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100 Cards in this Set

  • Front
  • Back
What are the meninges? Name the three layers.
Tough, moist membranes surrounding the brain and spinal cord.
1. Dura mater (outermost)
2. Arachnoid layer
3. Pia mater (innermost)
How many pairs of cranial nerves are there?
12
What do cranial nerve signs help you determine?
Location of the lesion in the brain. For example if the patient sticks out her tongue and it deviates to the left, the lesion involves the nucleus of the left hypoglossal nerve (don't freak out, this is a detailed an example, just get the concept :-)
Review pneumonics and diagram for cranial nerve's. What are they? KNOW THIS FOR NCLEX
"Oh Once One Takes The Anatomy Final A Good Vacation Seems Heavenly"
Olfactory, Optic, Occulomotor, Trochlear, Trigeminal, Abducens, Facial, Acoustic, Glossopharyngeal, Vagus, Spinal accessory, Hypoglosal
What is the circle of willis?
A circular ring of blood vessels at the base of the brain that supplies most of the cerebrum. The circle receives blood from the 2 internal carotid arteries and the basilar artery.
What parts of the brain do the carotid and vertebral arteries supply? Which circulates more blood?
Carotid --> anterior 2/3 of brain, 600-700 ml/minute
Vertebral --> posterior 1/3 of brain, 100-200 ml/ minute
What happens if you lose some blood supply to a specific location in the brain?
Will see a drop in particular function
How does most of the blood leave the brain?
Via internal jugular veins
Why is it important to have good venous return from the brain? What nursing intervention would help?
b/c it is a closed compartment
-position with head straight forward
-raise HOB 28-30 degrees (higher isn't better b/c that compartmentalizes other parts of the body)
The pneumonic "DASHING" helps you remember what to assess for if the cerebellum is injured. What does it stand for?
1. Dysdiadochokinisia (if injured can't touch the back of the hand and then the palm in the same place)
2. Ataxia
3. Speech
4. Hypotonia
5. Intention tremor
6. Nystagmus
7. Gait
What part of the brain is the "switching station"?
Cerebellum-it receives messages and communicates with other parts of the brain
What does the brainstem regulate (in general terms)?
Physiological processes
What part of the brain stem regulates breathing?
Pons- blood flows through it, CO2 is detected and the pons will tell your body to breathe faster or slower. This regulation can be upset by analgesics
What are ventricles?
openings in the tissue of the brain that are filled with CSF. They provide a cushion in terms of ICP. With edema of the brain, ventricles will get smaller (fluid will go into the spinal column)
What is a stroke?
an interruption of normal blood flow to the brain
What are the 2 types of stroke?
1. Ischemic
2. Hemorrhagic
What is an ischemic stroke?
A blockage or clot interrupts normal blood flow to the brain (80% of strokes). It can be treated with IV drugs. Thrombolytics "clot-busters" dissolve clots and prevent more strokes
Note that in the 1st three hours, some cells can be saved
How would you treat an ischemic stroke?
with IV thrombolytics and t-PA "activase"
Anticoagulants have mixed results
What is a hemorrhagic stroke?
A ruptured blood vessel interrupts the normal blood flow to the brain
More serious and fatal than ischemic
What is a lacunar stroke?
A type of ischemic stroke
Occur when the penetrating branches of the middle cerebral artery (MCA), the lenticulostriate arteries, or the penetrating branches of the circle of Willis, vertebral artery, or basilar artery become occluded.
Why is it crucial to know what type of stroke a person is having?
Because if you tare unsure and you treat it with thrombolytics, you will make a person with a hemorrhagic stroke worse. The bleed will be even worse in the brain
List some signs and symptoms of stroke
paralysis on one side, facial drop, limb weakness, paresthesias/sensory loss (numbness or tingling), ataxia (gait disturbance, uncoordinated fine motor movements, speech disturbance, vision problems, headache, confusion/agitation, dizziness/vertigo
What is aphasia?
inability to speak
What is dysphasia?
difficulty speaking
What is dysarthia?
impairment of the tongue muscles essential to speech
What is dysphagia?
difficulty swallowing (GI system)
What speech disturbances are signs and symptoms of stroke?
aphasia, dysphasia, dysarthia
What vision problems are signs and symptoms of stroke?
