CVA Flashcards
What is a CVA caused by?
disruption of normal blood supply to brain
what is a stroke also known as?
Brain attack
CVA
fill in the blank:
brain cannot store ______ or _______ and needs constant ____ ____ to supply
oxygen
glucose
blood flow
stroke is the _____ leading cause of death in the US.
3rd, after heart disease and cancer
what are the two major categories of stroke?
Ischemic
Hemorrhagic
what is an ischemic stroke?
a blockage
what is a hemorrhagic stroke ?
a bleed
what type of stroke is most common?
ischemic, it is a blockage caused by risk factors; making it the most common- diabetics, and those with plaque buildup are at higher risk
an ischemic stroke is a ______ ____ of function resulting from __________ __ _____ __ ____ __ _____.
sudden loss of function resulting from disruption of blood supply to part of brain
why do they sometimes call a stroke a brain attack?
to emphasize the urgency, similar to a heart attack
what is the method of early tx for a ischemic stroke?
thrombolytics: TPA
what is the window of treatment for a stroke?
3 hours from onset of symptoms
how do we determine when the stroke began?
form the time of last known well, the last time they felt normal
what is the patho of an ischemic stroke?
decreased cerebral blood flow results in anaerobic activity- then acidosis, then cell death
how might an area of low blood flow be salvaged before becoming ischemic?
with timely intervention and the breaking up of the clot
continued loss of cell function is caused by what?
destruction of cell membrane
vasoconstriction (decreased blood flow)
T/F
Deficits from a stroke will resolve over time?
FALSE
once tissue is damaged, there is no going back
deficit is permanent
what does TPA stand for?
tissue plasminogen activator
what is the goal of treatment of a stroke?
block the extent of secondary brain injury caused by initial stroke
what is TPA given for?
to break up the clot
what are some contraindications for use of TPA?
use of anticoagulants within the last 24 hours
brain bleed
recent trauma
recent surgery
what do clinical manifestation depend on?
location of lesion
which vessels are obstructed
size of area of obstruction
amount of collateral blood flow
what population has less collateral?
diabetics
high cholesterol
elderly
manifestations from a stroke?
motor loss communication loss perceptual disturbances sensory loss cognitive impairment psych effects
what is a TIA?
transient ischemic attack
what does a TIA mimic?
a stroke
has all the same s/s without evidence on imaging
what Can a TIA be a precursor to?
may be a warning sign of a stroke
what type of diagnostics to dx a stroke?
CT w/o contrast
CTA
MRI
what are some non modiafable risk factors of a stroke?
older than 35
male
african american
what are some modifiable risk factors of stroke?
HTN Afib Hyperlipidemia smoking alcohol use DM Diet and exercise treat circulation problems TIA's periodontal disease
secondary prevention of a stroke?
anticoagulation with Afib platelet inhibiting meds statins antiHTN meds carotid endarterectomy
management of stroke?
TPA
dx and initiation of tx within 3 hours of stroke increases outcome
how does TPA work?
binds fibrin and converts plasminogen to plasmin stimulating fibrinolysis
contraindications of TPA?
onset > 3hours ago
patient anti coagulated
INR (>1.7)
endovascular treatment?
intra-arterial thrombolysis
mechanical clot extraction
cerebral angiography
what is the risk with mechanical extraction?
high risk of breaking up the clot and causing a PE or DVT
what is the acute phase after a stroke?
1-3 days
what occurs in the acute phase of a stroke?
change in LOC vitals tone/posture eye opening pupils skin temp/color/moisture I and O kidney perfusion Bleeding dysphagia
what is the focus of care following the acute phase?
identifying impairment and of function and rehab
what is the NIH?
a method of evaluating severity of the stroke and deficits
who can do an NIH?
a NIH certified nurse
what is a hemorrhagic stroke?
bleeding into brain tissue, ventricles, and subarachnoid space
is a hemorrhagic or ischemic stroke worse?
hemorrhagic
what percent of strokes are hemorrhagic?
15-20% of them are primarily intracranial or subarachnoid bleeds
80% related to primary intracerebral hemorrhage from spontaneous rupture of small vessels
how do patients recover from hemorrhagic stroke?
patients who survive acute phase usually have more severe deficit and longer recovery
what is the chief cause of hemorrhagic strokes?
uncontrolled hypertension
what is a cause of a subarachnoid hemorrhagic stroke?
ruptured intracranial aneurysm 50% of the time
what is the most common area to have a leaky aneurysm?
the circle of willis
how do hemmorhagic strokes manifest?
migraines motor, sensory, cranial, and cognitive deficits vomiting Change in LOC focal seizures
how do rupruted aneurysms manifest?
sudden onset of headache loss of consciousness pain and rigidity of neck and spine from meningeal irritation visual changes tinnitus, dizziness, hemiparesis coma and death
what Increases the risk of death with hemorrhagic stroke?
age, DM, HTN, extent and location of hemorrhage or aneurysm
how to diagnose hemorrhagic stroke?
CT, MRI
angiography confirms aneurysm
how can we prevent strokes?
screening for high risk people
management of HTN
alcohol is a blood thinner
what are some complications of a stroke?
cerebral hypoxia
increased ICP
vasospasm
worsening HA, Change in LOC, neuromuscular deficit
nursing management after a stroke?
- Monitor vitals
- neuro checks
- LOC
- pupillary function
- motor function hourly
- Trends, NIH
