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NUR 141 > 2.9 Neurological and Sensory Motor STROKE > Flashcards

2.9 Neurological and Sensory Motor STROKE Flashcards

1
Q

Stroke What it is

A

Emergency! “time is brain”
Sudden decrease of blood flow (oxygen & nutrients) to an area of the brain.
The symptoms experienced depend on the area of the brain impacted
Can result in severe disability or death
Process evolves over hrs: primary cell death, secondary cell death, inflammation/immune response

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2
Q

Stroke
Causes:
A leak

A

Causes:
A leak – hemorrhagic stroke
-Most fatal
-Blood vessel ruptures and leaks into brain tissues surrounding the vessel –compression injury to tissue + anoxia etc
-2 types:
1. Intracerebral hemorrhage and subarachnoid hemorrhage aneurysm
2. arteriovenous malformation (AVM)
-Congenital vessel problems: aneurysm, AVM

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3
Q

Stroke

Causes: A plug

A

A plug – ischemic stroke

  • Most common
  • Blood supply to an area of the brain is interrupted = ischemia & death of tissue
  • Thrombotic: “grows there” stenosis, plaque rupture & clot formation
  • Embolic: “flows there” (often cardiogenic due to afib) lodges in a vessel too small to pass thru, bifurcations
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4
Q

Stroke Primary cell death

A

Primary cell death – anoxia & Lack of nutrients, free radical release, edema = burst, infarction & necrosis 4-5 min thru a few hours

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5
Q

Stroke Secondary cell death

A

Secondary cell death- exposure to products of cell death & inflammation, surrounding cells have enough blood supply to remain open a few hours PENUMBRA

As secondary cell death occurs the inflammatory/immune reaction causes further damage

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6
Q

Stroke Aneurysm

A

Aneurysm; congenital weakness, outpouching of the vessel wall, most common cause of hemorrhagic stroke

AVM (arteriovenous malformation): tangled collection of arteries and veins that bypass normal circulation, shunting increases pressure in venous system leads to bleeding

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7
Q

Stroke
Intracerebral hemorrhage
Subarachnoid hemorrhage

A

Intracerebral hemorrhage: The bleeding occurs inside of the brain. This is the most common type of hemorrhagic stroke.
Subarachnoid hemorrhage: The bleeding occurs between the brain and the membranes that cover it.

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8
Q

Transient Ischemic attack (TIA) what is it

A

“mini stroke”
Brief period of localized cerebral ischemia that causes neurologic deficits lasting for less than 24 hours.
warning sign for ischemic stroke
effects vary according to location and size of the vessel involved

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9
Q

Transient Ischemic attack (TIA)

Deficits include

A

Deficits include: contralateral numbness or weakness of the leg, hand, forearm, and corner of the mouth; aphasia; and visual disturbances such as blurring or amaurosis fugax(a fleeting blindness of one eye)

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10
Q

Transient Ischemic attack (TIA) Risk factors

A

Previous TIA or stroke
Hypertension = overdistention of cerebral vessels, ↥ plaque development
Atherosclerosis/hyperlipidemia = plaque accumulation, rupture, brittle vessel walls
Smoking, substance use, ETOH abuse
Low physical activity

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11
Q

Transient Ischemic attack (TIA)

Other disease processes

A

Other disease processes:
DM, sickle cell, sleep apnea, obesity, afib, autoimmune diseases, clotting disorders

Stress
Women: oral contraceptives, pregnancy, childbirth, menopause, migraines, long term hormone replacement therapy.
Unmodifiable: age, gender, race, heredity

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12
Q

Transient Ischemic attack (TIA)

Clinical manifestations

A 
Depend on the area of the brain area involved
Sudden onset
Transient or permanent
Can impact any brain function
Usually one-sided; focal
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13
Q

Transient Ischemic attack (TIA)

Contralateral deficits

A

Contralateral deficits: motor pathways cross at the junction of the medulla & spinal cord so the loss/impaired sensorimotor function appears on the side opposite the injury (example: a CVA in the right side of the brain will result in paralysis on the left side of the body)

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14
Q

ACT F.A.S.T.

A

ACT F.A.S.T.
F – face ask the person to smile; look for drooping
A – ask the person to lift both arms; look for unilateral drift down
S – ask the person to repeat a simple sentence; listen for slurred or strange speech
T- time; get the patient to the hospital ASAP

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15
Q

Transient Ischemic attack (TIA) Possible effects/complications:
Sensory-perceptual deficits

A

Possible effects/complications:
Sensory-perceptual deficits
-impaired ability to integrate, interpret, attend to sensory data
-can impact any sense & increase risk of injury significantly
-pain, numbness, strange sensations

Examples:
hemianopia– loss of half the visual field

agnosia- loss of recognition (can be visual, tactile (touching), or auditory)

apraxia- loss of ability to carry out motor pattern = impact on ADLs

hemineglect syndrome- ignores input from the affected side

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16
Q

Transient Ischemic attack (TIA) Possible effects/complications
Cognitive and behavior changes

A

Cognitive and behavior changes
Altered LOC
Behavior: emotional lability, loss of self-control, ↧ stress tolerance
Intellectual changes: memory, judgment, attention, & reasoning problems

