Test 3 Intracranial Flashcards
Acute focal neurologic deficit r/t a vascular disorder
Brain attack, aka stroke, aka CVA
- risk factors for?
- older age
- male gender
- african american
- HTN
- smoking
- high cholesterol
- diabetes
- afib
- polycythemia
- sickle cell disease
- atherosclerosis
risk factors for CVA
types of brain attack
- transient ischemic attack
- ischemic: thrombotic/embolic
- hemorrhagic
-blood clot involved (embolism, or thrombosis) that impedes blood flow
ischemic
hypertension, aneurysm, AV malformations, blood disorders, decreasing clotting factors
hemorrhagic
- obstruction of cerebral vessels
- localized cerebral tissue hypoxia
- oxygen depletion (10 seconds)
- glucose and glycogen depletion (2-4 min)
- intracellular ATP depletion (4-5) minutes
Ischemic pathogenesis
evolving stroke 3 areas
(from inside out) necrotic core–>penumbra–>normal tissue
- occurs in larger vessels
- atherosclerotic plaques, particularly at points of arterial bifurcation
thrombotic stroke
- site of origin
- left heart, carotid arteries, aortic arch
- predisposing conditions
- afib, MI, ventricular aneurysm,rheumatic heart disease
cardiogenic embolic stroke
An area of penumbra without a necrotic core
-symptoms resolve within 24 hours
TIA, or mini stroke
- rupture of a blood vessel
- bleeding into brain
- edema
- compression of brain contents
- spasm of adjacent vessels
Hemorrhagic stroke
- Left-sided paralysis “hemiplegia”
- Left-sided neglect
- spatial-perceptual deficits
- tendency to minimize or deny problems
- impulsive
- short attention span
- impaired concept of time
- impairment of judgement
Clinical manifestations of right brain damage
- Right-sided paralysis “hemiplegia”
- Aphasia: expressive/receptive
- Slow/cautious behavior
- Awareness of deficits: depression & anxiety
Clinical manifestations of left brain damage
thrombotic therapy can be given within…?
can be given within 3 hours of onset
antiplatelet drugs are _______with hemorrhagic CVA
contraindicated with CVA
spontaneous, abnormal, synchronous discharges from the cerebral cortex
-d/t a change in the excitability of a neuron or group of neurons
Seizures, aka convulsions
- etiology
- unprovoked: unknown “epilepsy”
- provoked: hyperthermia (< age 5), metabolic disturbances, drugs, brain lesions, eclampsia in pregnancy
Seizures etiology
- pathogenesis for?
- Alterations in cell membrane permeability, ion distribution
- inhibition of cortical or thalamic neuronal activity
- excess acetylcholine
- decreased gamma-aminobutric acid (GABA)
Seizure pathogenesis
Generalized or Partial?
-simultaneous onset of seizure activity in both hemispheres of the cerebral cortex
generalized seizure classification
Generalized or partial?
-activity begins in a localized area of one hemisphere
partial seizure classification
- kind of seizure?
- unilateral twitching
- unilateral tingling or crawling sensations
- conscious
- Jacksonian epilepsy
- Aura
Simple partial seizures
Jacksonian epilepsy
sequential involvement of body parts
- type of seizure?
- conscious but amnesic
- may be provoked
- repetitive movement
- inappropriate behavior
Complex partial seizure
Type of seizure where there is a brief loss of consciousness, younger age
Generalized, absence seizures
- preceeded by an aura: sensory simple partial seizure
- tonic muscle tension
- clonic muscle tension
- clonic muscle jerking
- incontinence (bowel and bladder)
- postictal period
generalized, tonic-clonic seizure
- dilantin
- phenobarbital
- mysoline
- tridione
- valium
- depakene
- clonopin
- mesantoin
- neurontin
- lamictal
- felbatol
- cerebyx
Seizure medications, start low and go slow (often), often times taking more than one
partial seizures can become?
can become generalized seizures
4 seizure precautions
- oxygen and suctioning equipment
- IV access
- Bed in low position
- Padded side rails
postictal period
- groggy, tired, achy
- period following tonic/clonic seizure
during seizure do ? (5 things)
- lower to the floor, pillow under head, don’t restrain
- no bite block or padded tongue blade
- prevent aspiration
- turn side; loosen clothing around neck
- document everything
- a change in perception of sensory stimuli
- examples are vision and hearing losses such as those caused by cataracts, glaucoma, and presbycusis (steady loss of hearing acuity that occurs with aging).
