class 13 stroke Flashcards
what is intracranial pressure (ICP)
the pressure exerted in the skull by the total volume from three components within the skulls
1.brain tissue
2.blood
3.cerebrospinal fluid (CSF)
normal ICP measurement
5-15 mmHg
increased ICP can cause:
-decreases in CSF
-cerebral edema
-brain shift
what is monro-kellie hypothesis
the body is able to balance ICP on it’s own by compensating for increases or decreases in the 3 components that make ICP
what is the glascow coma scale
assesses level of consciousness
-eye opening response
-verbal response
-motor response
increased ICP manifestations
-changes in LOC
-H/A
-N/V
-papilledema
-pupillary dysfunction
-dec GCS
-oculomotor/vision dysfunction
-motor impairment
-changes in speech
-seizures
-large gap between sys & dias (cushing’s triad)
-abnormal posturing (decerebrate/decorticate)
goals of care for increased ICP
-identify cause
-ABC’s
-peserve cerebral perfusion
-dec ICP
-prevention of complications
medications for increased ICP
-diuretics
-hypertonic saline
-corticosteroids
-H2 receptor antagonist/PPI
-anti-seizure
-antipyretics
-barbiturates
-stool softener
-sedation
nursing management for inc iCP
-neuro assessment
-maintain resp function
-fluid & lytes balance
-ICP monitoring
-body positioning (HOB 30)
-protection from injury
-VS monitoring
-GCS
-psychological considerations
what is a stroke
disruption of normal blood supply to the brain
types of stroke
ischemic (thrombolytic/embolic)
hemorrhagic
how long does blood flow in the brain have to be interrupted for complications to occur
-neurological metabolism altered in 30 sec
-metabolism stops after 2 mins
-cellular death occurs after 5 min
what is an ischemic stroke
occlusion of the cerebral artery by thrombus or embolus
50-60% are thrombotic 20-30% are embolic
what is a transcient ischemic attack
“mini strokes”
a temporary episode of neurological dysfunction without acute infarction of the brain
-s&s typically last <1h & depend on area of occlusion
-emergency, once it starts its impossible to know if its a TIA or true stroke
“angina of the brain”
signs and symptoms of TIA
-temporary loss of vision in 1 eye
-transient hemiparesis
-numbness or loss of sensation
-sudden inability to speak
-tinnitus
-vertigo
-darkened or blurred vision
-dysphagia
-diplopia
-ptosis
-dysarthria
-ataxia
what is a thrombotic ischemic stroke
-occurs when a blood clot forms in a diseased and narrowed blood vessel in the brain
-narrowed lumen of the blood vessel becomes occluded, and infarction occurs
-often associated with HTN or DM
what is an embolic ischemic stroke
-embolus lodges in and occludes a cerebral artery, resulting in infarction and edema of the area supplied by the involved
-embolus travels upward to the cerebral circulation and lodges where a vessel narrows or bifurcates
-onset of an embolic stroke is usually sudden
non-modifiable risk factors of stroke
-age
-gender
-race
modifiable risk factors for stroke
-HTN
-CV disease
-DM
-hyperlipidemia
-smoking
-oral contraceptives
-sedentary lifestyle
-substance abuse/ETOH
-hypercoagulation disorders
signs and symptoms of stroke
-numbness/weakness of the face/arm/leg
-confusion/changes in mental status
-trouble speaking
-visual disturbances
-difficulty walking, dizziness, loss of balance, or coordination
-sudden severe headache
what is a hemorrhagic stroke
-interruption vessel integrity
-intracerebral or subarchnoid hemorrhage
-brain etabolism is disrupted by exposure to blood
-ICP increases because of blood in the subarachnoid space
-rupture aneurysm or arteriovenous malformation
-cerebral aneurysms are viewed as a “silent killer”
clinical manifestations of hemorrhagic stroke
-sudden SEVERE headache
-quick change in LOC
-nausea,vomiting,seizures
-nuchual rigidity (stiff neck)
-motor, cognitive, visual, sensory, communication, emotional effects
motor deficits with hemorrhagic stroke
-hemiparesis
-hemiplegia
-ataxia
-apraxia
-dysarthria
-dysphagia
-hypo/hyper reflexia
-loss bowel/bladder
sensory deficits with hemorrhagic stroke
-paresthesia
-difficultly with proprioception
-unilateral neglect
-difficulty with spatial orientation
-agnosia (visual, auditory)
visual deficits with hemorhagic stroke
-hemianopia
-loss of peripheral vision
-dilopia
-pupillary abnormalities
-ptosis
communication deficits with hemorrhagic stroke
-aphasia
*global
*expressive (Broca’s)
*receptive (Wernicke’s)
-alexia
-agraphia
-dysarthria
-dysphagia
cognitive deficits with hemorrhagic stroke
-short/long term memory loss
-decreased attention span
-inability to concentrate
-altered judgement
-poor reasoning ability
emotional deficits with hemorrhagic stroke
-loss of self control (impulsive)
-labile emotions
-feeling of isolation
-depression
-hostility and anger
s&s of right sided brain damage
-paralyzed on left side
-left-sided neglect
-spatial perceptual deficits
-tends to deny or minimize problems
-rapid performance, short attention span
-impulsive, safety problems
-impaired judgment
-impaired time concepts
s&s left-sided brain damage
-paralyzed right side: hemiplegia
-impaired speech-language
-impaired right-left discrimination
-slow performance
-aware of deficits: depression, anxiety
-impaired comprehension related to language, math
diagnostic studies for stroke
-carotid angiography
-carotid duplex scanning
-cerebral angiography
-digital subtraction angiography
-transcranial doppler ultrasonography
cerebral blood flow studies
-cardiac markers (trop, CK-MB)
-chets radiograph
cardiac assessment studies
-echocardiography (transthoracic, transesophageal)
-electrocardiogram
medical management of TIA
-meds (AF, HTN, anticoag, antiplatelet)
-carotid endarterectomy (plaque removed)
medical management for stroke
-depends on type and extent
-thrombolytics
-management airway & HTN
-anticoags & antiplatelets
-anticonvulsants, stool softeners, analgesics, anxiolytics
nursing management for suspected stroke
-assess VS & N/S
-monitor for inc ICP
-elevate HOB 30, head midline, neutral posture
-avoid activities that inc ICP
-quiet dark environment
-GCS
surgical management for stroke
-endarterectomy
-extracranial-intracranial bypass
-AV malformation (embolize involved arteries)
-aneurysm (clipped or clamped, wrapped to reinforce, or coiling)
nursing management for stroke
passive ROM q2-3h affected extremities
-active ROM on unaffected side
-positioning/splinting to maintain alignment/prevent contracture
-monitor & prevent DVT
-approach from unaffected side
-prevent injury
-orientate to person, place, time
-prevent aspiration
-bladder and bowel training
