406 E2 - Stroke Treatment Flashcards
first thing to check when someone comes in on a stroke alert
ABCs & pulse
GCS less than what leads to intubation
8
after ABCs are checked, the next step is to
get a CT scan to determine whether or not it is hemorrhagic or ischemic
non contrast
if hemorrhagic stroke is ruled out by ct scan, next step is to
give anti coags or thrombolytic therapy to open up the occlusion causing an ischemic stroke
if ct scan dx hemorrhagic stroke, next step is to
-reserve any anti coags
-manage htn
-manage elevated ICP
how to manage elevated ICP
-elevate HOB
-give antipyretics if fever present
-head in neutral position
what do heparin and anti platelets not do
dissolve a clot -> they only prevent another one from forming
fibrinolytics
remove thrombi after they have formed
alteplase (tPA) MOA
promotes conversion of plasminogen to plasmin
alteplase indications
acute MI, PE, ischemic stroke
alteplase SE
increased risk for intracranial bleeding
alteplase antidote
aminocaproic aicd
penumbra procedure / thrombectomy
procedure to remove clot and reopen the vessel
if stroke is on left side of the brain, areas affected can include
-logic
-verbal
-detail
-science
-names
-math
-form strategies
-order
-thinking
-writing
if stroke is on right side of the brain, areas affected can include
-pictures / stories
-observations
-shapes
-muscle
-patterns
-beauty
-imagination
-possibilities
what is a main concern w/ someone who has had a stroke
dysphagia & aspiration
motor and sensory deficits consequences
pt can neglect part of their body bc they no longer get sensation to the damaged area
how might muscles be described after a stroke
flaccidity or limp weak muscles on the contralateral side, along with spasticity & contractures within 6 weeks
contractures
muscles are permanently shortened and the joints become stuck in an abnormal position
visual disturbances post stroke
-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)
what is the biggest language consequence of a stroke
aphasia: difficulty speaking, understanding, reading and writing
some degree of inability to speak or to comprehend
dysphasia
impairment of speech
dysarthria
imperfect speech sounds, word finding problems, incorrect use of verbs or nouns
expressive aphasia
comprehension intact but cannot express
receptive aphasia
can communicate but cannot comprehend what is being said (can’t receive)
other problems associated w/ strokes
-memory problems (names, words, objects)
-behavior problems (slow rx times, inc emotional response, underestimate own abilities, may be apathetic/confused/disoriented)
-depression
