+ cerebrovascular accident, traumatic brain injury, and concussion

CNS infarction is ____, ____, or ____ cell death attributable to ____

brain, spinal cord, retinal, ischemia

temporary or permanent that can lead to death of tissue

ischemia

____ is reversible

ischemia

ischemic stroke

-_____: plaque in cerebral vessel

-_____: dislodged portion of plaque travels to cerebral vessel

thrombotic, embolic

hemorrhagic stroke: ____ bleeds, ____ and ____ pressure

brain, swelling, increased

transient ischemic attack: ____ blockage of cerebral vessel, ____ symptoms

temporary, minimal to no

signs of stroke acronym

face, arms, speech, time

additional stoke manifestations (5)

numbness, confusion, troubling seeing, troubling walking, severe headache

the clinical presentation of a stoke is highly dependent on ____ and ____

location, severity

right hemispheric CVA

-____ side hemiparesis and ____ loss

-____ side, neglect, reduced ____

-____ problems

-____ changes

left, sensory, left, insight, memory, behavioral

left hemispheric CVA

-___ side hemiparesis and ____ loss

-____

-impaired ability to ___, ___, and learn new info

-____ problems

right, sensory, aphasia, read, write, memory

Ischemic stroke - modifiable risk factors

-____, smoking, ____ ratio, ____, low ____, hyperlipidemia, ____, ____ consumption

hypertension, waist to hip, diet, activity, diabetes, alcohol

medical management of stroke

-_____ control

-____ and ____ therapies

after stroke

• _____ surgery: break up thrombus

• ______ therapies to Involved vessels

risk factor, medications, behavioral, thrombolytic, invasive

prevention

-decrease cardiovascular risk

• ____, CAD, PAD, ____ fibrilation

• ____ level

• ____ history

-____ system

-_____/_____

HTN, atrial, activity, smoking, support, environment, occupation

history after acute CVA

-mental status: ____

-return to ____

A and O x4, prior level of function

with ischemic stroke, will want to ____ INR to ____ coagulation

increase, decrease

with hemorrhagic stroke: will want to ____ INR to ____ coagulation

decrease, increase

medical record after stroke

-____ orders

-allowed _____

-____ parameters

-_____

-lab values: (2)

-diagnostic tests: ____ or ____

physicians, mobility, blood pressure, medications, CBC, INR, CT, MRI

screening for patient with stroke: ___ status, ____ (look for ____ of one side), ____ pattern, ____ integrity, presence of ____, ____ signs, _____ rule, ____, ____-dermatomes, ____ reflexes, ____ screen

mental, posture, neglect, breathing, skin, deformity, vital, wells clinical decision rule, pain, sensation, deep tendon, movement

alterations in brain function or other evidence of brain pathology, caused by an external force

traumatic brain injury

when dura mater is breached, from high-velocity projectiles

open head injury

no penetration of the skull, brain swells and has no place to expand

closed head injury

diffuse axonal injury: caused by strong ____ or ____ of head, such as ____ syndrome, ____ accidents

shaking, rotation, shaken baby, car

concussion/mild traumatic brain injury (mTBI): caused by _____ blow to the ___

direct, head

contusion: _____ on the brain caused by a force to the head

bruise/bleeding

coup-countercoup injury: cause contusion at the site of ____ and move the brain causing it to slam against ____ side

impact, opposite

abusive head trauma (_____ syndrome) : violent ___ act that causes ____

shaken baby, criminal, TBI

clinical presentation of concussion/mild TBI

headache, dizziness, ____ problems, ____ pain, sensitivity to ____ and ____, fatigue, _____, difficulty regulating ____

balance, neck, light, sound, disorientation, emotions

clinical presentation of moderate-severe TBI

-____ that gets worse and does not go away

-repeating _____ or nausea

-convulsions/____

-cant ____ from sleep

-____ of pupils

-____ speech

-weakness or numbness in ____

-loss of ____/_____/restlessness/agitation

headache, vomiting, seizures, awaken, dilation, slurred, extremities, coordination, confusion

medical management of concussion/mild TBI

key is to rest for ____-____ hrs to avoid high risk activities to cranium

24, 48

medical management of moderate-severe TBI

-_____ presentation

-____ may be perfomed

-____ to control symptoms

-possible ___

variable, imaging, medications, hospitalization

acutely, sometimes with TBI, muscle tone will ___ because there is ____ control of their brain

increased, decreased

prevention TBI

-decrease ____ of risk factors

-____ system

-_____/_____

presence, support, environment, occupation

after concussion/TBI, try to…

-ascertain _____ and ____ functin

-prior ____

-____ systems

-____/____

mental status, behavioral, level of function, support, environment, occupation

after moderate to severe TBI

-____ orders

-allowed ____

-____ parameters

-____

-lab values: (2)

• prevent ___

-diagnostic tests: (2)

physicians, mobility, blood pressure, medications, CBC, INR, DVT, CT, MRI

screening for patient with TBI (moderate-severe): ____ status, ____, ____ pattern, ____ integrity, presence of associated ____, ____ signs, ____ rule, ____, ____-dermatomal pattern, ____ relfexes, ____ screen

mental, posture, breathing, skin, injuries, vital, wells clinical decision, pain, sensation, deep tendon, movement

test and measure for TBI - Ranchos Los Amigos scale

-higher number = ___

better