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Nursing Semester 3 > Beth - Week 5 - Exam 2 > Flashcards

Beth - Week 5 - Exam 2 Flashcards

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1
Q

what is the normal processes for the brain?

A
  • constant blood flow
  • blood flow removes waste
  • cerebral autoregulation
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2
Q

what occurs in the event of a stroke?

A

ischemia → hypoxia and hypoglycemia (lack of O2 and nutrients) → infarct (death of cell)

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3
Q

T/F we want to save the penumbra

A

YAAASSS

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4
Q

what is the penumbra?

A

the area that is surrounding the dead core that is minimally being perfused

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5
Q

the ability to save the penumbra depends on three things. what are they?

A
  • timely return of adequate circulation
  • volume of toxins released by dead cells
  • degree of cerebral edema
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6
Q

TEST: what are the main risk factors for stroke?

A
  • atherosclerosis
  • a. fib
  • diabetes
  • HTN
  • heart disease
  • hyperlipidemia
  • oral contraceptives
  • obesity
  • prior stroke
  • sedentary lifestyle
  • smoking
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7
Q

what are the other risk factors for stroke?

A
  • age
  • gender - male
  • familial tendency
  • African American
  • TIA
  • vasospasm
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8
Q

what is the warning sign of a stroke?

A

TIA - transient ischemic attack

  • **temporary stroke symptoms
  • **must be taken seriously
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9
Q

what are the sxs of a TIA?

A

confused, slurred speech, CT scan → blood in brain → seems normal in ER → red flag

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10
Q

T/F: a key point of TIA is that they are a precursor to thrombotic strokes

A

TRUE

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11
Q

how long can TIA s/sx last?

A

a few minutes to < 24hr

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12
Q

___% of stokes are preventable

A

80

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13
Q

stroke is the ____ leading cause of death in the US

A

5th

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14
Q

what are the types of stroke?

A
  • ischemic (87%) and hemorrhagic
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15
Q

what are the two types of ischemic strokes?

A

thrombotic and embolic

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16
Q

what is usually the cause of hemorrhagic strokes?

A

HTN

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17
Q

TEST: what are the clinical manifestations of a right hemisphere stroke?

A
  • left hemiplegia
  • spatial-perceptual defects
  • denial of deficits
  • neglect lt. side
  • euphoric/smile
  • impaired sense of humor
  • poor judgment
  • defects in lt. visual field (Hemianopsia)
  • impulsive
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18
Q

T/F there is a better outcome for a right hemisphere stroke

A

TRUE

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19
Q

what are the clinical manifestations of a left hemisphere stroke?

A
  • right hemiplegia
  • neglect rt side
  • defects in rt visual field
  • expressive/receptive aphasia or global aphasia (broca)
  • unable to discriminate words/letters (wernicke)
  • worry/depression/emotional lability
  • quick anger/frustration
  • intellectual impairment (cognitive)
  • slow/cautious
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20
Q

how to acute ischemic strokes (thrombotic) occur?

A

vessel loses elasticity (hardens) → narrowing of the vessels lumen
**NOT d/t a bleed

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21
Q

what is the #1 risk factor for acute ischemic stroke (thrombotic)?

A

atherosclerosis

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22
Q

how do sxs appear for acute ischemic stroke (thrombotic)?

A
  • symptoms sudden or often during sleep or in morning (HTN spikes)
  • OR a gradual process → collateral circulation plays a role
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23
Q

how do acute ischemic strokes (embolic) occur?

A
  • traveling blood clot

- tends to lodge in small vessels or bifurcations

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24
Q

how to the sxs present for an acute ischemic stroke (embolic)?

A

sudden onset of symptoms - could follow by a clearing for hours to few days

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25
Q

TEST: where does the AIS (embolic) occur?

A

middle cerebral artery - major game changer - now capable to do treatment endovascularly - pull out clot/plaque

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26
Q

TEST: what is the number 1 cause of AIS embolic? and what meds can we use as tx?

A

A. Fib → control A. fib and put on blood thinner

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27
Q

how does a hemorrhagic stroke occur?

A

integrity of the vessel is interrupted

- bleeding into tissue or subarachnoid space

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28
Q

for a hemorrhagic stroke, _____ immediately shows bleed

A

CT

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29
Q

what are the three examples of hemorrhagic stroke?

A
  • Intracerebral bleed
  • subarachnoid hemorrhage
  • AVM
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30
Q

T/F hemorrhagic stroke are less common

A

TRUE

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31
Q

what should you do to prevent hemorrhagic stroke?

A

control HTN

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32
Q

what is the most often occluded artery in a stroke?

A

the middle cerebral artery (MCA)

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33
Q

what is the largest branch of the internal carotids?

A

the middle cerebral artery

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34
Q

the MCA provides blood to where?

A
  • the frontal lobe
  • lateral surface of temporal and parietal lobes
  • motor and sensory
  • face, throat, hand, arm
  • if dominant - speech
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35
Q

A patient arrives in the ER with new symptoms of hemiparesis, sensory loss, gaze deficit and aphasia. what are these symptoms of?

A

consistent with MCA stroke → time is essence, call code stroke.

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36
Q

the brain requires ____ of total body’s O2 and ___ of cardiac output

A

20; 10

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37
Q

the arterial artery of brain: where does the anterior circulation originate from?

A

the carotids

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38
Q

the arterial artery of the brain: where does the posterior circulation originate from?

A

the vertebral

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39
Q

where do the anterior circulation and the posterior circulation merge?

A

the circle of willis

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40
Q

what are the 4 large vessel strokes?

A
  • carotid, vertebral (COW, ACA, MCA, PCA)
  • ischemic stroke (occlusion d/t thrombus)
  • ICH (hemorrhage at junctions and vessel turns)
  • SAH (aneurysms form at vessel junctions and turns)
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41
Q

what are the 3 small vessel strokes ?

A
  • ischemic stoke vessels (occlusion d/t atherosclerosis)
  • ICH (hemorrhage occurs d/t amyloid fibribr (fibrous protein deposits) tumor, or vascular malformation)
  • SAH (aneurysm or vascular malformation)
42
Q

what are the major structures affected when there is a stroke in the anterior cerebral artery?

A

Frontal lobe
Olfactory cortex
Corpus callosum
Leg motor cortex

43
Q

what are the anterior cerebral artery stroke symptoms?

A

Apathy
Conjugate eye deviation
Contralateral motor/sensory loss (Leg>arm)

44
Q

what are the structures affected when there is a middle cerebral artery stroke?

A
  • Speech & language
  • Motor & sensory
  • Gaze
  • Basel ganglia
45
Q

what are the major stroke symptoms with a middle cerebral artery stroke?

A
  • Aphasia (dominant)
  • Neglect (nondominant)
  • Eye deviation or gaze preference
  • Contralateral hemianopsia
  • Contralateral Motor/ sensory (face/arm>leg)
46
Q

what are the structures affected in a cerebral artery stroke?

A
  • occipital lobe
  • visual cortex
  • midbrain
  • thalamus
  • corpus callosum
47
Q

what are the major stroke symptoms of a cerebral artery stroke?

A
  • contralateral loss of pain or temp (thalamus - can’t ID hot or cold or even a pen on arm)
  • visual field loss
48
Q

what two diagnostics are used for a cerebral artery stroke?

A
  • cerebral angiogram (contrast - blood flow)

- cerebral MRA (contrast - well defined)

49
Q

what is a hemorrhagic stroke: intracerebral bleed and what is it caused by?

A
  • bleeding into the brain

- caused by HTN and age (vessels older/not great integrity)

50
Q

when do intracerebral bleed hemorrhagic strokes usually occur?

A

typically during an activity → muscles need blood flow

51
Q

what are the characteristics of an arterio-venous malformation hemorrhagic stroke?

A
  • congenital anomaly
  • high pressure to low pressure
  • age 10 - 40
52
Q

T/F the assessment for arterio-venous malformation hemorrhagic stroke is similar to SAH

A

TRUE

53
Q

what is a subarachnoid hemorrhagic stroke?

A

cerebral aneurysm leak or burst

54
Q

why is it called a subarachnoid hemorrage?

A

because the bleeding occurs in the sub arachnoid space.

55
Q

what is the most common sxs of a SAH stroke?

A

“worst HA i have ever had”

56
Q

what are the test finds for a SAH stroke?

A
  • blood on LP

- CT/MRI shows aneurysm on angiogram - berry aneurysm

57
Q

what are the symptoms of a ruptured aneurysm?

A
  • Sudden, extremely severe headache
  • Nausea and vomiting
  • Stiff neck
  • Blurred or double vision
  • Sensitivity to light
  • Seizure
  • A drooping eyelid
  • Loss of consciousness
  • Confusion
58
Q

T/F ruptured aneurysms are hard to tx and often confused with meningitis

A

TRUE

59
Q

what are the sxs of a UNruptured aneurysm?

A
  • Pain above and behind one eye
  • A dilated pupil
  • Change in vision or double vision
  • Numbness of one side of the face
60
Q

what is the surgical intervention to manage arterio-venous malformation?

A

lilgation

61
Q

what are the complications for an AVM pre/post surgery

A
  • vasospasm

- rebleed

62
Q

what is the role of health care providers in the event of a stroke?

A
  • ID with FAST assessment if pt has stroke symptoms

- activate the code stroke system

63
Q

what is the code stroke system?

A
  • Complete assessment (NIH scale)
  • Obtain Blood sugar
  • Obtain CT scan
  • IV start with Blood draw
  • Follow the Stroke Protocol
  • Frequently re-assess patient (any change report immediately; can figure out what artery → IR → tx)
64
Q

what does FAST stand for ?

A

Face, Arms, Speech, Time

65
Q

what we assessing for Face?

A
  • does one side droop when asked to smile?
66
Q

what are we assessing for Arms?

A
  • does one arm drift downward when asked to raise arms
67
Q

what are we assessing for Speech?

A
  • speech slurred or strange when stating a simple phrase
68
Q

what are we assessing for Time?

A

if you observe any signs, call 911

69
Q

what are the nursing interventions when we see someone who has sxs of a stroke?

A
  • Call a CODE Stroke
  • Stay with the patient
  • Communicate last known well time
  • Complete Stroke scale assessment
  • Do a Fingerstick
  • Plan for CT scan
  • Document
  • Check IV site/status
  • Lab draw for CMP, Pt, Ptt-INR (love but don’t need)
  • Swallow evaluation
  • Prepare for Medical
70
Q

the treatment window for a stroke is ______ from the ONSET of symptoms

A

3 - 4.5

71
Q

what is the first diagnostic test for a stroke?

A

CT non-contrast (within 25 min) to r/o bleed

72
Q

what is the tx after bleed is r/o?

A

TPA

73
Q

how is “altered tissue perfusion” different for ischemic vs hemorrhage?

A

ichemic → going to be able to give meds → stop/break up clot

hemorrhagic → bleed more with drugs → death

74
Q

If it is a ischemic stroke, we would then screen for ____

A

TPA - total time: onset < 3-24hr

75
Q

after screening for tPA we would then do what?

A

begin fibrionlytic tx within 60 min and up to 24 hrs and transfer to ICU

76
Q

what are the meds for fibrinolytic tx?

A

streptokinase or tPA (alteplase)

77
Q

what are the characteristics for giving fibrinolytic tx?

A
  • IF diagnosed as an ischemic stroke only!
  • IF within 3-24hours of onset of neuro symptoms
  • IF age 18 or older
  • IF other issues were ruled out….
78
Q

T/F the initial CT scan might be negative for an ischemic stroke

A

TRUE

79
Q

what are the nursing implications for someone on fibrinolytic tx after a stroke?

A

• Assess/Reassess neuro Q2-4h
• Monitor cardiac rhythm (greater risk of a fib)
• Antiplatelets/anticoagulants (immediate or 24 hrs
after tPA) (if ischemic stroke)
• Discharge Meds—might be anticoags and/or statins

80
Q

what is the gold standard med for a non hemorrhagic stroke?

A

tPA - dissolves clot - given 24 hrs after onset of symptoms

81
Q

what procedure is used with tPA?

A

endovascular procedures - defuse 3/rapid

82
Q

what are the invasive interventions to treat ischemic strokes?

A 
Corkscrew type-Merci, Solitaire, &amp; Trevo
Penumbra Systems
Snarelike devices
EKOS Utz devices
(acoustic pressure)
83
Q

what are the three methods of tx interventions/surgical management for SAH?

A
  • to prevent re-bleeding
  • endovascular therapy or coiling
  • surgical aneurysm clipping
84
Q

what is the one non surgical tx for SAH?

A

medical tx

85
Q

TEST: what are the complications of SAH?

A
  • Re-bleed
  • Hydrocephalus
  • Seizure
  • Vasospasm (diagnosed with Transcrainal doppler- TCD)
  • breakdown of blood
  • influx of calcium
  • MI, new aneurysm rupture, cerebral edema
  • Brain infarction
86
Q

what are the NI for managment of cerebral vasospasm?

A
  • Balloon angioplasty
  • Nimodipine 60mg q 4hr for 21 days
    *** HHH Therapy – (Hypervolemia, HTN, Hemodilution) – controversial
  • IVF +/- Inotropes/vasopressors
  • CVP 10-12mmHg
  • SBP 160-200 if aneurysm clipped and 120-150 if
    unclipped
  • IR-Selective intra-arterial verapamil, papaverine, or nitroprusside or Angioplasty can also be used
87
Q

what are the interventions for hypertensive post stroke patients?

