Week 3: Increased intracranial pressure, TBI & stroke
45 Questions
3 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following symptoms is specifically associated with right-brain damage during a stroke?

  • Left-sided neglect (correct)
  • Slow performance, cautious
  • Paralyzed right side: hemiplegia
  • Impaired speech-language

    • What is the primary cause of an intracerebral hemorrhage?

  • Cocaine use
  • Chronic hypertension (correct)
  • Trauma to the head
  • Coagulation disorders

    • Which imaging technique is considered easier and faster for diagnosing strokes?

  • CTA
  • Cerebral angiography
  • CT scan (correct)
  • MRI

    • Which of the following is a common clinical manifestation of both ischemic and hemorrhagic strokes?

    <p>Dysphagia</p> Signup and view all the answers

    Which approach is NOT recommended for the prevention of strokes?

    <p>Ignore existing cardiac issues</p> Signup and view all the answers

    What is a common risk factor associated with hemorrhagic strokes?

    <p>Atrial fibrillation</p> Signup and view all the answers

    What neurological condition contributes to increased fall risk in stroke patients?

    <p>Ataxia</p> Signup and view all the answers

    Which treatment is primarily indicated for managing acute ischemic strokes?

    <p>Thrombolytic therapy</p> Signup and view all the answers

    Which of the following statements is true regarding the clinical manifestations of a stroke?

    <p>They depend on the location of the stroke.</p> Signup and view all the answers

    Which medication inhibits platelet aggregation by targeting the P2Y12 receptor on platelets?

    <p>Clopidogrel (Plavix)</p> Signup and view all the answers

    What is a crucial nursing consideration when administering Clopidogrel?

    <p>The effects last 7-10 days after the last dose.</p> Signup and view all the answers

    What is the primary goal of thrombolytic therapy in acute ischemic stroke management?

    <p>To dissolve blood clots.</p> Signup and view all the answers

    Which surgical procedure is appropriate for a patient with a hemorrhagic stroke?

    <p>Evacuation of the hematoma</p> Signup and view all the answers

    During rehabilitation after a stroke, which aspect is least likely to be a focus?

    <p>Medication adherence to prevent future strokes</p> Signup and view all the answers

    Which of the following is NOT a main component of acute stroke management?

    <p>Perform routine imaging and biopsy</p> Signup and view all the answers

    What differentiates surgical therapy for ischemic stroke from that for hemorrhagic stroke?

    <p>Hemorrhagic strokes require evacuation of the hematoma.</p> Signup and view all the answers

    Which statement about antiplatelet therapy is correct?

    <p>Recognizing signs of bleeding is an essential teaching point for patients on antiplatelet therapy.</p> Signup and view all the answers

    What is the most critical monitoring requirement for patients prescribed warfarin?

    <p>Regular monitoring of INR levels to ensure they remain within the therapeutic range.</p> Signup and view all the answers

    When is thrombolytic therapy most effective in acute stroke management?

    <p>When given within 3-4.5 hours of stroke onset.</p> Signup and view all the answers

    What potential interaction should patients on warfarin be aware of?

    <p>Certain supplements and foods can increase or decrease warfarin's effects.</p> Signup and view all the answers

    What is a vital consideration when managing a patient with a history of stroke during rehabilitation?

    <p>Monitoring the patient for signs of complications and adjusting rehabilitation accordingly.</p> Signup and view all the answers

    Which medication should be avoided when a patient is receiving antiplatelet therapy?

    <p>NSAIDs, due to an increased risk of bleeding.</p> Signup and view all the answers

    What is a common misconception about the administration of anticoagulants like apixaban?

    <p>Patients can stop it immediately without any consequences.</p> Signup and view all the answers

    In the context of acute stroke management, what is the purpose of performing frequent neuro vitals monitoring?

    <p>To ensure signs of neurological deterioration are swiftly identified.</p> Signup and view all the answers

    Which statement accurately describes the role of antiplatelet medications?

