Perfusion Part 2
Anemia can occur 3 different ways which each have different catagories of how they occur. What are the 3 ways?
1. Blood Loss or Destruction
3. Bone Marrow Suppression/failure
What is the difference between acute and chronic blood loss?
Name the hemolytic anemias.
Hereditary cell membrane disorders
Defective hemoglobin (Sickle and Thalassemia)
What are the autoimmune hemolytic anemias
What kind of anemia is due to altered Hemoglobin synthesis?
What kinds of anemia are due to altered DNA synthesis?
What kind of anemia is due to bone marrow suppression/ failure?
aplastic or stem cell dysfunction
What are the platelets or clotting factor disorders?
Hemophilia A & B
What are the DVT assessment findings?
- pain, swelling and tenderness in one of your legs (usually your calf)
- a heavy ache in the affected area.
- warm skin in the area of the clot.
- red skin, particularly at the back of your leg below the knee.
- Homan's sign- (calf pain at dorsiflexion of the foot)
What are the DVT causes?
Illness or injury that causes prolonged immobility
Age > 40
Pregnancy, birth control pills and hormone replacement therapy
Cancer and its treatment
Major surgery (ex: abdomen, pelvis, hip facture, knee fracture, hip or knee replacement)
Surgery time > 30 minutes
Indwelling vascular devices
Previous DVT or PE
How do you diagnose a DVT?
What are DVT risk factors?
Major risk factors for DVT include: heart failure, severe respiratory disease and sepsis.
How does prophylaxis and treatment for a DVT differ?
What causes a pulmonary embolus?
Foreign bodies (IV/central venous catheters)
Certain disease states (combination of stasis, coagulation alterations, and venous injury)
Heart disease (especially heart failure)
Trauma (especially fracture of hip, pelvis, vertebra, lower extremites
Venous Stasis (slowing of blood flow in veins)
Prolonged immobilization (especially postop)
Prolonged periods of sitting/traveling
Spinal cord injury
Hypercoagulability (due to release of tissue thromboplastin after injury/surgery)
Tumor (pancreatic, GI, breast, lung)
Incidence higher in Black patients
What is used to diagnose a pulmonary embolus?
Pulmonary angiography (Gold Standard)
CT-PE or helical (spiral) CT
What are the two different kinds of stroke?
Ischemic and Hemorrhagic
What are the two different kinds of Ischemic stroke and how are they different from one another?
Embolitic stroke - clot breaks off from somewhere else in the body and travels to the brain
Thrombolytic stroke - Clot develops in the brain
What does B.E.F.A.S.T. stand for?
B - balance
E - eyes
F - face
A - arm
S - speech
T - time
What can cause a hemorrhagic stroke?
Use of illicit drugs (cocaine/Methamphetamines)MedicalUncontrolled HTN
High Cholesterol (Low HDL/High LDL)
Heart Disease – CHF, heart defects, heart infection abnormal heart rhythm
Personal Hx of stroke, MI or TIA
Race – African American are at high risk
Age older than 65
Gender – male higher risk however women who have stroke are more likely to die than men
Risk with women – birth control, hormone replacement and child birth
What are the after affects of a left sided stroke?
Expressive aphasia –
Agraphia – inability to write
Alexia – inability to read
Right hemiplegia (paralysis one side) or hemiparesis (weakness)
Right Homonymous hemianopsia (not able to past the midline)
Short term memory impairment
What are the after effects of a right sided stroke?
Paralyzed left side hemiplegia
spacial perceptual defecits
tends to minimize probs
short attention span
impaired time concept
What is the emergency treatment of a stroke?
What test is done immediately to distinguish between an ischemic stroke and a hemorrhagic stroke?
CT you can see hemorrhagic stroke
What is the emergency treatment difference between an ischemic stroke and a hemorrhagic?
Why is a lumbar puncture contraindicated in suspected ICP?
How soon are cerebral infarctions visible on a CT scan?
6-8 hrs after onset of symptoms
How soon is a hemorrhagic stroke visible on a CT scan?
What medications are given for ischemic stroke prevention?
cholesterol lowering drugs
What is Virchows Triad?
3 factors that contribute to thrombis
- Endothelial injury
- Stasis or turbulence of blood flow
- Blood hypercoagulability
What are the signs and symptoms for hydrocephalus?
- Difficulty focusing the eyes.
- Unsteady walk or gait.
- Leg weakness.
- Sudden falls.
What can cause hydrocephalus?
bleeding within the brain,
complications of premature birth such as hemorrhage, miningitis
Hydrocephalus can occur at any age, but is most common in infants and adults age 60 and older. ... Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles (fluid-containing cavities) of the brain and may increase pressure within the head.
What are early findings of ICP?
Change in LOC and respirations
What are the late findings of ICP?
What are possible causes of ICP?
What does decerebrate and decorticate posture indicate?
Decerebrate- mid brain and pons injury
Decorticate-worse- spinal tract or cerebral hemisphere
Why do we hyperoxygenate and ventilate patients with severely increased ICP?
What is a normal ICP range?
The normal ICP is 5 - 15 mmHg
What is cerebral perfusion pressure and how is it measured and what is normal?
MAP - ICP.
Cerebral perfusion pressure, or CPP, is the net pressure gradient causing cerebral blood flow to the brain.
What does more room in the cranial vault with older patients have to do with symptoms of increased ICP going unnoticed at first?
What are the parameters for the Glasgow coma scale?
Eye opening (1-4) none, to pain, to stimuli, spontaneous
Best Motor Response (1-6) none, extensor response, abnormal flexion, withdraws, localized, obeys
Verbal response (1-5) none, incomprehensible, innapropriate words, confused conversation, orientated
Pupillary responses mirror the status of what?
Midbrain and pons
Pressure on the brainstem compromises the function of cranial nerves IX and X. these control what?
gag reflex and cough reflex
Why do vasospasms in the brain occur?
What are lacunar infarcts?
Lacunar stroke or lacunar infarct (LACI) is the most common type of ischaemicstroke, and results from the occlusion of small penetrating arteries that provide blood to the brain's deep structures.
What is a TIA and its manifestations?
When are thrombotic strokes more likely to occur in older individuals and why?
A TIA usually comes before a thrombotic stroke and is ______________ but its progression is _______________.
What happens during stroke-in-evolution?
When are embolic strokes more likely to happen and why?
IN an embolic stroke onset is sudden but is progression slow or fast?
why is some one who has had an ischemic stroke at risk for a hemorrhagic stroke?
Which side of the brain is likely to have injury if the patient is experiencing aphasia, alexia, dyslexia, agraphia, and acalculia?
What is ataxia?
What is the result of a stoke that has affected the brain stem or cerebellum?