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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
Intracranial causes of change in LOC
Space-occupying lesions, head injury, hemmorhage, seizure, degneration disease, secondary insults
26
Extracranial causes for change in LOC
Electrolyte imbalance EndocrineL hypo/hyperglycemia liver or renal dysfunction, hypoxia, hypotension, drugs
27
Ischemia to a part of the brain means
restricted blood supply
28
Hemmorrhage into the brain means
acute loss of blood from damage blood vessels
29
what does ischemia and hemmorgae results in
cell death
30
Stroke is the blank leading cause of death in canada
3rd
31
The economis impact of stroke in canada is approximately
3.6 dollars
32
High risks for stroke include
Hypertension, Smoking, obesity, diabetes, Afib
33
Stroke prevention includes
Keeping Bp control, maintain healthy diet, quit smoking, be physically active
34
What does FAST stand for
Facail droop, Arms (are they able to raise both of them), Speech (is it slurred), Time (to call 911, when did this begin)
35
Non modifiable risk factors for stroke
Age, Priors, gender, ethnicity, fm hx, gender (men)
36
Modifiable risk factors for stroke
comorbidities, inactivuty, Alcohol, sleep apnea, cholesterol, obesity, preganancy, carotid stenosis
37
VAN stands for
Vision (left gaze, right), Aphasia (naming difficulty), Neglect (ingnoring one side of the body
38
Why shoudl we perform a lgucose test when a pateint comes in with stroke signs
to rule out hypo or hyperglycemia (stroke mimics)
39
When to provide oxygen for a pateint who is suspected of stroke
when SPO2 is less then 94%
40
What percent of strokes are ischmic vs Hemorrhagic
80-85% are Ischmic 15% are hemmorhagic
41
Ischmic Stroke (Thrombotic)
Most common stroke 61% Local clot, usually formed along plaque, atherosclerotic plaque is disrupted,
42
Who is most likely to have ischemic Stroke (Thrombotic)
2/3 have diabetes and or HTN
43
Ischemic Emolic stroke
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
No Oxygen mean
Cellular death within 5 minutesI
45
Penumbra
Area of viable but at risk tissue, marginal perfusion, unless blood flow is restored quicly the tissue within the pneumbra will be lost
46
Resuscitation of the Penumbra is a
MAJOR GOAL
47
1.9 million brain cells
die after every minute after stroke
48
Canadian stoke best practice recommenation for acute stroke management is
Neurovacular brain and vascular imaging All patients with suscpeted acute stoke should undergo braina dn vascular imaging CT or MRI
49
What does diagnostic tests dictate
CT: is it a stroke, what type od stroke , add on perfusion MRI: More specific, extent of the injury
50
Number one treatment of Ischmic stroke
Thrombolytic therapy -Decreases stroke severity -Change of increased intracerebral bleed -
51
How soon should someone get Thrombolytic therapy
whtin 4.5 hours from onset of symptoms
52
Nursing managament of IV thrombolysis
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
Post Tenecteplase admin
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
When to do a second head ct after a stroke
24 hours after tenecteplace admin
55
Things not to do after Tenecteplase admin
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
When should a pateint receive Endovascular thrombectomy
within 6 hours
57
Thrombotic stroke prevention: carotis stenosis
CT: is it a stoke, what kind Carotid UltrasoundL extent of atheroscleriosis
58
Endarterectomy
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
Thromotic stroke prevention
Aspirin (ASA)
60
Are Hemorrhagic strokes more severe then Ischemic?
Yes they are
61
Intraceberal bleed (Hemorrhagic stroke)
Ruptured vessels, bleed into brain tissue
62
Cause of Intraceberal bleed
HTN, AV malformations, thrombolytic/Coag therapy
63
Signs and symptoms of Intraceberal bleed
Sudden onset, severe headache, neuro defiticits, N and V, Increase ICP< Hypertensive, Decreased LOC in half patients
64
Subarachnoid bleed
BLeed into subarachnoid space, caused by a ruptured aneurysm,
65
Signs and Symptoms of a Subarachnoid bleed
"Worst heaedache of my life" LOC change, nuchal rigidy
66
Aneurysm repair
Leave, Clip, or coil Surgical (clip) ENdovascular (angioplasty or stent) (coil)
67
Cerebral Vasospasm
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
Clinical manifestations of a stroke
Motor function, communicatio, affect, intellectual function, spatial perceptual alterations, elimination
69
Right brain damage leads to
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
Left brain damage leads to
paralyzed right side, imparied speech language aphsia, slow performance, depression and anxiety, impaired comprehension related to language, math
71
anterior cerebral involvment for stroke
Motor or sensory deficit or both, sucking or rooting reflex, gait problems, loss of proprioception, fine touch
72
Middle cerebral involvement for stroke
Dominant side: Aphasia, motor and sensory deficit, hemianopia (Blindness over half the feild of vision) Nondominent side: Neglect, motor and sensory deficit, hemianopia
73
Posterior cerebral
Hemianopia, visual hallucination, spontaneous pain, motor deficit
74
Vertebral
Cranial nerve deficit, diplopia, dizziness, nausea, vomitting, dysarthria, dysphasia, coma
75
Priorites for Nursing
ABC, BP, Fluid, lytes, temp, seizure Head CT IV Bolus TNK Montior
76
Which gender is more likely to have a Ischemic stroke
men
77
Which gender is more likely to have a hemorrhagic stroke
women
78
Onset for thrombotc stroke
often during or after sleep
79
Warning sign for thrombotic stroke
TIA (30-40% of cases)
80
Onset for Embolic stroke
Lack of relationsip to activity, very sudden!!
81
Course of action for Thromcotic Stroke
Stepwise progression, signs and symptoms develop slowly, usually some improvement, recurrence in 20-15% of survirors
82
Course of action for Embolic stroke
Single event, signs and symptoms develop quickly, usually soem improvemnt, reccurence common without aggressive treatment of underlying disease
83
Warning/onset of intracerebral hemorrhagic stroke
Headaches
84
Course of intracerebral hemorrhagic stroke
Progressice over 24 hours fatility more likley presence of stroke
85
Hemorrhagic stroke onset is typically
activity
86
Subarachnoid stroke course
Acute onset, usually single sudden event, as the worst headache of their life, fatility with presence of coma
87
TIA S/S
Confusion, Vertigo, dysrarthis, transient hemiparesis, temporary vision changes, lasts a few minutes to 24 hours

CNUR 203 midterm (10 decks)

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