    <p>They help prevent new blood clots from forming.</p> Signup and view all the answers

    Match the following substances with their uses in the management of traumatic brain injury:

    <p>Mannitol = Osmotic diuretic for fluid management Sedatives = Decrease agitation and metabolic need Tube feeds = Early nutritional support Total Parenteral Nutrition (TPN) = Nutritional therapy via IV</p> Signup and view all the answers

    Match the following components of the Glasgow Coma Scale (GCS) with their corresponding assessments:

    <p>Eye opening = Response to verbal/painful stimuli Best verbal response = Ability to speak Best motor response = Ability to obey commands GCS score = Standardized assessment of consciousness</p> Signup and view all the answers

    Match the following abnormal motor responses with their clinical significance:

    <p>Abnormal flexion = Damage to both sides of the cerebral hemisphere Abnormal extension = More severe damage to the brainstem Eyes swollen = Condition affecting GCS accuracy Prior paralysis = Condition rendering GCS invalid</p> Signup and view all the answers

    Match the types of head injuries with their descriptions:

    <p>Scalp lacerations = Bleeding and infection risk Simple skull fracture = Non-depressed skull injury Basilar skull fracture = Injury at the base of the skull Depressed skull fracture = Skull inward indentation</p> Signup and view all the answers

    Match the following conditions that invalidate the Glasgow Coma Scale with their descriptions:

    <p>Nonverbal patient = May have dementia affecting response Infants = Developmental stage affecting assessment Language barrier = Difficulty in interpreting responses Blind patients = Visual impairment affecting assessment</p> Signup and view all the answers

    Match the types of cerebral edema with their descriptions:

    <p>Vasogenic = Fluid leaks from blood vessels due to disrupted blood-brain barrier Cytotoxic = Swelling of brain cells due to fluid accumulation inside them Interstitial = CSF leaks from the ventricles into surrounding brain tissue None of the above = A term not associated with cerebral edema</p> Signup and view all the answers

    Match the early signs of increased intracranial pressure (ICP) with their descriptions:

    <p>Altered LOC = Confusion or restlessness, often with unilateral pupil changes Variable signs = Focal findings indicating localized issues within the brain Unilateral hemiparesis = One-sided muscle weakness evident on examination Altered respiratory pattern = Irregular or bradypneic breathing observed</p> Signup and view all the answers

    Match the late signs of increased intracranial pressure (ICP) with their descriptions:

    <p>Dec LOC (stupor) = Decreased level of consciousness, might have pupillary changes Ineffective breathing pattern = Cheyne-Stokes respirations indicating severe dysfunction Abnormal motor response = Posturing such as decerebrate or decorticate responses HTN with widened pulse pressure = Indicates significant pressure effects in the brain</p> Signup and view all the answers

    Match the terminal signs of increased intracranial pressure (ICP) with their descriptions:

    <p>Coma = Unresponsive state with no motor response Bilaterally fixed and dilated pupils = Critical indicator of severe brain compromise Absence of motor response = Flaccidity indicating total loss of motor function Respiratory arrest = Complete cessation of breathing function</p> Signup and view all the answers

    Match Cushing's triad components with their corresponding symptoms:

    <p>Abnormal respiratory patterns = Changes in breathing rate and rhythm Bradycardia with full bounding pulse = Slow heart rate with strong pulse Increased SBP with widening pulse pressure = Elevated systolic blood pressure and varied difference Altered LOC = Change in consciousness and awareness of surroundings</p> Signup and view all the answers

    Cerebral herniation can occur due to brain tissue shifting downwards from the skull through the foramen magnum.

    <p>True</p> Signup and view all the answers

    CT scans are the least effective diagnostic test for detecting brain tumors and strokes in emergencies.

    <p>False</p> Signup and view all the answers

    Maintaining the head and neck in alignment can help reduce intracranial pressure.

    <p>True</p> Signup and view all the answers

    Hyperthermia is not considered a sign of cerebral herniation.

    <p>True</p> Signup and view all the answers

    Surgical intervention for managing cerebral herniation may include a decompressive craniotomy.

    <p>True</p> Signup and view all the answers

    What is the minimum cerebral perfusion pressure (CPP) required for adequate brain perfusion?

    <p>50 mmHg</p> Signup and view all the answers

    What physiological change occurs when CPP drops below 50 mmHg?

