2/9 Flashcards
Which of the following supports the difference between a stroke and Transient Ischemic Attack (TIA)?
A. only TIA can cause permanent damage
B. a stroke is a temporary interruption of blood flow to the brain
C. the manifestations of stroke are diff than the manifestations of a TIA
D. a stroke causes permanent damage while TIA only temporary
Answer: D
Rationale: change in status; TIA - only temporary; stroke like symptoms - is an emergency - not sit in the waiting room for long time; have diff levels of stroke activation - red: stroke symptoms occur within 3-4.5 hr window - time is brain within 3 hr window up to 4.5 window candidate to receive TPA - clot buster; yellow - out TPA window - relatively close, <8-10 hrs, do additional interventions; green - long enough and not lot do
Manifestations stroke diff - same manifestations - TIA - transient ischemic attack so still ischemic stroke
Stroke - temporary interruption to brain - same to TIA
TIA - not leave pt with damage; TIA huge warning signing for a stroke - over 50% have stroke within year following; aggressive lifestyle modification
Which of the following risks can be attributed to both ischemic and hemorrhagic stroke?
A. atherosclerosis
B. ruptured plaque
C. HTN
D. arterial spasm
Answer: C
Rationale:
HTN risk factor for both; HTN - can lead to atherosclerosis and ruptured plaques which are both risk factors for ischemic strokes
HTN and hemorrhagic stroke: constant pressure - weaken and get aneurysm - more likely to rupture and cause hemorrhagic stroke
Atherosclerosis - hardening arteries/build-up cholesterol causing narrowing - enough where cannot get build up fluid - breaks loose then floating around and lodge where not want to and obstruct blood flow not want to; dangerous for lot diff types ischemic events
Arterial spasm: most likely have this - after had subarachnoid hemorrhage (hemorrhagic stroke); associated with head bleeds; can cause ischemic strokes; could be an issue for both BUT risk for arterial spasm; bleed causes arterial spasm - risk factor for ischemic stroke; arteries spasming and if spasms where clamps down and not get past it causes ischemic stroke - subarachnoid bleed - at risk for this; frequent neuro assessments - potential conversion to ischemic stroke; cannot TPA it - not blood clot but clamped down and all bleeding; as nurse caring for subarachnoid pt how prevent conversion nimopidine - relax arterial muscles so less likely spasm and if do spasm not contract as tight - Ca channel blocker - crosses blood brain barrier; diltizem
Which of the following is known as a stroke mimic?
A. HTN
B. hypoglycemia
C. tachycardia
D. blood clot
Answer: B
Rationale: blood clot - that is a stroke
Mimic - look like stroke but not
Hypoglycemia - shaky side, confused, blurred vision, cold and clammy, BG low; most frequently seen mimic
Stroke pts appear same as hypoglycemia - first thing do is check BG - easier fix this
Coming in via ambulance - do enroute - if not is ready
Other mimics: hypotension - cool, clammy, diaphoretic, confusion, dizzy, nauseous, altered mental status; bradycardia - not adequate O2 demand due to decrease O2 output - cool, clammy, altered mental status, weakness; arterial spasm - comes and goes not related to subarachnoid hemorrhage; Bell’s Palsy - first time has attack or excerbation - full stroke work-up, but can have a stroke - inform provider about this for adv decision making; complex migraine - lose vision, tunnel vision, incredible pain, not go where hand goes
Full stroke work-up; until proven otherwise; not as easy identify - cont stroke work-up until proven otherwise
Priority: Treating what kill pt first and cause long-term disability
Complex migraine or Bell’s Palsy - no hemorrhage in CT with contrast - TPA - rather TPA and reduce long-term disability with stroke with increased building
Start NIHSS when pt presents - cont until have proof otherwise; want back to baseline before stop assessments and interventions
Which of the following is the most important in the assessment of a suspected stroke?
