Assessment For S&S of CVA

Question 0

Autonomic status includes ?

Answer 0

BP, HR, RR, temp

Question 1

Assessing S&S of a CVA

Answer 1

1. ) assessment of patients autonomic status, including LOC.
2. ) Assess sensorimotor status: Above & below shoulders.
3. ) Assess reflexes

Question 2

LOC includes ?

Answer 2

Alert / easily arousable to alertness if asleep.

Oriented x 4 = self, time, place, & events

Follows commands appropriately

Normal speech

Converses apropriately

Question 3

Spectrum of severity can measure what ?

Answer 3

Spectrum of severity

Question 4

Assessment of sensorimotor above the shoulders includes what ?

Answer 4

Eyes, face, tongue, and some shoulder functions.

If patient responds ok, then know that the 12 cranial nerves are intact.

Question 5

Cranial nerves branch out from (midbrain, pons, & medulla) to the face, neck, upper chest & shoulders ON THE SAME SIDE OF THE BODY AS THEIR ORIGIN IN THE BRAIN. This is also know as what ?

Answer 5

IPSILATERAL SIDE

Question 6

Right side CN compromised, expect to see what ?

Answer 6

Right side deficits of the face or above the shoulders.

Question 7

Corticospinal tracts AKA pyramidal tracts are descending motor tracts that cross over from their point of origin in the cerebral cortex to the opposite side of the BODY at the junction between the spinal cord and the brain stem. Crossing over looks like a rypamid, this is know as what specific term ?

Answer 7

Decussate

Question 8

Pyramidal tracts

Answer 8

Produce voluntary motor movements of purpose and skill

Question 9

Lesion

Answer 9

General term that could be describing; a tumor, ischemia, localized ICP or increased cerebral edema.

Question 10

Spinothalmic tracts

Answer 10

Ascending tracts that carry sensations of pain, temperature, and crude & light touch. They also cross from one side of the body to the other side of the brain .

Question 11

Focal lesion on corticospinal or spinothalmic tracts expect to see what ?

Answer 11

Asymmetric senserimotor changes. Unilateral, on the contralateral side of the body because of decussation. Ex: right side brain tumor = deficits on the left side of the body.

Question 12

Normal findings of peripheral reflex assessment suggests what ?

Answer 12

Suggest that there are good connections in the reflex arc of the spine. Therefore, a normal interpretation of the patients brain.

Question 13

Normal central reflexes include what ?

Answer 13

Cough, swallow, gag

Question 14

Explain a positive “BABINSKI REFLEX” AKA plantar reflex.

Answer 14

Stroke the plantar surface of the foot = Big toe flex, “upgoing toe”
Unilateral or Bilateral, depends if focal lesion or diffuse.

Normal until 2 years old, after that it is a sign of neurologic dysfunction of some sort.

Question 15

Diffuse injury stroke S&S =

Answer 15

Sensation, muscle tone, movement, & strength: BILATERALLY WEAKER.

Weaker reflexes, sometimes + “Babinski” : SYMMETRICAL

Question 16

Diffuse cerebral edema & IICP = what ?

Answer 16

Brain stem abnormalities, diminished LOC, usually comatose or near coma state.

Decerebrate or decorticate posturing that reflects the effect of cerebral edema on brain stem nuclei.

Question 17

S&S of a patient with diffuse cerebral edema & IICP ?

Answer 17

• Cheyne-Strokes, changes in HR & BP due to: PRESSURE ON THE MEDULLA.
• Diminished or lost protective reflexes: Sneezing, coughing, gagging.
• HR problems due to involvement of the vagus nerve.

Question 18

S&S of a CEREBELLAR CVA?

Answer 18

Problems with coordination and balance.

• vertigo, nystagmus (rapid eye movement)
• nausea & vomiting
• loss of coordination
• falling down

Question 19

R or L side CVA that results from lack of blood flow OR bleeding leads to swelling and cerebral edema. What are 3 possible sets of deficits ?

Answer 19

*Lesion/pressure on :
certain area of the hemisphere = sensorimotor deficits
* corticospinal tract = sensorimotor deficits
*deficits based on that special functions controlled by that hemisphere.

Question 20

What are you assessing for, if your assessment is focused above the shoulder ? Assessing the face, eyes, tongue, and some shoulder function ?

Answer 20

Cranial nerve function. Is there a lesion in a CN and/or in the cerebral brain tissue around it ? If the left side is not equal to the right side in sensation, tone, movement, & strenth, then we can consider a FOCAL PROBLEM WITH A CN.

Question 21

Assessment below the shoulders. Is the left side equal to the right side in sensation, tone, movement, & strength ? If not, we may consider what ?

Answer 21

Focal lesion and/or edema where a corticospinal tract passes through that cerebral hemisphere.

Question 22

Define dysphasia

Answer 22

Difficulty speaking

Question 23

Define dysphagia

Answer 23

Difficulty swallowing

Question 24

S&S of inability to do math, organize, reason, & analyze.

Dysphasia or aphasia. In general, varying degrees of inability to comprehend, integrate, & express language.
= what ?

Answer 24

Left side CVA.

Question 25

S&S of left-sided neglect

• (tendency to completely ignore everything on the left side).
• Hindered “spatiality” ( ability to perceive where you are in space, or other object).
• hindered seat of insight to the circumstances, creativity, face recognition, & musical ability.

Answer 25

Right CVA.

Question 26

Describe “act FAST scale”.

Answer 26

FACE: ask pt to smile, does one side of the face droop ?
ARMS: ask pt to raise both arms. Does one arm drift downward?
SPEECH: ask pt to repeat a simple sentence? Slurred speech?
can pt correctly repeat the sentence ?
TIME: act fast, 911 or POV to ER. Brain cells are dying.

Question 27

Prevention for further IICP in hospital setting ?

Answer 27

O2
BP management
Position pt to at least 30 degrees.
Diuretics
ICP monitor

Question 28

Interventions to treating ischemic CVAs?

Answer 28

Correct A Fib with drugs
Thrombolytic drugs within 2 hrs
Anticoagulant therapy initiated. 1st heparin, the sent home with Coumadin.