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Neuromus 2 > acute care of stroke > Flashcards

acute care of stroke Flashcards

1
Q

what does better in rehab hemo or ischemic

A

hemo

a lot of the deficits that are originally seen are due to brain swelling therefore once this swelling goes down the deficits are reduced

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2
Q

what is the main medical treatment for ischemic stroke

A

TPA - 3 hrs

thromboectomy - greater than 3 hrs

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3
Q

what is the NIHSS

A

a quantitative assessment that provides a measure of stroke related deficits

used to determine treatment, acuity of the stroke, and predict pt outcomes

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4
Q

NIHSS scoring

A

0 good

42 very very bad

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5
Q

NIHSS >25

A

very server neuro impairments

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6
Q

NIHSS 15-25

A

server impairment

need a second set of hands to work with these patients

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7
Q

NIHSS 5-15

A

mild to mod impairment

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8
Q

NIHSS <5

A

mild impairment

can handle this by myself

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9
Q

what NIHSS does well in rehab

A

middle ranges
up to 20

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10
Q

larger NIHSS and rehab

A

they may be a able to tolerated this amount of activity

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11
Q

D/C planning and NIHSS scale - <5

A

12x more likly to go home

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12
Q

D/C planning and NIHSS scale - 6-13

A

1.9x skilled facility

IPR>SNF

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13
Q

D/C planning and NIHSS scale - >14

A

3.4x skilled facility
IPR<SNF

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14
Q

ischemic stroke BP

A

has strict floor and caps

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15
Q

what is the point of monitoring BP in those who have ischemic stroke

A

prevent hemo conversion

encourage perfusion

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16
Q

do we want to keep the pressure high or low with an ischemic stroke

A

high

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17
Q

what does CPP stand for

A

cerebral perfusion pressure

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18
Q

what does CPP mean

A

net pressure of blood flow to the brain

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19
Q

how do we calculate CPP

A

MAP - ICP

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20
Q

what does MAP mean

A

force that pushes blood into the brain

> 60

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21
Q

what does ICP mean

A

force that pushed blood out of the brain

10-15

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22
Q

what is hemo conversion

A

Hemorrhagic conversion occurs when blood vessels in the brain rupture after blood flow is restored to the brain after a stroke

has both kind of strokes

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23
Q

ischemic stroke BP allowed with thromolytic agent (TPA/TNK)

A

180/105

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24
Q

ischemic stroke BP allowed without thromolytic agent

A

220/120

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25
Q

ischemic SBP floor

A

130

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26
Q

ischemic SBP cao

A

220 or 180

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27
Q

what is BP management for with hemo stroke

A

prevent further bleeding

vaso spasm

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28
Q

what is a vasospasm

A

after a hemorrhage the blood can irritate the brain and cause the vessels in the brain to narrow and spasm, limiting the blood and cuasing death of the brain tissue

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29
Q

what are the symptoms of vasospasm

A

lethargy

MS change

NS assessment worsens

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30
Q

what does SAH stand for

A

Subarachnoid hemorrhage (SAH)

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31
Q

what are the two types of hemo stroke

A

SAH

intracerebral hemorrhage

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32
Q

where does a intracerebral hemorrhage occur

A

is bleeding into the brain parenchyma

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33
Q

what is the parenchyma

A

the functional tissue in the brain that is made up of the two types of brain cell, neurons and glial cells

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34
Q

what is a subarachnoid hemorrhage

A

is bleeding into the subarachnoid space

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35
Q

what is the subarachnoid space

A

a space between your arachnoid mater and pia mater. It’s filled with cerebrospinal fluid

surrounds the brain

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36
Q

what is spasm watch

A

the first 14 day on the ICU/step down

looking for the sypmtoms of spasm

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37
Q

what is the target SBP for SAH

A

<160

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38
Q

what is the target SBP for ICH

A

<140

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39
Q

what are the common caps for vasospasm

A

140-180

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40
Q

what is cerebral edema

A

accumulation of fluid in the brain

midline shift

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41
Q

what are the symptoms of brain edema

A

lethargy

MS changes

confusion

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42
Q

when does cerebral edema peak

A

3-5 days

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43
Q

ischemic cerebral edema tx

A

BP management

medications

neurosurgical (bone flap removal)

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44
Q

hemo cerebral edema - effects

A

tissue swelling

increased blood in the ventricles

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45
Q

hemo cerebral edema - tx

A

EVD/LD (extra ventricular drain and lumbar drain)

bone flap removal

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46
Q

craniotomy

A

skull is temporarily removed

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47
Q

craniectomy

A

removing a portion of the skull without replacement

48
Q

craniectomy vs craniotomy which one needs a helmet

A

craniectomy

49
Q

EVD/LD stands for

A

extra ventricular drain and lumbar drain

50
Q

what kind of stroke is EVD/LD used for

A

hemo stroke - SAH

excessive blood in the CSF
clog villi that absorbs CSF causes increase in ICP

51
Q

what does a EVD/LD do

A

monitors the ICP

drains CSF

52
Q

what is a normal ICP

A

10-15

53
Q

how is a EVD/LD controlled

A

height of the chamber relative to the midbrain

raise decrease drainage

lower increase drainage

54
Q

if you are working with a pt who has this device what do you need to first do

A

must be clamped it is gravity dependent

55
Q

goals of a EVD/LD

A

raise drain above midbrain to safely discharge drain

otherwise may need a shunt for continued drainage

56
Q

what is a normal CSF color

A

clear yellow

57
Q

CSF with infect

A

yellow

58
Q

red CSF

A

lot of blood in the CSF

59
Q

pink CSF

A

some blood in the CSF

60
Q

what is a VP shunt

A

an internalized drain - stomach

these drains need to clammed when you stand up with a patient

61
Q

what can lead to a high risk of seizure

A

any injury to the brain

62
Q

anti-epileptic drugs (anticonvulsants) used to control seizures

A

dilantin and keppra

63
Q

side effects of dilantin and keppra

A

lethargy

64
Q

SAH and seizures

A

blood in the subarachnoid space is a irritant and can cause seizures

65
Q

what are some common signs of seizures

A

spaced out

UI - loss of bowl or bladder control

66
Q

what is duo tube

A

s a nasal, double lumen tube allowing simultaneous intestinal feeding and gastric drainage

