Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
41 Cards in this Set
- Front
- Back
|
CO2 is a potent vasodilator/vasoconstrictor and changes in arterial CO2 levels have a dramatic effect on ____ blood flow. Increased/decreased CO2 levels increase cerebral blood flow and vice versa. Very high/low partial pressure of arterial O2 less than __ or increases in ______ ion concentration increases/decreases cerebral blood flow.
|
CO2 is a potent vasodilator and changes in arterial CO2 levels have a dramatic effect on cerebral blood flow. Increased CO2 levels increase cerebral blood flow and vice versa. Very low partial pressure of arterial O2 less than 50 or increases in hydrogen ion concentration increases cerebral blood flow.
|
|
|
CO must decrease by how much for cerebral blood flow to be reduced?
|
1/3
|
|
|
Some factors that affect blood flow to the brain include systemic BP, CO, and blood viscosity. ICP also influences cerebral blood flow. Increased/decreased ICP causes brain ______ and increased/decreased cerebral blood flow. One of your major goals when caring for a stroke patient is to reduce secondary injury related to increased ICP.
|
Some factors that affect blood flow to the brain include systemic BP, CO, and blood viscosity. ICP also influences cerebral blood flow. Increased ICP causes brain compression and decreased cerebral blood flow. One of your major goals when caring for a stroke patient is to reduce secondary injury related to increased ICP.
|
|
|
Cerebral _____ occurs when a cerebral artery becomes blocked and blood supply to the brain beyond the blockage is cut off.
|
Cerebral infarction occurs when a cerebral artery becomes blocked and blood supply to the brain beyond the blockage is cut off.
|
|
|
What are some nonmodifiable risk factors for stroke?
(4) |
age- after 55, risk doubles each decade
gender- (more men suffer strokes but more women die from strokes) ethnicity/race- Af. Americans family hx/heredity |
|
|
What are some modifiable risk factors for stroke?
(10) |
MASHeD (couch potato) IDAHO
Metabolic Syndrome- diabetes Alcohol consumption - excess Smoking HTN Drug abuse Inactivity Diet is poor, high fat/ cholesterol etc Apnea (sleep) Heart Disease Obesity |
|
|
Explain the simple stroke test.
|
FAST
Face- ask person to smile, does one side of the face droop? Arms- ask person to raise both arms. Can he? Does one arm drift downward? S-Speech/Sight- Ask the person to repeat a simple sentence. Are words slurred? Can they repeat it? T-Time: If the person shows any of these symptoms, time is important. Call 911. |
|
|
Autoregulation ensures adequate blood flow to brain with changes in what 3 things
|
blood pressure
cardiac output blood viscosity |
|
|
True or False: Blood flow is effected by atherosclerosis, ke are classified cerebral edema, vasospasm, and collateral circulation.
|
true
|
|
|
Types of strokes are classified according to the different ways blood supply to the brain is interrupted.
A _____ stroke is when there is cerebral narrowing of the artery by fatty deposits called plaque. Plaque can cause a clot to form, which blocks the passage of blood through the artery. A ______ stroke is when an _____ (a blood clot or other debris circulating in the blood) reaches an artery in the brain too narrow to pass through and lodges there, blocking flow of blood. A _____ stroke is a burst blood vessel may allow blood to seep into and damage brain tissues until _____ shuts off the leak. |
Types of strokes are classified according to the different ways blood supply to the brain is interrupted.
A thrombotic stroke is when there is cerebral narrowing of the artery by fatty deposits called plaque. Plaque can cause a clot to form, which blocks the passage of blood through the artery. An embolic stroke is when an embolism (a blood clot or other debris circulating in the blood) reaches an artery in the brain too narrow to pass through and lodges there, blocking flow of blood. A hemorrhagic stroke is a burst blood vessel may allow blood to seep into and damage brain tissues until clotting shuts off the leak. |
|
|
If there's a temporary focal loss of neurologic function caused by ischemia,it's a...
|
tia- a transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction.
|
|
|
True or False: most TIA's resolve within 2 weeks.
|
False. Most resolve within 3 h. If it resolves within 24 h, it's a tia not a stroke. (the impairment could mimic a stroke- numbness in left arm, can't see out of one eye etc. but it resolves- could be tiny embolic blocking temporarily)
|
|
|
True or False: TIA's are nothing to worry about
|
False- it's a huge warning sign of progressive cerebrovascular athersclerotic disease
Should always go get tx. 30- 50% of people who have a thrombotic stroke had a tia. |
|
|
The first ____ days after symptoms of ischemia (TIA) is the highest period of risk for recurrence or stroke.
|
thirty
|
|
|
What drug is the tx of choice for a tia? What are some other meds? ______ is not routinely given, but may be prescribed if the pt....
|
aspirin
ticlopidine (Ticlid) clopidogrel (Plavix) dipyridamole & aspirin (Aggrenox) Coumadin is not routinely given, but may be prescribed if the pt has a tia and has a fib. |
|
|
What is a quick check we should do when someone is having stroke-like symptoms?
|
blood sugar!
hypoglycemia can mimic a stroke (however low blood sugar usually present as bilateral deficits compared to strokes which usually have unilateral deficits) |
|
|
Ischemia usually have a ____ origin while emboli have a ___ origin.
|
Ischemia usually have a pulmonary origin while emboli have a pulmonary origin.
|
|
|
what is the most common type of stroke?
