Acute Stroke Flashcards
Lists modifiable risk factors for strokes
Hypertension Smoking Alcohol Diabetes High cholesterol Obesity Diet
List non-modifiable risk factor for stroke
Age
Race
Gender
Family history
Is smoking a modifiable or non-modifiable risk factor for stroke?
modifiable
Which arteries supply the frontal lobe?
Anterior cerebral artery
Middle cerebral artery
Which arteries supply the parietal lobe?
Anterior cerebral artery
Middle cerebral artery
Damage to the Anterior cerebral artery is likely to cause injury in which part of the brain?
Frontal Lobe
Parietal lobe
Which arteries supply the occipital lobe?
Posterior cerebral artery
Which arteries supply the brainstem?
Vertebral basillar
Which arteries supply the cerebellum?
Basilar
Posterior inferior cerebellar artery
Anterior Inferior Cerebellar Artery
Superior Cerebellar Artery
Which arteries supply the Hippocampus?
Posterior Cerebral Artery
Which arteries supply the Temporal lobe?
Middle cerebral artery
Posterior cerebral artery
Damage to the middle cerebral artery could cause injury in which part of the brain?
Frontal lobe
Damage to the posterior cerebral artery could cause injury in which part of the brain?
Frontal lobe
parietal Lobe
Damage to the posterior inferior cerebellar artery could cause injury in which part of the brain?
Occipital lobe
hippocampus
temporal lobe
Damage to the Anterior inferior cerebellar artery could cause injury in which part of the brain?
cerrebellum
Damage to the superior cerebellar artery could cause injury in which part of the brain?
cerebellum
Damage to the vertebral basilar artery could cause injury in which part of the brain?
brainstem
What is the brainstem made up of? (3)
midbrain
pons
medulla
What is most common type of stroke in the UK?
ischemic stroke
What are the common causes of ischaemic stroke?
large vessel disease (i.e. carotid stenosis)
Atrial Fibrillation
Whyat are common causes of haemorrhagic strokes?
hypertension
aneurysms and avms
How does ischaemic stroke present on a ct scan?
oxygen deprived areas look slightly darker
How do haemorrhagic strokes present on a ct scan?
concentrated light/white areas
A head CT scan shows areas of slightly darker brain tissue.
what type of stroke is the patient likely to have?
ischaemic stroke
A head CT scan shows an concentrated white mass in the brain
what type of stroke is the patient likely to have?
haemorrhagic
What is the aim of acute reperfusion therapies?
ton rstore blood flow either through or around blocked arteries prior to a stroke occuring.
What is is thrombolysis (ART)?
The administration of drug treatment to lyse the clot in occluded vessel
What drug is usually administered to lyse a clot?
alteplase
How long from the onset of a stroke can thrombolysis be used?
4.5 hours
what is a Thrombectomy?
An interventional procedure to remove the clot from an occluded vessel.
How long from the onset of a stroke can thrombectomy be done?
6 hours
What are some of the contraindications for thrombolysis?
Haemorrhage on CT
Extensive established
ischaemia on CT
On anticoaugulation
Recent major surgery
Bleeding abnormality
how should thrombolysis be administered?
dose: 0.9mg/kg
provide 10% of total dose as bolus then 90% via infusion over 1 hour
What device is used for a thrombectomy?
a stent retriever device
what are some of the indications for a thrombectomy?
Stroke onset within 6 hours
Ongoing neurological
deficit
All ages
Eligible or ineligible for
thrombolysis
Large vessel occlusion on
CT angiogram
what are some of the contraindications for a thrombectomy?
Haemorrhage on CT
Extensive established
ischaemia on CT
Resolving neurological
deficits
What steps are taken for the management of an acute hemorrhage?
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
What are the common respiratory complications for someone who has just suffered a stroke?
- upper airway obstruction
- aspiration pneumonia
- reduced respiratory effort
- pulmonary embolism
- abnormal pattern e.g. Cheyne-Stokes
How should respiratory function be assessed following a stroke?
Rate, Patter and effort
What does TIA stand for?
Transient ischaemic attack
What is a Transient Ischaemic attack?
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
What is the most common acute neurological disease?
stroke
What are the steps for respiratory care management for a patient who had suffered an acut stroke?
• 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
Which artery is likely to be affected by an ischaemic stroke?
MC - Middle cerebral artery
Is weakness likely to occur on the same side as stroke or opposite?
opposite, brain works contralaterally
Which side is likely to have the broca’s area?
the left hemisphere
How does AF result in an ischaemic stroke?
blood pools in the atrium causinga collection of thrombus which can be transported to the arteries in the brain via circulation.
What is midline shift?
when the brain shifts past
What type of stroke is acute reperfusion therapy targeted at?
ischaemic strokes
what is penumbra?
ischaemic areas of the brain which are still salvageable. reversably ischaemic
Why is it integral to administer thrombolysis as soon as possible?
To prevent the spread of irreversably ischaemic areas.
