cerebrovascular disorders (stroke) - powerpoint

Question 1

______ is the inability to recognize familiar objects.

Answer 1

agnosia

Question 2

_______ is the inability to express oneself or to understand language.

Answer 2

aphasia

Question 3

_______ inability to perform previously learned
purposeful motor acts on a voluntary basis.

Answer 3

apraxia

Question 4

_________ is an impaired ability to coordinate movement, often
seen as a staggering gait or postural imbalance.

Answer 4

ataxia

Question 5

what are 3 unmodifiable risk factors of a cerebrovascular disorder like a stroke?

Answer 5

age
gender
ethnicity

Question 6

what are the MODIFIABLE risk factors of a cerebrovascular disorder like a stroke?

Answer 6

HTN (primary risk factor)
cardiovascular disease
elevated cholesterol
elevated hematocrit
obesity
diabetes
use of oral contraceptives
smoking/ drug + alcohol abuse

Question 7

how is an elevated hematocrit a risk factor of a cerebrovascular disorder or stroke?

Answer 7

because too many RBCs can hinder the amount of oxygen delivered

Question 8

An ischemic stroke is caused due to an obstruction of blood flow, this could be due to
1.
2.
3.

Answer 8

1.thrombus
2.embolism
3.plaque

Question 9

symptoms of an ischemic stroke depend on the size and location of the obstruction, but what are the manifestations you may see?

Answer 9

-numbness, weakness of face, arm, leg especially on one side of the body

-confusion/ change in mental status
-trouble speaking/ understanding speech
-difficulty walking/ loss of balance/ coordination
-dizziness/ headache
-perceptual disturbances

Question 10

definition - paralysis on one side of the body.

Answer 10

hemiplegia

Question 11

definition - weakness or partial loss of movement on one side of the body.

Answer 11

hemiparesis

Question 12

definition - pronunciation and speech are affected due to the muscles for speech being weak or difficult to control.

Answer 12

dysarthria

Question 13

definition - this is the impairment of language affecting comprehension, and the ability to read and write

Answer 13

aphasia

Question 14

________ _______ is where the individual knows what they want to say but they can’t or have difficulty communicating - this involves speaking, writing or even sign language

Answer 14

expressive aphasia

Question 15

________ _________ is where the individual has trouble understanding spoken or written language, even if language production is intact.

Answer 15

receptive aphasia

Question 16

what is it called when there is visual field loss on the left or right of the vertical midline? usually affects both eyes.

Answer 16

hemianopsia

Question 17

a ____ is the temporary loss/ impairment of blood flow to the brain; this is also the “warning sign” of an impending stroke.

Answer 17

TIA - transient ischemic attack

Question 18

what are the preventative treatments and secondary prevention of a TIA and a stroke?

Answer 18

-Carotid endarterectomy for carotid stenosis
-anticoagulants for a-fib
-antiplatelets
-statin’s
-antihypertensives

Question 19

Trans-carotid Artery Revascularization (TCAR) is a procedure to treat carotid artery disease - which involves placing a stent in the carotid artery to keep it open and ensure proper blood flow to the brain. Why is a sheath placed first to temporarily reverse blood flow away from the brain?

Answer 19

this is to prevent debris that may dislodge during the procedure from making its way up to the brain

Question 20

what is the biggest side effect of administering TPA for a stroke?

Answer 20

bleeding

Question 21

a hemorrhagic stroke can be cause by bleeding in the:
1.
2.
3.

Answer 21

brain tissue
ventricles
subarachnoid space

Question 22

a hemorrhagic stroke can be caused by a spontaneous rupture of small vessels in the brain, what is the primary cause of that rupture?

Answer 22

hypertension

Question 23

what is a hemorrhagic stroke in the subarachnoid space caused by?

Answer 23

a ruptured aneurysm

Question 24

In patient with left hemispheric damage will see disturbances and deficits on which side of the body?

Answer 24

disturbances and deficits will be seen on the right side

Question 25

what is the goal time to administer t-PA after the patient arrives to ER?

