WEEK 1 Flashcards Preview

PNH > WEEK 1 > Flashcards

Flashcards in WEEK 1 Deck (74)
1

Stroke

(CBA –cerebral vascular attack): interruption of arterial blood to the brain, resulting indamaged brain tissue|
*Cellular death occurs in 5 minutes*

2

2 TYPES OF STROKE:

1. ISCHEMIC STROKE >TIA
2.HEMORRHAGIC STROKE- bleeding into the brain tissue itself or into the subarachnoid space or ventricles
|>subarachnoid stroke
|>intracerebral stroke

3

Incidence -

the number of new cases in a particular period of time

4

Prevalence –

the number of new and old cases in a particular period
of time

5

Morbidity –

rates of disability

6

Mortality –

rates of death

7

TRANSIENT ISCHEMIC ATTACK (TIA):

*early warning signs of stroke* A temporary focal loss of neurological function caused by ischemia.

8

 Ischemic stroke: (80%)- THERE ARE TWO TYPES

inadequate blood flow to the brain from partial or complete occlusion of an artery.
 There are two types: thrombotic and embloic

9

 Signs & Symptoms OF tia

depend on the blood vessel involved and the brain area that is ischemic.

10

 Carotid involvement:

may have temporary vision loss in one eye, transient hemiparesis (weakness to one side of your body), or a sudden inability to speak, numbness/ loss of sensation

11

 Vertebrobasilar involvement may include:

tinnitus, vertigo, ataxia (looking drunk), darkened or blurred vision, diplopia, ptosis, dysphagia, dysarthria, and unilateral/bilateral numbness or weakness

12

1/3

 1/3 individuals will not experince it again, 1/3 will have another TIA, the rest will experience a stroke.

13

Management of TIA


 Diagnostic tests: Cardiac monitoring & CT
 Pharmacological: 1) Antiplatelet aggregation agents(ASA, Plavix)
2) Anticoagulant agents: Coumadin (Warfarin)

14

Acute Care Goals: CVA:

 *Maintain patent airway*
 Monitor for signs of neurologic deficit
 Decrease blood viscosity
 Control fluid & electrolyte balance
 Management of ICP
 Management of pain, hypovolemia, constipation, cerebral edema

15

Thrombotic stroke( ischemic)-

results from fatty deposits that enlarge over years in carotid and other cerebral vessels. Usually slow on their onset.

16

Embolic Stroke( ischemic)-

emboli or clot fragments break off and travel to cerebral arteries, usually originates from the heart or carotid artery.

17

HEMORRHAGIC STROKE-

usually caused by: a ruptured aneurysm, severe hypertension, or drugs like cocaine etc..
a patient will have headache, nuchal rigidity, and possible nausea.
usually after shitting really hard.

18

WHAT ARE THE CONSEQUENCES OF STROKE?

Third leading cause of death and disability in adults
• about 15% of sufferers die
• about 30% are left with moderate-severe disability

19

UNMODIFIABLE RISK FACTORS-

Age- increase risk with age

20

Agnosia-

, Agnosia- Inability to recognize familiar objects, persons, smells, shapes, even though the sensation is intact

21

Ataxia-

Impaired gait, unsteady, incoordination,

22

Dysphasia/aphasia-

Impaired capacity to interpret, formulate or express meaningful language, writing or gesturing,

23

Dysphagia-

Impaired swallowing

24

Hemiparesis-

Weakness on one side of the body

25

JUST LIKE A CAR ACCIDENT –

What caused the accident?
What caused the stroke?
Where did the accident happen?
Which artery did the stroke happen in?
What damage occurred?
(Where did the brain damage occur?)

26

RIGHT HEMISPHERE

Controls left side of body, Spatial abilities, Visual imagery, Music

27

LEFT HEMISPHERE

Controls right side of body, Language/Speech, Math, Logic

28

The Frontal Lobe has many ‘jobs’including:

movement, intellectual function, emotions, memory

29

PARIETAL LOBE-

located in the top middle of the cerebrum
• helps with sense of touch and with some complex visual perceptions

30

THE TEMPORAL LOBE

located in the bottom middle of the cerebrum
• helps hearing and speech

31

THE OCCIPITAL LOBE

located in the rear of the cerebrum
• plays a major role in vision

32

THE vertebrobasilar arterial system

SUPPLIES BRAIN STEM AND CEREBELLUM

33

STROKE in the brain stem

breathing, heartbeat, articulate speech.

34

Cerebellum stroke

Cerebellum stroke ruins smooth coordinated movement

35

To differentiate stroke vs stroke mimics
&
ischemic vs hemorrhagic stroke,
requires (at least):

• History & neuro assessment (including stroke scale)
• CT scan of the head
• Blood work (including BS, CBC, INR)
• Assessment of risk factors
ECG

36

tPA

clot-busting drug that destroys an existing blood clot (- given 3 hours after onset of symptom, major side effect: cerebral hemorrhage, of BP critical during treatment and 24 hours after treatment)

37

• Wernicke’s aphasia –

receives auditory speech impulses, but unable to comprehend them, Characterized by fluent, well-articulated speech, with intact tone, but inappropriate speech content that is unintelligible d/t poor word choices

38

• Anomic or amnesic aphasia

- probs finding correct names for certain stuff

39

 Signs & Symptoms OF tia

depend on the blood vessel involved and the brain area that is ischemic.

