Complications Flashcards
Neurological deterioration after a stroke can be caused by
Stroke enlargement Drop in perfusion pressure Recurrent stroke Cerebral edema and mass effect Hemorrhagic transformation Metabolic disturbance (decreased O2, decreased CO, increased glucose, decreased sodium, fever, sedatives) SZ - post ictal Symptom fluctuation Decreases cooperation
To decrease the chance of neurological deterioration in ischemic stroke what should the MAP be maintained at?
130 in hypertensive pts
110 innormotensive pts
How long should the MAP be kept at 110/130?
24 hrs
What should the HOB be kept at for ischemic strokes and why
Flat or 15 degrees.
To encourage collateral perfusion
What should cerebral perfussion for post stoke care?
> 60
What is the dose of mannatol for osmotherapy in AIS
.5-1 g/kg over 30-60 min
Then .25 g/kg every 6 hrs
To maintain serum osmolality 315mosm.
List the criteria for hemicraniectomy
- 5 hrs from onset of a > 50% MCA territory hypodense
- 48 hrs from onset , complete MCA territory hypodense
- 7.5 mm midline shift
- > 4 mm midline shift with lethargy
- Age< 60
- 145 ml infarct volume on MRI
How frequent are sz assiciated with strokes?
20% and occur more frequently in hemorrhagic
When would you expect a sz post stroke?
Within 24 hrs
Which meds should be given to control sz?
Fosphenytoin
Lamotrigine
Gabapentin
Levetiracetam (keppra)
Which type of stroke is deterioration seen most often and how far out?
Subcortical strokes, usually in the first 3 days but up to 2 weeks
For confused or uncoorperative stoke pts which class of drugs should be used to to help and avoid sedation
Low doses of antipsychotics
Haldol .5-2mg P.O. or IV
Risperidone 1 mg PO
Quetiapine 25 mg PO
What nursing care should be implemented in the confused or agitated patient before meds?
Reorientation
Quiet environment