    <p>Cerebral ischemia</p> Signup and view all the answers

    Which of the following conditions is NOT a cause of increased intracranial pressure (ICP)?

    <p>Hydration</p> Signup and view all the answers

    How does switching to anaerobic metabolism affect vasodilation during hypoxia?

    <p>It increases lactic acid production.</p> Signup and view all the answers

    What is the relationship between mean arterial pressure (MAP) and intracranial pressure (ICP)?

    <p>CPP is calculated by subtracting ICP from MAP.</p> Signup and view all the answers

    Study Notes

    Stroke Prevention and Management

    • Lifestyle changes crucial: quitting smoking, regular exercise, and limiting alcohol intake.
    • Medication management beneficial for patients with prior transient ischemic attacks (TIA).

    Antiplatelet Medications

    • Aspirin (ASA):
      • Inhibits cyclooxygenase enzyme pivotal for thromboxane synthesis.
      • Thromboxane critical for platelet aggregation.
    • Clopidogrel (Plavix):
      • Inhibits platelet aggregation by blocking P2Y12 receptor.
      • Non-reversible effects last 7-10 days post discontinuation.
      • Can be prescribed alongside aspirin.

    Surgical Options

    • Suggested for patients with significant atherosclerosis leading to narrowing or blockages.

    Stroke: Acute Care Protocols

    • Essential to maintain airway, breathing, and circulation (ABCs) and cerebral oxygenation.
    • Balance fluids and electrolytes to support patient stability.
    • For ischemic stroke, thrombolytic therapy indicated to restore blood flow.
    • Address complications: bleeding, cerebral edema, and stroke recurrence.

    Surgical Interventions

    • Ischemic Stroke: Endovascular treatment may be used to clear clots.
    • Hemorrhagic Stroke: Surgery necessary to remove hematomas.
    • Treatment of aneurysms through clipping or coiling.

    Rehabilitation Importance

    • Essential for recovery post-stroke.

    Medication Overview

    • Thrombolytics (e.g., alteplase tPA):
      • Administered within 3-4.5 hours in acute ischemic strokes to dissolve clots.
      • Close monitoring for bleeding required.
    • Antiplatelets (ASA, clopidogrel):
      • Prevents future clot formation.
      • Educate patients about bleeding risk and adherence to prescription.
      • Caution against NSAID co-administration due to bleeding risks.
    • Anticoagulants (warfarin, apixaban):
      • Prevents clot formation; patients must be aware of bleeding signs.
      • Regular INR monitoring (for warfarin) is essential; dietary and drug interactions possible.
      • Apixaban, a direct oral anticoagulant (DOAC), also has interaction risks.

    Hemorrhagic Stroke Risk Factors

    • Major cause for intracerebral hemorrhage linked to chronic hypertension, can result in blood vessel rupture.
    • Consider trauma, coagulation disorders, and cocaine use, which is often associated with severe hypertension.
    • Subarachnoid hemorrhages stem from ruptured cerebral aneurysms or vascular malformations.

    Clinical Manifestations of Stroke

    • Symptoms vary with stroke location, common signs include:
      • Hemiparesis (weakness) or hemiplegia (paralysis) on one side of the body.
      • Dysphagia (swallowing difficulty), dizziness, ataxia (coordination issues), and sensory deficits.

    Left vs Right Brain Damage Impacts

    • Left Brain Damage:
      • Right side paralysis and language comprehension deficits.
      • Patients often experience anxiety and depression.
    • Right Brain Damage:
      • Left side paralysis with potential neglect of the affected side.
      • Can display impulsivity and impaired judgment.

    Stroke Evaluation Techniques

    • Diagnostic imaging (CT or MRI) vital for identifying stroke type and location.
    • CT scans are more accessible, while CT angiography (CTA) provides detailed blood vessel imaging.
    • Cerebral angiography offers intricate details on vascular structures.

    Stroke Prevention Strategies

    • Control hypertension and diabetes, plus management of underlying cardiac conditions.
    • Lifestyle modifications and nutritional support (early nutrition post-TBI beneficial).
    • Consider osmotic diuretics like mannitol for fluid management and sedatives for patient calmness.

