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2514 Patho/phys/assess > Week 8 stroke > Flashcards

Week 8 stroke Flashcards

1
Q

Stroke drugs

A

Atorvistatin (HmG-CoA reductase inhibitor)
Labetalol (Trandate) - beta blocker
ASA - antiplatelet
Heparin: unfractioned heparins
t-PA: Fibrinolytic therapy

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2
Q

What is atorvistatin used for

A

Lower LDL and prevent plaque

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3
Q

What is Labetalol (trandate) used for

A

Post stroke
lower BP

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4
Q

what is ASA, Heparin and t-PA used for

A

Prevent/dissolve blood clots

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5
Q

What does the Cerebellum do

A

Fine motor movement
Balance
Determines limb movement

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6
Q

What does the brain stem do

A

Breathing
Heart rate
Blood Pressure
Alertness (A&O)
Temp
Swallowing

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7
Q

What does the occipital lobe do

A

Vision
Colour perception

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8
Q

What does Parietal lobe do

A

Knows left from right
Sensation
Reading
Body orientation

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9
Q

What does frontal lobe do

A

Higher level thinking
Problem solve
Emotional traits
Reasoning (judgement)
Speaking
Voluntary motor activity

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10
Q

What does the temporal lobe do

A

Language
Behaviour
Memory
Hearing

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11
Q

Pressure, 5 senses and pain go to this part of the brain

A

Thalamus

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12
Q

Smooth muscle sends signals to this part of the brain

A

Hypothalamus

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13
Q

What are the menengies (types and purpose)

A

3 layers that protect the brain and spinal cord
1. Dura mater
2. Arachnoid
3. Pia mater

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14
Q

How long does it take to see metabolic changes when oxygen is cut off such as strangulation

A

30 seconds

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15
Q

How long does it take for lactic acid to be produced when oxygen is restricted

A

2 min

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16
Q

How many min will cells start to die without oxygen

A

5 min

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17
Q

If PaCo2 is high blood vessels in the brain do what

A

relax: dilation
To increase blood flow

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18
Q

If PaO2 is too low blood vessels in the brain do what

A

relax: dilation
To increase blood flow

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19
Q

If PaCo2 is too low the blood vessels in the brain do what

A

constrict
To decrease blood flow so that Co2 can build more

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20
Q

If PaO2 is too high the blood vessels in the brain do what

A

constrict
To decrease blood flow so that O2 can slow down and levels lessen

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21
Q

When there is not enough O2 then lactic acid is produced. This causes pH to do what

A

lower (too many H+)
Acidic environment

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22
Q

When pH drops the blood vessels do this

A

Dilate
To get more O2 so that lactic acid production will slow down and stop creating too much H+

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23
Q

What is a stroke

A
  1. Not enough blood flow to the brain (ischemia)
  2. Hemorrhage into the brain spaces (bleeding)
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24
Q

What is the leading cause of disability in Canada

A

Stroke

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25
Q

what are the 3 types of Ischemic stroke

A
  1. TIA (transient ischemic attack)
  2. Thrombotic
  3. Embolic
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26
Q

What are the 3 causes of an Ischemic stroke

A

Inadequate blood flow to the brain
Artery occulsion (partial or full)
heart failure/shock - systemic

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27
Q

What is Ischemic penumbra

A

The zone around the core of ischemia but is still reversable if treated in time

28
Q

How many hours do we have to protect the penumbra area?

A

3 hours from the start of symptoms

29
Q

How many hours after ischemia will we see brain colour changes?

A

6-12 horus

30
Q

How many hours after an ischemic stroke do you see all the damage that has occured?

A

72 hours (3 days)

31
Q

What happens the few weeks after an ischemic stroke?

A

Macrophages get rid of dead tissue
This causes scarring in the brain

32
Q

What are the three causes of TIA

A
  1. carotid stenosis - narrow or occluded carotid artery
  2. Atherolsclerosis - dislodged plaque travels
  3. Atrial fibrillation - blood stasis - clot, travels to brain
33
Q

Aphasia

A

trouble with speech and/or language

34
Q

Dysarthria

A

slurred speech

35
Q

What are the main signs of TIA

A
  1. Visual changes
  2. Mobility issues
  3. Sensory issues
  4. Speech issues
36
Q

What is the associated cause of a thrombotic stroke?

