Patho

Front 1

Define cerebral ischemia

Back 1

ischemia to the brain. imbalance in blood flow where supply does not equal demand

Front 2

Define stroke

Back 2

Prologned ischemia with brain cell death

Front 3

What are 3 other names for stroke

Back 3

Cerebral vascular accident

Brain infarct

Brain attack

Front 4

symptoms/warning signs of a stroke

Back 4

weakness

trouble speaking

vision problems

headache

dizziness

Front 5

what are the two types or stroke types and which one is more common

Back 5

ischemic

hemorrhagic (more common)

Front 6

a thrombis is a type of _________stroke

Back 6

ischemic

Front 7

an Emboli is a type of ________stroke

Back 7

ischemic

Front 8

an intracerebral is a type of _______stroke

Back 8

hemorrahgic

Front 9

a subarachnoid is a type of _______stroke

Back 9

hemorrhagic

Front 10

subarachnoid stroke can be subdivided into which two categories

Back 10

Aneurysm

A/V malformation

Front 11

some risk factors for stroke

Back 11

hypertension

hyperlipidemia

DM

smoking

atrial fibrilation

carotid artery stenosis

sickle cell disease

Age

gender

race

previous TIAs

Front 12

define an embolic stroke

Back 12

embolus lodges in and occludes a cerebral artery

Front 13

where do the majority of emboli originate from

Back 13

heart

Front 14

what does TIA stand for

Back 14

Transient ischemic attack

Front 15

microemboli may cause....

Back 15

a TIA

Front 16

Secondary prevention for TIA

Back 16

manage risk factors

medications (antiplatlete agents)

Endarterectomy (removing plaque from artery)

Front 17

symptoms lasting longer than a TIA but no residual effects...

Back 17

ischemic stroke: reversible damage

Front 18

what is fibrinolytic therapy

Back 18

meds to break up clots in arteries

Front 19

why is it important to know whether someone is have an ischemic or hemorrhagic stroke in relation to medical interventions

Back 19

you cannot give fibrinolytics if it is hemorrhagic because it will increase the bleed

Front 20

Define the ischemic penumbra

Back 20

the zone around the main point of ischemia where the cells are ischemic but still viable cerebral tissue.

Front 21

what is the significance of the ischemic penumbra

Back 21

it is the target of acute therapies

Front 22

what are some potential complications during an ischemic stroke

Back 22

airway obstruction

aspiration

extension of stoke

increased intercranial pressure

cardiovascular complications

Front 23

what are some nursing actions in a ischemic stroke

Back 23

maintain airway through positioning, artificial airways, suctioning, and DB&C

Monitor VS, glasglow coma scale, and LOC

Monitor and adjust fluid balance

Front 24

what are some symptoms of a left hemispheric ischemic stroke

Back 24

aphasia

impaired cognition

slow and cautious

aware of deficits

Front 25

what are some symptoms or a right hemispheric ischemic stroke

Back 25

spatial perceptual deficit

minimized problems; impulsive

rapid actions

lack of awareness or deficits

Front 26

Dysarthia

Back 26

slurred of slow speech due to difficulties with controlling or coordinating the muscles associated with speech

Front 27

apraxia

Back 27

the mouth and tongue are physically able to move but the person finds it difficult or impossible to move the mouth and tongue

Front 28

what are the main client symptoms with an ischemic stroke

Back 28

motor loss

communication loss

perceptual/sensory loss

cognitive impairment

emotional defecits

Front 29

homonymous hemianopsia

Back 29

loss of vision to one side of both eyes

Front 30

Name motor losses associated with ischemic stroke

Back 30

hemiplagia (paralysis of one side of the body)

dysarthia (motor speech disorder)

dysphagia

arm pain

altered muscle function

dependent edema

self care deficits

Front 31

Name communication losses associated with ischemic stroke

Back 31

dysarthia

aphasia

apraxia

Front 32

Name perceptual/sensory losses associated with ischemic stroke

Back 32

homonymous hemianopsia

visual-spatial (L)

difficulty with proprioception (R) - orientation of limbs in space

one sided neglect

Front 33

Name cognitive impairment losses associated with ischemic stroke

Back 33

hemineglect

memory loss

decreased attention span

poor abstract reasoning

altered judgement

inability to follow instructions

Front 34

what are some interventions for an ischemic stroke

Back 34

risk factor management

medical interventions: endarterectomy, antiplatletes, thrombolytics

rehab: PT, SW, nutritionist

Front 35

define an intracerebral hemorrhage

Back 35

bleeding within the brain caused by a rupture of a blood vessel

Front 36

hypertension is one of the most common causes of...

