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Med II > Ch 62 > Flashcards

Ch 62 Flashcards

1
Q

When do cerebrovascular disorders occur

A

when the blood supply to the brain is disrupted

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2
Q

what is the primary cerebrovascular disorder, 5th leading cause of death in the US, and the leading cause of serious long-term disability

A

stroke

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3
Q

what are the nonmodifiable risk factors for stroke

A

age (greater than 55), gender (men > women), ethnicity (AA and Hispanic/Latino > caucasian)

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4
Q

what are the modifiable risk factors for stroke?

A
  • hypertension is the primary risk factor
  • Cardiovascular disease
  • Elevated cholesterol or elevated hematocrit
  • Obesity
  • Diabetes
  • Oral contraceptive use
  • Smoking and drug and alcohol abuse
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5
Q

Disruption of the blood supply caused by an obstruction, usually a thrombus or embolism that causes infarction of brain tissue is aka ?

A

ischemic stroke

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6
Q

what are the types of ischemic stroke

A
  • Large artery thrombosis
  • Small penetrating artery thrombosis
  • Cardiogenic embolism
  • Cryptogenic
  • Other
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7
Q

if a patient has a large artery thrombosis this means the stroke was caused by?

A

atherosclerotic plaques in the large vessels (accounts 20% of all ischemic stroke)

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8
Q

what is a cardiogenic embolism?

A

ischemic stroke related to cardiac arrythmias; primarily afib (accounts for 20% of all strokes)

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9
Q

what is cryptogenic strokes

A

cause of stroke is unknown (30%)

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10
Q

what is a small penetrating artery thrombosis

A

affect one or more small vessels in the brain
- normally more diffuse and localized
- accounts 25% of all strokes
- aka lacunar strokes

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11
Q

what is lacuna?

A

cavity created after death of infarcted tissue

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12
Q

5% of strokes result from?

A

things such as illicit drug use, coagulopathies, migraines/vasospasm, dissection of carotid or vertebral arteries

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13
Q

symptoms of stroke depend on?

A

the location and size of the affected area called penumbra

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14
Q

what are some of the symptoms of stroke

A
  • numbness or weakness of face, arm, leg mainly on one side
  • confusion/change in mental status
  • trouble understanding or producing speech
  • difficulty walking, dizzy, loss of coordination or balance
  • sudden, severe headache
  • perceptual disturbances
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15
Q

what is the difference between receptive and expressive aphasia

A

receptive aphasia= difficulty understanding speech; usually due to damage to temporal lobe (wernicke)
- can hear what you are saying but cannot understand spoken words

Expressive aphasia: inability to express onself through speech; often due to damage in left side of frontal lobe (Broca area)
- cannot find the words they need or string words together correctly aka word salad

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16
Q

the nurse finds the patient experiencing difficulty speaking due to weak speech muscles. The nurse would document this as?

A

dysarthria

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17
Q

the nurse would document a patient experiencing difficulty and impairment producing speech as?

A

dysphasia

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18
Q

what is apraxia

A

difficulty in skilled voluntary movement

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19
Q

hemiplegia

A

paralysis of one side of the body, or part of it, due to damage to motor area of the brain

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20
Q

hemianopsia

A

blindness of half of thefield of vision in one or both eyes

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21
Q

agnosia

A

not being able to recall the name of common objects

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22
Q

a patient in the ED had a temporary neurologic deficit caused by a temporary impairment of blood flow. Symptoms resolved after about an hour. This is known as

A

TIA

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23
Q

TIA is a warning for? how are permanent deficits prevented?