40

 Carotid involvement:

may have temporary vision loss in one eye, transient hemiparesis (weakness to one side of your body), or a sudden inability to speak, numbness/ loss of sensation

41

 Vertebrobasilar involvement may include:

tinnitus, vertigo, ataxia (looking drunk), darkened or blurred vision, diplopia, ptosis, dysphagia, dysarthria, and unilateral/bilateral numbness or weakness

42

1/3

 1/3 individuals will not experince it again, 1/3 will have another TIA, the rest will experience a stroke.

43

Management of TIA


 Diagnostic tests: Cardiac monitoring & CT
 Pharmacological: 1) Antiplatelet aggregation agents(ASA, Plavix)
2) Anticoagulant agents: Coumadin (Warfarin)

44

Acute Care Goals: CVA:

 *Maintain patent airway*
 Monitor for signs of neurologic deficit
 Decrease blood viscosity
 Control fluid & electrolyte balance
 Management of ICP
 Management of pain, hypovolemia, constipation, cerebral edema

45

Thrombotic stroke( ischemic)-

results from fatty deposits that enlarge over years in carotid and other cerebral vessels. Usually slow on their onset.

46

Embolic Stroke( ischemic)-

emboli or clot fragments break off and travel to cerebral arteries, usually originates from the heart or carotid artery.

47

HEMORRHAGIC STROKE-

usually caused by: a ruptured aneurysm, severe hypertension, or drugs like cocaine etc..
a patient will have headache, nuchal rigidity, and possible nausea.
usually after shitting really hard.

48

WHAT ARE THE CONSEQUENCES OF STROKE?

Third leading cause of death and disability in adults
• about 15% of sufferers die
• about 30% are left with moderate-severe disability

49

UNMODIFIABLE RISK FACTORS-

Age- increase risk with age

50

Agnosia-

, Agnosia- Inability to recognize familiar objects, persons, smells, shapes, even though the sensation is intact

51

Ataxia-

Impaired gait, unsteady, incoordination,

52

Dysphasia/aphasia-

Impaired capacity to interpret, formulate or express meaningful language, writing or gesturing,

53

Dysphagia-

Impaired swallowing

54

Hemiparesis-

Weakness on one side of the body

55

STROKE in the brain stem

breathing, heartbeat, articulate speech.

56

Cerebellum stroke

Cerebellum stroke ruins smooth coordinated movement

57

To differentiate stroke vs stroke mimics
&
ischemic vs hemorrhagic stroke,
requires (at least):

• History & neuro assessment (including stroke scale)
• CT scan of the head
• Blood work (including BS, CBC, INR)
• Assessment of risk factors
ECG

58

tPA

clot-busting drug that destroys an existing blood clot (- given 3 hours after onset of symptom, major side effect: cerebral hemorrhage, of BP critical during treatment and 24 hours after treatment)

59

• Wernicke’s aphasia –

receives auditory speech impulses, but unable to comprehend them, Characterized by fluent, well-articulated speech, with intact tone, but inappropriate speech content that is unintelligible d/t poor word choices

60

• Broca’s aphasia

- expressive aphasia characterized by no fluent, telegraphic speech with outbursts of profanity, uninhibited speech and word-finding difficulties

61

• Anomic or amnesic aphasia

- probs finding correct names for certain stuff

62

• Global aphasia-

loss of all expressive and receptive

63

• Dysarthia

disturbance in the muscular control of speech

64

• Dysphasia

impaired communitcation

65

Primary assessment of the patient

with stroke is focused on cardiac, respiratory status, and neurological examination.

66

Secondary assessment should include a comprehensive neurological examination of the patient including:

LOC (Glasgow Coma Scale), cognition, motor abilities, cranial nerve function, sensation, proprioception, cerebellar function, and deep tendon reflexes.

67

Homonymous hemianopsia

(blindness in the same half of each visual field):

68

Stroke complications

Risk of recurrent stroke is 5 to 20%
 5% for cardioembolic strokes
 20% for atherosclerotic strokes

69

No significant diff between ischemic and hemorrhagic stroke.

Because destruction of neural tissue is the basis for neurological dysfunction regardless of the etiology. Therefore clinical mani. Related to the location in the brain the stroke occurred.

70

Cerebral Angioplasty –

a balloon catheter to mechanically dilate vessels

71

artherosclerosis

hardening and thickening of arteries

72

tia vs stroke

in tia ischemia occurs without infraction but in a stroke infraction and cell death occur

73

cerebral aneurysms are viewed

as the silent killers

74

antiplatelet drugs

to prevent stroke in paitents who have had TIA