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Year 2: Nursing Adults with Acute conditions > Acute Stroke > Flashcards

Acute Stroke Flashcards

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1
Q

Lists modifiable risk factors for strokes

A 
Hypertension
Smoking
Alcohol
Diabetes
High cholesterol
Obesity
Diet
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2
Q

List non-modifiable risk factor for stroke

A

Age
Race
Gender
Family history

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3
Q

Is smoking a modifiable or non-modifiable risk factor for stroke?

A

modifiable

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4
Q

Which arteries supply the frontal lobe?

A

Anterior cerebral artery

Middle cerebral artery

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5
Q

Which arteries supply the parietal lobe?

A

Anterior cerebral artery

Middle cerebral artery

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6
Q

Damage to the Anterior cerebral artery is likely to cause injury in which part of the brain?

A

Frontal Lobe

Parietal lobe

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7
Q

Which arteries supply the occipital lobe?

A

Posterior cerebral artery

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8
Q

Which arteries supply the brainstem?

A

Vertebral basillar

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9
Q

Which arteries supply the cerebellum?

A

Basilar

Posterior inferior cerebellar artery

Anterior Inferior Cerebellar Artery

Superior Cerebellar Artery

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10
Q

Which arteries supply the Hippocampus?

A

Posterior Cerebral Artery

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11
Q

Which arteries supply the Temporal lobe?

A

Middle cerebral artery

Posterior cerebral artery

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12
Q

Damage to the middle cerebral artery could cause injury in which part of the brain?

A

Frontal lobe

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13
Q

Damage to the posterior cerebral artery could cause injury in which part of the brain?

A

Frontal lobe

parietal Lobe

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14
Q

Damage to the posterior inferior cerebellar artery could cause injury in which part of the brain?

A

Occipital lobe

hippocampus

temporal lobe

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15
Q

Damage to the Anterior inferior cerebellar artery could cause injury in which part of the brain?

A

cerrebellum

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16
Q

Damage to the superior cerebellar artery could cause injury in which part of the brain?

A

cerebellum

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17
Q

Damage to the vertebral basilar artery could cause injury in which part of the brain?

A

brainstem

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18
Q

What is the brainstem made up of? (3)

A

midbrain

pons

medulla

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19
Q

What is most common type of stroke in the UK?

A

ischemic stroke

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20
Q

What are the common causes of ischaemic stroke?

A

large vessel disease (i.e. carotid stenosis)

Atrial Fibrillation

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21
Q

Whyat are common causes of haemorrhagic strokes?

A

hypertension

aneurysms and avms

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22
Q

How does ischaemic stroke present on a ct scan?

A

oxygen deprived areas look slightly darker

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23
Q

How do haemorrhagic strokes present on a ct scan?

A

concentrated light/white areas

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24
Q

A head CT scan shows areas of slightly darker brain tissue.

what type of stroke is the patient likely to have?

A

ischaemic stroke

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25
Q

A head CT scan shows an concentrated white mass in the brain

what type of stroke is the patient likely to have?

A

haemorrhagic

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26
Q

What is the aim of acute reperfusion therapies?

A

ton rstore blood flow either through or around blocked arteries prior to a stroke occuring.

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27
Q

What is is thrombolysis (ART)?

A

The administration of drug treatment to lyse the clot in occluded vessel

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28
Q

What drug is usually administered to lyse a clot?

A

alteplase

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29
Q

How long from the onset of a stroke can thrombolysis be used?

A

4.5 hours

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30
Q

what is a Thrombectomy?

A

An interventional procedure to remove the clot from an occluded vessel.

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31
Q

How long from the onset of a stroke can thrombectomy be done?

A

6 hours

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32
Q

What are some of the contraindications for thrombolysis?

A

Haemorrhage on CT

Extensive established
ischaemia on CT

On anticoaugulation

Recent major surgery

Bleeding abnormality

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33
Q

how should thrombolysis be administered?

A

dose: 0.9mg/kg

provide 10% of total dose as bolus then 90% via infusion over 1 hour

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34
Q

What device is used for a thrombectomy?

A

a stent retriever device

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35
Q

what are some of the indications for a thrombectomy?

