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CNUR 203 midterm > Unit 7 CNS-Stroke > Flashcards

Unit 7 CNS-Stroke Flashcards

1
Q

Is alertered mental status and LOC a disease

A

no, it is a symptom

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2
Q

Ranges of causes for LOC

A

Relitively benign: Alcohol intoxication
Reversibility: hypoglycemia
Permanent: Stroke
Life-threatening: Menengitis

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3
Q

TIPPS of LOC

A

T: trauma
I: infection
P: psych
P: Poison
S: shock stroke

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4
Q

Vowel of LOC

A

A: alcohol acidosis
E: Epilepsy
I: insulin
O: Opiates oxygen
U: uremia

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5
Q

Components of Neuro assessment

A

Cerebral function
Brainstem function
Motor and Cerrebellar funtction

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6
Q

Cerebral Function of Neuro assessment

A

LOC, mental status, cognitive function, behvaior, speech

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7
Q

Brainstem Function of Neuro assessment

A

cranial nerve, pupillary exam, eye movement, cough/gag reflex

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8
Q

Motor and cerebellar function of neuro assessment

A

strength, movement, gait, posture

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9
Q

Sensory function of neuro assessment

A

tactile and pain sensation

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10
Q

Reflexes

A

superfocail and deep tendon reflexes

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11
Q

Neuro rechecks

A

Pupils, glassglow scale, vital signs, limb movement (hand grip, arms, legs)

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12
Q

Ipsilateral

A

on the same side of the body as another structure or given point ex. sensation arises from right side adn travels to right

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13
Q

Contralateral

A

On the opposite side of the body ex. sensation arises from the left and travels to the right

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14
Q

Alert means

A

awake, oriented, respins appropriately

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15
Q

Lethargic (somnolent) means

A

drowsy, appripriate but slow/fuzzy thinking

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16
Q

Obtunded

A

sleeps most of the time, difficult to arouse, confused

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17
Q

Stupor (Semi-Comatose)

A

Motor response only to vigorious shake or pain grumbles, and moans

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18
Q

Components of the Glassglow scale

A

Eye opening, Verbal response, Best motor response

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19
Q

Components of eye opening

A

spontaneous, to speech, pain, none

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20
Q

Compenents of verbal response

A

orientated, confised conversation, words (inappropriate) sounds (incomprehensible) sounds (Incomprehensive), none

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21
Q

Components of best motor response

A

obey comands, localise pain, flexion normal or abnormal, extend, none

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22
Q

what indicates a coma

A

Less than 8 intubate

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23
Q

Typically a pateint who is deteriorating will lose orientation in what order

A

time, place, and person

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24
Q

When assessing motor response be sure you are assessing

A

bilaterally

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25
Q

Intracranial causes of change in LOC

A

Space-occupying lesions, head injury, hemmorhage, seizure, degneration disease, secondary insults

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26
Q

Extracranial causes for change in LOC

A

Electrolyte imbalance
EndocrineL hypo/hyperglycemia liver or renal dysfunction, hypoxia, hypotension, drugs

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27
Q

Ischemia to a part of the brain means

A

restricted blood supply

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28
Q

Hemmorrhage into the brain means

A

acute loss of blood from damage blood vessels

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29
Q

what does ischemia and hemmorgae results in

A

cell death

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30
Q

Stroke is the blank leading cause of death in canada

A

3rd

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31
Q

The economis impact of stroke in canada is approximately

A

3.6 dollars

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32
Q

High risks for stroke include

A

Hypertension, Smoking, obesity, diabetes, Afib

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33
Q

Stroke prevention includes

A

Keeping Bp control, maintain healthy diet, quit smoking, be physically active

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34
Q

What does FAST stand for

A

Facail droop, Arms (are they able to raise both of them), Speech (is it slurred), Time (to call 911, when did this begin)

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35
Q

Non modifiable risk factors for stroke

A

Age, Priors, gender, ethnicity, fm hx, gender (men)

36
Q

Modifiable risk factors for stroke

A

comorbidities, inactivuty, Alcohol, sleep apnea, cholesterol, obesity, preganancy, carotid stenosis

37
Q

VAN stands for

A

Vision (left gaze, right), Aphasia (naming difficulty), Neglect (ingnoring one side of the body

38
Q

Why shoudl we perform a lgucose test when a pateint comes in with stroke signs

A

to rule out hypo or hyperglycemia (stroke mimics)

39
Q

When to provide oxygen for a pateint who is suspected of stroke

A

when SPO2 is less then 94%

40
Q

What percent of strokes are ischmic vs Hemorrhagic

A

80-85% are Ischmic
15% are hemmorhagic

41
Q

Ischmic Stroke (Thrombotic)

A

Most common stroke 61%
Local clot, usually formed along plaque, atherosclerotic plaque is disrupted,

42
Q

Who is most likely to have ischemic Stroke (Thrombotic)

A

2/3 have diabetes and or HTN

43
Q

Ischemic Emolic stroke

A

2nd most common stroke 24%, Travelling clots, swept into cerebral circulation, majority are cardiac origin, Embolus lodges in cerebral artery infarction and edema SUDDEN ONSET

44
Q

No Oxygen mean

A

Cellular death within 5 minutesI

45
Q

Penumbra

A

Area of viable but at risk tissue, marginal perfusion, unless blood flow is restored quicly the tissue within the pneumbra will be lost

46
Q

Resuscitation of the Penumbra is a

A

MAJOR GOAL

47
Q

1.9 million brain cells

A

die after every minute after stroke

48
Q

Canadian stoke best practice recommenation for acute stroke management is

A

Neurovacular brain and vascular imaging
All patients with suscpeted acute stoke should undergo braina dn vascular imaging CT or MRI

