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NURS 416 > Week 11a: Brain Injury, Seizure disorders, Stroke, Sleep > Flashcards

Week 11a: Brain Injury, Seizure disorders, Stroke, Sleep Flashcards

1
Q

What are 3 examples of excitatory neurotransmitters?

A
  • glutamate
  • aspartate
  • acetylcholine
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2
Q

What are two examples of inhibitory neurotransmitters?

A
  • GABA

- Glycine

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3
Q

What is the dominant inhibitory neurotransmitter in the higher brain areas?

A

GABA

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4
Q

What is the dominant inhibitory neurotransmitter in the brainstem and spinal cord?

A

glycine

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5
Q

Inhibitory neurotransmitters

A

decrease the rate of neuronal firing by hyperpolarzing the neuron

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6
Q

Excitatory neurotransmitters

A

increase the rate or likelihood of a neurone firing by depolarizing the neuron

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7
Q

Causes of overstimulation of excitatory neurotransmitters?

A
  • stroke
  • hypoglycemic injury
  • trauma
  • Huntington’s disease
  • alzheimers
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8
Q

deficits in levels of consciousness, from mild confusion to stupor or coma, indicates…?

A

either direct injury to the RAS or to both the cerebral hemispheres concurrently

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9
Q

What are some characteristics of a vegetative state?

A
  • absence of awareness of self and environment
  • inability to interact with others
  • absence of sustained or reproducible voluntary behavioural responses
  • lack of language comprehension
  • hypothalamic and brainstem action to sustain life
  • bowel and bladder incontinence
  • variably preserved cranial nerve and spinal cord reflexes
  • condition has continued for at least one month
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10
Q

What are metabolic factors that increase cerebral blood flow?

A
  • carbon dioxide (hypercapnia)
  • Hydrogen Ion (decrease in pH)
  • Oxygen concentration (hypoxia)
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11
Q

factors that increase the cerebral blood flow also increases?

A

intracranial pressure

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12
Q

What ia a normal intracranial pressure?

A

0-15 mmHg

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13
Q

what is an ominous late sign of increased intracranial pressure and impending herniation?

A

cushings triad

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14
Q

Cushing’s triad

A
  1. hypertension with widened pulse pressure
  2. bradycardia
  3. changes in respiratory pattern in the presence of increased ICP (decreased RR)
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15
Q

brain herniation occurs when…?

A

when increased ICP causes the abnormal protrusion of brain tissue through openings in rigid intracranial barriers (tectorial notch)

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16
Q

Increased intracranial pressure in infants:

A
  • irritability
  • change in the pitch of the babies cry
  • bulging fontanels
  • lethargy
  • flat affect
  • poor feeding
  • may develop macrocephaly and/or split sutures
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17
Q

Increased ICP in children:

A
  • retinal hemorrhage with increased ICP should raise suspicion of non-accidental head trauma
  • “sun-setting” appearance of the eyes
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18
Q

What is the formula for measurement of cerebral perfusion pressure?

A

CPP = MAP - ICP

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19
Q

When CPP is less than 60 mmHg….

A

cerebral blood flow is compromised and auto regulation is impaired

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20
Q

CPP should be kept between?

A

60 - 70 mmHg in patients with elevated ICP to avoid ischemic injury

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21
Q

CPP more than 70 mmHg….

A

should be avoided because of increased risk for adult respiratory distress syndrome

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22
Q

What are 3 drugs used to lower ICP?

A
  • manitol
  • propofol
  • benzodiazepines
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23
Q

What other drugs can be used to decrease increased ICP?

A
  • analgesics
  • anti-epileptics for prevention of seizures
  • glucocorticoids: dexamethasone
  • antipyretics
  • antihypertensive meds
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24
Q

what are some interventions for increased ICP?

A
  • positioning
  • activity management
  • airway management
  • hyperventilation
  • bowel management
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25
Q

cingulate (subfalcine) brain herniation involves?

A

the cerebral artery

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26
Q

cingulate (subfalcine) brain herniation clinical sign?

A

leg weakness

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27
Q

Central transtentorial brain herniation involves?

A

the reticular activating system and corticospinal tract

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28
Q

Central transtentorial brain herniation clinical signs?

A

altered LOC, decorticate posturing, rostral-caudal deterioration

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29
Q

uncal brain herniation involves?

A

the cerebral peduncle, occulomotor nerve, posterior cerebral artery, cerebellar tonsil, and respiratory centre

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30
Q

uncal brain herniation clinical signs?

A

hemiparesis, pupil dilation, visual field loss, respiratory arrest

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31
Q

hydrocephalus

A

an abnormal increase in CSF volume in any part or all of the ventricular system

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32
Q

vasogenic cerebral edema

A

occurs with conditions that impair the function of the BBB and that allow transfer of water and protein from the vascular into the interstitial space. Ex: sepsis

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33
Q

cytotoxic cerebral edema

A

involves an increase in intracellular fluid

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34
Q

interstitial cerebral edema

A

edema in the central white matter as in hydrocephalus affecting the brain

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35
Q

primary or direct brain injuries

A
  • damage is caused by an impact

- include diffuse axonal injury, and the focal lesions of laceration, contusion and hemorrhage

36
Q

secondary brain injuries

A
  • damage results from the subsequent brain swelling, infection and cerebral hypoxia
  • often diffuse or multifocal, including concussion, infection and hypoxic brain injury
37
Q

what are the symptoms of post concussion syndrome?

