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Pathophysiology & Pharmacology 218 > Transport and Cerebral Perfusion (Week 5) > Flashcards

Transport and Cerebral Perfusion (Week 5) Flashcards

1
Q

Causes of a stroke

A

Ischemia in a brain area; 80% of strokes

Hemmorhage of a brain blood vessel; 20%

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2
Q

Stroked can result in loss or impaired:

A

Movement, sensation or emotions.

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3
Q

Hemiparesis

A

1- sided weakness (partial parylysis)

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4
Q

After effects of a stroke

A
  1. Hemiparesis
  2. Inability to walk
  3. Partial or complete loss of independence in performing 4.ADL’s
  4. Aphasia
  5. Depression
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5
Q

Unmodifiable risk factors of stroke

A
  1. Age
  2. Sex
  3. Race
  4. Genetics
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6
Q

Modifiable risk factors of a stroke

A
  1. Hypertension
  2. Heart disease
  3. Diabetes
  4. Hypercholesterolemia
  5. Smoking
  6. Alcohol <2good, >2bad
  7. Obesity
  8. Physical inactivity
  9. Poor Diet
  10. Cocaine
  11. Birthcontrol
  12. Migrane headaches
  13. Hypercoaguability
  14. Chronic Inflammation
  15. Hyperhomocystenimia
  16. Sickle cell anemia
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7
Q

Primary blood vessels that supply the brain with blood

A

Carotid Arteries

Vertebral arteries

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8
Q

Where does the greatest risk of stroke development occur?

A

Circle of Willis

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9
Q

How much blood supply does the brain require

A

20% of the bodys cardiac output, 750-1000 mL/min.

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10
Q

How fast do CNS changes occur after complete loss of bloodflow to the brain?

A 
30 sec
Permanent damage (cell necrosis) within 5 mins
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11
Q

What are the factors that contribute to the severity of stroke damage?

A
  1. Rate of onset
  2. Size of lesion
  3. Presence of collateral circulation
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12
Q

Cerebral Autoregulation

A

Refers to the ability of the brains bloodvessels to adapt to systemic blood pressure changes. Adjusts mean systemic blood pressures of 50-100 mmHg.

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13
Q

How does increased CO2 levels effect brain blood supply?

A

Increases blood flow (it is a potent vasodilator)

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14
Q

How does atherosclerosis contribute to a stroke?

A
  1. Plaque depositions narrow the blood vessels creating areas for the clots to become lodged.
  2. Bits of plaque break off and become lodged in smaller vessels.
  3. Weakening of blood vessels from atherosclerosis increase risk of hemorrhage.
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15
Q

3 Types of Ischemic strokes

A
  1. Thrombotic
  2. Embolic
  3. Lacunar
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16
Q

Thrombotic Stroke

A

Occur when a clot or plaques form and occlude vascular blood flow.

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17
Q

Embolic strokes

A

Occur when a circulating clot or piece of broken off plaque becomes lodged in a narrow vessel. Most clots originate in the heart (endocardial) from AFib or Valvular disease.

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18
Q

Lacunar Strokes

A

When a vessel supplying blood to the deeper structures of the brain becomes blocked. Can be asymptomatic b/c of collateral circulation.

When symptoms do occur they are severe including hemiplegia, or total collateral sensory loss.

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19
Q

What kind of stroke has much more sudden effects and severe symptoms.

A

Embolic

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20
Q

Cerebral Infarction

A

Death of brain cells from cerebral ischemia.

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21
Q

Classifications of Hemorrhagic strokes

A

Intracerebral, intraparenchymal, subarachnoid, or intraventricular.

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22
Q

Transient ischemic attack (TIA)

A

Essentially a “temporary stroke”. When an area become ischemic but blood flow is restored after a period of time.

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23
Q

Intracerebral hemorrhages

A

Bleeding in the brain caused by a ruptured blood vessel. HTN is the greatest cause. 50% death rate.

