week 8 : perfusion Flashcards
true or false. Cerebrum has a left and right hemisphere ?
yes this is true
name the different parts of the brain :
first one is frontal lobe : name the function, now name the rest
frontal lobe is in charge of our decision making, voluntary motor activity , speaking, reasoning, emotional traits
parietal lobe : is in charge of knowing left from right, sensation, body orientation, reading
occipital lobe : vision, color perception
cerebellum : fine muscle control, balance, coordination and control of voluntary movement
brain stem : in charge of breathing, body temperature, alertness/sleep / swallow
temp lobe: understanding language, behaviour, memory , hearing
what is this describing : this is processing of information on the opposite side of the body
contralateral processing
Recall we have a right and left hemisphere: sensory and motor functions are controlled by opposite sides of the brain. Is this true or false?
this is true
A brain injury on one side of the brain, a lesion or an area of hypoxia or a stroke will affect movement on the opposite side of the body : what is this describing ?
contralateral processing
recall from the diagram : the right hemisphere, the right side of the brain, which is in geay is going to receive visual input from which side of the brain?
from the left side of the brain division in both eyes
true or false. recall from the slide : left hemisphere, which is in pink, is going to receive visual input from the right field division in one eye
false, both eyes
why does left side receive an input from the right side , and vice versa?
because they are going to cross over in that optics
give an example of contralateral processing
if someone as a brain injury on the right side of their brain will affect their left field division in both eyes and vice versa.
what is important when we are talking abt brain damage ? what type of processing?
contralateral processing
what is cerebellum?
controls fine motor movement, balance, allows brain to determine limb movment
what is this describing : fine details help us become more precise with our movements and helps us with our coordination
cerebellum
what is essential for life ? although every function is vital, what is the most vital amongst all of them ?
brain stem
what is the brain stem ?
controls breathing, heart rate ; blood pressure and alertness
what is important for emergencies , for example when some has intracranial pressure and when someone goes into a coma u wanna start worrying if this specific part of the brain is involved ?
brain stem
name the functions of cerebrum : that includes frontal lobe, temp lobe, brain stem, parietal lobe, occipital lobe, cerebellum
frontal :
- problem solving
emotional traits
reasoning
speaking
voluntary motor activity
parietal :
- knowing right to left
sensation
reading
body orientation
occipital lobe
- vision
color perception
cerebellum
- balance
coordination and control of voluntary movement
brain stem
- breathing
body temp
digestion
alertness/sleep
swallowing
temp lobe
- understanding language
behavior
memory
hearing
what is this describing : relay sensory impulses or sensation from parts of the body to the cerebral cortex where those impulses can then interpreted
this is describing thalamus
where do most emboli originate?
endocardium - breaks off and travels and lodge in the cerebral circulation
what is embolic stroke commonly associated with?
valvular heart disease, MI, infective endocarditis (inflammation of the endocardium, clumps of bacteria to form), rheumatic heart disease, congenital heart defects and a fib
what is a thalamus job?
main function is to relay sensory impulses or sensation from parts of the body to the cerebral cortex where those impulses can then be interpreted.
which one has more warning signs, embolic or thrombotic?
thrombotic
true or false. the thalamus sorts the info and passes it into the cerebral cortex where it can initiate and coordinate movement to response to the sensations.
true
what is this describing: sudden onset, body does not have time to accommodate by developing collaterals
embolic stroke
what is atherosclerosis?
ardening and thickening of arteries (Carotid Stenosis)
hypothalamus what is the job of it ?
controls heart rate, bladder contraction and passage of food
how does atherosclerosis connect to the brain?
not enough blood flow to the brain due to narrowing or occlusion
what is this? Characterized by deposits of lipids within intima of artery
Atherosclerosis
what stimulates smooth muscle lining the intestine, stomach, blood vessels as well as receive sensory impulses
hypothalamus
what are the four stages of atherosclerosis?
damaged endothelium, fatty streaks, fibrous plaque, complicated lesion
name another job that the hypothalamus do ?
stimulates smooth muscle lining the intestine, stomach, blood vessels as well as receive sensory impulses
what is a hemorrhagic stroke?
15% of strokes, results from bleeding
ten out of the 12 cranial nerves come from where ? which connects to the the cerebrum to the spinal cord`
brain stem, critical for regulating the cardaic, resp function, sleepcycle, and important to sustain life
what are the two subtypes of strokes?
