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BSNC 7110 > Quiz 3 - Module 5 > Flashcards

Quiz 3 - Module 5 Flashcards

1
Q

Main vessels of cerebral circulation and the general areas of the brain they feed

A

internal carotid –> common carotid –> ACA, MCA
basilar artery –> vertebral –> PCA

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2
Q

Vessels involved in epidural bleed + S/S

A

arterial

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3
Q

Vessels involved in subdural bleed + S/S

A

venous

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4
Q

Vessels involved in subarachnoid bleed + S/S

A

arterial

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5
Q

Circle of Willis + collateral circulation

A

where pca, aca, mca join at the base of brain
protects against ischemia

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6
Q

CPP

A

CPP = MAP - ICP

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7
Q

Determinants of ICP

A

brain volume 80%
CSF 10%
blood 10%

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8
Q

Normal ICP

A

<10 mmHg
(some sources state 5-15)

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9
Q

Cerebral autoregulation

A

ability of cerebral blood vessels to vasodilate/vasoconstrict to maintain metabolic demand
vasoconstriction when BP too high
vasodilation when acidosis, hypercapnia, hyperglycemia, temperature

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10
Q

RAS function

A

level of consciouss
circadian rhythm
sleep-wake cycle

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11
Q

AEIOUTIPS

A

acidosis, alcohol
epilepsy, encephalitis, electrolytes, hepatic encephalopathy
infection
overdose
uremia, underdose
trauma, tumor, temperature
insulin (hypo or hyperglycemia)
psychosis, poisoning
stroke (ischemic/hemorrhage), seizure, syncope

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12
Q

A&P cerebrum

A

frontal lobe (executive function, memory, problem-solving, personality)
parietal (somatosensation)
temporal (listening/comprehension, memory)
occipital (vision

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13
Q

A&P brainstem

A

pons
midbrain
medulla

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14
Q

A&P cerebellum

A

muscle coordination/balance

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15
Q

Layers of meninges

A

dura mater
arachnoid mater
pia mater

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16
Q

Epidural space

A

between dura and skull

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17
Q

Subarachnoid space

A

between dura and arachnoid mater
where CSF circulates

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18
Q

Where is CSF produced?

A

in the ventricles
chondroid plexus

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19
Q

S/S encephalitis

A

focal neurologic deficit (slurred speech, blurry vision, muscle weakness)
fever
headache
N/V
neck stiffness

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20
Q

S/S meningitis

A

triad: fever >38, stiff neck, altered LOC usually sudden onset (<24 hours)

other S/S: headache, nausea/vomiting, vision changes
**usually DOES NOT have neurological deficits)

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21
Q

Differential diagnoses

A

meningitis
stroke (ischemic or hemorrhage)
traumatic intracranial hemorrhage
concussion
overdose
alcohol intoxication

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22
Q

Normal pupil size

A

2-6 mm

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23
Q

Which cranial nerves does extraocular movement test

A

3, 4, 6

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24
Q

Cushings triad

A

late sign of impending brain herniation

irregular resps
bradycardia
widened pulse pressure (elevated SBP)

