA?

A

they are temporary!

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17
Q

What causes a thrombotic stroke?

A

a thrombus located in a cerebral vessel that causes narrowing and occlusion

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18
Q

What are risk factors for thrombotic stroke?

A

athersclerosis!

HTN, DM & TIA

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19
Q

What is the onset like of a thrombotic stoke?

A

gradual progression of Sx over period of time b/c collateral circulation can compensate initially. No LOC change in 1st 24 hours. Around 72 hours infarction & cerebral edema peak

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20
Q

When do thrombotic stokes most often occur? why?

A

during or after sleep b/c liver makes clotting factors during sleep.

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21
Q

What is a lacunar stroke?

A

occlusion of a small artery that results in cavity formation, not infarction. Asymptomatic unless multiple occur over period of time

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22
Q

What is an embolic stoke?

A

a stroke that occurs when a plaque breaks off & enters cerebral circulation (usually originates from heart) causing necrosis & edema at affected area

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23
Q

What is associated with development of emboli?

A

heart diseases

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24
Q

What causes a hemorrhagic stroke?

A

cerebral hemorrhage causes a lack of blood flow to brain

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25
Q

What are 2 subdivisions of hemorrhagic stroke?

A

intracerebral & subarachnoid

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26
Q

What are S/Sx of intracerebral hemorrhagic stroke?

A

Sudden onset N&V with SEVERE HA, decreased LOC, HTN as body tries to compensate

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27
Q

Where is bleeding in intracerebral hemorrhagic stroke?

A

directly into brain tissue from deep cerebral blood vessel

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28
Q

What is the primary cause of an intracerebral hemorrhagic stoke?

A

HTN (weakens blood vessels)

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29
Q

Which kind of stroke has the slowest recovery time?

A

intracerebral hemorrhagic stroke, extensive residual loss!

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30
Q

Where is bleeding in subarachnoid hemorrhagic stroke?

A

into the subarachnoid space

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31
Q

What is the most common cause of a subarachnoid hemorrhagic stroke?

A

ruptured aneurysm

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32
Q

What are S/Sx of a subarachnoid hemorrhagic stroke?

A

N/V, SEVERE HA, seizures & stiff neck (b/c CSF fills with blood causing increased pressure)

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33
Q

What is primary complication we are concerned about with a subarachnoid hemorrhagic stroke?

A

Vasospasms (narrowed vessels)

ICU monitoring for 2 weeks until risk decreases.

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34
Q

What is an arteriovenous malformation (AVM)? and what causes them?

A

tangled web of arteries connected directly to veins with out a capillary bed
caused by traumatic injury

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35
Q

What can a CT tell you about a CVA?

A

differentiate between ischemic & hemorrhagic

size & location of lesion

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36
Q

What Dx test is used after a TIA? why?

A

CT angiogram. to visualize occlusions & narrowing in blood vessels

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37
Q

What does an MRI show you in reference to a CVA?

A

extent of the damage, more accurate than a CT

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38
Q

What is the best Dx tool for locating source of subarachnoid hemorrhagic stroke?

A

Cerebral angiogram

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39
Q

When is a LP performed after CVA?

A

If suspected subarachnoid stroke, but CT negative. LP will show blood in CSF. Contraindicated with IICP!!

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40
Q

Which factors affect the S/Sx of CVA??

A

site & size of lesion
rate of onset
presence of collateral circulation

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41
Q

What does FAST stand for?

A

Facial weakness
Arm & leg weakness
Speech problems
Time is tissue

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42
Q

What are S/Sx of CVA?

A

Unilateral numbness or weakness of face, arm, leg
confusion or other change in mental status
trouble speaking
visual disturbances
ataxia

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43
Q

If a patient has a MCA stroke where will they experience Sx?

A

UE compared to LE

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44
Q

Motor Sx of stroke are contralateral. Why? and what does contralateral mean?

A

lesions on R side of brain affect L side of body and vice versa. b/c motor pathways cross at the medulla

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45
Q

What is dysarthria?

A

difficulty with motor aspect of speech = slurred speech. Impaired pronounciation, articulation, phonation

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46
Q

What do L sided lesions cause?

A

L= Language & Lengthy (pt becomes more cautious)

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47
Q

What do R sided lesions cause?