A. MRI of the head and neck
B. CT of the head and neck with contrast
C. CT of the head without contrast
D. MRA of the head and neck
Answer: C
Rationale: SUSPECTED
Get IV and through CT quickly - allergies no worries about - do quickly and no worries about contrast reaction; looking for: ischemic/hemorrhagic stroke: see blood; not TPA hemorrhagic stroke - make bleed more - before intervention - know if bleed or not; with ambulance - done very little - not make worse; one more piece info can get for us: last known well-time: time determine if can TPA
Before give contrast dye need know allergy status
CT head and neck with contrast - eventually but not off hand
MRA - not crucial
MRI - far better than CTs; more clear; takes longer than CTs; lot more checklist - metal, shrapnel, implants - super dangerous; super expensive; wait for prior-authorization from health insurance before get that
CTs quick and good enough pic to move forward
Time for it not when first come it
Often get MRI but not first couple hours
Which of the following provides the most information regarding the severity of the stroke?
A. NIHSS
B. CT head without contrast
C. FAST
D. TPA
Answer: A
Rationale: most information regarding the severity of the stroke
TPA - medication give
FAST - acronym for face, arms, speech, time to hospital; teach community how recognize symptoms of stroke - get loved ones to hospital
CT head without contrast - imp test but tell about severity
NIHSS - will tell severity: EB stroke scall 0-42; 0 - no deficits; 42 - dead; higher number = bad; scale looks for: eye movement, visual threat, drifting of UE and LE or not hold against gravity, pics where tell us what going on - checking comprehension, read statements, pronounce illiterative words where can assess speech; accomplished nurse - do about 6 mins
High NIHSS scale score = associated with big amount of deficit, large amount deficit tends be more severe stroke, more severe stroke tends affect larger blood vessels
Pt with high NIHSS score - large vessel involved - in addition to TPA - potential intervention to fix pt - percutaneous intervention/clot retrieval - catheter inserted and pull it out; big clots TPA not fast enough to restore blood flow - get blood flow quickly before tissue dies
Clot retrieval - depends - bring in consultation and advice on that; TPA only set amount time; sometimes straight clot retrieval; yellow window - no longer candidate TPA do clot retrieval; receives TPA can do clot retrieval - increased risk bleeding with TPA
Shows no bleed
Not large areas white/small areas white - not hemorrhage
Not confirm ischemic stroke
Acute ischemic stroke
Darker tissue - area hypodensity; tissue death - body break it down - scar tissue, WBC phagocytosis dead cells - inflammation
More inflammation and swelling - ventricles squished due to swelling - ICP
Hypodensity - not give blood thinners - likely to bleed
Time matters on last known well - even without TPA ischemic strokes have chance converting to hemorrhagic strokes - watch out for this; NIHSS - 20, given TPA, got better to NIHSS to 8, all sudden develop new right sided weakness - need another CT: as med/surg floor nurse - call code stroke or rapid response to get some help; could have had another ischemic event - more likely converted to hemorrhagic event
Subacute (3 days) infarction
Anything dense/blood - white
Less dense - black
CT
See more with this
CT with contrast
Arachnoid - webbing - blood filling in sulci
Not TPA canditate
Subarachnoid bleed
CT with angiography - looking at blood vessels
Strokes from carotid blockage - at least ½ to all carotid affected
Whenever stop seeing squiggly veins - have blockage
Get TPA - break up clot - large vessel which same in neck - likely do clot retrively
CTA of the neck
Get TPA - break up clot - large vessel which same in neck - likely do clot retrively
Missing sev vessels - not dye get through - neither can blood or O2
CTA of neck
Still within potential window for clot retrieval
High NIHSS score
After clot retrieval more blood perfused
Sig improvement because clot retrieval; faster seen better outcome
Big NIHSS - large vessel occlusion - candidate clot retrieval for
Can have permanent damage depending on how long without oxygen; replaced with scar tissue - not same func as original tissue
Clot retrieval
Do CT without, CT with, CTA, not enough info, do MRI after
Lot info on MRI
Much better pic and info
Get day-two after had stroke and see more detail area affected
MRI
improved and getting better but getting worse again; high probability - ischemic converted to hemorrhagic stroke - high change give nimotipine - reduce chance arterial vasospasms
Came in with score 9 -