Intracerebral hemorrhage Subarachnoid hemorrhage
true or false abt hemorrhagic stroke: when someoen has bleeding in the brain, brain tissue becomes compressed and diplaced - this causes ischemia, increased pressure and necrosis
true
what is intracerebral hemorrhage?
Bleeding within brain caused by a ruptured vessel
* Usually associated with hypertension and arterio-venous malformations
* Usually occurs during periods of activity
brain stem also provides _____ and sensory nerve to supply to ____ and the neck
motor function, face
this is important in critically neurologic patients ( see changes to heart rate, ability to temp regulate )
brain stem
what is Intracerebral hemorrhage associated with?
symptoms of ICP
what is this describing: “worst headache of my life”, Sudden onset of symptoms with progression over minutes and hours
ntracerebral Hemorrhage
what is subarachnoid hemorrhage?
Intracranial bleeding into space between pia mater and arachnoid layers, much more common
true or false. hypothalamus is important in controlling body temp, promote heat loss when needed, or sweat when we are trying to lower down our temp . Shivering and etc.
true
between the cns and the endocrine , hypothalamus is also connected , recall what this means
changes in the body and stimulating various organs and glands to release hormones
these are cavities within the brain that are filled with cerebral spinal fluid
ventricles
we also use ___ analysis to diagnose various disease
Cerebrospinal fluid
what is subarachnoid hemorrhage commonly associated with?
ruptured aneurysm
what gender is subarachnoid hemorrhage common in?
women
true or false: Brain aneurysms are considered “silent killers” because there are usually no warning signs until they rupture
true
what is the difference between hematoma and hemorrhage?
Hemorrhage – active bleed
Hematoma – bleed that has already clotted (this leaves a large clot)
what are the general risk factors for a stroke? (very similar to CAD risks)
Age
* Genetics
* Ethnicity
* Hypertension
* Dyslipidemia
* Tobacco use
* Diabetes
* Obesity
* Elevated levels of stress
* Substance abuse
* Alcohol
* Arteriovenous malformations
* Medications (anticoagulants, antiplatelet)
* Atrial fibrillation
* Valvular heart disease
* Sedentary
* Birth Control pills/Hormone replacement therapy/pregnancy
* TIA (transient ischemic attack)
what are the clinical manifestations of acute stroke ?
Sudden numbness/weakness in the
face, arm, or leg on one side of the body
* Sudden confusion
* Difficulty speaking, slurring speech
* Sudden trouble seeing
* Sudden trouble walking, dizziness, loss of balance
* Sudden severe headache
right brain damage..
paralyzed left side - hemiplegia
left side neglect
spatial-perceptual deficits
tends to deny or minimize probems
rapid performance, short attention span
impulsive,, impaired judgement impaired time concepts
left side damage.
paralyzed on right side
impaired speech (aphasia)
impaired right left discrimination
slow performance, cautious
aware of deficits - depression anxiety
impaired comprehension related to language - math
what are the Clini manis of high intracranial pressure (hemorrhage)
Headache, Vomiting, Change in Level of consciousness, Pupil changes, Posturing, Seizures
clini mani’s of deficits (this is whats going to happen to the patients)
- Related to location of stroke
- Ischemic and hemorrhagic strokes have similar manifestations
- Functions affected are directly related to artery involved and area it supplies
- Motor Function
- Communication
- Affect
- Intellectual Function
- Spatial-Perceptual
Alterations - Elimination
what is CSF
is a clear colorless fluid that circulate with the subarachnoid space, it provides cushioning for the brain and spinal cord
true or false. CSF is not continually formed , hwoever there are factors that influence the rate of absorption and formation
false, it is continually formed.
what are the 3 protective laters that surronding the brain and spinal cord called
meninges
1) dura mater
2. arachnoid
3) pia mater
this comes from greek word membrane
meninges
what is dura mater
outer most layer closest to the skull
what is arachnoid
this is the middle layer within that meninges
what is pia mater
very delicate an it adheres to the surface of the brain and spinal cord
cerebral spinal fluid is found, in the subarchnoid space and the arachnoid and pia matters become very important in meningitis and hematoma can develop within the layers.is this true or false.
this is true
what is a blood brain barrier ?
its a wall between blood capillaries and brain tissues , ultimately protects the brain from the harmful substances while allowing nutrients and oxygen to enter.
cerebral circulation : what are the two major arteries that supply blood brain
internal carotid arteries ( anterior circulation )
vertebral arteries ( posterior circulation )
cerebral circulation :
what are the both major artery systems ( anterior and posterior ) that are important, and where is this connected to?
internal carotid arteries ( anterior circulation ) and vertebral arteries ( posterior circulation )
both major artery are connected to the circle of willis
what can circle of willis provide ?
it can provide back circulation because it has interconnections between anterior and posterior circulation
true or false. different arteries supply different parts and lobes of the brain with oxygenated blood, when blood is interrupted in any of the cerebral arteries the area they feed will be impaired.
this is true
cerebral blood flow :
what does the brain required ?
how long does cellular death occurs of no blood flow ?
what is the blood flow to the brain affected by ?