A

R= Rapid (quick & impulsiveness) & Risk for falls

problems with space & awareness, time & judgement

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48
Q

What is neglect syndrome?

A

when a patient denies their own body parts (more common with R side lesions)

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49
Q

What is homonymous hemianopsia?

A

blindness that occurs in same half of visual field in both eyes (more common with R side lesions)

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50
Q

What is agnosia?

A

Inability to recognize an object (more common with R side lesions)

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51
Q

What is apraxia?

A

Inability to perform sequential movements on command (more common with R side lesions)

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52
Q

What lifestyle changes can be made to prevent stroke?

A

diet, exercise, control HTN!!!, smoking cessation

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53
Q

What is medication therapy for TIA?

A

Antiplatelet medications (ASA, plavix)
Oral anticoagulation for those w Afib (coumadin & predexa)
Statins to control cholesterol & reduce athersclerosis

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54
Q

What are surgical Tx for TIA?

A 
carotid endarterectomy (removal of plaques from carotid artery)
EC-IC (anastamose an extracranial artery to an intracranial artery to perfuse beyond an obstruction)
Transluminal angioplasty (balloon inflated in carotid artery to open vessel)
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55
Q

Why do we not Tx HTN in acute stage of stroke until it is greater than 220?

A

b/c the HTN is a compensatory mechanism to improve perfusion of brain

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56
Q

why is airway compromised in ischemic stroke?

A

decreased LOC

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57
Q

What is drug therapy for ischemic stroke?

A

tPA- tissue plasmainogen activator. “clot buster”

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58
Q

When must tPA be taken?

A

3-4.5 hours after onset of 1st S/Sx

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59
Q

Where is tPA administered with an MCA stroke?

A

locally at the blockage site guided via catheter, within 6 hrs of Sx onset

60
Q

What is surgical Tx for ischemic stroke?

A

MERCI (mechanical embolus retrieval in cerebral ischemia) clot pulled out of body using corkscrew like instrument

61
Q

Acute hemorrhagic stroke care:

A

Maintain BP & increase cerebral perfusion AFTER aneurysm is treated. (must stop bleeding first)
seizure prophylaxis

62
Q

What is hemorrhagic stroke drug therapy?

A

Antiplatelet & anticoagulation therapy CONTRAINDICATED!!!

Nimotop!!

63
Q

What does nimotop do?

A

prevents vasospasm

64
Q

Surgical therapy for hemorrhagic stroke?

A

craniotomy to evacuate hematomas > 3 cm
Tx of aneurysm: coils or clamp
Tx of AVM: Radiation causes to clot off or “super glue” to reduce

65
Q

When should you initiate ROM exercises?

A

Day 1!

66
Q

When turning pt to prevent pressure ulcers, how long should they lay on their affected side?

A

30 minutes

67
Q

Why do we avoid enemas for stroke patients?

A

b/c excess stimulation of vagal nerve can increase ICP

68
Q

What kind of IVF should be used with ICP?

A

hypertonic IVF

69
Q

What should you teach pt with homonymous hemianopsia?

A

to scan environment

70
Q

After how much time are deficits considered to be permanent?

A

6 months

71
Q

What is a hordeolum?

A

a sty

72
Q

What is an acute infection of the sebaceous gland on the lid margin called?

A

a hordeolum

73
Q

What causes a hordeolum?

A

staph aureus

poor hygiene & cosmetic use

74
Q

What are S/Sx of a hordeolum?

A

local erythema, edema, pain

75
Q

What are Tx for hodeolum?

A

warm, moist compresses

ABX topical or eye drops

76
Q

What is a chalazion?

A

Chronic (wks to months) inflammation of the meinomian (sebaceous) gland with granuloma

77
Q

S/Sx of chalazion?

A

granuloma = hard, shiny lump within eyelid, with local erythema, edema & pain

78
Q

What is Tx for chalazion?

A

compresses QID

surgical removal if impacting vision

79
Q

What is the most common infection worldwide?

A

conjunctivits

80
Q

What is conjunctivitis?

A

inflammation & infection of the conjunctiva

81
Q

What is “pink eye”?

A

conjunctivitis caused by bacteria

82
Q

S/Sx of bacterial conjunctivitis?

