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S3 1538 > S M12 Intracranial Regulation > Flashcards

S M12 Intracranial Regulation Flashcards

1
Q

Cerebrovascular disorder due to stroke

A

functional abnormality of the CNS that occurs when the blood supply tot he brain is disrupted

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2
Q

2 types of stroke

A

Ischemic - vascular occlusion, hypoperfusion to the brain

Hemorrhagic - extravasation of blood into brain or subarachnoid space

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3
Q

Ischemic stroke

A

vascular occlusion and significant hypoperfusion to the brain

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4
Q

Hemorrhagic stroke

A

extravasation of blood into the brain or subarachnoid space

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5
Q

“Brain attack”

A

Sudden loss of function resulting from disruption of blood supply to brain

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6
Q

Stroke

FAST symptoms

A

Face - looks uneven

Arms - one arm hangs lower

Speech - slurred

Time - call 911 now

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7
Q

Ischemic stroke causes

A

Thrombus or emboli obstruction

Results in infarction of brain tissue

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8
Q

Types of ischemic stroke

A

Large artery thrombosis

Small penetrating artery thrombosis

Cardiogenic embolism - most common A-fib

Cryptogenic - no cause

Other - drug use

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9
Q

Ischemic stroke meds

A

tPA

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10
Q

tPA

tissue Plasminogen Activator

101

A

Give within 3 hours

will minimize symptoms and loss of function

GOAL - IV tPA to be given within 60min of arriving to the ED

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11
Q

Ischemic stroke Motor S/S

A

Hemiplagia - paralysis to one side

Hemiparesis - loss of strength to one side

Apraxia - cant perform learned movements

Difficulty walking, loss of coordination

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12
Q

Ischemic stroke numbness/weakness occurs in

A

Face, arms, legs, especially in once side

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13
Q

Ischemic stroke and sensory S/S

A

Agnosia - loss of sensory recognition

Dysphasia - difficulty swallowing

Visual/spatial dysfunction

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14
Q

Ischemic stroke cognitive S/S?

A

confusion and changes in mental status

learning capacity and memory loss

Aphasia - trouble speaking and understanding speech (expressive and receptive)

