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neuro final exam > acute stroke > Flashcards

acute stroke Flashcards

1
Q

what does timely out of bed activities prevent

A
  • DVT
  • pulmonary emboli
  • pneumonia
  • falls
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2
Q

why is orthostatic hypertension so bad for CVA pts

A
  • because it decrease blood perfusion and O2 to the brain
  • do not avocate for high intensity in acute care only rehab
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3
Q

types of stokes

A
  • embolic
  • lacunar
  • athero-thrombotic
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3
Q

what does the lacunal strokes affect

A
  • motor due to lack of O2 during stroke to internal capsule
  • usually involves the posterior limb of the internal capsule
  • no sensory, aphasia, or visual field abnormalities
  • dysarthria might be present
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3
Q

lacunar stroke or lacunar infarct pathology

A
  • most common type of ischemic stroke
  • resulting from the osculation of small penetrating arteries the provide blood to the brains deep structures (internal capsule)
  • etiology of chronic hypertension
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4
Q

signs and symptoms to review prior to out of bed activities

A
  • nausea
  • vomiting
  • dizziness
  • light-headedness
  • loss of alertness
  • confusion
  • headache
  • ringing in ears
  • sweating
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5
Q

location of the internal capsule

A
  • subcortical structures that include: internal capsule, caudate, putamen, globus pallidus, thalamus, brainstem
  • anterior limb separates the caudate nucleus and lenticular nucleus
  • the posterior limb separates the thalamus and lenticular nucleus
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6
Q

type of fibers in the internal capsule

A
  • anterior limb: frontopontine fibers, thalamocortical fibers
  • genu: corticobulbar fibers
  • posterior limb: corticospinal fibers (cortex to spine), sensory fibers
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7
Q

blood supply to the internal capsule

A
  • anterior limb: lenticulostriate branches of MCA and ACA
  • Genu: lenticulostriate branches of MCA
  • posterior limb: lenticulostriate branches of MCA and anterior choroidal artery
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8
Q

clinical findings in internal capsular stroke

A
  • weakness of the face, arm and or leg (test CN 7 and 2)
  • UMN signs: hyperreflexia, babinski sign, hoffman present, clonus, spasticity
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9
Q

watershed infarctions

A
  • infarcts in areas where this is reduced profusion due to blockage of the ACA, MCA, or PCA.
  • occurs with internal carotid artery blockage or a carotid artery blockage
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10
Q

Transient Ischemic Attacks (TIA)

A
  • typically less then 10 minutes
  • longer then 10 minutes tissue cells will start to die
  • TIA lasting longer then an hour will cause small infarcts
  • requires an ER visit
  • Early warning sign for a larger stroke
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11
Q

Etiology of TIA

A
  • thrombus emerging
  • vasospasm
  • small emboli: dissolves
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12
Q

signs and symptoms of a TIA

A
  • high BP
  • weakness on one side of the body
  • vision problems
  • slurred speech
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13
Q

treatment of TIA

A

medication, surgery, and healthy lifestyle changes

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14
Q

cerebral edema

A
  • internal pressure within the cortex from hemorrhage or inflammation
  • fluid can push the brain contents to the other side
  • serious consequence of stroke that can lead to early mortality
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15
Q

cerebral perfusion pressure (CPP)

A

the net pressure gradient that drives oxygen delivery to cerebral tissue

16
Q

intracranial pressure (ICP)

A
  • measured invasively though an intracranial pressure transduction device (intraventricular monitor)
  • mean arterial pressure - ICP = cerebral perfusion pressure
17
Q

normal CPP

A

55 to 60

18
Q

normal ICP

A

5 to 15
ICP values of 20 to 30 represent intracranial hypertension

19
Q

hemorrhagic stroke

A

leads to increased pressure in teh brain and reduces cerebral perfusion

20
Q

tumors in the brain

A

create cortical pressure and reduce brain perfusion

21
Q

infection of the brain

A

changes in the regulation of cerebral perfusion may occur

22
Q

CARE for individual with CVA

A

stage 1: hospital and acute care
stage 2: inpt rehab or SNF
stage 3: At home health care
stage 4: outpt care
stage 5: after discharge

23
Q

goldilocks : u shaped curve

A

make sure the ex is an appropriate level of intensity so the BP does not get too high or too low

24
Q

tissue plasminogen activator (tPA)

A
  • clot buster and timely management of high BP
  • when administered 3 hrs after a sroke it helps to restore blood flow to brain regions affected by a stroke, thereby limited the risk of damage and functional impairment
25
Q

what is tPA associated with

A
  • more frequent independent ambulation at discharge
  • discharge to home
  • reduced mortality and symptomatic intracerebreal hemorrhage
26
Q

not a candidate for IV tPA or IAT

A

BP up to 220/120 may be permitted to allow for maximal perfusion unless otherwise contraindicated

27
Q

candidate for IV tPA or IAT

A

lower BP to less them 185/110 prior to giving tPA or in preperation for the angiography suite

28
Q

hypotension in the intial setting of stroke care

A

no formal guidelines exist for a lower limit of BP, hypotension is associated with worse outcomes. ensure that it is not related to volume depletion, cardiac abnormalities or shock

29
Q

during IAT

A

maintain systolic BP at 140-180

30
Q

incomplete reperfusion after tPA

A

maintain BP of greater then 180/105 consider induces hypertension

31
Q

successful reperfusion of tPA

A
  • consider a lower threshold of systolic less then 140-160
  • monitor closely for changes in neurologic examination which can suggest reperfusion injury
32
Q

mobility after acute ischemic stroke

A

pt should receive mobility 13-24 hours after receiving tPA
SBP should be between 140-160

33
Q

what is the recommendation for out of bed activities

A

Early lower- dose out of bed activities
first day: 10-20 minutes

34
Q

Preparing for out of bed activities

A
  • receive orders from MD
  • review the chart (look for type of stroke, location and meds)
35
Q

PT area if assessment and decision making

A
  • skin integrity: ER and one floor
  • Mobility: out of bed with PT
  • Caregiver availability (education)
  • spasticity
  • durable medical equipment
  • recommendation regarding transition to appropriate level of care
36
Q

rapid large falls in BP can reduce

A

cerebral blood flow leading to extension of the cerebral infarction or perihematomal ischemia

37
Q

what is the general goal for CVA patients BP

A

less then 180. 20 point role fro systolic

38
Q

deterioration

A

change in orientation
- symptoms: new headache, acute hypertension, nausea or vomiting, changes in pulse ox or 02 sat, SOB, syncope

39
Q

when should BP start to return back to nomal after tPA

A

48 hrs after given

40
Q

outcome measures for stroke

A
  • 6 minute walk
  • TUG
  • 5 TSTS
  • 10 MWT

neuro final exam (7 decks)

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