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101 Cards in this Set
- Front
- Back
functional abnormality of CNS caused by disruption of normal blood supply to brain
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cerebrovascular disorders
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what can brain not store (2)
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02 and glucose
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cerebrovascular disorders are the _____ leading cause of death
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3rd
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what are the 2 categories of stroke
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-ischemia (85%)
- hemorrhagic (15) |
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backflow and 02
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ischemic
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sudden loss of function resulting from disruption of blood supply to part of brain
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ischemic stroke
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ishemic AKA
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brain attack
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with early tx of this ischemic strokes can result in fewer stroke sx and less loss of function
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thrombolytics
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tx window with ischemic stroke
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3 hrs after onset
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plaques in large vessels of brain
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larger arter thrombotic stroke
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functional abnormality of CNS caused by disruption of normal blood supply to brain
|
cerebrovascular disorders
|
|
what can brain not store (2)
|
02 and glucose
|
|
cerebrovascular disorders are the _____ leading cause of death
|
3rd
|
|
what are the 2 categories of stroke
|
-ischemia (85%)
- hemorrhagic (15) |
|
backflow and 02
|
ischemic
|
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sudden loss of function resulting from disruption of blood supply to part of brain
|
ischemic stroke
|
|
ishemic AKA
|
brain attack
|
|
functional abnormality of CNS caused by disruption of normal blood supply to brain
|
cerebrovascular disorders
|
|
with early tx of this ischemic strokes can result in fewer stroke sx and less loss of function
|
thrombolytics
|
|
what can brain not store (2)
|
02 and glucose
|
|
tx window with ischemic stroke
|
3 hrs after onset
|
|
cerebrovascular disorders are the _____ leading cause of death
|
3rd
|
|
plaques in large vessels of brain
|
larger arter thrombotic stroke
|
|
what are the 2 categories of stroke
|
-ischemia (85%)
- hemorrhagic (15) |
|
backflow and 02
|
ischemic
|
|
sudden loss of function resulting from disruption of blood supply to part of brain
|
ischemic stroke
|
|
ishemic AKA
|
brain attack
|
|
with early tx of this ischemic strokes can result in fewer stroke sx and less loss of function
|
thrombolytics
|
|
tx window with ischemic stroke
|
3 hrs after onset
|
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plaques in large vessels of brain
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larger arter thrombotic stroke
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1 or more vessels---most common
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small penetrating artery thrombotic stroke
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dysrhythmias, valvular disease. most commonly left middle cerebral artery
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cardiogenic embolic stroke
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most common cardiogenic emobolic stroke
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left middle cerebral artery
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no known cause
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cryptogenic stroke
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other types of strokes caused by what (4)
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- drug use
- coagulopathies - migrane - spont dissection carotid/ vertebral arteries |
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decrease cerebral blood flow resulting in anaerobic activity---acidosis--- cell death
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ischemic cascade
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what is the penumbra region
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area of low blood flow around infarction--- at risk for cont' cell death
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what does size of infarction depend on
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area of flow and size of clot
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goal for ischemic stroke/cascade
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block extent of 2ndary brain injury caused by initial stroke
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helps to increase blood flow by getting rid of clot
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neuroprotectants (t-PA)
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clinical manifestations dependent upon what? (4)
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- location of lesion
-vessels obstructed - size of area -amt of collateral blood flow |
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S&S of ischemia stroke (5)
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- motor loss
- communication loss - perceptual disturbances - sensory loss - cognitive impairment |
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assessment for ischemic stroke should include (3)
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- careful hx
- complete Px/neuro exam - airway patency |
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may be a warning sign
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TIA
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resolves spont w/ return of normal function
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TIA
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how can stroke be dx
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CT w/o contrast
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aif stroke is ischemic what should be done after CT
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further determination of source of emboli or thrombi
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detects areas of ischemia earlier
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MRI
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#1 cause of hemorrhagic stroke
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HTN
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at higher risk for stroke
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AA
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2ndary prevention following TIA/stroke (4)
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- anticoags w/ a fib
- PLT meds (ASA, plavix, ticlid - statins - surgery |
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what does t-PA do
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binds fibrin and converts plasminogen to plasmin, causing fibrinolysis (dissolving)
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if t-PA is given after 3 hrs what happens
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revascularization of necrotic tissues and increases risk edema and hemorrhage
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contraindications for t-PA (4)
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- >3 hrs
- pt anticoagulated - INR .1.7 - any recent intracranial pathology |
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cannot be given for 24hrs after t-PA
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anticoagulants
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VS protocols for t-PA
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- q 15min for 2hrs