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25
Decorticate positioning
abduction of arm at shoulder elbows flex inwards legs extended
26
Decerebrate positioning
extended, adducted, internal rotation of arm wrists pointed outwards legs extended feet plantar flexed
27
Subdural hematoma
between dura mater + arachnoid mater venous bleed
28
Epidural hematoma
between dura + skull arterial bleed
29
Frontal lobe
personality emotions/arousal intelligence concentration, executive function, problem solving self awareness voluntary movement speak/write behavior control
30
Where is broca's area located
in the frontal cortex damage --> expressive aphasia
31
Where is wernicke's area located
in the temporal lobe damage --> comprehension aphasia
32
S/S of stroke
facial droop slurred speech arm drift hemiparesis loss of sensation to one side of body sudden trouble seeing/blurred vision/loss of sight
33
S/S of increased ICP
headache N/V altered LOC
34
S/S of impending brain herniation
pupillary asymmetry unilateral/bilateral fixed + dilated pupils decorticate/decerebrate positioning respiratory depression
35
Normal CPP
60-80 min 60 needed to maintain cerebral perfusion
36
At what map does cerebral autoregulation fail?
map <60 or >150
37
Target MAP for ICP
90
38
Normal ICP
5-15 max <20
39
How does fever affect metabolism?
an increase of one degree increases O2 demand by 6-10%
40
ICP components
brain 80% blood 10% CSF 10% brain can compensate for increased ICP by causing cerebral vasoconstriction and increasing CSF absorption
41
S/S of increased ICP
change in LOC loss of detail/orientation forgetfulness restlessness (hypercapnia, acidosis, hypoxia) sudden quietness pupillary changes (sluggish, fixed + dilated = BAD) motor changes
42
How long does it take for brain cells to die without perfusion?
4-6 minutes
43
Types of cerebral edema
vasogenic cytotoxic interstitialV
44
Vasogenic edema
caused by inflammation + disruption of blood brain barrier vasodilation + increased vascular permeability = fluid + proteins move into tissue
45
Cytotoxic edema
damage to cells/loss of ATP malfunction of Na/K pump increase in intracellular sodium = water moves in = intracellular edema
46
Factors causing increased ICP
hypercapnia hypoxia acidosis hyperglycemia temperature loss of autoregulation (MAP <60 or >150) impaired venous outflow (neck flexion) anemia
47
Interventions for ICP
airway --> intubate if necessary ATP --> adequate glucose (NG feed, SLP ax for dysphagia) blood pressure --> maintain adequate MAP (IV fluids, pressors, inotropes, beta blockers) cervical collar --> if c-spine injury suspected (can inhibit venous outflow) calm environment --> decrease stress/stimuli gastric decompression --> improve intraabdo/intrathoracic pressure to promote breathing dim the lights HOB 30 degrees, neck in neutral alignment, avoid flexion therapeutic hyperventilation (blow off CO2 to prevent acidosis) hypertonic IV fluids (mannitol) avoid hyperthermia avoid hip flexion --> increases ICP by changing intraabdo pressure surgical --> resection, CSF drainage with catheter IV steroids --> for brain tumors hypertonic normal saline barbiturate coma --> refractory ICP sedation = decrease O2 demand neuromuscular blocking agents = decrease peripheral O2 consumption
48
Adverse fx of mannitol
hyperglycemia decreased hematocrit + blood viscosity dehydration fluid overload hypo/hyper natremia or kalemia can cross BBB --> vasogenic edema
49
Jugular vein anatomy
does not have veins fluid moves from areas of high to low pressure drainage facilitated by gravity
50
Interstitial edema
CSF leaks from ventricles into interstitial tissue *occurs in meningitis
51
Anticoagulant reversal agents:
warfarin: PCC (blood infusion), Vitamin K DOAC: none in canada heparin/LWMH: protamine sulfate
52
Hypoxia
poor oxygenation of tissue with normal blood flow low arterial oxygen content
53
Ischemia
decreased/interrupted blood flow --> poor oxygenation
54
Water shed areas
areas of the brain that lie between border zones not supplied by major arteries vulnerable to ischemia
55
Etiology of vasogenic edema
vasogenic edema = disrupted BBB hemorrhage brain injury infection
56
Etiology of cytotoxic edema
cytotoxic edema = intracellular swelling hypoosmotic state (hyponatremia, water intoxication) failure of Na/K pump (ischemia, low ATP)
57
LOC continuum
alert confusion lethargy obtunded stupor coma
58
Hydrocephalus
increase in ventricles d/t increase in CSF 1) overproduction of CSF 2) impaired reabsorption 3) obstruction
59
Traumatic Brain Injury
caused by a/d forces brain makes contact with skull --> damage to tissue, hematoma, contusions
60
Brain contusion
bruising of brain surface lacerations tearing of brain tissue
61
Brain hematoma
vascular injury/bleeding location can be: epidural (arterial) subdural subarachnoid (intracerebral)
62
Concussion
transient neurological dysfunction caused by mechanical injury to brain may have temporary loss of consciousness or amnesia brain imaging negative usually recovers within 24 hours side fx can last months
63
Types of stroke
ischemic (>80%) hemorrhagic (AV malformation, ruptured aneurysm, spontaneous bleed)
64
Ischemic stroke treatment
tPA within 3 hours thrombectomy
65
Contraindications to tPA
BP >185/110 bleeding RF (genetic dx, low platelets, prolonged clotting times) >3 hours hx of stroke/head injury within last 3 months hx of recent GI/GU bleed in last 21 days hemorrhagic stroke oral anticoagulants major surgery last 14 days active internal bleed
66
Medications that increase ICP + catecholaminse
nifedipine nitric oxide nitroprusside
67
Medications to treat BP in ICP
beta-blockers a-receptor antagonists
68
VAN (stroke sequelae)
vision (hemiparesis) aphasia neglect (touch pt bilaterally, they cannot detect sensation on one side)
69
How quickly should you drop BP during a stroke
15-25% in first 24 hours

BSNC 7110 (4 decks)

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