17
Q

Transient Ischemic attack (TIA) Possible effects/complications
Communication disorders

A

Communication disorders

Result from damage to dominant hemisphere (usually left side)

Impact speech (mechanical, motor process of forming words) -Dysarthria

Impact language (formation of ideas to communicate meaning & thoughts)

Complex process: oral, written, auditory, and reading elements

  • Aphasia: inability to use or understand language
  • Expressive: can not find the words to communication what needs to be said but can understand the language, can not associate words and meaning
  • Receptive: can’t understand the language.
  • Mixed (global): combination of both receiving and expression
18
Q

Transient Ischemic attack (TIA) Possible effects/complications
Motor deficits

A

Motor deficits (body movement is complex function)

  • Weakness, paralysis, spasticity with damage in some areas of the brain
  • Hemiplegia – paralysis on one half of the body
  • Hemiparesis – weakness on one half of the body
  • Flaccidity- loss of muscle tone
  • Spasticity – excessive muscle tone = weakness, rotation, contractures
  • Dysphagia- can’t swallow
  • Secondary complications of immobility
19
Q

Transient Ischemic attack (TIA) Possible effects/complications
Elimination problems

A

Elimination problems
Sensory loss: frequency, urgency, incontinence

Secondary problems: due to cognitive dysfunction, altered intake or immobility

20
Q

Comparison of right vs left CVA:

RIGHT

A

RIGHT
Affects left side of the body

Difficulty with perception

Vision loss

Impulsiveness & ↓ attention span

Problems with decision making

Difficulty with time concepts

Neglect syndrome more common

Short term memory problems

21
Q

Comparison of right vs left CVA: LEFT

A

LEFT
Affects right side of the body

Difficulty with speech/language

Slow careful movement

Depression

Math ability impaired

Dysphagia

22
Q

Stroke Nursing interventions (acute phase):

A

Focus of care is to maintain cerebral perfusion to minimize brain injury
Certified stroke centers

23
Q 
Nursing interventions (acute phase):
Assessment:
A

Assessment:

  • History : time of onset of symptoms is CRITICAL
  • Physical exam: airway, VS, cardiac rhythms, temperature regulation, seizures, risk of IICP (increased intercranial pressure)

-NIH Stroke scale:
standardized systematic stroke assessment tool that quantifies stroke-related deficits scoring is key to determining eligibility for lytic therapy and evaluating effectiveness of therapy

Imaging tests: CT, arteriogram, MRI/MRA, PET, and SPECT

24
Q

Interprofessional Treatment

A 
Interprofessional Treatment:
Surgery:
Prevention: carotid endarterectomy
Repair & revascularization
Clot evacuation
Hemorrhagic stroke: repair of aneurysm or AVM to prevent/treat bleeding
25
Q

NIH: standardized stroke assessment

A

NIH: standardized stroke assessment (LOC, vision, facial paralysis, motor ability, ataxia, sensation, language, and attention)

26
Q

Medications for CVA Prevention

A

Prevention:
antiplatelet agents
Control HTN, DM, lipids

27
Q

Medications for CVA Acute ischemic stroke

A

Acute ischemic stroke:

  • Fibrinolytics (tPA) to lyse the clot – must be given within a few hours of onset of manifestations, protocols animation:
    https: //www.youtube.com/watch?v=dClu6nC2qNs

strict criteria due to bleeding risk: R/O correct BS, BP, lytes prevent bleeding & other injuries like falls

Anticoagulants to prevent extension of the clot
Blood pressure management

28
Q

Nursing care:

A

Airway/breathing: Sats, lung sounds, suction prn, oxygen therapy, manage aspiration risk

Circulation: vitals, cardiac rhythm monitoring

Neuros: mental status, LOC, pain, change in motor or sensory functions, reflexes, S/S IICP

Maintain body temp

Accurate I & O’s (diabetes insipidus = excessive urination = dehydration)

Seizure precautions

Promote Mobility: ROM, turning, DVT risk

Promote self-care: appropriate to cognitive function, encourage independent ADLs

Communication: treat like an adult, allow time, face pt/speak slowly, honest, use short simple sentences, yes/no if needed, accept frustration, alternate methods

Elimination: bladder training, constipation management, bowel training

Nutrition & aspiration risk: dysphagia, swallow studies, lung sounds

Emotional support, coping, grieving & anxiety in acute phase

SAFETY CONCERNS: aspiration, falls, pressure ulcer prevention

Interdisciplinary collaboration: PT, OT, ST

29
Q

Rehab stage of stroke patient

Physical therapy

A

Physical therapy may help prevent contractures and improve muscle strength and coordination.
Physical therapists teach exercises to enable the patient to relearn how to walk, sit, lie down, and change from one type of movement to another.

**Rehab can be a prolonged process!

30
Q

Rehab stage of stroke patient

Occupational therapy

A

Occupational therapy provides assistive devices and a plan for regaining lost motor skills that greatly improve quality of life after a stroke. These skills include eating, drinking, bathing, cooking, reading, writing, and toileting.

**Rehab can be a prolonged process!

31
Q

Rehab stage of stroke patient

Speech therapy

A

Speech therapy is provided to help the patient improve swallowing as well as how to relearn language and communication skills.

**Rehab can be a prolonged process!

NUR 141 (48 decks)

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