Cerebral Vascular Accident (CVA) Flashcards
1
Q
Incidence
A
- 795,000 strokes per year in the US
- 130,000 americans die from strokes each year
- 87% of all strokes are ischemic strokes
2
Q
Symptoms
A
- Somewhat variable based on artery affected
- Always sudden, usually happen on one side
- Weakness of face, arm, leg, numbness on one side, difficulty speaking, loss of vision, sudden severe headache, off-balance
3
Q
Pathophysiology
A
•Lack of cerebral blood flow leads to brain cell death. That’s pretty much it!
- Classified as 3 main “types”
- Ischemic – blockage or stenosis of artery, usually blood clot
- Transient Ischemic Attack (TIA) – same as ischemic more or less only temporary or transient, not a “full” stroke so to speak
- Hemorrhagic – blood vessel ruptures
* Intracerebral Hemorrhage – bleeding within the brain
* Subarachnoid Hemorrhage – bleeding into the spaces around the brain
4
Q
Ischemic
A
- Caused by embolus or thrombus
- Usually occurs rapidly but progresses slowly, may start as a TIA and then worsen over a few days
- As symptoms develop and worsen is called stroke in evolution
- Symptoms get worse until area of brain tissue is completely necrotic, at this point called a full stroke
5
Q
Transient Ischemic Attack (TIA)
A
- A “mini-stroke” – brief period (<24 HRS) of cerebral ischemia
- TIAs can develop into strokes or might happen before a stroke/be a warning sign for stroke
- Similar symptoms to CVA – numbness, weakness, aphasia, etc.
- Temporary blindness in one eye, like a shade being pulled over it
6
Q
Hemorrhagic
A
- Caused by bleeding in cerebral artery
- Blood can’t get to part of the brain and blood causes pressure as it leaks into intracranial cavity
- Happens suddenly, often when engaged in activity
- Vomitting, headache, seizures, hemiplegia, ↓ LOC, ↑ICP may lead to coma/death
7
Q
Diagnosis
A
- Imaging – MRI, x-ray, CT-scan
- PLAC test – screening tool for recurrent stroke risk, measures presence of certain enzymes that predispose to stroke
- National Institutes of Health Stroke Scale – helps assess neurological outcome and degree of recovery
8
Q
Complications – Sensory-perception
A
- Can alter neurological ability to sense or perceive stimuli
- Changes in vision, smell, hearing, sense of pain, temperature, etc.
- Proprioception – ability to sense body parts in space
- Hemianopia – loss of half of visual field in one or both eyes
- Agnosia – can’t recognize objects or subjects
- Apraxia – can’t carry out motor function, even when strength and coordination are present
9
Q
Neglect Syndrome
A
- Due to impairments on one side of body, pt ignores or loses ability to focus or use that side of body
- E.g. the feel pain or numbness in arm so they neglect using that arm, making it weaker over time
- Vision – hemianopia
- Try to engage affected side where possible – ROM, PT, OT, etc.
10
Q
Cognitive and Behavioral
A
- Following stroke, change in LOC common.
- Can range from confusion to coma
- Emotional lability
- Loss of self control
- Memory loss, short attention span, poor judgement and reasoning
11
Q
Communication - Aphasia
A
- Inability to use or understand language
- Expressive aphasia – can understand, but cannot speak back
- Receptive – Speaks fine but can’t understand what is said or written
- Global – neither understanding or expression
•Dysarthia – difficulty with muscle movements for speech
12
Q
Motor
A
- Weakness, paralysis, spasticity
- Hemiplegia – one half of body
- Hemiparesis – weakness on one half of body
- Flaccidity – absence of muscle tone
- Spasticity – hypertonia, usually flexors. Can lead to contractions or abnormal body positioning e.g. foot drop, external leg rotation
13
Q
Rehabilitation
A
- Long term prognosis is variable – some can see improvements with therapy
- Physical therapy – think gross motor movement, walking, sitting
- Occupational therapy – more fine motor skills, writing, brushing teeth
- Speech therapy – improve communication skills, and swallowing
14
Q
Elimination
A
- Urinary frequency, urgency, incontinence
- Can be exacerbated by complications of immobility and other complications from stroke e.g. aphasia
- What diagnoses? What does a nursing care plan look like for dealing with these elimination issues?
15
Q
Medications - Prevention
A
- Meds that target contributing factor – BP meds for example
- Clopidogrel (Plavix) – makes it so platelets are less likely to stick or bind to each other
- Aspirin - used to treat pain, inflammation. Also antiplatelet and suppresses ability to bind
* May also be given immediately after a TIA, stroke, heart attack to prevent a recurrence
16
Q
Medications – Emergency Management
A
•Anticoagulants – heparin, coumadin, enoxaparin
- Tissue plasminogen activator (tPA) – causes fibrinolysis of clot(s)
- Typically given on arrival or entry to ED
- Closely monitor vital signs after administration
- high risk for bleeding
•No anticoagulants in hemorrhagic stroke
17
Q
Continuous Heparin therapy
A
- Heparin administered via IV
- Baseline Partial Thromboplastin Time (PTT) drawn, with subsequent PTTs drawn to monitor therapy usually every 6 hours
- Goal is PTT that is 1.5-2.5x normal level
- Rate is adjusted based off of PTT sliding scale
18
Q
Warfarin
A
- What do you already know about Warfarin?
- What sort of things will a patient need to do while on Warfarin?
OR
•What sort of patient education will a patient require while on Warfarin?
19
Q
Surgery
A
- Removal of atherosclerotic plaque – endarterectomy
- Arterial bypass – redirect blood flow around area of occlusion
- Angioplasty – placement of stent to treat stenosis
20
Q
Proprioception
A
ability to sense body parts in space
21
Q
Hemianopia
A
loss of half of visual field in one or both eyes
22
Q
Agnosia
A
can’t recognize objects or subjects
23
Q
Apraxia
A
can’t carry out motor function, even when strength and coordination are present
24
Q
Dysarthia
A
difficulty with muscle movements for speech
25
Q
Endarterectomy
A
removal of atherosclerotic plaque
