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Critical Care Nursing Exam 4 > CVA > Flashcards

CVA Flashcards

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1
Q

What is a CVA caused by?

A

disruption of normal blood supply to brain

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2
Q

what is a stroke also known as?

A

Brain attack

CVA

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3
Q

fill in the blank:

brain cannot store ______ or _______ and needs constant ____ ____ to supply

A

oxygen
glucose
blood flow

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4
Q

stroke is the _____ leading cause of death in the US.

A

3rd, after heart disease and cancer

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5
Q

what are the two major categories of stroke?

A

Ischemic

Hemorrhagic

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6
Q

what is an ischemic stroke?

A

a blockage

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7
Q

what is a hemorrhagic stroke ?

A

a bleed

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8
Q

what type of stroke is most common?

A

ischemic, it is a blockage caused by risk factors; making it the most common- diabetics, and those with plaque buildup are at higher risk

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9
Q

an ischemic stroke is a ______ ____ of function resulting from __________ __ _____ __ ____ __ _____.

A

sudden loss of function resulting from disruption of blood supply to part of brain

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10
Q

why do they sometimes call a stroke a brain attack?

A

to emphasize the urgency, similar to a heart attack

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11
Q

what is the method of early tx for a ischemic stroke?

A

thrombolytics: TPA

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12
Q

what is the window of treatment for a stroke?

A

3 hours from onset of symptoms

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13
Q

how do we determine when the stroke began?

A

form the time of last known well, the last time they felt normal

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14
Q

what is the patho of an ischemic stroke?

A

decreased cerebral blood flow results in anaerobic activity- then acidosis, then cell death

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15
Q

how might an area of low blood flow be salvaged before becoming ischemic?

A

with timely intervention and the breaking up of the clot

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16
Q

continued loss of cell function is caused by what?

A

destruction of cell membrane

vasoconstriction (decreased blood flow)

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17
Q

T/F

Deficits from a stroke will resolve over time?

A

FALSE
once tissue is damaged, there is no going back
deficit is permanent

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18
Q

what does TPA stand for?

A

tissue plasminogen activator

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19
Q

what is the goal of treatment of a stroke?

A

block the extent of secondary brain injury caused by initial stroke

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20
Q

what is TPA given for?

A

to break up the clot

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21
Q

what are some contraindications for use of TPA?

A

use of anticoagulants within the last 24 hours
brain bleed
recent trauma
recent surgery

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22
Q

what do clinical manifestation depend on?

A

location of lesion
which vessels are obstructed
size of area of obstruction
amount of collateral blood flow

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23
Q

what population has less collateral?

A

diabetics
high cholesterol
elderly

24
Q

manifestations from a stroke?

A 
motor loss
communication loss
perceptual disturbances
sensory loss
cognitive impairment 
psych effects
25
Q

what is a TIA?

A

transient ischemic attack

26
Q

what does a TIA mimic?

A

a stroke

has all the same s/s without evidence on imaging

27
Q

what Can a TIA be a precursor to?

A

may be a warning sign of a stroke

28
Q

what type of diagnostics to dx a stroke?

A

CT w/o contrast
CTA
MRI

29
Q

what are some non modiafable risk factors of a stroke?

A

older than 35
male
african american

30
Q

what are some modifiable risk factors of stroke?

A 
HTN
Afib
Hyperlipidemia
smoking
alcohol use
DM
Diet and exercise
treat circulation problems
TIA's
periodontal disease
31
Q

secondary prevention of a stroke?

A 
anticoagulation with Afib
platelet inhibiting meds
statins
antiHTN meds
carotid endarterectomy
32
Q

management of stroke?

A

TPA

dx and initiation of tx within 3 hours of stroke increases outcome

33
Q

how does TPA work?

A

binds fibrin and converts plasminogen to plasmin stimulating fibrinolysis

34
Q

contraindications of TPA?

A

onset > 3hours ago
patient anti coagulated
INR (>1.7)

35
Q

endovascular treatment?

A

intra-arterial thrombolysis
mechanical clot extraction
cerebral angiography

36
Q

what is the risk with mechanical extraction?

A

high risk of breaking up the clot and causing a PE or DVT

37
Q

what is the acute phase after a stroke?

A

1-3 days

38
Q

what occurs in the acute phase of a stroke?

A 
change in LOC
vitals
tone/posture
eye opening 
pupils
skin temp/color/moisture
I and O
kidney perfusion 
Bleeding 
dysphagia
39
Q

what is the focus of care following the acute phase?

A

identifying impairment and of function and rehab

40
Q

what is the NIH?

A

a method of evaluating severity of the stroke and deficits

41
Q

who can do an NIH?

A

a NIH certified nurse

42
Q

what is a hemorrhagic stroke?

A

bleeding into brain tissue, ventricles, and subarachnoid space

43
Q

is a hemorrhagic or ischemic stroke worse?

A

hemorrhagic

44
Q

what percent of strokes are hemorrhagic?

A

15-20% of them are primarily intracranial or subarachnoid bleeds
80% related to primary intracerebral hemorrhage from spontaneous rupture of small vessels

45
Q

how do patients recover from hemorrhagic stroke?

A

patients who survive acute phase usually have more severe deficit and longer recovery

46
Q

what is the chief cause of hemorrhagic strokes?

A

uncontrolled hypertension

47
Q

what is a cause of a subarachnoid hemorrhagic stroke?

A

ruptured intracranial aneurysm 50% of the time

48
Q

what is the most common area to have a leaky aneurysm?

A

the circle of willis

49
Q

how do hemmorhagic strokes manifest?

A 
migraines
motor, sensory, cranial, and cognitive deficits
vomiting
Change in LOC
focal seizures
50
Q

how do rupruted aneurysms manifest?

A 
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
51
Q

what Increases the risk of death with hemorrhagic stroke?

A

age, DM, HTN, extent and location of hemorrhage or aneurysm

52
Q

how to diagnose hemorrhagic stroke?

A

CT, MRI

angiography confirms aneurysm

53
Q

how can we prevent strokes?

A

screening for high risk people
management of HTN
alcohol is a blood thinner

54
Q

what are some complications of a stroke?

A

cerebral hypoxia
increased ICP
vasospasm
worsening HA, Change in LOC, neuromuscular deficit

55
Q

nursing management after a stroke?

A
  • Monitor vitals
  • neuro checks
  • LOC
  • pupillary function
  • motor function hourly
  • Trends, NIH

Critical Care Nursing Exam 4 (4 decks)

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