A

atherosclerosis

37
Q

What are the associated causes of Embolic stroke ?

A

All Systemic and sudden
1. valvular heart disease
2. MI
3. infective endocarditis
4. rheumatic heart disease
5. congential heart defect
6. a-fib

38
Q

Examples of embolus responsible for Embolic stroke

A
  1. fat embolus
  2. air embolus
  3. Tumour embolus
  4. bacterial clumps
  5. foreign bodies
39
Q

What is the most common cause of Ischemic stroke?

A

Atherosclerosis

40
Q

What are the 2 types of hemorrhagic stroke?

A
  1. Intercerebral Hemorrhage
  2. Sub arachnoid Hemorrhage
41
Q

What is intercerebral hemorrhage caused by?

A

ruptured arterial vessel

42
Q

what are the 2 associated causes of intercerebral hemorrhage

A
  1. HTN * #1
  2. Aterio-venous malformation
43
Q

What is a main symptom of intercerebral hemorrhage

A

Worst headache ever

44
Q

What is a subarachnoid hemorrhage caused by?

A

intercranial bleeding in to the space that is between the Pia mater (close to skull) and arachnoid layers (closer to brain)

45
Q

Subarachnoid hemorrahage is associated with

A

ruptured aneurysm

46
Q

What stroke type is most common in females?

A

Subarachnoid hemorrhage due to aneurysm

47
Q

Which type of stroke has the worst outcomes and what does it depend on?

A

Subarachnoid hemorrhage
location in the brain is key

48
Q

Clinical manifestations of stroke

A
  1. Sudden numb/weak on left side of body
  2. Sudden confusion (LOC)
  3. Speech difficulty and slurring
  4. Vision issues
  5. Ataxia
  6. Sudden severe headache
49
Q

What are the typical deficits associated with stroke

A
  1. motor function * most obvious
  2. Communication
  3. Cognition
  4. Spacial- perceptual alterations
  5. Elimination
50
Q

What are the complications of stroke we assess for?

A
  1. Aspiration PN
  2. DVT
  3. UTI
  4. Falls/injury
  5. Dehydration
  6. Constipation
  7. Depression
  8. Seizures
51
Q

What is the saying for stoke complications?

A

A Dirty Dog Danced Under Falling Star Constellations

52
Q

Anosognosia

A

not knowing (gnosia) anything is wrong (ano)

53
Q

Homonymous hemianopia

A

Field of vision loss on both eyes (so if left side of the right eye and left side of the left eye)

54
Q

Agnosia

A

Can’t recognize what objects or people are

55
Q

Apraxia

A

Know what they want to do but can’t (A) perform (praxia) the movement.

56
Q

Dysarthria

A

Slurring words

57
Q

Stuporous/stupor

A

Very deep sleep
need repetitive vigourous stimulation

58
Q

Obtunded

A

Can’t wake up very easily
need less repetitive vigourous stimulation

59
Q

Lethargy

A

Drowsy but will wake up

60
Q

Mentation

A

What is their LOC - metal status

61
Q

Canadian Neurologic scale

A

Evalulation and monitoring of neurological status for stroke patients
Acute stage (1-7 days)
8 items
High number is good (less deficits)

62
Q

National Institute of Health Stroke Scale

A

15-item impairment scale
evaluate neurologic outcome and degree of recovery for patients with stroke
High # is bad - severe

63
Q

CT or MRI in stroke helps us determine

A

location of injury
size of injury
hemorrhagic or ischemic stroke

64
Q

Blood work in hyper acute stroke

A

CBC - hemoglobin
INR/PTT/Platelets
Blood sugar
Renal/liver function - creatinine, urea, liver enzymes
Lipid profile - try to prevent stroke

65
Q

Acute stroke priorities

A
  1. When did it happen (time is brain)
  2. Airway - RR, O2, protectives (cranial 9&10)
  3. RR - is the brain driving breathing
  4. circulation
  5. Rapid neuro assess
    - LOC
    - GCS
    - FAST
    - Pupils (PERRLA)
    - speech/motor - hand grips/push pedals (cranials 9, 10, 12)
  6. Blood sugar
  7. 2nd neuro check
66
Q

How many days do we still see brain changes after ischemic stroke?

A

2-3 days

2514 Patho/phys/assess (27 decks)

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