1) brain requires continous blood flow for glucose and oxygen
2) 5 minutes
3) it is affected by systemic blood pressure
- cardiac output ( how much blood the heart pumps per minute )
- blood viscosity
-intracranial pressure
true or false. the brain has protective mechanisms for increasing perfusion such as auto regulation ?
yes this is true
regulation of cerebral blood flow includes
collateral circulation
recall that the skull is a rigid structure, which mean an increase in blood fluid swelling in to the brain , will what ?
increase intracranial pressure
when you have a high pressure in the brain, what does it usually impact ?
it impacts perfusion
true or false. anytime there is a higher pressure in the brain, it means that the perfusion is going down
true
what is autoregulation?
protects against the fluctuations in our blood pressure
recall : that auto regulation protects against the fluctuations in our blood pressure, what occurs when we have fluctuates?
when we have fluctuation to our blood flow to the brain
it ensures that the brain still has adequate blood flow regardless of the conditions that are in the body
what would the cerebral vessels do in attempts to ensure blood flow is maintained ?
the cerebral vessels will dilate and constrict
what are the three conditions will cause cerebral dilation ?
increased in carbon dioxide, increased acidity, and low oxygen
true or false. cardiac output must be reduced by 1/3 to be impacted and also drop
trueq
true or false.
collateral circulation may develop in situations of low cerebral blood flow if the blood supply is cut off to one area of the brain due to a blocked artery, it can sometimes receive blood from a different blood vessel
- it depends on the individual pt and they develop to maintain consistent perfusion when the primary roots are blocked ( similar to the heart )
true
when does stroke occur?
occurs when there is inadequate blood flow to the brain ( ischemia ) or hemorrhage into the brain
results in death of brain cells : what is this describing ?
stroke
what type of functions will stroke impact ?
language, sensation that were controlled by the area of damage will be impaired or lost
in canada , what is the leading cause of disability in adults ?
stroke
brain perfusion is necessary, why ?
because the brain needs a constant flow of oxygen and glucose
brain perfusion is necessary for removal of metabollic waste like what ?
lactic acid, inadequate flow can happen for various reasons
what is going to set off a cascade of events or “ domino effect “ ( this is a trigger of many bad things worse, so it sets off of a cascade of events that will lead to neuron damage and death )
blockage or narrowing ( stroke )
true or false. bleeding into the brain will cause low perfusion to the neurons because it increases the intracranial pressure and compresses the tissues, reducing blood flow
true
what are the types of stroke
what are the three subtypes
artery occlusion ( partial or total )
three subtypes :
transient ischemic attack
thrombotic
embolic
true or false. when stroke occurs, the area that’s affected is going to become pale within 6 to 12 hours. After the occlusion happens so it’s already start to changing color.
true
what occurs to the brain tissue before ad after stroke occurs?
brain tissue : before that necrosis you are going to develop cell death and there’s going to be swelling and then you’re going to start having disintegration happen within 2 to 3 days after infraction.
What would 72 hours look like for someone who had a stroke ?
you’re going to see all the damages happening and you won’t know until about three days later the ultimate damage that’s occurred
a stroke would be similar to MI? explain how
yes this is true, process of macrophages and phagocytosis coming and trying to infiltrate the necrotic tissue causing some scarring
True or false. Stroke is very similar to MI : an idea of a central core of irreversible ischemia and necrosis when someone has a cerebral infraction.
true
what is this describing ? this leads to inadequate blood flow or from hypoperfusion
TIA
what is TIA : make a brief description of what she said in the lecture
this leads to inadequate blood flow or from hypoperfusion , which is related to systemic issue like a heart failure or shock
True or false. A blockage or narrowing within the artery would be like your atherosclerosis when you’re dealing with the brain, so now it’s the same concept, you have a narrowing of the artery and have an obstruction.
true
what is a core within the brain?
an area where there’s a cell death that is irreversible, where the most damage has occured
what is penumbra within the brain
this is surrounding the core, this is a zone where it is reversible , however it’s an area where it’s also vulnerable
Penumbra :
If you do not act quick with it ( a stroke ) it’s going to become necrotic however we have time to save it, it’s not a permanent damage, how long is the hours that the penumbra protects ?