Back 36

hemorrahgic stroke

Front 37

True of false: hemorrhagic stroke symptoms have a sudden onset

Back 37

true

Front 38

manifestations of a hemorrhagic stroke

Back 38

neurological deficits, headache, nausea, vomiting, decreased LOC, HTN

Front 39

what is an aneurysm?

Back 39

a weak buldging spot on the wall of a brain artery very much like a thin balloon or weak spot on an inner tube

Front 40

what is a saccular aneurysm and what is another name for it

Back 40

an aneurysm that looks like a sac at the bifurcation or the Y segment of arteries. It is also called a berry aneurysm

Front 41

what are the main goals with the management of a hemorrhagic stroke

Back 41

-let the brain recover

-prevent or minimize risk of rebleed

-prevent complications

Front 42

what are some complications during a hemorrhagic stroke

Back 42

-decreased blood flow

-vasospasm

-manage ICP

-manage HTN

-surgery

Front 43

when managing a hemorrhagic stroke, how do you minimize stimulation?

Back 43

-bedrest with head elevated

-dim lighting

-restrict visitors

-provide hygiene care

-reduce anything that might raise BP or decrease venous return

Front 44

what two procedures can be preformed when surgery is done for a hemorrhagic stroke and which one is more common

Back 44

-clipping the aneurysm to prevent rebleed (most common)

-coiling the aneurysm

Front 45

what are the 5 classifications of skull fractures

Back 45

-simple/linear

-depressed

-basilar

-open

-closed

Front 46

what is a simple/linear skull fracture

Back 46

break in the continuity of the bone - no compression, just a crack, causes headache but no real risk for bleed

Front 47

what is a depressed skull fracture

Back 47

bone fragments imbedded into the brain tissue

Front 48

if someone has brain swelling is it better to have a depressed or simple skull fracture and why?

Back 48

depressed because there is an opening in the skull so there is somewhere for the swelling to go instead of continually increasing the ICP

Front 49

what is a basillar skull fracture?

Back 49

fracture involving bones that form the base of the skull

Front 50

what is an open skull fracture?

Back 50

scalp laceration or tear in dura (underneath the skull)

Front 51

what is a closed skull fracture?

Back 51

dura is intact

Front 52

what are racoon eyes and battle signs and what are they associated with?

Back 52

bruising around the eyes and bruising behind the ear. Associated with basilar skull fractures

Front 53

what is the difference between primary and secondary traumatic brain injury?

Back 53

-Primary: initial brain damage including lacerations, contusions, torn blood vessels from impact, acceleration/decceleration, or foreign object penetration

-Secondary: hours or days after primary, due primarily to brain swelling or ongoing bleeding

Front 54

how are primary traumatic brain injuries categorized?

Back 54

according to locations and mechanism of injury

Front 55

what are the 3 locations for primary traumatic brain injury?

Back 55

-Focal (coup)

-Polar injury (coup contracoup)

-Diffuse injury

Front 56

What is a focal (coup) traumatic brain injury?

Back 56

localized to site of impact to the skull and may be superficial or extended deep into the brain

Front 57

What is a polar (coup contracoup) traumatic brain injury?

Back 57

consequences of the brain shifting within the skull during the course of an acceleration-deceleration movement resulting in local injury at two opposite poles of the brain

Front 58

what is a diffuse traumatic brain injury?

Back 58

movement of the brain causes widespread neural damage

Front 59

shaken baby syndrome is which type of traumatic brain injury?

Back 59

diffuse injury

Front 60

what are the classifications of a traumatic brain injury

Back 60

-concussion

-contusion

-dissuse axonal injury

-intracranial hematomas

Front 61

Concussion

Back 61

-mild shearing

-Inflammation

- temporary amnesia or disorientation

-with or without loss of consciousness

-post concussion syndrome

Front 62

What is treatment for a concussion?

Back 62

observing for PCS, providing information, explanations, and encouragement to pt

Front 63

After being discharged from a concussion, when should pt seek medical attention?