67
Q

what is a cerebral angiogram

A

threading a plastic catherter into your vessel and using x-ray to examine the blood vessel of the brain to determine a treatment

68
Q

femoral angiogram

A

BR if catheter remain otherwise 4 hr rest

69
Q

radial angiogram

A

no strict precuations

mim wrist activity

70
Q

EVD/LD and OOB

A

must always be clamped

it is a gravity driven device

71
Q

what is the first observations that you make with stroke ICU/acute care pts

A

EO/EC

gaze preference

purposeful/spontaneous movement

tone/synergies

72
Q

what is arousel

A

the global state of responsiveness

brainstem

73
Q

what is awareness

A

brain’s ability to perceive specific environmental stimuli in different domains, including visual, somatosensory, auditory, and interoceptive (e.g. visceral and body position).

cortex

74
Q

what is stupor (noxious)

A

a state of near-unconsciousness or insensibility.

75
Q

what is a noxious stimuli

A

noxious stimulus is actually, or potentially, damaging to tissue and liable to cause pain, but does not invariably do so

76
Q

examples of noxious stimuli

A

sternal rub

nailbed

77
Q

what are the types of responses we look for with noxious stim

A

no response

extends

flexes

withdrawals

localized

78
Q

how to assess STM

A

3 words

what did you eat for breakfast

do you remember me from yesterday

79
Q

LTM questions

A

how is here visiting with you

80
Q

mimicking vs demostrative

A
  • We want to do things related to function
  • Hand someone a phone and see what they are doing with it
81
Q

what is the best score for GCS

A

15

82
Q

comatosed on the GCS

A

</= 8

83
Q

unresponsive on the GCS

A

3

84
Q

what does MS stand for

A

mental status

85
Q

what is a focal problem

A

problem with nerve, spinal cord, or brain function.

It affects a specific location, such as the left side of the face, right arm, or even a small area such as the tongue.

Speech, vision, and hearing problems are also considered focal neurological deficits.

86
Q

what is Generalize (non-focal)

A

NOT specific to a certain area of the brain, there isn’t a particular area or spot that stands out as abnormal or concerning.

may include a general loss of consciousness or emotional problem.

87
Q

what info do you want to look at is the pt is presenting with preceptual deficts

A

VF

general visual acuity

hearing impairment

88
Q

what is included in the sensation examination

A

light touch

JPS

sharp vs dull

89
Q

sensation wise how do you test if cognition is impaired

A

pinching

do they withdrawl

90
Q

what is extiniction

A
  • Can see or feel something when one stimulus is present but when both stimulus is present then they do not feel or see it because there is to much for the brain to do
91
Q

what is a another way to look at JPS

A

is their arm stuck under them

92
Q

motor examination - how to test motor strength and ROM

A

hold up your arm

put something on their face

hand them something

93
Q

what are Brunnstrom stages

A

Describe the development of the ability to move and the reorganization of the brain after a stroke

94
Q

Brunnstrom stages 1-4

A
  • Stage 1: flaccid (hypotoncity)
  • Stage 2 – 3: increased spasticity (hyper, movement within syngergies)
  • Stage 4: decrease in spasticity
95
Q

spasticity vs synergy

A

passive vs active

96
Q

what is the synergy pattern we often see in the UE

A

flexion pattern

97
Q

what is the syngery pattern wee often see in LE

A

extension pattern

98
Q

what is a field cut

A

involve partial blindness where the patient cannot see on the affected side

99
Q

field cut vs neglect

A

they can see in neglect but are not attentive to it

100
Q

neglect vs inattention

A

inattention - they prefer on side

neglect: pt does not pay attention to one side

101
Q

what is Unilateral spatial neglect (USN)

A

is a disorder of contralesional space awareness which often follows unilateral brain lesion

102
Q

Unilateral spatial neglect is normally due to lesion on what side of the brain

A

right hemp

103
Q

what is more common R or L neglect

A

left sided neglect

104
Q

personal self space neglect - - Personal neglect

A

lack of exploration or awareness of the side of the body opposite the brain lesion

o Examples: failure to dress one half of the body or combing only one side of the head.

105
Q

Peripersonal neglect

A

refers to neglect behaviors occurring within reaching space (near space).
 Example: failure to eat the food on one half of a plate.

106
Q

Extrapersonal neglect

A

refers to neglect behaviors occurring in far space.
 Example: inadvertently contacting obstacles such as a doorway when walking.

107
Q

why is R sided neglect rare

A

there is a redunacy of the processing fo the right space

108
Q

what is pusher syndrome

A

inaccurate perception of vertical orientation resulting in postural control deficits

109
Q

can you push someone with pusher synndrome

A

no they will just push back harder

pull them towards you

110
Q

what is pusher syndrome often accompanied with

A

hemisensory

server inattention - spatial neglect

111
Q

what side lesion do we often see pusher syndrome

A

right side

112
Q

left hemp and pusher syndrome is associated with what

A

aphasia

113
Q

do you ever pull on the flaccid side

A

NO

114
Q
A
115
Q
A

Neuromus 2 (17 decks)

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