49
Q

What does diagnostic tests dictate

A

CT: is it a stroke, what type od stroke , add on perfusion
MRI: More specific, extent of the injury

50
Q

Number one treatment of Ischmic stroke

A

Thrombolytic therapy
-Decreases stroke severity
-Change of increased intracerebral bleed
-

51
Q

How soon should someone get Thrombolytic therapy

A

whtin 4.5 hours from onset of symptoms

52
Q

Nursing managament of IV thrombolysis

A

CBC, aPTT< INR, K, CL, Creatinine, BUN, GLucose, ALT, AST< ALP, CK, BP Target is less then 180/105, Large bore IV access x2

53
Q

Post Tenecteplase admin

A

Continuous montioring for a minimum of 2 hours
-Bed rest for 24 hours, then AAT, Vitals, signs of bleeding, q15, q30, them q4 hours
-Hold Labetalol if HR is less then 60 bpm

54
Q

When to do a second head ct after a stroke

A

24 hours after tenecteplace admin

55
Q

Things not to do after Tenecteplase admin

A

No antiplatelet agents or oral anticoagulants, avoid nasal swabs for 6 ours, avoid IM, Centeral venous access, arterial puncture, Avoid NG tubes, avoid catheterization,

56
Q

When should a pateint receive Endovascular thrombectomy

A

within 6 hours

57
Q

Thrombotic stroke prevention: carotis stenosis

A

CT: is it a stoke, what kind
Carotid UltrasoundL extent of atheroscleriosis

58
Q

Endarterectomy

A

Treatment for sympomatic patient with atleast 70% stenosis of the internal carotid artery
-The plaque is removed to restore patency and arterial flow to the brain

59
Q

Thromotic stroke prevention

A

Aspirin (ASA)

60
Q

Are Hemorrhagic strokes more severe then Ischemic?

A

Yes they are

61
Q

Intraceberal bleed (Hemorrhagic stroke)

A

Ruptured vessels, bleed into brain tissue

62
Q

Cause of Intraceberal bleed

A

HTN, AV malformations, thrombolytic/Coag therapy

63
Q

Signs and symptoms of Intraceberal bleed

A

Sudden onset, severe headache, neuro defiticits, N and V, Increase ICP< Hypertensive, Decreased LOC in half patients

64
Q

Subarachnoid bleed

A

BLeed into subarachnoid space, caused by a ruptured aneurysm,

65
Q

Signs and Symptoms of a Subarachnoid bleed

A

“Worst heaedache of my life” LOC change, nuchal rigidy

66
Q

Aneurysm repair

A

Leave, Clip, or coil
Surgical (clip)
ENdovascular (angioplasty or stent) (coil)

67
Q

Cerebral Vasospasm

A

Narrowing of the large blood vessels at the base of the brain.
At risk 7-10 days post SAH
-Interaction of metabolites within the vessels = endothelial damage = vasospasm

68
Q

Clinical manifestations of a stroke

A

Motor function, communicatio, affect, intellectual function, spatial perceptual alterations, elimination

69
Q

Right brain damage leads to

A

paralysis of left side
Spatial perceptual deficit
tends to deny or minimize problems
Rapid performance short attention span
Impulsive
Imparied judgement
impaired time concepts

70
Q

Left brain damage leads to

A

paralyzed right side, imparied speech language aphsia, slow performance, depression and anxiety, impaired comprehension related to language, math

71
Q

anterior cerebral involvment for stroke

A

Motor or sensory deficit or both, sucking or rooting reflex, gait problems, loss of proprioception, fine touch

72
Q

Middle cerebral involvement for stroke

A

Dominant side: Aphasia, motor and sensory deficit, hemianopia (Blindness over half the feild of vision)
Nondominent side: Neglect, motor and sensory deficit, hemianopia

73
Q

Posterior cerebral

A

Hemianopia, visual hallucination, spontaneous pain, motor deficit

74
Q

Vertebral

A

Cranial nerve deficit, diplopia, dizziness, nausea, vomitting, dysarthria, dysphasia, coma

75
Q

Priorites for Nursing

A

ABC, BP, Fluid, lytes, temp, seizure
Head CT
IV Bolus TNK
Montior

76
Q

Which gender is more likely to have a Ischemic stroke

A

men

77
Q

Which gender is more likely to have a hemorrhagic stroke

A

women

78
Q

Onset for thrombotc stroke

A

often during or after sleep

79
Q

Warning sign for thrombotic stroke

A

TIA (30-40% of cases)

80
Q

Onset for Embolic stroke

A

Lack of relationsip to activity, very sudden!!

81
Q

Course of action for Thromcotic Stroke

A

Stepwise progression, signs and symptoms develop slowly, usually some improvement, recurrence in 20-15% of survirors

82
Q

Course of action for Embolic stroke

A

Single event, signs and symptoms develop quickly, usually soem improvemnt, reccurence common without aggressive treatment of underlying disease

83
Q

Warning/onset of intracerebral hemorrhagic stroke

A

Headaches

84
Q

Course of intracerebral hemorrhagic stroke

A

Progressice over 24 hours fatility more likley presence of stroke

85
Q

Hemorrhagic stroke onset is typically

A

activity

86
Q

Subarachnoid stroke course

A

Acute onset, usually single sudden event, as the worst headache of their life, fatility with presence of coma

87
Q

TIA S/S

A

Confusion, Vertigo, dysrarthis, transient hemiparesis, temporary vision changes, lasts a few minutes to 24 hours

CNUR 203 midterm (10 decks)

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