Nystagmus (involuntary jerking of the eyes), diplopia (double vision), monocular blindless (blindness in one eye)
What is arm drift (a sign of stroke)?
Patient closes eyes and extends arms for 10 seconds, one arm will drift down
What speech test is good for stroke? What indicates normal? Abnormal?
Have the patient repeat a sentence with S and B "The sky is blue in boston"
Normal: states correctly without slurring on first attempt
Abnormal: slurs words, says the wrong words or is unable to speak on the first attempt (mute)
What are the two major mechanisms of stroke?
1. Blockage of an artery produces ischemia, depriving the brain of O2 and glucose, leading to infart if it persists
2. Rupture of an artery causes hemorrhage within or around the brain, this distorts, compresses, and tears surrounding tissue
NOTE: both kinds of stroke can increase intracranial pressure, this can lead to patient's death
What are three sources of emboli to the brain?
1. Thrombus that initially formed in the diseased heart (such as if have A-fib so need to be on coumadin)
2. Thrombus that forms on a heart valve
3. Thrombus associated with atherosclerotic plaque that formed in the extra or intrcranial parts of the vertebral artery
What can be the result of local pressure in the brain tissue?
Shut down of circulation in the smaller arteries. The local pressure is the result of blood or other fluid in the extracellular space, or swollen brain cells themselves (know this concept)
This is treated with mannitol, an osmotic diuretic.
If a client has a suspected brain attack with two episodes of speech difficulty, what type of stroke would you think this is?
Thrombolytic
At what INR (international normalized ratio) indicates anticoagulation for coumadin is adequate?
2-3
What test is used to determine stroke type?
CT scan is used to EXCLUDE the presence of hemorrhage which is essential if thrombolytics are being used. Ischemia doesn't show up well, therefore CT scans in first hours rule out hemmorhagic rather than confirm ischemic - KNOW THIS!
When might herniation happen after a stroke?
Infarct could leads to edema causing herniation (the protrusion of brain tissue through the base of skull from pressure due to mass or lesion)
How does a MRI differ from a fMRI?
MRI shows anatomy, fMRI looks at brain function, physiology
Why would you get an ECG for a client with a stroke? What might you find?
There is a high incidence of heart involvement in stroke patients and coincidence of stroke and myocardial infarction. Get an ECG to see if heart has problems that may cause it to throw clots. Ischemic stroke may cause arrhythmias. Detection of atrial fibrillation as a possible cause of embolic stroke
When might ultrasound studies be used to diagnose a stroke?
In an emergency situation
What emergency diagnostic tests would be used for stroke?
-ultrasound
-hematology (CBC to look at platelets, hematacrit, hgb)
-Clotting parameters
-Electrolytes
-Renal and hepatic function (to make sure they can get rid of dye)
-cardiac enzymes
-basic parameters of infection
***What is the most important diagnostic tool in patients with suspected stroke?***
CT scan
What is a transient ischemic (TIA) attack?
A brief episode in which neurologic deficits occur and then disappear completely, most last a few minutes to an hour but may last to 24 hours. No neurological deficits remain once the attack has ended, because little or no brain tissue is permanently damaged.
Patients often ignore these attacks so be sure to ask about them.
What does a TIA indicate?
that the stage is set for an ischemic stroke (risk is highest during the month following TIA), treatment of these patients can reduce their risk
If same symptoms occur each time, the same region of one artery is being blocked
What medical conditions increase risk of stroke?
