Perfusion Part 2

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1

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

2. Nutritional

3. Bone Marrow Suppression/failure

2

What is the difference between acute and chronic blood loss?

...

3

Name the hemolytic anemias.

Hereditary cell membrane disorders

Defective hemoglobin (Sickle and Thalassemia)

G6PD deficiency

4

What are the autoimmune hemolytic anemias

Warm antibody

Cold anitbody

5

What kind of anemia is due to altered Hemoglobin synthesis?

Iron Deficiency

6

What kinds of anemia are due to altered DNA synthesis?

B12

Folic acid

7

What kind of anemia is due to bone marrow suppression/ failure?

aplastic or stem cell dysfunction

8

What are the platelets or clotting factor disorders?

ITP

TTP

Hemophilia A & B

Von Willebrands

HIT

9

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)
10

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

Obesity

Indwelling vascular devices

Previous DVT or PE

11

How do you diagnose a DVT?

...

12

What are DVT risk factors?

Major risk factors for DVT include: heart failure, severe respiratory disease and sepsis.

13

How does prophylaxis and treatment for a DVT differ?

...

14

What causes a pulmonary embolus?

Thrombophlebitis

Vascular disease

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

Varicose veins

Spinal cord injury

Hypercoagulability (due to release of tissue thromboplastin after injury/surgery)

Injury

Tumor (pancreatic, GI, breast, lung)

Incidence higher in Black patients

15

What is used to diagnose a pulmonary embolus?

ABGs

D-dimer

BNP

Metabolic panel

Chest x-ray

V/Q scan

Pulmonary angiography (Gold Standard)

CT-PE or helical (spiral) CT

16

What are the two different kinds of stroke?

Ischemic and Hemorrhagic

17

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

18

What does B.E.F.A.S.T. stand for?

B - balance

E - eyes

F - face

A - arm

S - speech

T - time

19

What can cause a hemorrhagic stroke?

Lifestyle

Overweight/Obesity

Physical inactivity

Heavy/Binge drinking

Use of illicit drugs (cocaine/Methamphetamines)MedicalUncontrolled HTN

Smoking

High Cholesterol (Low HDL/High LDL)

DM II

Sleep Apnea

Heart Disease – CHF, heart defects, heart infection abnormal heart rhythm

Other

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

20

What are the after affects of a left sided stroke?

Expressive aphasia –

Global 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

Depression

21

What are the after effects of a right sided stroke?

Paralyzed left side hemiplegia

spacial perceptual defecits

tends to minimize probs

short attention span

visual defecits

impaired time concept

22

What is the emergency treatment of a stroke?

Altepase (tPa)

23

What test is done immediately to distinguish between an ischemic stroke and a hemorrhagic stroke?

CT you can see hemorrhagic stroke

24

What is the emergency treatment difference between an ischemic stroke and a hemorrhagic?

...

25

Why is a lumbar puncture contraindicated in suspected ICP?

...

26

How soon are cerebral infarctions visible on a CT scan?

6-8 hrs after onset of symptoms

27

How soon is a hemorrhagic stroke visible on a CT scan?

Immediately

28

What medications are given for ischemic stroke prevention?

Antiplatelet

anticoagulants

antihypertensive

cholesterol lowering drugs

29

What is Virchows Triad?

3 factors that contribute to thrombis

  • Endothelial injury
  • Stasis or turbulence of blood flow
  • Blood hypercoagulability
30

What are the signs and symptoms for hydrocephalus?

  • Headaches.
  • Nausea.
  • Difficulty focusing the eyes.
  • Unsteady walk or gait.
  • Leg weakness.
  • Sudden falls.
  • Irritability.
  • Drowsiness
31

What can cause hydrocephalus?

Spina Bifida,

bleeding within the brain,

brain tumors,

head injuries,

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.

Causes

32

What are early findings of ICP?

Change in LOC and respirations

33

What are the late findings of ICP?

...

34

What are possible causes of ICP?

...

35

What does decerebrate and decorticate posture indicate?

Decerebrate- mid brain and pons injury

Decorticate-worse- spinal tract or cerebral hemisphere

36

Why do we hyperoxygenate and ventilate patients with severely increased ICP?

...

37

What is a normal ICP range?

The normal ICP is 5 - 15 mmHg

38

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.

39

What does more room in the cranial vault with older patients have to do with symptoms of increased ICP going unnoticed at first?

...

40

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

Max 15

min 3

41

Pupillary responses mirror the status of what?

Midbrain and pons

42

Pressure on the brainstem compromises the function of cranial nerves IX and X. these control what?

gag reflex and cough reflex

43

Why do vasospasms in the brain occur?

...

44

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.

45

What is a TIA and its manifestations?

...

46

When are thrombotic strokes more likely to occur in older individuals and why?

...

47

A TIA usually comes before a thrombotic stroke and is ______________ but its progression is _______________.

...

48

What happens during stroke-in-evolution?

...

49

When are embolic strokes more likely to happen and why?

...

50

IN an embolic stroke onset is sudden but is progression slow or fast?

...

51

why is some one who has had an ischemic stroke at risk for a hemorrhagic stroke?

...

52

Which side of the brain is likely to have injury if the patient is experiencing aphasia, alexia, dyslexia, agraphia, and acalculia?

Left

53

What is ataxia?

gate disturbance

54

What is the result of a stoke that has affected the brain stem or cerebellum?

Ataxia

hemiparesis

quadriparesis