A

Stroke onset within 6 hours

Ongoing neurological
deficit

All ages

Eligible or ineligible for
thrombolysis

Large vessel occlusion on
CT angiogram

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36
Q

what are some of the contraindications for a thrombectomy?

A

Haemorrhage on CT

Extensive established
ischaemia on CT

Resolving neurological
deficits

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37
Q

What steps are taken for the management of an acute hemorrhage?

A

Reversal of anticoagulation:
- Vit K and prothrombin complex for warfarin
- Iduracuzimab for dabigatran
- Prothrombin complex for other direct oral
anticoagulants

Immediate blood pressure control
- Aim for <140mmHg within 24 hours and for 7 days

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38
Q

What are the common respiratory complications for someone who has just suffered a stroke?

A
  • upper airway obstruction
  • aspiration pneumonia
  • reduced respiratory effort
  • pulmonary embolism
  • abnormal pattern e.g. Cheyne-Stokes
39
Q

How should respiratory function be assessed following a stroke?

A

Rate, Patter and effort

40
Q

What does TIA stand for?

A

Transient ischaemic attack

41
Q

What is a Transient Ischaemic attack?

A

Also known as a “mini stroke”

A temporary disruption to the blood supply which results in symptoms similar to a stroke.

Symptoms may not last and may not result in infarcted tissue

42
Q

What is the most common acute neurological disease?

A

stroke

43
Q

What are the steps for respiratory care management for a patient who had suffered an acut stroke?

A

• Oxygen only if needed to maintain SpO2 >95% (SOS
trial, 2014)

  • Suction at each bedside
  • Good positioning to optimise respiratory function

• Airway management for patients with low conscious
level

44
Q

Which artery is likely to be affected by an ischaemic stroke?

A

MC - Middle cerebral artery

45
Q

Is weakness likely to occur on the same side as stroke or opposite?

A

opposite, brain works contralaterally

46
Q

Which side is likely to have the broca’s area?

A

the left hemisphere

47
Q

How does AF result in an ischaemic stroke?

A

blood pools in the atrium causinga collection of thrombus which can be transported to the arteries in the brain via circulation.

48
Q

What is midline shift?

A

when the brain shifts past

49
Q

What type of stroke is acute reperfusion therapy targeted at?

A

ischaemic strokes

50
Q

what is penumbra?

A

ischaemic areas of the brain which are still salvageable. reversably ischaemic

51
Q

Why is it integral to administer thrombolysis as soon as possible?

A

To prevent the spread of irreversably ischaemic areas.

52
Q

How should cardiovascular function be assessed following a stroke?

A

rate, rhythm and any abnormalities

53
Q

What are some common abnormalities seen in patients who have suffered an acute stroke?

A
  • Atrial fibrillation
  • Bradycardia
  • Tachycardia
  • Ectopics
  • Acute myocardial infarct
  • Heart failure
54
Q

What are the steps for cardiovascular monitoring and care management for a patient who had suffered an ischaemic stroke?

A

• Post-thrombolysis <180/85
mmHg

➢Use IV labetalol or GTN

• Provide usual medication but do
not actively lower BP

• Avoid hypotension

55
Q

What are the steps for cardiovascular monitoring and care management for a patient who had suffered an haemorr stroke?

A

• Aim for <140mmHg (Interact
trial, 2016)

• Administer patient’s usual
medication

• Add additional agents as
needed

56
Q

Why is it important to be particularly sinful of airway, respiratory management for patients suffering a hemorrhagic stroke?

A

reduced conciousness

57
Q

Why are stroke patient at higher risk of aspiration pneumonia?

A

due to risk of acquiring dysphagia after stroke.

58
Q

what are the potential causes for stroke patient developing neurological deterioration

A
  • Cerebral oedema
  • Hydrocephalus
  • Haemorrhagic transformation
  • Stroke extension/recurrence
  • Seizure
59
Q

How long should patient have a cardiac monitor following a stroke?

A

24 hours

60
Q

What neurological assessment should be done following a stroke?

A

GCS

limb function

NIHSS - stroke severity scale.

61
Q

How can neurological deterioration be prevented?

A

By regular monitoring

62
Q

Why is it important to monitor BM in patints who have suffered a stroke?

A

Hyper-glycaemia produces poorer outcomes from stroke.

63
Q

What are the current recommendations for maintaining blood sugar?