    Glasgow Coma Scale (GCS)

    • A standardized assessment for consciousness level in patients.
    • Includes eye opening, verbal response, and motor response criteria.
    • Conditions affecting assessment validity include nonverbal status, trauma, or language barriers.

    Traumatic Brain Injury (TBI)

    • Management of scalp lacerations for infection risks is critical.
    • Understanding different types of skull fractures is essential for treatment and monitoring.

    Cerebral Edema

    • Three types of cerebral edema are recognized: vasogenic, cytotoxic, and interstitial.
    • Vasogenic Edema: Most common; occurs when the blood-brain barrier is disrupted, allowing fluid to leak into brain tissue, primarily affecting white matter.
    • Cytotoxic Edema: Results from fluid accumulation within brain cells, increasing the risk of stroke.
    • Interstitial Edema: Caused when cerebrospinal fluid (CSF) leaks from the ventricles into surrounding brain tissue, often linked with hydrocephalus or meningitis.

    Clinical Manifestations of Increased Intracranial Pressure (ICP)

    • Change in level of consciousness (LOC) is the earliest indicator of increased ICP.
    • Vital signs are altered due to pressure on critical brain regions like the hypothalamus and medulla.
    • Cushing's Triad: Characterized by abnormal respiratory patterns, bradycardia with a full bounding pulse, and increased systolic blood pressure with widening pulse pressure.

    Signs of Increased ICP

    • Early Signs: Altered LOC (confusion, restlessness), unilateral pupil changes, altered respiratory patterns, unilateral hemiparesis.
    • Late Signs: Decreased LOC (stupor), abnormal pupil responses, ineffective breathing patterns, abnormal motor responses.
    • Terminal Signs: Coma, bilaterally fixed and dilated pupils, respiratory arrest, absence of motor response.

    Management of Increased ICP

    • Mannitol: Osmotic diuretic administered intravenously to shift fluid from extravascular to intravascular space; requires monitoring of fluids and electrolytes.
    • Sedatives: Help reduce agitation while decreasing metabolic needs.
    • Early nutritional therapy post-traumatic brain injury (TBI) improves patient outcomes and should ideally begin within five days of injury.

    Glasgow Coma Scale (GCS)

    • The GCS assesses patient LOC through three indicators: eye opening, best verbal response, and best motor response.
    • A GCS score of 3 indicates the lowest possible level of consciousness.
    • Certain conditions render the GCS assessment invalid, including language barriers and non-verbal status.

    Traumatic Brain Injury (TBI)

    • Head trauma is categorized into mild, moderate, and severe based on GCS.
    • Key Injuries: Scalp lacerations, skull fractures (including basilar), contusions, and concussions, with the leading cause being motor vehicle accidents.
    • Basilar skull fractures present with specific signs like periorbital and postauricular ecchymosis, rhinorrhea, and otorrhea.

    Types of Hematomas

    • Epidural Hematoma: Arterial bleeding between dura mater and skull; rapid deterioration in condition; requires surgical intervention.
    • Subdural Hematoma: Venous bleeding between dura and arachnoid; symptoms may develop weeks post-injury, including confusion and lethargy.
    • Intracerebral Hematoma: Bleeding within brain tissue that may result from trauma or ruptured aneurysms.
    • Subarachnoid Hemorrhage: Bleeding between arachnoid and pia, often associated with trauma and presenting as "worst headache ever."

    Stroke Overview

    • Stroke, or cerebral vascular accident (CVA), is a leading cause of disability and the third leading cause of death in Canada.
    • Common risk factors include hypertension, diabetes, cardiovascular disease, and certain contraceptive uses.

    Transient Ischemic Attacks (TIA)

    • TIAs involve temporary neurological deficits and serve as warning signs for possible ischemic stroke.
    • Symptoms may include unilateral weakness, diplopia, sudden confusion, and loss of balance.

    Ischemic Stroke Types

    • Thrombotic Stroke: Caused by atherosclerosis; risk factors include hypertension and diabetes.
    • Embolic Stroke: Results from an embolus occluding a cerebral artery; management includes antiplatelet medications.

