acute care of stroke Flashcards
(115 cards)
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
2
Q
what is the main medical treatment for ischemic stroke
A
TPA - 3 hrs
thromboectomy - greater than 3 hrs
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
4
Q
NIHSS scoring
A
0 good
42 very very bad
5
Q
NIHSS >25
A
very server neuro impairments
6
Q
NIHSS 15-25
A
server impairment
need a second set of hands to work with these patients
7
Q
NIHSS 5-15
A
mild to mod impairment
8
Q
NIHSS <5
A
mild impairment
can handle this by myself
9
Q
what NIHSS does well in rehab
A
middle ranges
up to 20
10
Q
larger NIHSS and rehab
A
they may be a able to tolerated this amount of activity
11
Q
D/C planning and NIHSS scale - <5
A
12x more likly to go home
12
Q
D/C planning and NIHSS scale - 6-13
A
1.9x skilled facility
IPR>SNF
13
Q
D/C planning and NIHSS scale - >14
A
3.4x skilled facility
IPR<SNF
14
Q
ischemic stroke BP
A
has strict floor and caps
15
Q
what is the point of monitoring BP in those who have ischemic stroke
A
prevent hemo conversion
encourage perfusion
16
Q
do we want to keep the pressure high or low with an ischemic stroke
A
high
17
Q
what does CPP stand for
A
cerebral perfusion pressure
18
Q
what does CPP mean
A
net pressure of blood flow to the brain
19
Q
how do we calculate CPP
A
MAP - ICP
20
Q
what does MAP mean
A
force that pushes blood into the brain
> 60
21
Q
what does ICP mean
A
force that pushed blood out of the brain
10-15
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
23
Q
ischemic stroke BP allowed with thromolytic agent (TPA/TNK)
A
180/105
24
Q
ischemic stroke BP allowed without thromolytic agent
A
220/120
25
ischemic SBP floor
130
26
ischemic SBP cao
220 or 180
27
what is BP management for with hemo stroke
prevent further bleeding
vaso spasm
28
what is a vasospasm
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
29
what are the symptoms of vasospasm
lethargy
MS change
NS assessment worsens
30
what does SAH stand for
Subarachnoid hemorrhage (SAH)
31
what are the two types of hemo stroke
SAH
intracerebral hemorrhage
32
where does a intracerebral hemorrhage occur
is bleeding into the brain parenchyma
33
what is the parenchyma
the functional tissue in the brain that is made up of the two types of brain cell, neurons and glial cells
34
what is a subarachnoid hemorrhage
is bleeding into the subarachnoid space
35
what is the subarachnoid space
a space between your arachnoid mater and pia mater. It's filled with cerebrospinal fluid
surrounds the brain
36
what is spasm watch
the first 14 day on the ICU/step down
looking for the sypmtoms of spasm
37
what is the target SBP for SAH
<160
38
what is the target SBP for ICH
<140
39
what are the common caps for vasospasm
140-180
40
what is cerebral edema
accumulation of fluid in the brain
midline shift
41
what are the symptoms of brain edema
lethargy
MS changes
confusion
42
when does cerebral edema peak
3-5 days
43
ischemic cerebral edema tx
BP management
medications
neurosurgical (bone flap removal)
44
hemo cerebral edema - effects
tissue swelling
increased blood in the ventricles
45
hemo cerebral edema - tx
EVD/LD (extra ventricular drain and lumbar drain)
bone flap removal
46
craniotomy
skull is temporarily removed
47
craniectomy
removing a portion of the skull without replacement
48
craniectomy vs craniotomy which one needs a helmet
craniectomy
49
EVD/LD stands for
extra ventricular drain and lumbar drain
50
what kind of stroke is EVD/LD used for
hemo stroke - SAH
excessive blood in the CSF
clog villi that absorbs CSF causes increase in ICP
51
what does a EVD/LD do
monitors the ICP
drains CSF
52
what is a normal ICP
10-15
53
how is a EVD/LD controlled
height of the chamber relative to the midbrain
raise decrease drainage
lower increase drainage
54
if you are working with a pt who has this device what do you need to first do
must be clamped it is gravity dependent
55
goals of a EVD/LD
raise drain above midbrain to safely discharge drain
otherwise may need a shunt for continued drainage
56
what is a normal CSF color
clear yellow
57
CSF with infect
yellow
58
red CSF
lot of blood in the CSF
59
pink CSF
some blood in the CSF
60
what is a VP shunt
an internalized drain - stomach
these drains need to clammed when you stand up with a patient
61
what can lead to a high risk of seizure
any injury to the brain
62
anti-epileptic drugs (anticonvulsants) used to control seizures
dilantin and keppra
63
side effects of dilantin and keppra
lethargy
64
SAH and seizures