Back 63

-difficulty walking or speaking

-confusion

-severe headache

-vomiting

-weakness to one side of body

Front 64

what is the difference between concussion and contusion?

Back 64

person is unconscious with a contusion

Front 65

Contusion

Back 65

-unconscious

-brain is bruised with possible surface hemorrhage

-may arouse with effort but slips back into unconsciousness

-BP and temp subnormal

-may have abnormal motor function and increased ICP

Front 66

Diffuse axonal injury

Back 66

-severe shearing (breaking of the capillaries)

-neuronal axons torn

-hemorrhage and inflammation

-global cerebral edema

-immediate coma

-decorticate and decerebate posturing

Front 67

decorticate and decerebate posturing

Back 67

-both and plantar flexion

-decorticate has hands flexed ontop of chest

-decerebate has hands flexed at sides

Front 68

what are the two types of intracranial hematomas?

Back 68

epidural

subdural

Front 69

what is the most common cause of an epidural hematoma?

Back 69

trauma

Front 70

where are epidural hematoma's?

Back 70

between skull and dura matter, usually temperoparietal region

Front 71

what are signs and symptoms associated and epidural hematoma?

Back 71

-unconscious to conscious to unconscious

-ipsilateral pupil changes

-contralateral motor changes (weakness on side of body opposite to brain injury)

Front 72

what is ipsilateral pupil changes and what is it associated with

Back 72

changes to pupils are on the side of the injury and it is assosicated with epidural hematomas

Front 73

where is a subdural hematoma?

Back 73

between dura matter and arachnoid matter

Front 74

a subdural hematoma is a ______ bleed and a epidural hematoma is a ______ bleed

Back 74

1. venous

2. artery

Front 75

what three types of subdural hematomas can you have?

Back 75

acute

subacute

chronic

Front 76

acute subdural hematoma

Back 76

-trauma

-symptoms within 24 hours

-lose consciousness and do not regain it

-ipsilateral pupil changes

-contralateral motor changes

Front 77

subacute subdural hematoma

Back 77

-2-10 days

-may produce symptoms of increased ICP

Front 78

what are symptoms of increased ICP

Back 78

-headache

-vomiting

-blurred vision

Front 79

chronic subdural hematoma

Back 79

-due to: atherosclerosis, anticoagulant therapy, thrombocytopenia, alcohol abuse

-mild trauma

-happens in elderly

-more prevelant in women

-week later

-confusion, lethargy, decreased LOC, headache

Front 80

what are burr holes and when are they done

Back 80

drilling into the head to allow evacuation of blood thats collected - in hematomas

Front 81

what does it mean to ligate a bleeding vessel?

Back 81

tie it off

Front 82

why would you hyperventilate someone with a traumatic head injury?

Back 82

to get their CO2 down because CO2 causes vasodilation

Front 83

what do you have to keep sterile with a basal skull fracture and why?

Back 83

ear and nose because CSF is leaking out and if it can get out then bugs could potentionally get into the spinal fluid

Front 84

what are some things you want to maintain within a normal range with a traumatic brain injury?

Back 84

-temperature

-PCO2

-serum glucose level

-intravascular volume

Front 85

what are the mechanisms of a secondary traumatic brain injury?

Back 85

-ischemia

-increased ICP

-altered vascular regulation

Front 86

what three things contribute to ICP?

Back 86

Brain tissue

Blood

CSF

Front 87

what two things autoregulate the ICP

Back 87

Blood

CSF

Front 88

What is a normal ICP

Back 88

0-15 mmhg

Front 89

What regulates cerebral blood flow

Back 89

CO2

O2

BP

Front 90

what is cerebral perfusion pressure?

Back 90

pressure at which brain adequatley perfused with blood. 70-100mmHg

Front 91

what can cause increasing ICP in the brain, the blood, and the CSF?

Back 91

-Brain: trauma, ischemia, infection, tumor

-Blood: R-sided heart failure, acidosis, hypoxia

-CFS: hydrocephalus

Front 92

what is hydrocephalus?