A

impending stroke
diagnostic workup and evaluation

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24
Q

what are the treatment options both preventative and to prevent secondary prevention

A
  • Carotid endarterectomy for carotid stenosis
  • ANTICOAG for afib (pradaxa or eliquis)
  • antiplatelet therapy
  • statins to control cholesterol
  • BP meds
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25
what must we use to determine the dosage window for tPA?
last known well time
26
what are the components of LKWT?
date and time
27
what exam can be used in the "field" to assess potential stroke patient
FAST face, arm, speech, time
28
after arrival to EC how long does care team have to get CT scan
20 min
29
how long does care team have to interpret CT results once arrival to EC
45 min from the time of arrival (25 min after CT scan done)
30
if a patient is eligible for tPA and arrived to the EC at 0800, what is the latest time tPA can be given according to standard protocol?
0845
31
what is the timeframe for the administration of tPA from the last known well time (LKWT)?
3 hours
32
if the patients LKWT was 0700 and the patient arrived at the EC at 1030. can the nurse still give tPA?
only by physican orders tPA 3 hr window can be extended by MD especially if pt is younger and healthier
33
what is the maximum amount of time that an MD can decide to perform a thrombectomy
24 hours it is usually between 4.5-24 hrs
34
what screening tool is normally used for stroke patients?
NIH stroke scale
35
what is the criteria for extended tPA window?
< 80 years old - no hx of previous stroke in combo with diabetes - NIH stroke scale score < 25 - no oral anticoags were being taken at time of stroke
36
true or false: a CT scan can diagnose ischemic stroke?
False- ischemic strokes do not show up on CT scans and take up to 24 hrs to bloom
37
if CT scan can not dx an ischemic stroke, why is it still done?
it is used to rule out hemorrhagic stroke because hemorrhagic strokes will show up on CT
38
what immediate medical interventions need to be done in the acute phase of stroke?
- prompt dx & tx - NIH stroke scale - thrombolytic therapy - elevate HOB unless contraindicated - maintain airway & ventilation - continuous hemodynamic monitoring & neurologic assessment
39
what is the criteria for tPA
- age > 18 - dx of ischemic stroke - SBP /= 100,000 - no symptoms of infective endocarditis - no prior intracranial hemorrhage - no subarachnoid hemorrhage - no stroke, intra cranial surgery, or serious head trauma w/in 3 months - no GI bleed w/in 21 days or GI malignancy
40
what is the tPA dosage protocol
- 0.9 mg/kg - 90 mg is MAX! - 10% given as bolus over 1 min - 90% given IV infusion over 1 hr
41
True or False: the nurse is administering tPA through a patient's IV. The nurse can give other medications through the same IV
False- one dedicated line for tPA!!!
42
what is a carotid endarterectomy
plaque is removed from the carotid artery to reduce risk of TIA or stroke - removes innermost layer of artery as well
43
who is eligible for carotid endarterectomy
TIA patients and those w/ mild stroke for secondary prevention - 70-99% stenosis of carotid artery (definite) - 50-69% (usually)
44
what should the nurse assess during the acute phase of ischemic stroke
- Ongoing, frequent monitoring of all systems, including vital signs and neurologic assessment -LOC - Motor symptoms - Speech - Pupil changes - I & O - Maintain BP - Bleeding - Oxygen saturation
45
what are the 2 most important assessments during the first 24 hrs of ischemic stroke?
bleeding & BP!
46
Assessment of the nurse after the acute phase of stroke and into recovery phase
- mental status - Sensation/perception - Motor control - Swallowing ability - Nutritional and hydration status - Skin integrity - Activity tolerance - Bowel and bladder function
47
After a stroke, how long does pt need to remain NPO after ischemic stroke?
until gag/swallow reflex returns
48
problems assoicated with ischemic stroke recovery
- Decreased cerebral blood flow - Inadequate oxygen delivery to brain - Pneumonia
49
nursing interventions for pts recovering from ischemic stroke (#1)
- Improving mobility and preventing joint deformities - Prevent shoulder abduction - Position the hands and fingers - Change positions—every 2 hours - Establish an exercise program - Passive or active ROM four- or five-times/day - Prepare for ambulation - Assist patient out of bed as soon as possible - Preventing shoulder pain- associated with shoulder subluxation and motor weakness of the rotator cuff muscles
50
nursing interventions for pts recovering from ischemic stroke (#2)
- Enhancing self-care - Use of assistive devices and modification of clothing - Adjusting to physical changes - Assisting with nutrition - Consult with speech therapy or nutritional services - Have patient sit upright, preferably out of bed, to eat - Chin tuck for swallowing method (prevent aspiration) - Use of thickened liquids or pureed diet
51
nursing interventions for pts recovering from ischemic stroke (#3)
- Attaining bowel and bladder control - Assessment of voiding and scheduled voiding - Measures to prevent constipation: fiber, fluid, toileting schedule - Improving thought processes - Strategies to enhance communication - Maintaining skin integrity - Improving family coping - Coping with sexual dysfunction - Monitoring and managing potential complications
52
what is hemorrhagic stroke
bleeding into brain tissue, subarachnoid space, or ventricles
53
causes of hemorrhagic stroke
- spontaneous rupture of small vessels primarily related to hypertension; - subarachnoid hemorrhage caused by a ruptured aneurysm; - or intracerebral hemorrhage related to amyloid angiopathy, arteriovenous malformations (AVMs) (congenital anomalies), intracranial aneurysms, or medications such as anticoagulants
54
what happens to the brain during hemorrhagic stroke
- Brain metabolism is disrupted by exposure to blood - ICP increases, caused by blood in the subarachnoid space - Compression or secondary ischemia from reduced perfusion and vasoconstriction causes injury to brain tissue
55
manifestations of hemorrhagic stroke
Similar to ischemic stroke Severe headache Early and sudden changes in LOC Vomiting Bleeding Sudden Death
56
medical management of hemorrhagic stroke
- Diagnosis: CT scan, cerebral angiography, lumbar puncture if CT is negative and ICP is not elevated to confirm subarachnoid hemorrhage - Care is primarily supportive . - Bed rest with sedation. - Oxygen - Treatment of vasospasm, increased ICP, hypertension, potential seizures (need prophylaxis), and prevention of further bleeding
57
complications associated with hemorrhagic stroke
Vasospasm Seizures Hydrocephalus Rebleeding Hyponatremia
58
what causes hyponatremia in pts after hemorrhagic stroke?
SIADH-- worst outcome
59
Assessment findings in pts with hemorrhagic stroke
Complete and ongoing neurologic assessment; use neurologic flow chart Altered LOC Sluggish pupillary reaction Motor and sensory dysfunction Cranial nerve deficits Speech difficulties and visual disturbances Headache and nuchal rigidity. Other neurologic deficits
60
which one has higher risk of complications and mortality, hemorrhagic or ischemic stroke?
hemorrhagic
61
goals for pts with hemorrhagic strokes
Improved cerebral tissue perfusion Relief of anxiety The absence of complications
62
how can the nurse optimize cerebral perfusion and implement aneurysm precautions after hemorrhagic strokes?
- Provide a nonstimulating environment, prevent increases in ICP, prevent further bleeding - Absolute bed rest with HOB 30 degrees - Avoid all activity that may increase ICP or BP; such Valsalva maneuver, acute flexion or rotation of neck or head - Stool softener and mild laxatives - Nonstimulating, nonstressful environment; dim lighting, no reading, no TV, no radio - visitors are restricted
63
what are important precautions and patient education after hemorrhagic stroke
- Relieving anxiety - Keep sensory stimulation to a minimum for aneurysm precautions - Reality orientation - Monitoring and managing potential complications - seizure precautions - Patient and family education - strategies to regain and promote self-care and rehabilitation
64
home care and pt educations during stroke recovery
- Prevention of subsequent strokes, health promotion, and follow-up care - Prevention of and signs and symptoms of complications - Medication education - safety measures - Adaptive strategies and use of assistive devices for ADLs - Nutrition: diet, swallowing techniques, tube feeding administration - Elimination: bowel and bladder programs, catheter use - Exercise and activities, recreation and diversion - Socialization, support groups, and community resources

Med II (4 decks)

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