3 hours, this number is critical to our treatment for someone who’s having a stroke
true or false. cerebral infractions , you basically have 3 hours before, but the time they start having symptoms it is important to get interventions right away, or permanent damage can get further.
true
TIA : what is this similar to in the previous lesson we learned?
similar to angina in the heart
describe TIA briefly of what she said in class
the brain is reduced or completely blocked but it is relieved shortly after. It’s temporary and the worst transient ( a warning sign = a mini stroke )
what is a risk factor for an actual stroke ?
TIA
what is this describing : this is a temporary episode of neurological dysfunction
transient ischemic attack
what causes a brief interruption in cerebral blood flow ?
TIA
Re-call in the previous question we identified two characteristics of TIA : name the rest
caused by ischemia
usually, symptoms last less 30-60 mins , but can last long as 24 hours
most resolve, but stroker isk increaes immediately after the event
warning signs of cerebrovascular disease
signs and symptoms are based on the area involved
what is this describing : this usually caused by atherosclerosis, carotid stenosis, and AFIB
TIA
define what atherosclerosis :
recall that it is the thickening and hardening of the artery ( stenoid carotid)
what is another description we could define it ?
plaque development, that could travel to various area of the brain
what would thrombotic stroke individuals already had prior to having this type of stroke ?
they would already have a warning sign ( TIA ) , might set off ishcemic cascade and this is series of biochemical reactions that are iniated in the brain
how does blood clot forms during a thrombotic stroke?
blood clot forms in a narrowed cerebral artery
Where does thrombosis develop during a thrombotic stroke?
develops in areas with atherosclerotic plaque
what is thrombotic associated with ?
atherosclerosis
how long does symptoms progress during thrombotic stroke ?
symptoms progress within the first 72 hours
thrombotic :
extent of stroke depends on ____ of lesion and presence of _____ circulation
size , collateral
what is impacted that undergoes motor function when a person had stroke ?
- Most obvious effect of stroke
- Mobility
- Respiratory Function
- Speech
- Swallowing
- Gag Reflex
- Ability to perform ADL’s
ipsilateral deficits
contralateral deficits
what is ipsilateral deficits ?
refer to neurological symptoms or impairments that occur on the same side of the body as the affected area of the brain or spinal cord
recall that the ability to perfom’s adl is impact during a stroke name these terms :
hemiparesis
hemiplegia
akinesia
hyporeflexia
hemiparesis - weakness to half of the body
hemiplegia - paralysis of half the body
akinesia - impairment of voluntary movement
hyporeflexia - lead to hyperreflexia
true or false. when motor deficits occur it impacts all muscles, not just limb movement
true
motor function is impacted during a stroke, and it’s more than just arms and legs. Name an example given the lecture
bladder muscle
pyramidal pathway cross at the medulla and motor function on the opposite site: what is this describing?
contralateral deficits
communication is also affected with stroke :
what type of language given the lecture notes is impacted ?
receptive language
expressive language
what is receptive language and what is expressive language
receptive = Understanding what others say or write.
expressive = speaking or writing to convey thoughts and feelings.
what is aphasia
dysphasia
dysarthria ?
aphasia - loss of receptive or receptive language
dysphasia - difficulty with receptive or expressive language
dysarthria - difficulty to express with words ( cannot find the words )
- affects pronunciation =, articulate and phonation
what is global aphasia
anomic aphasia
global aphasia - loses both expressive and receptive function
anomic aphasia - milder form, pt have trouble finding correct names for objects or places
what is wernicke aphasia
wernickeaphasia - nickes are found in temporal lobe - responsible for language comprehension
express well but words are used incorrectly and lack context
cognition is also impacted with stroke : name the characteristics that undergoes that are impacted
- Memory
- Impaired judgment
- Impulsivity
- Overly cautious
- Impaired math skills * Short attention span
true or false. these are all impacted by stroke : Memory, judgment, critical thinking, math skills, ability to pay attention, and safety can be impacted. A person can become overly cautious or slow, or they can do the complete opposite, which is being impulsive and moving quickly without thinking
yes and they all undergo cognition
spatial perceptual alterations : what undergoes them
- Anosognosia
- Homonymous hemianopia * Agnosia
- Apraxia
- Anosognosia
- Homonymous hemianopia * Agnosia
- Apraxia
what does these terms mean? and under what category do they below that gets altered when a person had a stroke
Spatial-Perceptual Alterations
- Anosognosia = trouble recognizing objects, is an awareness of their own body parts or disease
process. The person fails to notice aspects of one side of the world in front of
them. - Homonymous hemianopia = worsening neglect of the one side, because it causes blindness in the same half of the
visual field of both eyes - Agnosia = unable to recognize and identify objects, persons, or sounds using one or more of their senses despite otherwise normally functioning senses.