    Acute Stroke Care

    • Focus includes maintaining ABCs, managing cerebral oxygenation and fluid balance, and restoring cerebral blood flow with thrombolytic therapy.
    • Surgical options may be necessary for ischemic and hemorrhagic strokes, along with rehabilitative care post-stroke.

    Medication Summary

    • Thrombolytics (e.g., alteplase): Used to dissolve blood clots during acute ischemic strokes; careful monitoring is essential.

    Cerebral Herniation

    • Life-threatening complication where brain tissue shifts downward into the brainstem through the foramen magnum.
    • Signs include unilateral, fixed dilated pupil; Cushing's triad indicates increased intracranial pressure (ICP).

    Diagnostic Tests

    • Aimed at identifying the underlying cause of symptoms.
    • CT scan provides quick insights into brain injuries, bleeding, or tumors.
    • MRI is more detailed but not suitable for emergencies; helpful for identifying tumors and strokes.
    • CTA/MRA offers non-invasive imaging of blood vessels.
    • ICP measurement is critical in neuro-monitoring settings like the ICU.

    Management of Increased ICP

    • Continuous monitoring of vitals, electrolytes, ICP, and brain tissue oxygenation is necessary.
    • Minimize environmental stimuli to reduce ICP.
    • Proper positioning can enhance venous drainage, with head of bed elevated at 30 degrees and head/neck alignment maintained.
    • Surgical options include decompressive craniotomy and hematoma evacuation.
    • Medications like osmotic diuretics (e.g., mannitol) help manage fluid levels while sedatives decrease metabolic needs.

    Glasgow Coma Scale (GCS)

    • Standardized tool for assessing a patient's level of consciousness (LOC).
    • Consists of three indicators: eye opening, best verbal response, and best motor response.
    • Conditions such as dementia, trauma, or language barriers may invalidate the GCS.

    Traumatic Brain Injury (TBI)

    • Types include diffuse (generalized) and focal (localized) injuries.
    • Common causes include car accidents and impacts to the head.
    • GCS classifications: Mild (13-15), Moderate (9-12), Severe (3-8).

    Types of Brain Injuries

    • Diffuse Axonal Injury (DAI): Shearing or tearing of axons due to rapid movements; significant implications.
    • Focal Brain Injury: Localized damage, potentially from lacerations or contusions.

    Concussions

    • A mild TBI resulting from jarring impact leading to cerebral dysfunction; can be diagnosed with just one symptom.
    • Red flags for severe concussion include severe headaches, loss of consciousness, and progressive neurological symptoms.

    Hematomas

    • Epidural Hematoma: Bleeding between dura mater and skull, typically arterial; urgent surgical intervention often needed.
    • Subdural Hematoma: Bleeding between dura and arachnoid layers usually from venous injury; symptoms may take weeks to appear.
    • Intracerebral Hematoma: Bleeding within the brain tissue itself; can develop from trauma or ruptured vessels.
    • Subarachnoid Hemorrhage: Bleeding between arachnoid and pia mater, often associated with trauma.

    Stroke

    • Leading cause of disability and the third leading cause of death in Canada.
    • Risk factors include hypertension, type 2 diabetes, cardiovascular disease, and atrial fibrillation.

    Types of Stroke

    • Transient Ischemic Attacks (TIA): Temporary neurological deficits; warning signs for ischemic stroke.
    • Ischemic Stroke: Caused by arterial blockages leading to brain tissue death.

    Stroke Management

    • Focus includes airway maintenance, restoring cerebral blood flow via thrombolytics, managing complications, and rehabilitation.
    • Surgical therapy may be necessary to remove clots or evacuate hematomas.

    Medication Summary

    • Thrombolytics (e.g., alteplase) dissolve blood clots during acute ischemic stroke emergencies.

    Hemodynamics and Autoregulation

    • Low levels lead to constriction for adequate perfusion.
    • Anaerobic metabolism produces lactic acid, increasing H+ concentration, which causes vasodilation and loss of autoregulation.