A
  • headache
  • irritability
  • insomnia
  • poor concentration and memory
38
Q

an immediate and transient loss of consciousness accompanied by a brief period of amnesia after a blow to the head

A

concussion

39
Q

Which type of hematoma is usually caused by head injury in which the skull is fractured?

A

epidural hematoma

40
Q

which type of hematoma develops between the inner table of the bones of the skull and the dura

A

epidural hematoma

41
Q

which type of hematoma is usually the result of a tear in the small bridging that connect veins on the surface of the cortex to the dural sinuses

A

subdural hematoma

42
Q

which type of hematoma develops in the area between the dura and the ararchnoid (subdural) space?

A

subdural hematoma

43
Q

which type of hematoma may be single or multiple and can occur in any lobe of the brain but are most common in the frontal or temporal lobes?

A

traumatic intracerebral hematoma

44
Q

inflammation of the Pia matter, the arachnoid, and the CSF filled subarachnoid space

A

meningitis

45
Q

infection of the parenchyma of the brain or spinal cord

A

encephalitis

46
Q

status epilepticus

A

continual seizures that do not stop spontaneously

47
Q

first line treatment of status epileptics

A

benzodiazepines

48
Q

what are the 4 mechanisms of action of drugs for seizures and epilepsy

A
  • increasing the stimulation of GABA receptors
  • Reduce Na+ influx into neurons
  • Reduce Ca2+ influx into neurons
  • block glutamate receptors
49
Q

barbiturates are indicated primarily for?

A

tonic clonic seizures

50
Q

benzodiazepines are indicated primarily for?

A

absence and myoclonic seizures

51
Q

gabapentin is indicated for?

A

partia seizures

52
Q

what are 3 types of drugs that stimulate GABA receptors?

A
  • barbiturates
  • benzos
  • gabapentin
53
Q

what is the prototype drug for seizures

A

phenobarbital

54
Q

phenobarbital is indicated for?

A

most seizure types except absence seizures

55
Q

adverse effects of phenobarbital?

A
  • respiratory depression
  • hypotension
  • drowsiness, sedation, excitation (children), difficulty focusing, confusion, depression, headache
56
Q

therapeutic effects and uses of diazepam

A
  • status epilepticus
  • prevention of seizures
  • anti anxiety, sedative hypnotic
57
Q

adverse effects of diazepam

A
  • drowsiness
  • fatigue
  • dizziness
58
Q

risks of IV delivery of diazepam

A
  • risk of muscle weakness
  • hypotension
  • respiratory depression
59
Q

3 examples of drugs that reduce Na+ influx

A
  1. phenytoin
  2. carbamazepine
  3. valproate
60
Q

Phenytoin is indicated for?

A

all seizures except absence seizures

61
Q

carbamazepine is indicated for?

A

tonic-clonic and partial seizures

62
Q

valproate is indicated for?

A

absence and tonic-clonic seizures as well as bipolar disorder

63
Q

phenytoin has many…?

A

drug interactions!

64
Q

what are some adverse effects of phenytoin?

A
  • lethargy, drowsiness, dizziness
  • headache
  • bradycardia, hypotension
  • agranulocytosis, leukopenia, thrombocytopenia
  • rashes
65
Q

what is an adverse effect of valproic acid

A

prolonged bleeding and clotting times

66
Q

TIA

A

a mini stroke. usually resolves within 24 hours. A warning sign for a stroke

67
Q

What happens during a stroke?

A
  1. glutamate release
  2. Ca influx
  3. membrane depolarization
  4. apoptosis
  5. ischemic penumbra
68
Q

ischemic penumbra

A

central core of dead or dying cells, surrounded by an ischemic band or area of minimally perfused cells called the penumbra

69
Q

Dysarthria

A

weak muscle control resulting in slurred speech

70
Q

dysphagia

A

problems swallowing including coughing or choking when eating or drinking

71
Q

aphasia

A

impairment of language and speaking

72
Q

Expressive aphasia

A

includes speaking any words or saying the correct words

73
Q

apraxia

A

dysfunction in moving the muscles needed in the correct order and sequence

74
Q

dyslexia

A

trouble reading

75
Q

dysgraphia

A

trouble writing

76
Q

agnosia

A

inability to recognize and identify objects or persons

77
Q

hemianopia

A

blindness in one half of the visual field

78
Q

which type of CVA involves awareness of deficits, anxiety and depression

A

Left

79
Q

TPA is usually given within?

A

3 hours

80
Q

diagnosis of sleep apnea

A
  • sleep studies
  • EOG
  • EEG
  • polysomnography
81
Q

signs and symptoms of sleep apnea

A
  • noisy snoring
  • insomnia
  • abnormal movements during sleep
  • morning headaches
  • excessive daytime sleepiness
  • cognitive and personality changes
  • sexual impotence
  • systemic hypertension
  • Brady cardia (ventricular tachycardia may occur in severe hypoxemia)
  • severe cases: pulmonary hypertension, cor pulmonale, polycythemia
82
Q

benzodiazepines can reduce…?

A

REM sleep

83
Q

benzodiazepines are antagonized by?

A

flumazenil

84
Q

therapeutic effects of lorazepam

A
  • GAD
  • anxiolytic, sedative-hypnotic
  • anti-seizure
  • pre-anesthetic
85
Q

tolerance to barbiturates can promote…?

A

tolerance to opioids and other CNS depressants

NURS 416 (17 decks)

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