Hypertension (risk for hemorrhagic), heart disease (risk for ischemic), diabetes, hyperlipidemia (risk for ischemic), carotid artery stenosis
***What is the most significant treatable risk factor of hemorrhagic stroke?***
HTN
What behaviors or lifestyle factors increase stroke risk?
cigarette smoking, physical inactivity, excess alcohol use, obesity, drub abuse
What unchangeable factors increase stroke risk?
-Age (risk doubles every 10 years after age 55)
- Gender (women's first strokes occur when they are older)
- Race/ethnicity (higher for African-Americans)
-Family history
-Previous stroke or TIA
***What is the number one risk factor for stroke?***
Old age
How can you teach patients to recognize a stroke?
"STaR"
S= ask the individual to Smile
T= ask the person to Talk, speak a simple sentence
R= ask person to Raise both arms
How do you treat or prevent a stroke?
-Platelet aggregation inhibitors
-ASA
-Plavix
-Ticlid
-Patients with cardiogenic sources of emboli are often treated with coumadin (a-fib, valve abnormalities, abnormal reduced motion of heart wall)
What surgery will be performed if carotid arteries are narrowed by atherosclerosis?
Two types of carotid endoarterectomy- shunted or clamped
How does a MRI differ from a fMRI?
MRI shows anatomy, fMRI looks at brain function, physiology
Why would you get an ECG for a client with a stroke? What might you find?
There is a high incidence of heart involvement in stroke patients and coincidence of stroke and myocardial infarction. Get an ECG to see if heart has problems that may cause it to throw clots. Ischemic stroke may cause arrhythmias. Detection of atrial fibrillation as a possible cause of embolic stroke
When might ultrasound studies be used to diagnose a stroke?
In an emergency situation
What emergency diagnostic tests would be used for stroke?
-ultrasound
-hematology (CBC to look at platelets, hematacrit, hgb)
-Clotting parameters
-Electrolytes
-Renal and hepatic function (to make sure they can get rid of dye)
-cardiac enzymes
-basic parameters of infection
***What is the most important diagnostic tool in patients with suspected stroke?***
CT scan
What is a transient ischemic (TIA) attack?
A brief episode in which neurologic deficits occur and then disappear completely, most last a few minutes to an hour but may last to 24 hours. No neurological deficits remain once the attack has ended, because little or no brain tissue is permanently damaged.
Patients often ignore these attacks so be sure to ask about them.
What does a TIA indicate?
that the stage is set for an ischemic stroke (risk is highest during the month following TIA), treatment of these patients can reduce their risk
If same symptoms occur each time, the same region of one artery is being blocked
What medical conditions increase risk of stroke?
Hypertension (risk for hemorrhagic), heart disease (risk for ischemic), diabetes, hyperlipidemia (risk for ischemic), carotid artery stenosis
***What is the most significant treatable risk factor of hemorrhagic stroke?***
HTN
What behaviors or lifestyle factors increase stroke risk?
cigarette smoking, physical inactivity, excess alcohol use, obesity, drub abuse
What unchangeable factors increase stroke risk?
-Age (risk doubles every 10 years after age 55)
- Gender (women's first strokes occur when they are older)
- Race/ethnicity (higher for African-Americans)
-Family history
-Previous stroke or TIA
***What is the number one risk factor for stroke?***
Old age
How can you teach patients to recognize a stroke?
"STaR"
S= ask the individual to Smile
T= ask the person to Talk, speak a simple sentence
R= ask person to Raise both arms
How do you treat or prevent a stroke?
-Platelet aggregation inhibitors
-ASA
-Plavix
-Ticlid
-Patients with cardiogenic sources of emboli are often treated with coumadin (a-fib, valve abnormalities, abnormal reduced motion of heart wall)
What surgery will be performed if carotid arteries are narrowed by atherosclerosis?
Two types of carotid endoarterectomy- shunted or clamped
What are two goals of treatment in the first 3 hours after symptoms of stroke?