    Cerebral Hemodynamics

    • Cerebral perfusion pressure (CPP) measures blood flow needed for brain tissue.
      • Normal CPP: 70-100 mmHg.
      • Minimum CPP: 50-60 mmHg for adequate perfusion.
      • CPP < 50 mmHg indicates cerebral ischemia.
    • Mean arterial pressure (MAP) averages pressure during the cardiac cycle.
      • MAP formula: DBP + 1/3(SBP-DBP) or SBP + 2(DBP).
      • Normal MAP: 70-110 mmHg.
    • CPP affected by MAP and intracranial pressure (ICP).

    Pressure-Volume Curve

    • Intracranial compliance represents volume change per pressure change.
    • Four stages from high to low compliance:
      • High compliance: small volume changes do not affect ICP.
      • Low compliance: small volume increases lead to significant ICP changes.

    Causes of Increased ICP

    • Brain Tissue: Tumors, contusions, abscesses, and edema.
    • Blood: Hemorrhages, hematomas, hypoxia, and hypercapnia.
    • Cerebrospinal Fluid (CSF): Hydrocephalus due to excess CSF or tumors affecting CSF flow.

    Cerebral Edema

    • Increases ICP by fluid accumulation in brain tissue.
    • Causes include lesions, tumors, hemorrhages, and infections.
    • Types of edema:
      • Vasogenic: Blood-brain barrier disruption leads to fluid leakage into brain tissue.
      • Cytotoxic: Cellular swelling increases risk for stroke.
      • Interstitial: CSF leaks into brain tissue, often seen in hydrocephalus and meningitis.

    Clinical Manifestations of Increased ICP

    • Early indicator: change in level of consciousness (LOC).
    • Vital sign changes due to pressure on brain structures.
    • Cushing's Triad: Abnormal respiratory patterns, bradycardia with a full bounding pulse, increased systolic blood pressure with widened pulse pressure.
    • Change in LOC: confusion or restlessness to stupor or coma.

    Glasgow Coma Scale (GCS)

    • Measures LOC through eye opening, verbal, and motor responses.
    • Conditions making GCS assessment invalid include dementia, cultural/language barriers, and facial trauma.

    Traumatic Brain Injury (TBI)

    • Types: scalp lacerations, skull fractures, and concussions.
    • Signs include headache, dizziness, coordination issues.
    • Management includes bed rest, gradual return to activity, and monitoring for red flags.

    Diffuse Axonal Injury (DAI)

    • Axonal damage occurs due to shearing, tearing, or stretching.
    • Develops within 12-24 hours post-injury; signs include decreased LOC and increased ICP.

    Focal Brain Injury

    • Localized injuries: lacerations and contusions.
    • Coup-contrecoup injuries involve damage from initial impact and rebound.

    Brain Anatomy Protection

    • Brain protected by skull, CSF, and meninges (dura mater, arachnoid mater, pia mater).

    Hematomas

    • Epidural Hematoma: Bleeding between dura mater and skull, often arterial, requires rapid intervention.
    • Subdural Hematoma: Bleeding between dura and arachnoid mater, venous, can be acute or chronic.
    • Intracerebral Hematoma: Bleeding within brain tissue; clinical manifestations vary by location.
    • Subarachnoid Hemorrhage: Bleeding in the space between arachnoid and pia mater.

    Stroke Overview

    • Leading cause of disability and third leading cause of death in Canada.
    • Major risk factors include hypertension, diabetes, cardiovascular disease, and atrial fibrillation.

    Transient Ischemic Attacks (TIA)

    • Temporary neurological deficits, warnings for ischemic stroke.

    Ischemic Stroke Types

    • Thrombotic Stroke: Often due to atherosclerosis, involves clot formation.
    • Embolic Stroke: Occurs when embolus blocks cerebral artery; common emboli include blood clots.

    Stroke Management

    • Immediate treatment is crucial for thrombolytics within 3-4.5 hours.
    • Antiplatelets (Aspirin) and anticoagulants (Warfarin, Apixaban) to prevent further clots.
    • Patient education is essential for recognizing bleeding signs and adherence to medication.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Week 3 Recap of Increased Intracranial Pressure, TBI & Stroke PDF

    Description

    Increased intracranial pressure, TBI & stroke

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser