Cerebral Vascular Accident Flashcards
What kinds of medications are used to prevent a TIA/stroke?
antiplatelets
Plavix (clopidogrel) & Ticlid (ticlopidine) are what kinds of meds?
antiplatelets
Xarelto (rivaroxaban) is what kind of med?
anticoagulant
Ischemic stroke are due to?
Thrombus or Embolism (blockage)
Hemorrhagic strokes are do to?
a ruptured aneurysem
Large artery thrombotic strokes consist of?
atherosclerotic plagues and thrombosis formation at the site
Small penetrating thrombotic strokes consist of?
poorly controlled HTN, DM and /or hyperlipidema
A cardiogenic embolic stroke is due to?
Afib
Difference between a cerebral thrombosis and a cerebral embolism
Cerebral thrombosis occurs rapidly & progresses slowly, can start off as a TIA and progress to a stroke. A cerebral embolism is a clot/plaque that travels to the brain. It is sudden & has immediate deficits. Treat with thrombolytic agents
Who cant have thrombolytic therapy?
Intracranial/ spinal surgery, head trauma, or stroke, within the past 3 months, suspicion of hemorrhage, hx of intracranial hemmorrage, uncontrolled HTN, Internal bleeding, seizure at the onset of stroke, intracranial neoplasm, AV malformaton, or has an aneurysm, current use of oral anticoagulants, INR greater than 1.7, PT greater than 15 secs
Reperfusion by Embolectomy
basically pulls clot out (looks like a wine screw)
Why is a cerebral hemorrhage common in older people?
because their arteries are not has stiff, they have an increase of peripheral resistance and a decrease in CO
Why is cerebral hemmorrhage common in people with HTN?
because they have a decrease in diastolic BP & an increase in systollic BP
Difference between intracerebral hemorrhage & subarachnoid hemorrhage
Intracerebral hemorrhage blood goes into tissues (stop any anticoaglants and put on steriods), Subarachnoid hemorrhage blood goes ontop of brain so we can go in surgically and remove blood
What do you do when a person has a stroke and you arrive at their home?
check bp/glucose, give O2, FAST (face, arm, speech, time) and then give IV access in transit
Care in the acute phase of a Stroke, the first 24-48 hours
O2, elevate HOB, no flexing or twisting the neck, monitor vs changes to indicate ICP, Seizure precautions, I&O
If the stroke is due to a thrombolitic, what will you do?
youll give a clot bustor or do reperfusion by emolectomy
If stroke is due to a hemorrhage what will you do?
use supportive care
What is Decadron?
its a steroid and it helps with swelling in the brain and prevents further damage
s/s of ischemic stroke
numbness/weakness of face, arms or legs, slurred speech and difficulty with comprehension
s/s of a hemorrhagic stroke
“Exploding” h/a, Altered LOC, NV, seizures, Visual changes
what is contralateral deficit?
if your body is effected on the left side, the right side of your brain is effected
s/s of Left side problem
Aphasia (inability/impairment to communicate), expressiev or receptive or global (both expressive & receptive) problems, Dysartia (prob pronouncing words), memory deficits,, difficulty learning something new, difficulty distinguishing from right to left
s/s of right side problem
misjudge distances, apraxia (inability to use objects properly), inappropriate social behavior, short attention span, left sided neglect, cant recognize own arms/legs
s/s of stroke effecting the brain stem
decrease in breathing/HR & a decrease in arousal/consciousness
s/s of stroke effecting the cerebellum
balance problems (ataxia), abnormal reflexes of the head & upper body, dizziness, n/v
what do you do for a patient with ICP?
maintain airway, monitor VS, elevate HOB 30 degrees, avoid neck flection, give O2, decrease stimuli, decrease cerebral edema with diuretics, give decadron, restrict fluids to 1500 ml/day, glascow scale
Hemiparesis vs hemiplegia
Ability to move at least one side of body; cant move at all
Fluoxetine (Prozac), Methylphenidate ( Ritalin) & Nortriptyline (Aventyl) are used for what?
to treat depression that comes along with a stroke
How should you have the HOB during the acute phase of a stroke?
elevated
How should you have the HOB for ICP?
30 degrees
Rehab phase
teach patient about meds to be taken after discharge, reinforce gait training and transfer techniques, teach that they need follow up care