A

crusting, tearing, redness, epiphora, irritation & mucopurulent drainage

83
Q

What is Tx for bacterial conjunctivitis?

A

ABX eye drops to shorten duration from weeks to just days

84
Q

What is Tx for viral conjunctivitis?

A

there is no Tx to cure or shorten duration

topical steroids can help with discomfort if severe

85
Q

What is trachoma?

A

bilateral conjunctivitis caused by a chlamydial infection

86
Q

What are 2 types of trachoma?

A 
Chlamydial trachomatis (Serotypes A-C)
AIC (adult inclusion conjunctivitis (serotypes D-K)
87
Q

What is the most preventable cause of blindness worldwide?

A

Chlamydial trachomatis (serotypes A-C)

88
Q

How is chlamydial trachomatis spread?

A

Not sexually! contaminated hands & flies, poor sanitation

89
Q

How is AIC spread?

A

sexually transmitted. does not cause blindness!

90
Q

What are S/Sx of Trachoma?

A

mucopurulent drainage, erythema, irritation & edema

91
Q

What is Tx for Trachoma?

A

ABX oral or ocular

92
Q

What causes neonatal conjunctivitis? What are S/Sx & how is Tx?

A

exposure to chlamydia or gonorrhea during birth.
S/Sx= ocular inflammation, yellow D/C, & edema.
Tx= erythromycin ointment (all babies prophylactically)

93
Q

What is Keratitis?

A

corneal inflammation or infection caused by injury, bacteria, virus or fungus

94
Q

How is bacterial keratitis Tx’ed?

A

subconjunctival ABX (injection into conjunctiva)

95
Q

What is most common cause of viral keratitis?

A

herpes

96
Q

What do mydriatics cause?

What are cyclopegics?

A

Mydriatics cause pupil dilation by constricting iris muscle

cyclopegics cause pupil dilation by blocking Ach @ the iris sphincter

97
Q

What is a corneal ulcer?

A

complication of corneal infection where corneal tissue is lost. ER b/c cornea is avascular & cant defend itself

98
Q

What is Tx for corneal ulcer?

A

topical anti-infective qhour 24 hr/day for up to 3 weeks

99
Q

What is blepharitis?

A

“Eye dandruff” inflammation of lid margins caused by staph or seborrhea

100
Q

What are Sx of blepharitis?

A

itching, erythema, scales, crusting, burning

101
Q

What is Enucleation?

A

Surgical removal of the entire eye & part of the optic nerve

102
Q

What is panopthalmitis?

A

inflammation of all 3 layers of the eye (sclera, cornea & retina)

103
Q

What is keratoconjunctivitis sicca?

A

decrease in quality or quantity of tears “dry eyes”

104
Q

What is a retinoblastoma?

A

Malignant retinal tumor

105
Q

What causes retinoblastoma?

A

chromosome 13

106
Q

What are S/Sx of retinoblastoma?

A

Cat’s eye, strabismus, erythema, swelling

107
Q

What is Tx for retinoblastoma?

A

enucleation

108
Q

What is emmetropia?

A

normal vision in which cornea bends light and focuses it on the retina precisely

109
Q

What is myopia? & how is it Tx’ed?

A

Near-sightedness (far vision is blurred) too long so image focuses in front of retina
Tx with concave lenses

110
Q

What is hyperopia? & how is it Tx’ed?

A

Far-sightedness (near vision is blurred) too short so image focuses beyond the retina
Tx with convex lenses

111
Q

What is presbyopia?

A

form of hyperopia that occurs with aging (MOM!!!) lens becomes rigid & can’t accommodate near objects

112
Q

Astigmatism?

A

irregular corneal shape causes image to focus on 2 points of the retina

113
Q

What is strabismus?

A

“cross-eyed”

114
Q

What is amblyopia?

A

“lazy-eye”

115
Q

What are cataracts?

A

lens clouding or opacity of lens caused by changes in metabolism = H2O accumulation in lens

116
Q

How are cataracts Dx’ed?

A

Opthalmoscope or slit lamp

117
Q

How are cataracts Tx’ed?

A

surgical cataract removal = only cure

118
Q

What is Aphakia?

A

absent lens, either congenital or surgical

119
Q

What is Glaucoma?