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15
Q

Ischemic stroke psych and pain

A

Sudden SEVERE headache

Depression, emotional lability, hostility, frustration, resentment

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16
Q

Left side stoke

A

Right side body problems

Aphasia

Intellectual disability

Slow cautious behavior

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17
Q

Right side stroke

A

Left side body problems

Left visual problems

Distractibility

Impulsive behavior

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18
Q

Transient ischemic attack TIA

A

Temporary neuro deficit due to blood flow impairment

Sudden onset of motor sensory and visual S/S

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19
Q

TIA is a precursor to

A

Impending stroke

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20
Q

TIA last

A

1-2 hours

less than 24h

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21
Q

Stroke prevention lifestyle

A

No smoking

Physical activity

Healthy weight and diet

Modest alcohol consumption

Sleep apnea

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22
Q

Non modifiable risks of stroke

A

Older than 55

AA

Male gender

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23
Q

Modifiable risk factors of stroke

A

Hypertension PRIMARY RISK

cardiovascular disease - a fib, stenosis

^ cholesterol, hematocrit

Obesity

Diabetes

Oral contraceptives

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24
Q

Med management of ischemic stroke

A

CT within 25min - determines ischemic or hemorrhagic

12 lead EKG and carotid ultrasound

CT angiography, MRI of brain and neck vessels

tPA

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25
Q

Assessment tool for tPA qualification

A

NIHSS

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26
Q

tPA

A

dissolves clots

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27
Q

tPA admin

A

Need 2 IV sites - 1 tPA, 2 other fluids

IV dosage 0.9mg/kg, ma is 90mg

10% of dose given over 1min, the rest over 1 hour

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28
Q

tPA monitoring

A

V/S q15m for 2h

then q30m for 6h

then q1h for 24h

BP maintained greater than 180/105

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29
Q

tPA side effects

A

Risk for bleeding

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30
Q

tPA maintanance

A

Airway and ventilation

Hemodynamic monitoring

Neuro assessment

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31
Q

tPA interventions

A

Monitor intracranial pressure

Provide O2, intubate if needed

Elevate HOB to 30 degrees

Hemodynamic monitoring

Neuro checks

32
Q

If intracranial pressure high

A

mannitol diuretic

33
Q

Carotid endarterectomy

A

Removes plaque from artery

Ischemic stroke prevention

34
Q

Secondary prevention of Ischemic stroke

A

anticoagulation therapy

antiplatelet therapy

“statin” meds

antihypertensive meds

35
Q

Hemorrhagic stroke 101

A

bleeding into brain, ventricles or subarachnoid space

36
Q

Hemorrhagic stroke causes

A

rupture of small vessels

ruptured aneurism

AVMs

Trauma

Hypertension

37
Q

Brain exposure to blood in hemorrhagic stroke

A

slows brain metabolism

^ in intracranial pressure

Secondary ischemia due to reduced perfusion

38
Q

Hemorrhagic manifestations

A

Same as ischemic

+

Vomiting

Pain and rigidity in back of neck

39
Q

Secondary problems with stroke

A

Cerebral hypoxia

Vasospasms

ICP

Seizures

Rebleeding

Hydrocephalus

Hypertension

40
Q

Vasospasms S/S

A

Intensified HA

decrease in LOC

aphasia

partial paralysis

41
Q

Rebleeding S/S

A

Sudden severe HA

N/V

Decrease in LOC

Neuro deficit

42
Q

Hydrocephalus S/S

A

Gradual

drowsiness

behavior changes

Acute

stupor/coma

43
Q

Secondary stroke management

A

Bedrest sedation

Clip aneurism

Reverse anticoagulation with prothrombin

44
Q

For seizures give

A

Dilantin

anticonvulsant

45
Q

To prevent DVT

For fever

For pain

A

Intermittent pneumatic compression devices

Tylenol, ice

Analgesics

46
Q

Nursing care other assessments

A

I&O

O2

Complications - seizures, hydrocephalus, rebleeding, vasospasms, hyponatremia

47
Q

Environment for Stroke

A

Non-stimulating quite dim

Monitor pain

restrict visits

Reassurance to decrease anxiety

No valsalva

48
Q

Post acute nursing care

A

set realistic goals

encourage personal hygiene

ensure pt does not neglect affected side

use assistive devices

49
Q

Nutrition post stroke

A

speech therapy

sit upright, out of bed to eat,

Chin tuck swallow method

Thickened liquids and puree diet

50
Q

Bowel and bladder post stroke

A

Voiding assessment

schedule

Constipation prevention - fiber fluids

Bowel and bladder retraining

51
Q

Edu post stroke

A

med education

safety edu

exercise and activity

socialization

52
Q

Ictus on exam

When someone has a seuzure start a timer to know how long they are

A
53
Q

Seizure precaution

A

o2

suction

padded bedrails

IV access

make sure stuff works

54
Q

Decorticate posture has a better

A

prognosis

55
Q

Decerebrate posturing has a

A

poorer prognosis

56
Q

Due to post concussion syndrome being treated at different time frames

A

Pt may lose confidence in healthcare as problem is not resolved

57
Q

Know glasgow coma scale

A

all parts

58
Q

how to read coma GCS

A
59
Q

When axons tear due to TBI

A

they release toxins that worsen the condition

60
Q

Know cushings triad

A
61
Q

With ICP fluids are

A

Normal saline

isotonic

keep pressure same

62
Q

Final say in brain functin

A

?

63
Q

rule of 100?

A
64
Q

For pt with seizures ask about

A

aura

65
Q

Seizure vs epilepsy

A

one time vs many times

66
Q

If seizure is longer than 5 min

A

activate emergency response

67
Q

Seizure patients are at risk for

A

Hypoxia

Vomiting

Pulmonary aspiration

68
Q

Visually diagnosing epilepsy

A

EEG

69
Q

Status epilepticus

A

Medical emergency

70
Q

Drugs of choice for epilepsy/seizure

A

Valium and Ativan

71
Q

PT education for seizure/epilepsy

A

get meds

follow ups

S/S of toxicity

med alert bracelets

injury precaution

avoid triggers

72
Q

Meningitis bacteria

A

Streptococcus pneumonia

Neisseria meningitidis

73
Q

Opisthotonic position

flexing at back

A

S/S of

Baby will meningitis

74
Q

Protein high

glucose low

in spinal fluids

A

Meningitis

75
Q

Antibiotics for meningitis should be give

A

within 30 min of arrival to hospital

76
Q

ICP pulse and resp vs BP?

A

S3 1538 (15 decks)

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