1. Provide support and determine if stroke is ischemic or hemorrhagic
2. Once ischemia is determined- location of blockage, and cause should be established (thrombolytics, TPA can be done in first three hours, best results are within 90 minutes of onset)
Rheumatic heart disease puts you at risk for what type of stroke?
Embolic, remember that rheumatic heart disease is a valve issue
Can someone with a pacemaker have an MRI?
no, it will turn off the pacemaker
What is the therapy for stroke after the first three hours?
-Prevent brain swelling and potential herniations
-Prevent complications of immobility (DVTs, aspiration pneumonia, pressure sores, contractures)
-Control excessive HTN, hyperglycemia and fever
How would you manage the acute phase of stroke?
-Pulmonary and airway care (O2, risk for aspiration, consider hypoventilation, risk for obstruction)
-NPO
-Monitor vital and neurological functions (continuous heart rate and O2 sats)
-BP (want them to be as normotensive as possible, BP is elevated in most pts with acute stroke)
- body temp (***fever negatively influences neurological outcome***)
-glucose metabolism (high glucose level increasing infarct size and reduces functional outcome)
-fluid and electrolyte management
How (specifically) is acute stroke treated?
-Acute anti-thrombotic therapy (thrombolytic therapy, defibrinogenating enzymes, ASA)
-Treatment of elevated ICP and brain edema (medical and surgical treatment)
What are some key differences between hemmorhagic and ischemic stroke?
Many hemorrhagic strokes produce severe or unusual headache, n/v, with or without LOC
The presence of 1 or more of these symptoms increases the possibility of intracranial hemorrhage
coma, vomiting, severe headache, current warfarin therapy, systolic BP >220 mm Hg, glucose >170 mg/dL
What type of CVA is most fatal?
rupture of intracerebral vessel, large hemorrhages are usually evacuated, prognosis is poor for medium or large clots
What is a subarachnoid hemorrhage? How does it happen and what are some S&S?
-Blood fills and outlines brain sulci, many cases are fatal in a few hours
-sudden and severe headache, n/v
-increased edema brings about compression of the brain contents or spasm of adjacent vessels
-most common predisposing factor is HTN but other causes are aneurysms, trauma, erosion of vessel by tumor, blood dyscrasias
What is the definition of neonatal CVA?
Cerebrovascular event around the time of birth
-Perinatal (28 weeks gestation to 7 days old)
-Neonatal (under 28 days old)
-Presentation includes seizures, hypotonia, lethargy, apnea
-Can be dx retrospectively in patients who are failing to reach milestones or have hemiparesis
-Many etiologies
-Baby should not sleep all the time
What are two goals of treatment in the first 3 hours after symptoms of stroke?
1. Provide support and determine if stroke is ischemic or hemorrhagic
2. Once ischemia is determined- location of blockage, and cause should be established (thrombolytics, TPA can be done in first three hours, best results are within 90 minutes of onset)
What are two goals of treatment in the first 3 hours after symptoms of stroke?
1. Provide support and determine if stroke is ischemic or hemorrhagic
2. Once ischemia is determined- location of blockage, and cause should be established (thrombolytics, TPA can be done in first three hours, best results are within 90 minutes of onset)
Rheumatic heart disease puts you at risk for what type of stroke?
Embolic, remember that rheumatic heart disease is a valve issue
Can someone with a pacemaker have an MRI?
no, it will turn off the pacemaker
Rheumatic heart disease puts you at risk for what type of stroke?
Embolic, remember that rheumatic heart disease is a valve issue
What is the therapy for stroke after the first three hours?
-Prevent brain swelling and potential herniations
-Prevent complications of immobility (DVTs, aspiration pneumonia, pressure sores, contractures)
-Control excessive HTN, hyperglycemia and fever
Can someone with a pacemaker have an MRI?
no, it will turn off the pacemaker
How would you manage the acute phase of stroke?