A

maintain between 5-15 mmol/l

64
Q

what is ataxia?

A

lack of coordination in movement

65
Q

How do HCP assess patients for ataxia? what would ataxic patient do?

A

finger to nose. Patients with ataxia will overshoot.

66
Q

Why might a stroke patient be hyperglycaemic?

A

• Hyper-glycaemia can be transient as a result of the
stroke itself or as a result of undiagnosed or poorly
managed diabetes

• Stress response

67
Q

What can be used to reduced the likelihood of developing DVT in stroke patients?

A

Intermittent pneumatic compression (IPC)

68
Q

Why are TEd stocking not indicated for preventing DVT in stroke patients?

A

proven not to be effective

69
Q

Why is heparin not indicated for preventing DVT in stroke patients

A

likely to cause additional haemorrhage rather than prevent DVT

70
Q

In terms of prevention for aspiration pneumonia, what should be done for all patients within 4 hours of arrival?

A

swallow screening

71
Q

Within how many hours from hospital arrival should swallow screening be done?

A

4 hours

72
Q

What should be done if patient fails swallow screen?

A

nil by mouth until

formal speech therapy review

73
Q

What should be done if patient passes swallow screen?

A

observe for signs of

coughing, increased respiratory rate, hypoxia

74
Q

How should adequate hydration be delivered to patient?

A

oral, NG or IV route of fluids

within 24 hours of admission

75
Q

What should be done if unable to maintain sufficient nutrition?

A

Consider NG feeding within 24 hours of admission

- Refer to dietitian for appropriate nutritional support

76
Q

What is shoulder subluxation?

A

Downward movement of head of humerus in shoulder

joint

77
Q

What causes shoulder subluxation in stroke patients?

A

muscle weakness and poor

handling/positioning

78
Q

What steps should be taken to prevent prssure sore in stroke patint?

A

Early risk assessment e.g. Waterlow score

  • Early use of pressure mattress/cushion
  • Full assessment of at risk pressure areas
  • Regular repositioning
79
Q

What should be done to prevent immobility complication?

A

Early mobilisation:
- Early mobilisation <24 hours for mild stroke
- Cautious mobilisation 24-48 hours for moderate to
severe stroke
- Short, frequent sessions better than longer sessions

80
Q

What should be done prevent UTI’s in stroke patients?

A

-avoid catheterisation

-unless retention confirmed
by bladder scan or need for
critical fluid balance

81
Q

Why does pyrexia need to be managed in stroke patients?

A

-unmanaged pyrexia is likely to produce a poorer

outcome

82
Q

What is the secondary prevention intervention for patients with ischaemic stroke?

A

Antiplatelets

➢Aspirin 300mg immediately and for 2 weeks
➢Thereafter clopidogrel 75mg daily

83
Q

What is the secondary prevention intervention for patients with atrial fibrillation?

A

anticoagulation

➢Warfarin or direct oral anticoagulant reduced the risk of
stroke recurrence of up to 68%

➢Usually started at 14 days post-stroke

84
Q

How can rehabillitation help stroke patients regain certain functions?

A

Repetition will stimulate and allow neurons to make new connections

85
Q

What is hemiplegia?

A

paralysis on one side of the body as a result of brain or spinal cord damage

86
Q

What is expressive receptive aphasia?

A

aphasia caused by damage to Broca’s and Wernicke’s area resulting in difficulty expressing what to say to receive information

87
Q

What is hemianopia?

A

Blindness over half the field of vision.

88
Q

What is the difference between hemiplegia and hemiparesis?

A

Hemiplegia is the most severe form of hemiparesis

89
Q

If a patient has right-sided hemianopia, where should you position yourself so that you are within the patient’s field of vision?

A

On the left side

90
Q

what is secondary prevention?

A

it’s an intervention which prevents stroke patients from having another stroke.

91
Q

What type of antihypertensives should be given to patients for secondary prevention?

A

ACE inhibitors or/and calcium channel blockers.

92
Q

Why does the patient need to take clopidogrel ?

A

to prevent a clot from forming around an atheroma.

93
Q

What are the secondary interventions drugs patient needs to take?

A

antihypertensives
statins
anticoagulants

Year 2: Nursing Adults with Acute conditions (12 decks)

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