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24
Q

Subarachnoid Hemorrhage

A

When there is bleeding into the CSF space between the pia matter and the arachnoid membranes covering the brain. Usually occurs due to the rupture of a cerebral aneurysm.

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25
Q

Clinical Manifestations of stroke

A
  1. Changes in motor function.
  2. Changes in intellectual function.
  3. Spatial-perceptual alterations.
  4. Communication changes.
  5. Changes in affect.
  6. Changes in elimination function.
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26
Q

Motor function symptoms of stroke

A

Motor deficits are the most apparent symptoms of a stroke and are seen as a loss of function in mobility, rep function, swallowing and speech, gag reflex, and ability to perform ADL’s.

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27
Q

Akenesia

A

Loss of skilled voluntary movement.

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28
Q

A stroke on which side of the brain causes aphasia?

A

Left

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29
Q

Expressive aphasia is known as what?

A

Broca’s aphasia

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30
Q

Receptive aphasia is known as what?

A

Wernike’s aphasia

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31
Q

Amnesic Aphasia

A

“loss of words”

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32
Q

Global Aphasia

A

Loss of receptive and expressive function.

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33
Q

Dysarthria

A

Disturbances in the muscular components of speech.

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34
Q

Intellectual function

A

Changes in memory and judgement from stroke. Left sided stroke pt’s become more cautious. Right- more impulsive

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35
Q

Perceptual alterations

A

Four primary types:

  1. Anosognosia - Inability to recognize objects
  2. Erroneous perception of self in space - Sensory input from one side of body.
  3. Homonymous hemianopsia- is when blindness occurs on one half of the visual field of both eyes)
  4. Apraxia- The inability to carry out learned sequences of movement.
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36
Q

Affect post stroke

A

After a stroke the individual may express exaggerated or uncontrollable emotions of any type. Often depression will become evident.

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37
Q

Elimination function post stroke

A

Because of loss of sensory and muscle function, constipation and urinary retention commonly occur. These are most often resolved after time.

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38
Q

Diagnostic studies re: stroke

A

MRI/CT, they can determine it was in-fact a stroke as well as determine the cause of the stroke.

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39
Q

Stroke prevention (collaborative care)

A
  1. Blood pressure control
  2. Blood glucose control
  3. Diet and exercise
  4. Smoking cessation
  5. Limiting alcohol consumption
  6. Routine health assessments
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40
Q

Drug therapy for strokes

A

Hypertensives, aspirin ( or other antiplatelets like clopiodril). Patients with Afib are also prescribed prophylaxis such as warfarin.

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41
Q

Carotid Endarterectomy

A

Surgical removal of artheromatous areas from the carotid artery.

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42
Q

Transluminal angioplasty

A

The insertion and inflation of a baloon device to open stenosed vessels.

43
Q

Stenting for stroke

A

May be used to maintain the patency of cerebral artery.

44
Q

Acute care for a stroke is focused on (general)

A

Preserving life
Preventing further brain damage
Reducing disability

45
Q

Why would stroke patient have difficulty keeping their airway patent?

A

Compromised LOC. Ensuring adequate O2 is critical to prevent further damage. In severe cases intubation and mechanical ventilation are required.

46
Q

What does the body often do to maintain cerebral perfusion following a stroke?

A

Elevate its BP (>220 systolic). Antihypertensives will be administered.

47
Q

What happens with fluid and electrolytes for stroke patients?

A

Possible hypovolemia.

48
Q

ICP’s

A

Increased intracranial pressures. Most often with hemorrhagic but also with ischemic.

49
Q

Cerebral edema during stroke can cause

A

Brain herniation

50
Q

Prevention and reduction of intracranial pressures

A

Elevate the head, use antidiuretics, drain CSF (possibly with boneflap).

51
Q

Acute surgical therapy for stroke

A

Larger hematomas >3cm must be evacuated surgically. (sucked off)

52
Q

Aneurisms can be surgically treated with what procedures?

A

Clipping
Wrapping
Coiling

53
Q

Clipping

A

Insertion of metal clip to separate aneurism from the rest of the vessel.