-Pulmonary and airway care (O2, risk for aspiration, consider hypoventilation, risk for obstruction)
-NPO
-Monitor vital and neurological functions (continuous heart rate and O2 sats)
-BP (want them to be as normotensive as possible, BP is elevated in most pts with acute stroke)
- body temp (***fever negatively influences neurological outcome***)
-glucose metabolism (high glucose level increasing infarct size and reduces functional outcome)
-fluid and electrolyte management
What is the therapy for stroke after the first three hours?
-Prevent brain swelling and potential herniations
-Prevent complications of immobility (DVTs, aspiration pneumonia, pressure sores, contractures)
-Control excessive HTN, hyperglycemia and fever
How (specifically) is acute stroke treated?
-Acute anti-thrombotic therapy (thrombolytic therapy, defibrinogenating enzymes, ASA)
-Treatment of elevated ICP and brain edema (medical and surgical treatment)
How would you manage the acute phase of stroke?
-Pulmonary and airway care (O2, risk for aspiration, consider hypoventilation, risk for obstruction)
-NPO
-Monitor vital and neurological functions (continuous heart rate and O2 sats)
-BP (want them to be as normotensive as possible, BP is elevated in most pts with acute stroke)
- body temp (***fever negatively influences neurological outcome***)
-glucose metabolism (high glucose level increasing infarct size and reduces functional outcome)
-fluid and electrolyte management
What are some key differences between hemmorhagic and ischemic stroke?
Many hemorrhagic strokes produce severe or unusual headache, n/v, with or without LOC
How (specifically) is acute stroke treated?
-Acute anti-thrombotic therapy (thrombolytic therapy, defibrinogenating enzymes, ASA)
-Treatment of elevated ICP and brain edema (medical and surgical treatment)
The presence of 1 or more of these symptoms increases the possibility of intracranial hemorrhage
coma, vomiting, severe headache, current warfarin therapy, systolic BP >220 mm Hg, glucose >170 mg/dL
What are some key differences between hemmorhagic and ischemic stroke?
Many hemorrhagic strokes produce severe or unusual headache, n/v, with or without LOC
What type of CVA is most fatal?
rupture of intracerebral vessel, large hemorrhages are usually evacuated, prognosis is poor for medium or large clots
The presence of 1 or more of these symptoms increases the possibility of intracranial hemorrhage
coma, vomiting, severe headache, current warfarin therapy, systolic BP >220 mm Hg, glucose >170 mg/dL
What is a subarachnoid hemorrhage? How does it happen and what are some S&S?
-Blood fills and outlines brain sulci, many cases are fatal in a few hours
-sudden and severe headache, n/v
-increased edema brings about compression of the brain contents or spasm of adjacent vessels
-most common predisposing factor is HTN but other causes are aneurysms, trauma, erosion of vessel by tumor, blood dyscrasias
What type of CVA is most fatal?
rupture of intracerebral vessel, large hemorrhages are usually evacuated, prognosis is poor for medium or large clots
What is the definition of neonatal CVA?
Cerebrovascular event around the time of birth
-Perinatal (28 weeks gestation to 7 days old)
-Neonatal (under 28 days old)
-Presentation includes seizures, hypotonia, lethargy, apnea
-Can be dx retrospectively in patients who are failing to reach milestones or have hemiparesis
-Many etiologies
-Baby should not sleep all the time
What is a subarachnoid hemorrhage? How does it happen and what are some S&S?
-Blood fills and outlines brain sulci, many cases are fatal in a few hours
-sudden and severe headache, n/v
-increased edema brings about compression of the brain contents or spasm of adjacent vessels
-most common predisposing factor is HTN but other causes are aneurysms, trauma, erosion of vessel by tumor, blood dyscrasias
What is the definition of neonatal CVA?
Cerebrovascular event around the time of birth
-Perinatal (28 weeks gestation to 7 days old)
-Neonatal (under 28 days old)
-Presentation includes seizures, hypotonia, lethargy, apnea
-Can be dx retrospectively in patients who are failing to reach milestones or have hemiparesis
-Many etiologies
-Baby should not sleep all the time