- q 30 mins x6 hrs - q 1hr until 24hrs after tx |
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most common SE of t-PA
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bleeding
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dose for t-PA
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0.9 mg/kg (max 90mg)
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how is t-PA given
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10% IV over 1 min and remainder over 1 hr
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needed with use of t-PA (2)
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- cont cardiac mtr
- freq neuro assess |
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HTN increases risk of what with t-PA (2)
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- bleeding
-rupture |
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BP parameters for t-PA
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systolic <180
diastolic <105 |
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catheter delivers t-PA
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intra-arterial thrombolysis
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when is the acute phase
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1-3days
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after acute phase, assess should include (7)
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- mental status
- sensation/perception - motor control -swallowing - nutrition/hydration - bowel/ bladder function - ADLs |
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convalescence
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rehab period
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helpful to know in the convalescence stage
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baseline before stroke
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long term deficit in stroke pts
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shoulder pain
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% of hemorrhagic strokes
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15-20
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cerebrovascular disorders, primarily intracranial or subarachnoid bleeds
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hemorrhagic stroke
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where does bleeding occur with hemorr (3)
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brain tissue
vents subrachnoid space |
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pts who survive acute phase of hemorrhagic stroke often have what
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more severe deficits and longer recovery
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80% of hemorrhagic strokes r/t what
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primary intracerebral hemorrhage from spont
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what is the cheif cause of hemorrhagic stroke
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uncontrolled HTN
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results from ruptured intracranial aneurysm
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subarachnoid bleed
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other causes of hemorrhagic stroke (4)
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- cerebral amylod angiopathy
- ateriovenous malformation - intracranial neoplasms - medications (anticoag/amphetamines) |
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what is AVM
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tangle of arteries and veins w/o capillary bed
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mortality rate for hem strokes at 30 days
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48%
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very damaging
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blood in brain tissue
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brain metab can be disrupted by what (3)
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- exposure to blood
- increase ICP - 2ndary ischemia from decreased perfusion pressure and vasospasm |
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what are Sx produced from
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pressure on cranial nerves from primary hemorrhage, aneurysm, or AVM
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most common with HTN and cerebral atherosclerosis
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intracerebral hemorrhage
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what do degenerative changes result in
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vessel rupture
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with intracerebral hemorrhage, where is bleeding most common (5)
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- cerebral lobes
- basal ganglia - thalamus - brain stem -cerebellum |
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dilation of walls of cerebral artery resulting from weakness in wall
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intracranial aneurysm
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where does intracranial aneurysm occur
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bifurcation larger arteries in circle of Willis
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which arteries are most commonly affected with intracranial aneurysm (3)
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- internal carotid
- anterior/middle/posterior cerebral - anterior/posterior communicating |
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what is a berry aneurysm
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round like a berry
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congenital defect that is twisting of w/o cap bed
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AVM
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what does absence of cap beds result in
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dilation of arteries and veins
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usually the outcome for AVM
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rupture
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most commonis AVM stroke for which group
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young adults
|
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subarchnoid hemorrhage can result from what (4)
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- AVM
- intracranial aneurysm - trauma - HTN |
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what are the most common causes of sub hemorrhage
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leaking from circle of Willis
and AVM |
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S&S of sub hemorrhage (8)
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- severe HA
- vomitting - change in LOC - Szs d/t brain stem involvement - neuro deficits - tinnitus/dizziness -bleeding - pain in back, neck, spine |
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what can CT or MRI determine (3)
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- size
- location -stroke type |
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confirms aneurysm or AVM
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angiography
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prevention for stroke (3)
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- screening high risk pts
- mgnt HTN - decrease ETOH intake |
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used for HTN control (4)
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- labetalol
- nicardipine - nitroprusside -hydralazine |
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if cause if unknown oftern r/t influx of Ca into cells... what is given to help
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CCB
|
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what is the goal of stroke (3)
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-brain recovery from initial insult
-protect from rebleeding - prevent/tx complications |