54
Q

Wrapping

A

Application of “band aid” to recompress ballooned aneurism.

55
Q

Coiling

A

Insertion of platinum threads into the aneurism balloon space to prevent circulated blood from entering it.

56
Q

What is administered during surgical aneurism treatment and why?

A

Calcium channel blockers, to prevent vasospasm and further ischemia.

57
Q

Nursing data gathering right after a stroke:

A 
Current illnesses.
Hx of similar symptoms.
Current meds
Hx of risk factors
Family Hx
58
Q

Nursing neurological assessment after a stroke:

A 
LOC
Cognitive status
Motor abilities
Cranial nerve function
Sensation
Proprioception
Cerebellar Function
Deep tendon reflexes
59
Q

Care planning categories after a stroke

A

Cognition stabilization
Mood stabilization
Promoting independence
Avoiding complications

60
Q

Nursing health promotion after a stroke

A 
Prevention
Hypertension reduction
Reducing diabetes effects
Smoking cessation
Anticoagulant meds
61
Q

Resp. nursing intervention for stroke

A

Assess airway patency and function, oxygenation, suctioning, client mobility.

62
Q

Neuro. nursing intervention for stroke

A

Monitor neurological changes, they may indicate advancement of stroke symptoms, complications or recovery of the stroke.
GLASGOW may be used.

63
Q

Cardiovasc. nursing intervention for stroke

A

Monitor for DVT development. Possibly administer blood thinners.

64
Q

Musculoskeletalnursing intervention for stroke

A

MAINTAIN function after stroke.
Prevent contractures or atrophy.
Place joints high to prevent edema.

65
Q

Integument. nursing intervention for stroke

A

Prevent skin breakdown. Immobility is common with stroke.

66
Q

Urinary intervention for stroke

A

Maintaining regular bladder function. Retention and incontinence is often present.

67
Q

GI system nursing intervention for stroke

A

Maintain GI function with the assistance of medications.

68
Q

Nutrition intervention for stroke

A

Dysphagia assessment
Dysphagia treatment
Oral hygiene

69
Q

Communication interventions after stroke

A

Asses ability to speak and understand. Can resort to gesturing if needed.

70
Q

Vision alterations from stroke

A

Homonymous hemianopsia- (blindness) same half visual field for both eyes
Diplopia- Double vision, can be treated with eyepatch.
Ptosis- Eyelid drooping. Usually doesn’t affect vision and doesn’t necessate treatment.

71
Q

Coping after stroke

A

Help arrange care for patient.

Help patient and family cope with occurence of stroke.

72
Q

Ambulatory and home care for stroke

A

Must be able or have the ability otherwise to complete ADL’s
Must be completely educated on disease and changes that may occur in their lives
Must see many members of the healthcare team and be approved for discharge.

73
Q

Rehabilitation Categories for stroke

A 
Musculoskeletal Function
Nutritional Therapy
Bowel function
Bladdar function
Sensory-perceptual alterations
Affect (emotional state)
Coping
Sexual Funcion
Communication
Community reintergration
74
Q

Volume of brain consists of

A
  1. Brain tissue (78%)
  2. Blood (12%)
  3. CSF (10%)
75
Q

Factors that ICP (inter cranial pressure)

A 
Blood pressure
Cardiac Function
Intra-Abdominal and Intra-Thoracic Pressures.
Body Position
Temp
Blood gasses (esp. CO2)
76
Q

Normal Intercranial pressure

A

Pressure exerted on the skull from blood, csf and brainmatter that is self regulated to some degree. 0-15 mmHg, any elevation above for over 5 mins is considered abnormal.

77
Q

Where can a pressure transducer be inserted?

A 
Ventricles
Subdural Space
Subarachnoid Space
Epidural space
Parenchyma (RIght into the actual white or grey matter :O )
78
Q

Causes of increased ICP

A 
Head Trauma
Stroke
Subarachnoid Hemorrhage
Brain Tumour
Inflammation
Hydrocephalus
79
Q

What is expected when a client suddenly loses consiousnesS?