Sensory deficit
- a state of reduced sensory input from the internal or external environment
- individuals can experience sensory deprivation as a result of illness, trauma, or isolation
sensory deprivation
vagal nerve stimulator
- used when they can pinpoint where the seizure activity is coming from
- can help control the excessive hyper-exciteability
- myopia (nearsightedness: problems far away)
- hyperopia (farsightedness: problems close up)
- astigmatism
- presbyopia (loss of accommodation of the eye that occurs as we get older)
visual deficits
- diabetes, HTN, Grave’s disease, infections (CMV, TB), vitamin deficiencies, immunosuppression (AIDS, Herpes)
- all types of disorders that effect?
systemic disorders that affect the eye
- inflammation of the conjunctiva
- etiology: bacterial, viral, or rickettsial organisms, allergens, or irritants
Conjunctivitis, aka “pink eye”
- increased ocular pressure resulting from inadequate drainage or overproduction of aqueous humor
- pressure leads to damage of retina and optic nerve
- increased incidence: aging; African-Americans
Glaucoma
- most common type of glaucoma
- bilateral
- slow onset
- usually painless
- blurred vision
open angle glaucoma
- sudden onset
- emergency
- severe pain radiating around eyes and face
- colored halos around lights
close angle glaucoma
- IOP
- blurred vision
- decreased accommodation
- difficulty adjusting to darkness
- all are____signs of?
Early signs of glaucoma
- loss of peripheral vision
- decreased acuity (uncorrectable)
- halos around lights
- pain
- all are____signs of?
Later signs of glaucoma
- miotics
- sympathomimetic
- beta blockers
- carbonic anhydrase inhibitors
- osmotic diuretcs
- prostaglandin agonist
medications for glaucoma
trabeculoplasty and iredectomy are both surgical procedures for?
surgical procedures for glaucoma
3 types of glaucoma medications for increased drainage of aqueous humor?
- Miotics
- Pilocarpine hydrochloride (Isopto Carpine)
- Osmotic Diuretcs
- glycerin
- Mannitol (Osmitrol)
- Prostaglandin Agonists
- Latanoprost (Xalatan)
Glaucoma medications for decreased production of aqueous humor (3)
- Beta Blockers
- Timolol maleate (Timoptic)
- CAI’s
- Actetazolamide (Diamox)
- Sympathomimetics
- Dipivefrin (Propine)
Surgical method that may be used in open-angle glaucoma if pharm rx ineffective or as primary rx
-laser rx to trabecular meshwork increases space between fivers and increased outflow of aqueous humor into conjunctivae
Trabeculoplasty
- Emergency rx for acute closed angle glaucoma
- Section of iris is removed to create pathway for flow of aqueous humor
Iridectomy
- An opacity of lens; distorts image
- age related etiology=most common
- All people > 70 y.o. have some degree
- Etiology: Exposure to ultraviolet light, trauma, congenital defects, associated diseases
Cataract
- Clinical manifestations for?
- blurred vision
- decreased color perception
- opacity of lens
- absence of red reflex
- vision better in dim light w/pupil dilation
- gradual loss of vision
- painless
Cataracts clinical manifestations
Cataract surgical interventions?
Surgical removal of diseased lens and replacement with silicone prosthetic lens
-Extracapsular procedure, outpatient surgery
- eye is unpatched
- dark glasses required
- instill antibiotic-steroid eyedrops
- mild itching normal
- pain indicates complications
- reduce IOP
- prevent infection
- assess for bleeding
cataract post-op care
Signs of complication for cataracts
- sharp, sudden pain in eye
- bleeding or increased discharge
- lid swelling
- decreased vision
- flashes of light or floating shapes
- Atrophy or deterioration of the macula, the point on the retina where light rays meet as they are focused by the cornea and lens of the eye.
- The person loses central vision, but maintains peripheral vision.
- Commonly associated with aging process.
macular degeneration
________ intake decreases risk and slows progression of macular degeneration
Antioxidant intake
types of macular degenerations
dry and wet
_______have increased risk for macular degeneration
Smokers increased risk
- Presbycusis
- Cerumen drier
- Tympanic membrane less elastic
- bony ossicles and cochlea function diminish
- changes in vestibular function
- acuity diminishes
the aging process of the ear
- “mycin” drugs
- salicylates
- loop diuretcs, diamox
- Quinine, Quinidine
Ototoxic medications
- Sound wave blocked d/t external or middle ear disorders
- causes: inflammatory process, tumors, scar tissue on ossicles, otosclerosis
- correctible
- type of hearing loss?
Conductive hearing loss
- type of hearing loss?
- pathological process of inner ear or 8th cranial nerve
- causes: Trauma, ototoxic medications, loud noise exposure, presbycusis
- PERMANENT and progressive
Sensorineural
- A conductive hearing loss secondary to a pathologic change of the bones in the middle ear
- bony overgrowth around ossicles
- fixation of bones
- stapes fixation leads to conductive loss
- inner ear involvement leads to sensorineural loss
- family tendency
Otosclerosis etiology
-Slowly progressing conductive loss
-Bilateral; may be worse in one ear
-Ringing/roaring tinnitus
-Loud sounds when chewing
-Negative Rinne test
-Weber test shows lateralization of sound
to ear with most conductive loss
*clinical manifestations of?
Clinical manifestations of otosclerosis
Stapendectomy Fenestration
otosclerosis surgical intervention
- removal of stapes
- prosthesis places between incus and stapes footplate