|
thrombotic
|
|
|
What are 2 things we don't want to do until we know what kind of stroke someone is having?
|
Don't give aspirin til you know what kind of stroke, don't use dye in CT without knowing either
|
|
|
A ______ stroke is often preceded by a TIA. These kinds of strokes are sudden/gradual in onset. They are most likely to occur in the early evening/morning or during rest when blood pressure is higher/lower They are associated with hypertension and ____.
|
A thrombotic stroke is often preceded by a TIA. These kinds of strokes are gradual in onset. They are most likely to occur in the early morning or during rest when blood pressure is lower.They are associated with hypertension and diabetes.
|
|
|
What kind of stroke usually has a cardiac origin? Is the onset rapid/gradual? Are the symptoms mild or severe?
|
cardiac
rapid severe- severe neurologic deficits |
|
|
True or False: Recurrence of an embolic stroke is common unless the underlying cause is treated.
True or false: People who have embolic strokes are usually found unconscious. |
true
false- usually conscious, may have h/a |
|
|
Most patients with ischemic stroke don't have a decreased LOC unless it is due to a ____ stroke or other conditions such as seizures, Inc. ICP, or hemorrhage.
|
Most patients with ischemic stroke don't have a decreased LOC unless it is due to a brainstem stroke or other conditions such as seizures, Inc. ICP, or hemorrhage.
|
|
|
What type of stroke is often described as the "worst headache of my life."?
|
subarachnoid hemorrhage
|
|
|
Hemorrhagic strokes result from bleeding into the brain tissue itself or into the ______ space or ____. An _________ hemorrhage is when there is bleeding within the brain caused by a ruptured vessel. ______ is the most important cause. Hemorrhage often occurs during periods of ____. The onset is ____ with progression over minutes to hours.
|
Hemorrhagic strokes result from bleeding into the brain tissue itself or into the subarachnoid space or ventricles An intracerebral hemorrhage is when there is bleeding within the brain caused by a ruptured vessel. HTN is the most important cause. Hemorrhage often occurs during periods of ACTIVITY. The onset is RAPID with progression over minutes to hours.
|
|
|
In an intracerebral hemorrhage, the person may manifest the following symptoms: hypertension/hypotension, decreased _____, _____ deficits, nausea, vomiting, headache.
|
In an intracerebral hemorrhage, the person may manifest the following symptoms: hypertension, decreased LOC, neurological deficits, nausea, vomiting, headache.
|
|
|
We can give fibrinolytics if we know....
|
pt is still within 3 h window, they were acting normal within last 3 h. If longer, high risk of bleed.
|
|
|
true or false: During/after a stroke, If SBP is around 180 we might not treat because we need to maintain cerebral blood flow, there's a balancing act with maintaining adequate MAP & BP, we might not treat until SBP >210-220 depending on orders
|
true
|
|
|
Are there usually warning signs with an embolic or a thrombotic stroke?
|
thrombotic- yes (TIA)
embolic- no |
|
|
A ______ ______ involves intracranial bleeding into cerebrospinal fluid-filled space between the arachnoid and pia matter.
|
subarachnoid hemorrhage
|
|
|
A subarachnoid hemorrhage is usually caused by rupture of a cerebral _____ or ______.
|
A subarachnoid hemorrhage is usually caused by rupture of a cerebral aneurism or AVM.
|
|
|
A cerebral ____ is the dilation of the walls of a cerebral artery caused by a congenital weakness, trauma, arteriosclerosis, and/or HTN. It compresses nearby ___nerves causing focal deficits, or other brain structures. It may rupture, which causes hemorrhage. There is initial ___ formation then f____. There is a risk for ____ ____ from vasospasm 4 - 12 days after the initial bleed (may rebleed).
|
A cerebral aneurysm is the dilation of the walls of a cerebral artery caused by a congenital weakness, trauma, arteriosclerosis, and/or HTN. It compresses nearby cranial nerves causing focal deficits, or other brain structures. It may rupture, which causes hemorrhage. There is initial clot formation then fibrinolysis There is a risk for ischemic stroke from vasospasm 4 - 12 days after the initial bleed (may rebleed).
|
|
|
________ is used to prevent vasospasm after an aneurysm.
|
namodipine (and other calcium channel blockers)
|
|
|
If tPA is going to be administered, what should be inserted first?
|
multiple IV's
urinary catheter ng tube |
|
|
WIth a hemorrhagic stroke, _____ prophylaxis should be initiated.
|
seizure
|
|
|
When should nimodipine (Nimotop) be withheld? and why do we use it?
|
HR < or equal to 60
SBP < 90 prevent vasospasm |
|
|
Screening for tPA administration involves what?
|
non-contrast CT MRI to r/o hemorrhagic stroke
blood test for coagulation disorders screening for recent GI bleed, stroke, or head trauma within past 3 months major surgery within 14 days (any of these are contraindications) |
|
|
compare the manifestations of right and left sided stroke damage
|
..ch 58
|
|
|
how do you calculate CPP? What's the normal range?
What happens when out of this range? |
CPP = MAP - ICP
normal is 60-100 <50 ischemia and cell death <30 incompatible with life |
|
|
how do you calculate MAP? What's the normal range?
What happens when out of this range? |
MAP is 2 diastolics + 1 systolic divided by 3
50-150 Best if above 50 <50 cerebral ischemia >150 no more ability to increase, can't constrict vessels any further |
|
|
normal ICP
|
0-15 mm Hg
|