A

ICP (Increased cranial pressure)

80
Q

Nursing interventions for increased ICP

A

Preservation of cerebral oxygenation and perfusion

Early identification of neurological changes

Prevention of complications secondary to increased ICP

81
Q

Cerebral blood flow normal rate

A

50mL per minute per 100g of brain tissue.

ex. 1.5kg= average 750 mL per min.

82
Q

Why is ongoing blood flow critical to the brain?

A

Because it does not store O2 or glucose.

83
Q

Autoregulation

A

Vasoconstriction or dilation of cerebral blood vessels in response to changing systemic pressures.

84
Q

Cerebral perfusion pressure

A

Pressure that pushes through brain tissues

85
Q

What pressure changes make the CPP change?

A

Mean Arterial Pressure (MAP)

Intracranial Pressure (ICP)

86
Q

MAP-ICP=

A

CPP

ex. 93.33mmHg -10mmHg =83.33mmHg

87
Q

Summary of CPP’s

A

Average human norm: 70-100mmHg

Borderline Damaging to cerebral tissues: 50-60mmHg

Catastrophic brain damage and death: <30 mmHg

88
Q

Cerebral edema

A

Increased fluid in the vascular spaces in the brain. Causes damage. Three types:
Vasogenic
Cytotoxic
Interstitial

89
Q

Vasogenic Cerebral Edema

A

MOST COMMON
Occurs due to changes in the endothelial lining of cerebral capillaries. Pores in capillaries enlarge enough to allow molecules to escape into the extravascular space. These macromolecules create and osmotic gradient that pulls water our of serum into the interstitial regions of white matter in the brain.

90
Q

Cytotoxic cerebral edema

A

Cellular edema.

Water and proteins shift from interstitial compartment into the cells causing cellular swelling and loss of function.

91
Q

Interstitial cerebral edema

A

Caused by blocked CSF return (hydrocephalus) causing increased hydrostatic pressures in cerebral capillaries forcing serum into the interstitial spaces or changes in electrolyte levels such as hyponatremia. When interstitial osmolality exceeds vascular osmolality, water is pulled into the interstitial space.

92
Q

Clinical manifestations of increased ICP

A 
Changes in LOC
Changes in vital signs
Ocular signs
Decrease in motor function
Headache
Vomiting
93
Q

Ocular signs of increased ICP

A

Compression of the oculomotor nerve results in dilation of the pupil on the same side.

94
Q

Complications of increased ICP

A

Cerebral herniation

Decreased cerebral perfusion

95
Q

Diagnostics for ICP

A

CT and MRI

96
Q

Neuromonitoring: measurement of ICP

A

Transducer (pressure sensor) inserted into brain via catheter.

97
Q

CSF Drainage

A

Dangerously elevated ICP’s deteted, CSF may be removed to make room for swelling.

98
Q

Multimodal Monitoring

A

Measurement of the brains level of O2.

99
Q

Collaborative care for ICP

A

Identify and treat underlying cause
Support brain function
Oxygenation

100
Q

Drugs used for ICP

A 
Mannitol
Corticosteriods
Dexamethasone
Benzos
Anticonvulsants
Phenytoin (dilantin)
101
Q

Hyperventilation therapy for ICP

A

THis is a good therapy for primary intervention to reduce ICP. BUT research has shown that this method increased the risk of cerebral ischemia.

102
Q

Nursing management for ICP includes

A

Pupillary assessment

Motor function assessment

103
Q

Care planning for client with ICP

A

Airway clearance
Ensuring ICP and CPP stay within normal limits
Maintain fluid and electrolytes
Avoid complications secondary to decreased LOC and immobility.

104
Q

Acute interventions for ICP

A 
Resp function
Fluid and electrolyte balances
Monitoring of intracranial pressure
Body positioning
Protection from injury
Psychological Considerations

Pathophysiology & Pharmacology 218 (20 decks)

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