Cerebrovascular Accident Flashcards
Stroke
Ischemia or hemorrhage
TIA
Medical emergency
Result in death of brain cells
Primary cause of adult disability in the US
Ischemia
Inadequate blood flow to a part of the brain
Hemorrhage
Bleeding into the brain
Teaching about stroke
Prevention!! Andteaching
Non modifiable risk factors
Age
Gender
Ethnicity
Hereditary / family history
Modifiable risk factors
Uncontrolled hypertension
Heart disease
Diabetes
Serum cholesterol
Smoking
Obesity
Sleep apnea
Metabolic syndrome
Lack of physical excercise
Poor diet
Drug and alcohol abuse
Oral contraceptives
Cause blood clots , dvt
Types of strokes
Transient ischemic attack (TIA)
Ischemic
Hemorrhagic
Pt that have a fib
25% of strokes give blood thinners for a fib
TIA
Acute infarction of brain symptoms
Warning sign of further cerebrovascular accident
Last for lessthan an hour
Treated as a real stroke
Medical emergency
Ischemic stroke
Results from inadequate blood flow to brain from partial or incomplete occlusion of an artery
Thrombotic
Embolic
Thrombotic stroke
Injury to a blood vessel wall and formation of a blood clot
Results from thrombosis or narrowing of a blood vessel
Can be preceded by TIA
Associated with DM and HTN
Most common cause of stroke
Embolic stroke
Embolus dislodges and occludes a cerebral artery resulting in infarction and edema , comes from other part of body but usually from endo cardiac layer of heart , bowel replacement
Effects pt with MI , a fib ,
S/s of Embolic stroke
Pt remains conscious
Prognosis is related to amount of brain tissue deprived of blood supply
Complains of headaches
Symptoms can be temporary if clot is broken up
Can reoccur unless underlying cause is treated
Hemorrhagic stroke
Caused by bleeding into the brain tissue, ventricles or sub arachnoid space
Causes can vary - HTN ,aneurysm , intracranial neoplasm ,AVM
Deficit are severe and recovery is long
Can happen during periods of activity
Sub arachnoid Hemorrhagic stroke s/s
N&v
Headache
Seizure
Stiff neck
Intracerebral hemorrhage
Bleeding within the brain caused by ruptured vessel
Sudden onset of symptoms
Progresses from minutes to hours because of ongoing bleeding
Prognosis poor
Hypertension
Occurs during activity
Deaths within i the first 48 hours
Subarachnoid hemorrhage
Intracranial bleeding into cerebrospinal fluid filled space between arachnoid and pia mater
Commonly caused by rupture of a cerebral aneurysm
Silent killer
MORE common in women
Intracerebral hemorrhage s/s
Headaches
N&v
decrease LOC
Neuro defecits
Happens during activity
Hemorrhagic stroke complications
Neuro and systematic complications
Cerebral vasospasm
Hyponatremia
Myocardial ischemia and infarction ARDS
What do you give when a pt has a cerebral vasospasm following an aneurysm
Administration of calcium channel blocker Nimodipine
manifestiations of stroke
Cognitive
Memory loss, decrease attention span
Poor reasoning
Altered judgement
Psychological effects of stroke
Loss of self control
Depression
Emotions lability(can’t control feelings)
And elimination
Hemiplegia hemiparesis
Paralysis and weakness on one side of body
Ataxia
Lack of motor control
dysarthria
Disturbance in muscle control of speech
Dysphasia
Impaired ability to communicate
Expressive Aphasia
Unable to express what they want to say
Receptive aphasia
Unable to receive or understand
Dysphagia
Inability to swallow at risk for aspiration
Spatial perceptual alterations
Homonymous hemianopsia
Loss of peripheral vision
Agnostic
Apraxia
Homonymous hemianopsia
Blind on one side of the body
Agnosia
The ability to recognize an object by touch and site
Apraxia
The inability to carry out commands
Diagnostic studies for stroke
CT scan or MRI
ECG , labs
What do CT scan or MRI identify
Size and location of lesion
Differentiate between ischemic
And hemorrhagic stoke
If a CT scan shows a bleed what’s next
MRI so they can see a much bigger picture
Ischemic stroke medical management
Thrombolytic therapy within 3 hours of s/s TPA
TPA
Need noncontrast CT of head
Blood tests for coagulation studies
Screening for history of GI bleeding in past 3 months or major surgery in last 14 days (recent stroke , head trauma within 3 months )
TPA cont
Will be in icu for first 24 hours to montor BP
Risk for bleeding first 48 hrs
Start foley to prevent falls and bleeding
Surgical management for stroke
Carotid endarterectomy
Carotid stenting
Aneurysm clipping, coiling
Resection of arteriosclerosis malformation (AVM)
Coiling , clipping
For hemorrhagic
Carotid endarterectomy
For ischemia stroke
Lesion is removed from carotid artery to improve blood flow
Stenting
Ischemic -thrombo
Nimodipine
Calcium channel blocker
Give for cerebral vasospasm to prevent myocardial ischemia and infarction , ARDS ( complication frin hemorrhagic stroke)
Prentice drug therapy for stroke
Warfarin a-fib
Anti platelets; Clopidogrel , aspirin
Statins
Antihypertensive
Bladder retraining
Encourage pt to go once every two hours
Avoid use of indwelling Catheters
Offer urinal or bed pan on schedule