A

increased intraocular pressure caused by an obstruction in outflow of aqueous humor (secreted by ciliary body)

120
Q

What occurs as a result of inability to drain aqueous humor?

A

increase in pressure decreases blood flow to retina and puts pressure on optic nerve = vision loss

121
Q

How is glaucoma Dx’ed?

A 
tonometry readings (normal = 10-21 mmHGg)
slit lamp microscopy
gonioscopy (to measure angle & distinguish type)
122
Q

What is primary open angle glaucoma?

A

inadequate outflow caused by clogging of the tribecular meshwork. 22-33 mmHg

123
Q

S/Sx of Primary open angle glaucoma?

A

gradual peripheral vision loss, “tunnel vision”

124
Q

What is Tx for primary open angle glaucoma?

A

Beta-Blocker drops decrease aqueous humor production by effect on ciliary body
Alpha adrenergic blockers decrease aqueous humor secretion
miotics/cholinergics increase outflow @ tribecular meshwork by contracting iris sphincter muscle

125
Q

What is closed-angle glaucoma?

AKA primary angle-closure glaucoma

A

medical emergency: sudden onset of increased IOP. vision loss will occur within 48-72 hours.

126
Q

What are S/Sx of closed-angle glaucoma?

A

Frosted cornea, halos around lights, sudden pain, N&V, HA, blurry vision, tonometry 50+ mmHg

127
Q

Tx of closed-angle glaucoma

A

hyperosmotics (glycerin or osmotriol)

128
Q

What medications must patients with glaucoma never take?

A

mydriatics & cyclopegics

129
Q

What is age-related macular degeneration?

A

Partial blindness (macula= sharp, central vision

130
Q

What are 2 types of macular degeneration? Which is more common? Which is more serious?

A

Dry & wet
Dry = more common
Wet = more serious

131
Q

How is macular degeneration Dx’ed?

A

Amsler grid: lines appear wavy
Opthalmoscope exam: look at retinal layer to see drusen or vessels
Fundal photography IV angiography determine wet or dry

132
Q

Tx for dry mac-degen:

Tx for wet mac-degen:

A

Dry: antioxidants & betacarotene
Wet: IV injection of photosensitive dye, activated by cold laser, causes destruction of abnormal blood vessels.
Also vitreous cavity injections of Macugen, Avastin, Lucentis (inhibits endothelial growth factor responsible for abnormal proliferation of blood vessels)

133
Q

What are 2 types of retinopathy?

Which is more severe?

A

Nonproliferative & proliferative

Proliferative is more severe

134
Q

S/Sx of retinopathy:

A

Blurred vision, floaters, spots, black/red lines

135
Q

What are characteristics of nonproliferative retinopathy?

A

microaneurysms, retinal swelling, & hard exudates

136
Q

What are characteristics of proliferative retinopathy?

A

collateral circulation forms, new vessels are fragile & weak, hemorrhage easily, bleed into vitreous cavity blocking light focusing.

137
Q

Dx retinopathy:

A

fluorescein angiography (inject dye to look for leakage of broken vessels)

138
Q

Tx retinopathy:

A

Photocoagulation

Vitrectomy (drain vitreous cavity if blood present, replace with saline)

139
Q

what separates in retinal detachment:

A

sensory retina (rods & cones) separates from pigment epithelium (nourishing layer)

140
Q

What are S/Sx of detaching retina?

A

vision changes or loss with out pain, floaters, cobwebs, photopsia (light flashes)

141
Q

S/Sx of detached retina?

A

depends where detached, peripheral or central vision loss, described as curtain falling over eye

142
Q

What is Tx for retinal detachment?

A

for tears: stimulate inflammation to induce scarring to seal hole/tear. photocoagulation, cryopexy
for detachment: surgery required:
scleral buckling procedure
Pneumatic retinopexy: injection of gas bubble puts pressure on retina to help reattach

143
Q

What is important after pneumatic retinopexy?

A

head position to keep bubble at site (like a carpenters level)

144
Q

What is total blindness?

A

no light perception or visual field

145
Q

What is functional blindness?

A

some light perception but not visual field (inadequate to guide in anyway)

146
Q

What is criteria to be considered legally blind?

A

visual field less than or equal to 20 degrees

visual acuity 20/200 or less with correction

Nursing 102 (9 decks)

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