blood in the subarachnoid space is a irritant and can cause seizures
65
what are some common signs of seizures
spaced out
UI - loss of bowl or bladder control
66
what is duo tube
s a nasal, double lumen tube allowing simultaneous intestinal feeding and gastric drainage
67
what is a cerebral angiogram
threading a plastic catherter into your vessel and using x-ray to examine the blood vessel of the brain to determine a treatment
68
femoral angiogram
BR if catheter remain otherwise 4 hr rest
69
radial angiogram
no strict precuations
mim wrist activity
70
EVD/LD and OOB
must always be clamped
it is a gravity driven device
71
what is the first observations that you make with stroke ICU/acute care pts
EO/EC
gaze preference
purposeful/spontaneous movement
tone/synergies
72
what is arousel
the global state of responsiveness
brainstem
73
what is awareness
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
what is stupor (noxious)
a state of near-unconsciousness or insensibility.
75
what is a noxious stimuli
noxious stimulus is actually, or potentially, damaging to tissue and liable to cause pain, but does not invariably do so
76
examples of noxious stimuli
sternal rub
nailbed
77
what are the types of responses we look for with noxious stim
no response
extends
flexes
withdrawals
localized
78
how to assess STM
3 words
what did you eat for breakfast
do you remember me from yesterday
79
LTM questions
how is here visiting with you
80
mimicking vs demostrative
- We want to do things related to function
- Hand someone a phone and see what they are doing with it
81
what is the best score for GCS
15
82
comatosed on the GCS
83
unresponsive on the GCS
3
84
what does MS stand for
mental status
85
what is a focal problem
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
what is Generalize (non-focal)
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
what info do you want to look at is the pt is presenting with preceptual deficts
VF
general visual acuity
hearing impairment
88
what is included in the sensation examination
light touch
JPS
sharp vs dull
89
sensation wise how do you test if cognition is impaired
pinching
do they withdrawl
90
what is extiniction
- 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
what is a another way to look at JPS
is their arm stuck under them
92
motor examination - how to test motor strength and ROM
hold up your arm
put something on their face
hand them something
93
what are Brunnstrom stages
Describe the development of the ability to move and the reorganization of the brain after a stroke
94
Brunnstrom stages 1-4
- Stage 1: flaccid (hypotoncity)
- Stage 2 – 3: increased spasticity (hyper, movement within syngergies)
- Stage 4: decrease in spasticity
95
spasticity vs synergy
passive vs active
96
what is the synergy pattern we often see in the UE
flexion pattern
97
what is the syngery pattern wee often see in LE
extension pattern
98
what is a field cut
involve partial blindness where the patient cannot see on the affected side
99
field cut vs neglect
they can see in neglect but are not attentive to it
100
neglect vs inattention
inattention - they prefer on side
neglect: pt does not pay attention to one side
101
what is Unilateral spatial neglect (USN)
is a disorder of contralesional space awareness which often follows unilateral brain lesion
102
Unilateral spatial neglect is normally due to lesion on what side of the brain
right hemp
103
what is more common R or L neglect
left sided neglect
104
personal self space neglect - - Personal neglect
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
Peripersonal neglect
refers to neglect behaviors occurring within reaching space (near space).
Example: failure to eat the food on one half of a plate.
106
Extrapersonal neglect
refers to neglect behaviors occurring in far space.
Example: inadvertently contacting obstacles such as a doorway when walking.
107
why is R sided neglect rare
there is a redunacy of the processing fo the right space
108
what is pusher syndrome
inaccurate perception of vertical orientation resulting in postural control deficits
109
can you push someone with pusher synndrome
no they will just push back harder
pull them towards you
110
what is pusher syndrome often accompanied with
hemisensory
server inattention - spatial neglect
111
what side lesion do we often see pusher syndrome
right side
112
left hemp and pusher syndrome is associated with what
aphasia
113
do you ever pull on the flaccid side
NO
114
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