Question 26

an _________ ________ is a dilation of the wall of the cerebral artery that develops due to weakness in the arterial wall.

Answer 26

intracranial aneurysm

Question 27

TRUE or FALSE? HTN is the most common cause of an intracerebral hemorrhage.

Answer 27

true

Question 28

an ________ stroke, cerebrovascular disease, or "brain attack" is described as a sudden loss of function resulting from a disruption of blood supply to the brain.

Answer 28

ischemic

Question 29

hemorrhagic strokes are primarily caused by _______ hemorrhage or subarachnoid hemorrhage.

Answer 29

cranial

Question 30

cerebral _________ is a serious complication of subarachnoid hemorrhage and fatal in patients who survive the initial hemorrhage.

Answer 30

vasospasm

Question 31

the main surgical procedure for patients with TIA's and mild stroke is ________ __________.

Answer 31

cerebral enterectomy

Question 32

what are the 4 things that can cause an intracerebral hemorrhage?

Answer 32

1.amyloid angiopathy 2.arterial venous malformations (AVM) 3.intracranial aneurysms 4.anticoagulants

Question 33

_____ _______ ______ increases caused by blood in the subarachnoid space when a hemorrhagic stroke is occurring.

Answer 33

intracranial pressure

Question 34

what are 2 secondary issues that occur from reduced perfusion and vasoconstriction that will cause brain tissue injury, after a hemorrhagic stroke?

Answer 34

compression and secondary ischemia

Question 35

what are 4 manifestations of a hemorrhagic stroke?

Answer 35

-severe headache -early + sudden confusion or change in LOC -vomiting -bleeding

Question 36

to diagnose a hemorrhagic stroke a CT or cerebral angiography is done to visualize the bleed, what diagnostic test is done if the CT comes back negative and the ICP isn't increased to confirm the hemorrhage?

Answer 36

lumbar puncture

Question 37

After a hemorrhagic stroke, what are 5 things we need to be assessing for and treating to avoid further decline?

Answer 37

-vasospasm -increased ICP -HTN -potential seizures -further bleeding

Question 38

during the acute phase of an ischemic stroke, ongoing, frequent assessment is so important. What do we need to be monitoring? (vitals +neurologic status) (8)

Answer 38

-LOC -motor symptoms -speech -pupils -I&O -blood pressure -bleeding -O2 sat.

Question 39

After the acute phase of an ischemic stroke, when they're in recovery, what 8 things need to be assessed

Answer 39

mental status sensation + perception motor control swallowing ability nutrition/ hydration status skin integrity activity tolerance bowel + bladder function

Question 40

what are the 3 priority potential complications associated with an ischemic stroke?

Answer 40

1. decreased cerebral blood flow 2. inadequate oxygen delivery to the brain 3. pneumonia

Question 41

What nursing interventions need to be performed to improve mobility and prevent joint deformities for a patient recovering from an ischemic stroke?

Answer 41

-prevent shoulder abduction + shoulder pain -positioning the hands + fingers -Q2 position changes -passive/ active ROM 4-5x/day -ambulate/OOB as soon as possible

Question 42

What are 4 ways we will assist a patient recovering from an ischemic stroke with their nutrition?

Answer 42

-consult speech therapy + nutrition -sit upright/ OOB preferably -chin tuck swallowing method -thickened liquid/ pureed diet

Question 43

what are 5 complications of a patient with a hemorrhagic stroke?

Answer 43

-vasospasm -seizures -hydrocephalus -rebleeding -hyponatremia

Question 44

With a patient recovering from a hemorrhagic stroke, how are we going to optimize tissue perfusion and prevent complications or further decline?

Answer 44

-aneurysm precautions (decreased sensory stimulation) -provide a non-stimulating environment (dim lighting, no TV/ radio/ reading) -prevent increases in ICP + further bleeding -absolute bedrest w/ HOB at 30 degrees -avoid all activity that could increase ICP or BP (Valsalva maneuver, acute flexion or rotation of neck or head) -stool softeners/ mild laxative so they don't strain -no visitors -seizure precautions