How should cardiovascular function be assessed following a stroke?
rate, rhythm and any abnormalities
What are some common abnormalities seen in patients who have suffered an acute stroke?
- Atrial fibrillation
- Bradycardia
- Tachycardia
- Ectopics
- Acute myocardial infarct
- Heart failure
What are the steps for cardiovascular monitoring and care management for a patient who had suffered an ischaemic stroke?
• Post-thrombolysis <180/85
mmHg
➢Use IV labetalol or GTN
• Provide usual medication but do
not actively lower BP
• Avoid hypotension
What are the steps for cardiovascular monitoring and care management for a patient who had suffered an haemorr stroke?
• Aim for <140mmHg (Interact
trial, 2016)
• Administer patient’s usual
medication
• Add additional agents as
needed
Why is it important to be particularly sinful of airway, respiratory management for patients suffering a hemorrhagic stroke?
reduced conciousness
Why are stroke patient at higher risk of aspiration pneumonia?
due to risk of acquiring dysphagia after stroke.
what are the potential causes for stroke patient developing neurological deterioration
- Cerebral oedema
- Hydrocephalus
- Haemorrhagic transformation
- Stroke extension/recurrence
- Seizure
How long should patient have a cardiac monitor following a stroke?
24 hours
What neurological assessment should be done following a stroke?
GCS
limb function
NIHSS - stroke severity scale.
How can neurological deterioration be prevented?
By regular monitoring
Why is it important to monitor BM in patints who have suffered a stroke?
Hyper-glycaemia produces poorer outcomes from stroke.
What are the current recommendations for maintaining blood sugar?
maintain between 5-15 mmol/l
what is ataxia?
lack of coordination in movement
How do HCP assess patients for ataxia? what would ataxic patient do?
finger to nose. Patients with ataxia will overshoot.
Why might a stroke patient be hyperglycaemic?
• Hyper-glycaemia can be transient as a result of the
stroke itself or as a result of undiagnosed or poorly
managed diabetes
• Stress response
What can be used to reduced the likelihood of developing DVT in stroke patients?
Intermittent pneumatic compression (IPC)
Why are TEd stocking not indicated for preventing DVT in stroke patients?
proven not to be effective
Why is heparin not indicated for preventing DVT in stroke patients
likely to cause additional haemorrhage rather than prevent DVT
In terms of prevention for aspiration pneumonia, what should be done for all patients within 4 hours of arrival?
swallow screening
Within how many hours from hospital arrival should swallow screening be done?
4 hours
What should be done if patient fails swallow screen?
nil by mouth until
formal speech therapy review
What should be done if patient passes swallow screen?
observe for signs of
coughing, increased respiratory rate, hypoxia
How should adequate hydration be delivered to patient?
oral, NG or IV route of fluids
within 24 hours of admission
What should be done if unable to maintain sufficient nutrition?
Consider NG feeding within 24 hours of admission
- Refer to dietitian for appropriate nutritional support
What is shoulder subluxation?
Downward movement of head of humerus in shoulder
joint
What causes shoulder subluxation in stroke patients?
muscle weakness and poor
handling/positioning
What steps should be taken to prevent prssure sore in stroke patint?
Early risk assessment e.g. Waterlow score
- Early use of pressure mattress/cushion
- Full assessment of at risk pressure areas
- Regular repositioning
What should be done to prevent immobility complication?
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
What should be done prevent UTI’s in stroke patients?
-avoid catheterisation
-unless retention confirmed
by bladder scan or need for
critical fluid balance
Why does pyrexia need to be managed in stroke patients?
-unmanaged pyrexia is likely to produce a poorer
outcome
What is the secondary prevention intervention for patients with ischaemic stroke?
Antiplatelets
➢Aspirin 300mg immediately and for 2 weeks
➢Thereafter clopidogrel 75mg daily
What is the secondary prevention intervention for patients with atrial fibrillation?
anticoagulation
➢Warfarin or direct oral anticoagulant reduced the risk of
stroke recurrence of up to 68%
➢Usually started at 14 days post-stroke
How can rehabillitation help stroke patients regain certain functions?
Repetition will stimulate and allow neurons to make new connections
What is hemiplegia?
paralysis on one side of the body as a result of brain or spinal cord damage
What is expressive receptive aphasia?
aphasia caused by damage to Broca’s and Wernicke’s area resulting in difficulty expressing what to say to receive information
What is hemianopia?
Blindness over half the field of vision.
What is the difference between hemiplegia and hemiparesis?
Hemiplegia is the most severe form of hemiparesis
If a patient has right-sided hemianopia, where should you position yourself so that you are within the patient’s field of vision?
On the left side
what is secondary prevention?
it’s an intervention which prevents stroke patients from having another stroke.
What type of antihypertensives should be given to patients for secondary prevention?
ACE inhibitors or/and calcium channel blockers.
Why does the patient need to take clopidogrel ?
to prevent a clot from forming around an atheroma.
What are the secondary interventions drugs patient needs to take?
antihypertensives
statins
anticoagulants