- Apraxia = inability to carry out learned movement son command ex. tying shoelaces
true or false. a person who where a stroke may be occurring : may be having a hard time telling telling their right from their left, manipulating
objects, being aware of their body in space and perception of their environment
true
elimination: is also impacted during a stroke
- Most issues of bladder and bowel eventually resolve
- Frequency, urgency, and incontinence of urine
- Constipation results from immobility, weak abdominal muscles, and dehydration
complications of stroke
as nurses it is important to assess for all of these things
aspiration pneumonia
DVT
UTI
Falls and injury
Dehydration
Constipation
Depression
Seizures
what are the immediate priorities in acute stroke
Note the onset of symptoms
Assess/Manage Airway (Check Gag/Cough/Swallow)
Assess/Manage Breathing Assess/Manage Circulation
Rapid Neurological Assessment→Level of Consciousness . GCS (done first to ensure patient is conscious), FAST Assessment, Pupils, Movement of arms/legs
Assess blood sugar
Secondary Neurologic Assessment (specific to stroke) not comprehensive neuro exam) Speech, Motor, use Canadian Neurological Scale or National Institutes of Health Stroke Scale
CT Scan Treatment
what type of assesment do we do in hyper acute stroke pt
find out onset of symptoms
airway breathing
circulation
GSC –> PERRLA ( pupils )
assess for blood sugar
secondary neurological assessment
complete a more comprehensive history
what is PERRLA >
pupils equal, round, reactive to light and accommodation
what do we want the pupils to be ? constrict or dilate?
we want them to be constricted, dilate means they are not reactive
what do we use for cva diagnosis ?
ct
cta
mra
Mri
true or false we must have a brain imaging ( ct or mri ) when dealing with stroke
true
what provides the location and size of lesion when assessing, along with differentiating between ischemic and hemorrhagic ?
cva diagnosis using tools such as ct
cta
mra
mri
what are the different cva blood work we look at?
cbc
coagulation studies
blood glucose
renal/liver function labs
lipid profile
true or false. A ct scan is necessary to determine if the stroke is ischemic or hemorrhagic before any treatment can happen.
this is true
answer the following questions :
what is a significant part of cerebral perfusion?
if this is too low , this mean there is not enough blood flow to brain in which causes what ?
however if this is to high, there is a risk of brain bleeds which also causes what ?
following a stroke , many patients presents with what type of diagnosis?
blood pressure
blood pressure , it causes ischemia
if blood pressure is too high, also causes ischemia
many patients presents with high blood sugar or high blood pressure
Ischemic Stroke→If candidate for TPA→we must keep Systolic BP ≤
____ mmHg and Diastolic BP
≤ _____ mmHg
less than or equal to 180
less than or equal to 110
and this has to be confirmed by ct scan and onset must be within 3-4.5 window.
Ischemic Stroke → If not candidate for TPA→ we must keep systolic blood pressure < ____ mmHg or diastolic blood pressure <____ mmHg
less than 220
less than 120
Hemorrhagic Stroke→Goal systolic between ___ to ____ mmHg to prevent rebleeds
140 - 160
increased blood sugar following stroke is usually the result of a stress response. It worsens outcomes and needs to be tightly controlled. Is this true or false.
true
true or false. elevated blood pressure is common after a stroke?
thought to be protective response to maintain cerebral perfusion
stroke specific label : labetalol
in order to adminsiter thrombolytic therapy →Systolic BP must be ≤ ___ mmHg and diastolic BP must be ≤ ____ mmHg
185
110
stroke specific label : labetalol
If patient is not receiving thrombolytics for an ischemic stroke, then patient only requires antihypertensives if Systolic BP > ____ mmHg and diastolic > ___ mmHg
220
120
stroke specific label : labetalol
For hemorrhagic stroke, administer antihypertensive if systolic > ___ mmHg
160