Back 92

accumulation of CSF in the brain

Front 93

what are the mechanisms that lead to increased ICP

Back 93

inflammation

cerebral edema

Front 94

Vasogenic ICP is: interstitial or intracellular

Back 94

interstitial

Front 95

Cytotoxic ICP is: interstitial or intracellular

Back 95

intracellular

Front 96

what is herniation and what causes it

Back 96

part of the brain being squeezed across structure in the cell. Caused by increased intracranial pressure

Front 97

Define supratentorial, uncal, and infratentorial

Back 97

All types of herniations

supra - above tentorial notch

uncal - common subtype, inner most part of temporal lobe

infra - below tentorial notch

Front 98

what are some manifestations of increased ICP

Back 98

decreased LOC

decreased of abnormal pupil and eye response

decreased or abnormal motor response

decreased or abnormal resps

cardiovascular side effects

Front 99

what does widening pulse pressure mean and when does it happen?

Back 99

as diastolic falls, systolic increases, creating a bigger gap between the two. Happens with increasing ICP

Front 100

what is the main goal with increasing ICP

Back 100

prevent secondary injury and maintain adequate cerebral oxygenation

Front 101

what kind of surgical interventions could take place with increased ICP

Back 101

evacuate blood clots

debridement and elevation of depressed skull

suture severe scalp lacerations

Front 102

what are some nursing actions for increasing ICP

Back 102

elevate head of bed

maintain normal blood volume

maintain adequate oxygenation

ventilator support

seizure prevention

nutritional support

pain and anxiety management

NG tube (prevent aspiration)

sedation

hypothermia

Front 103

what medications are used with increasing ICP and why

Back 103

Mannitol - osmotic diuretic - decrease edema

Diazepam - sedative/hypnotic - depresses the CNS

Propafol - general anasthetic - no analgesia

Antiobiotics - open head injuries

Front 104

who is at greatest risk for spinal cord injury?

Back 104

men age 15-34

Front 105

what are the most common causes of spinal cord injuries

Back 105

car accidents

falls/industrial accidents

sports injuries/violence/other

Front 106

true or false: primary spinal cord injuries may be reversible

Back 106

false, secondary injuries may be reversible. primary injuries are irreversible

Front 107

what causes primary spinal cord injury

Back 107

mechanical trauma

Front 108

what causes secondary spinal cord injury

Back 108

hemorrhage

inflammation

vasospasms

spinal shock

Front 109

how are spinal cord injuries classified?

Back 109

mechanism of injury

skeletal and neurological level of injury

degree of injury

Front 110

what are the skeletal levels of spinal cord injury

Back 110

cervical

thoracic

lumbar

Front 111

which skeletal level of spinal cord injury results in tetraplegia

Back 111

cervial

Front 112

which skeletal level of spinal cord injury results in parapelegia

Back 112

lumbar and thoracic

Front 113

what are the degrees of injury of a spinal cord injury?

Back 113

complete and incomplete cord lesion

Front 114

what is the difference between an complete and incomplete cord lesion?

Back 114

complete = total loss of sensory and motor function below level of lesion

incomplete = mixed loss and voluntary motor activity and sensation. leaves some tracts intact

Front 115

how can edema cause a secondary spinal cord injury?

Back 115

cord compression -> more ischemia -> necrosis

Front 116

what is spinal shock

Back 116

loss of sensorimotor functions. A state of depression of cord function below the level of injury with associated loss of all sensorimotor functions.

Front 117

what is neurogenic shock

Back 117

loss of autonomic nervous system (neurogenic) functions. (SNS and PNS). Loss of vasomotor tone.

Front 118

what are signs of spinal shock

Back 118

decreased reflexes

loss of sensation

flaccid paralysis below level of injury

Front 119

true of false: neurogenic shock is generally associated with a cervical or high thoracic injury?

Back 119

true

Front 120

signs of neurogenic shock

Back 120

hypotension

bradycardia

warm dry exremities on paralyzed portion of body

Front 121

what are some concerns with a patient with a spinal cord injury

Back 121

skin breakdown

clot formation

feeding

voiding

prevent increase swelling

log roll

Front 122

what are manifestations of a chronic spinal cord injury?

Back 122

-vasovagal response - bradycardia - asystole = fainting

-orthostatic hypotension

-poikilothermia - no shivering

-autonomic dysreflexia/hyperreflexia - anything (full bladder, fold in sheets) setting off sympathetic stimulation below level of injury

Front 123

why can autonomic dysreflexia be life threatening and how is it fixed

Back 123

the stimulation travels only up to point of lesion so sympathetic response goes out only below point of lesion causing vasospasm, HTN, pilomotor spasm, and pallor. HR can go well above 200. Fix by removing the initial stimulus