Cerebrovascular Accident Flashcards by Elizabeth Gausin

Stroke

Ischemia or hemorrhage

TIA
Medical emergency
Result in death of brain cells
Primary cause of adult disability in the US

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Ischemia

Inadequate blood flow to a part of the brain

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Hemorrhage

Bleeding into the brain

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Teaching about stroke

Prevention!! Andteaching

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Non modifiable risk factors

Age
Gender
Ethnicity
Hereditary / family history

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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

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Oral contraceptives

Cause blood clots , dvt

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Types of strokes

Transient ischemic attack (TIA)
Ischemic
Hemorrhagic

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Pt that have a fib

25% of strokes give blood thinners for a fib

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TIA

Acute infarction of brain symptoms
Warning sign of further cerebrovascular accident
Last for lessthan an hour
Treated as a real stroke
Medical emergency

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Ischemic stroke

Results from inadequate blood flow to brain from partial or incomplete occlusion of an artery
Thrombotic
Embolic

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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

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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 ,

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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

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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

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Sub arachnoid Hemorrhagic stroke s/s

N&v
Headache
Seizure
Stiff neck

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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

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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

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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