A
  • parameters?
  • high B/P needed for perfusion?
  • is there a cause for the HTN? vomiting?
  • too high = rebleed
88
Q

what are the interventions for hypotensive post stroke patients?

A
  • too low B/P = poor or slow perfusion

* Ischemia Infarction!!

89
Q

T/F ALWAYS clarify with MD about parameters

A

TRUE

90
Q

what are the nursing precautions/interventions for stroke in general?

A 
• Calm/Quiet
• Pain meds
• Nausea
• Dim lights
• frequent assessment
• ↓ stimulation; quiet
• ↑ HOB
• Limit Val-Salva
• SBP maintained 120-150
- Fibrinolytic therapy patients treat BP>185/110
- Labetalol or Nicardipine
- Watch for DI or SIADH
- Keep Normothermic
- I &amp; O balance
- Regulate Glucose between 120-200
91
Q

what are we looking for during frequent assessment?

A
  • Note Neuro changes
  • Note Blood pressure changes
  • Ensure stool softener is given
  • Avoid straining with voiding
92
Q

nursing must monitor what three things?

A
  • seizures
  • electrolytes/coags (Na, K, Cl, Pt-INR, PTT, plts)
  • DVT (PAS stocking, lovenox after 24hrs LWM heparin/subq heparin)
93
Q

what is important to teach patient and family regarding stroke patients?

A
  • Prevention of complications
  • Mobility (falls, around house)
  • Communication (speech therapy)
  • Swallow Precautions (dysphagia)
  • Sensory/Perceptual (tactile & visual)
  • Self Care (ADLs)
  • Rehabilitation
94
Q

what are characteristics of TIA and stroke preventions?

A
  • Education:
  • Diet (Low sodium + Low fat)
  • Weight control
  • Blood Pressure control
  • Exercise routine
  • No smoking
95
Q

what are interventions for patients with receptive/expressive/global aphasia?

A
  • Eye contact
  • Speak normal-verbal cues
  • Minimal correction
  • Don’t answer for pt.
  • Acknowledge frustration
96
Q

what are the interventions for patients with dysphasia/dysarthria?

A
  • Call light?
  • Elicit “yes” or “no” responses
  • Watch for non-verbal cues
  • Check accuracy of “yes” + “no” answers
  • Pictures or word board
97
Q

Nursing MUST address mobility and skin integrity. what are the interventions?

A 
• Hemiplegia vs. Hemiparesis
• Support affected joint
• Passive ROM
• Turn Q2h
• Alignment of extremities
• Prevent contractures in hands/ankles—keep in a
neutral position--Remove splints Q2h—check skin
• Keep skin clean
98
Q

Nursing MUST review dysphagia screening. what are the implications/interventions?

A
  • Aspiration precautions
  • High fowlers
  • 1 tsp food on unaffected side
  • Pt. to sweep own mouth
  • Check affected side for pocketing
  • Thickeners
  • Cold foods
  • No straws
  • Assess breath sounds after meals
  • Allow for extra time to eat
  • No milk
  • Reinforce keeping chin tucked with swallow
  • REQUEST a Swallow Evaluation
99
Q

terms to remember sensory/perceptual?

A 
Homonymous
Hemianopsia
Apraxia
Agnosia
Kinesthesia
Paresthesia
Proprioception deficit
• Scan entire room
• unilateral neglect
• Have the patient look at the Clock/Calendar
100
Q

Nursing must assess/intervene for neglect. what are the interventions?

A
  • Unilateral Neglect:
  • Use cues cards/mirror
  • Approach patient on unaffected side (ACUTE phase)
  • Give care on affected side (REHAB phase)
  • Put call light on unaffected side
  • Protect the affected extremity
101
Q

nursing must assess for self care needs. what are the interventions?

A 
• Set realistic goals— patient/family
• Reinforce O.T.
• Clocks
• Simple
commands/Praise/Feedback
• Use demonstration
• Foster independence
• Use of devices
• Guide patients hands
102
Q

nursing must now rehab phase.. what are the characteristics?

A

Assessment of Patients

  • Ability to perform ADLs, meals, Mobility, continence
  • Swallow
  • Nutritional support
  • Safety level?
  • Ability to communicate
  • Affect
  • Cope
  • Physical endurance— can they perform therapy for 3 hrs/day?
  • Safety level–which hemisphere stroke is more at risk?
  • Home environment—Safe?
  • Family circumstances—support system
  • Expectations—Set realistic goals
  • Ability to learn—can the pt. relearn

Nursing Semester 3 (29 decks)

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