406 E2 - Stroke Treatment

Question 1

first thing to check when someone comes in on a stroke alert

Answer 1

ABCs & pulse

Question 2

GCS less than what leads to intubation

Answer 2

8

Question 3

after ABCs are checked, the next step is to

Answer 3

get a CT scan to determine whether or not it is hemorrhagic or ischemic
non contrast

Question 4

if hemorrhagic stroke is ruled out by ct scan, next step is to

Answer 4

give anti coags or thrombolytic therapy to open up the occlusion causing an ischemic stroke

Question 5

if ct scan dx hemorrhagic stroke, next step is to

Answer 5

-reserve any anti coags
-manage htn
-manage elevated ICP

Question 6

how to manage elevated ICP

Answer 6

-elevate HOB
-give antipyretics if fever present
-head in neutral position

Question 7

what do heparin and anti platelets not do

Answer 7

dissolve a clot -> they only prevent another one from forming

Question 8

fibrinolytics

Answer 8

remove thrombi after they have formed

Question 9

alteplase (tPA) MOA

Answer 9

promotes conversion of plasminogen to plasmin

Question 10

alteplase indications

Answer 10

acute MI, PE, ischemic stroke

Question 11

alteplase SE

Answer 11

increased risk for intracranial bleeding

Question 12

alteplase antidote

Answer 12

aminocaproic aicd

Question 13

penumbra procedure / thrombectomy

Answer 13

procedure to remove clot and reopen the vessel

Question 14

if stroke is on left side of the brain, areas affected can include

Answer 14

-logic
-verbal
-detail
-science
-names
-math
-form strategies
-order
-thinking
-writing

Question 15

if stroke is on right side of the brain, areas affected can include

Answer 15

-pictures / stories
-observations
-shapes
-muscle
-patterns
-beauty
-imagination
-possibilities

Question 16

what is a main concern w/ someone who has had a stroke

Answer 16

dysphagia & aspiration

Question 17

motor and sensory deficits consequences

Answer 17

pt can neglect part of their body bc they no longer get sensation to the damaged area

Question 18

how might muscles be described after a stroke

Answer 18

flaccidity or limp weak muscles on the contralateral side, along with spasticity & contractures within 6 weeks

Question 19

contractures

Answer 19

muscles are permanently shortened and the joints become stuck in an abnormal position

Question 20

visual disturbances post stroke

Answer 20

-contralateral field blindness (can lose up to half of their vision or half becomes blurry)
-may lose right side of both visual fields or the left side of both visual fields (homonymous hemianopia)

Question 21

what is the biggest language consequence of a stroke

Answer 21

aphasia: difficulty speaking, understanding, reading and writing
some degree of inability to speak or to comprehend

Question 22

dysphasia

Answer 22

impairment of speech

Question 23

dysarthria

Answer 23

imperfect speech sounds, word finding problems, incorrect use of verbs or nouns

Question 24

expressive aphasia

Answer 24

comprehension intact but cannot express

Question 25

receptive aphasia

Answer 25

can communicate but cannot comprehend what is being said (can’t receive)

Question 26

other problems associated w/ strokes

Answer 26

-memory problems (names, words, objects)
-behavior problems (slow rx times, inc emotional response, underestimate own abilities, may be apathetic/confused/disoriented)
-depression