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Critical Care > CVA > Flashcards

CVA Flashcards

1
Q

CVA: S/Sx

A
  • numbness/weakness face, arm, leg
  • confusion
  • dysphasia
  • visual disturbance in one or both eyes
  • ataxia
  • dizziness
  • severe headache

Face drooping
Arm weakness
Speech Difficulty
Time

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2
Q

Possible Hidden Causes of CVA

A
  • a-fib
  • heart structure problem
  • heart atherosclerosis
  • blood clotting disorders
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3
Q

Hemiplegia

A

paralysis of one side of the body

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4
Q

Hemiparesis

A

weakness of one side of the body

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5
Q

Dysphasia

A

speech disorders in which there was impairment of the power of expression by speech, writing, or signs or impairment of the power of comprehension of spoken or written language

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6
Q

Dysphagia

A

difficulty swallowing

impairment of cranial nerves 9 and 10

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7
Q

Expressive Aphasia (Broca’s area)

A

can understand
can’t speak or write

impairment of motor speech center in frontal lobe

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8
Q

Receptive Aphasia (Wernicke’s area)

A

can’t understand or follow commands

impairment of auditory association area in temporal lobe

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9
Q

Types of Strokes

A

thrombotic stroke: from plaque

embolic stroke: from embolus (blood clot, fat, air)

hemorrhagic stoke: burst blood vessel (usually aneurysm)

  • intracerebral hemorrhage: bleeding w/in the brain
  • subarachnoid hemorrhage: bleeding into the CSF-filled space between the arachnoid and the pia mater membranes on the surface of the brain
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10
Q

Penumbra

A

the area surrounding an ischemic event such as thrombotic or embolic stoke

salvageable brain area

immediately following the event, blood flow and therefore O2 is reduced locally > hypoxia of the cell near the location of the original insult

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11
Q

CVA: Risk Factors

A
  • female = more deaths
  • male = more likely to have 2nd CVA in 5 years
  • african americans = 2x risk and mortality
  • > 50YO
  • women taking birth control pills
  • young black w/ sickle cell disease
  • diabetics w/ carotid artery disease
  • hx of heart disease
  • hx of HTN
  • high cholesterol
  • obesity
  • smoking
  • sedentary lifestyle
  • heredity
  • alcohol
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12
Q

Developmental Processes of Ischemic/Embolic Strokes

A
  • TIA
  • RIND (reversible ischemic neuro deficit)
  • Stroke in evolution: recognized stroke and comes to hospital, can be treated
  • Completed Stroke: stroke in sleep or unrecognized, doesn’t get tx until much later

*TIA and RIND are reversible on their own

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13
Q

TIA

A
  • more likely to have CVA after TIA (like a warning sign)
  • last seconds to 12 hours w/o residual effect (avg = 10-20 minutes and resolve in 1 hr)
  • signifies advanced atherosclerosis

-will do carotid u/s in to r/o clots and plaques, if there is significant blockage > carotid endarterectomy to prevent future stroke

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14
Q

TIA and Cerebral Edema

A

cerebral edema peaks in 72 hours and remains for 2 weeks

need CT scan to look for further bleeding and cerebral edema

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15
Q

RIND

A

reversible ischemic neurological deficit

small stroke

reversible by itself in 48hrs to 3wks

may have multiple over years in the same are of the brain

usually d/t to carotid artery stenosis

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16
Q

Stroke in Evolution

A

progressive stroke

deficit occurs in steps

some over 24 hours, other 72 hours

17
Q

Completed Stroke

A

stable deficits w/in 1 hour

can have secondary injury up to 72 hours as a result of stroke (do NIH stroke scale and CT scan to monitor for changes)

approximately 60% occur during sleep

18
Q

Collaborative Care of Stroke

A

involve radiology, PT, OT, Speech ASAP

19
Q

tPA Therapy

A

max time frame for use - 3 hours

dosage: 0.9mg/kg; max: 90mg

20
Q

tPA Therapy: Complications

A

intracerebral hemorrhage:

  • highest risk is w/in 24 after administration
  • control BP to prevent (keep systolic less than 185, keep diastolic less than 105)
21
Q

tPA Therapy: Exclusion Criteria

A
  • evidence of hemorrhage on CT scan
  • <18 YO
  • minor or rapidly improving stroke symptoms (this indicates TIA or RIND and tPA isn’t needed)
  • outside 3 hour time frame
  • active bleeding or hx of recent surgery (less than 8 weeks ago)
  • seizure activity w/ stroke symptoms
22
Q

Mechanical Revascularization

A

used when:

  • tPA therapy ineffective b/c the clot was a thrombosis (from plaque) not an embolus
  • client is not a candidate for tPA
23
Q

CVA and BP

A

maintain systolic BP at 150mm Hg to perfuse brain

24
Q

CVA and Hypervolemic/hemodilution w/ NS and albumin

A
  • maintain CPP
  • lowers blood viscosity
  • maintains slightly elevated BP
  • Hct decreases from 35-33 d/t dilution of hematocrit and it’s a false reading
  • vasodilates cerebral vessels = increased perfusion
  • works well for subarachnoid bleeds and vasospasm
  • not as well in ischemic/embolic strokes
25
Q

How do you minimize disuse syndrome?

A
  • minimize time on flaccid side
  • use affected hand to wrist; wrist to elbow
  • avoid excessive pull on affected shoulder (vulnerable to subluxation and adduction contractures)
  • prevent external rotation of hip
  • heels off mattress
  • AROM and PROM as much as possible
  • hi-top sneakers to prevent foot drop
  • resting splint (assess skin under splint regularly)
  • skin care - assess frequently (decrease skin pressure in chairs)
  • place things on affected side to force pt to use this side
  • use adaptive equipment to regain ADLs
  • early ambulation
26
Q

Dysphagia: Sx

A

facial droop
drooling
weak voice

27
Q

Dysphagia: Silent Aspiration

A

silent aspiration = aspirate w/o choking (no reflexes)

28
Q

Dysphagia: Standard of Care

A
  • speech therapist will do barium swallow test
  • evaluate swallowing before allowing PO fluids/food/meds
  • quiet environment for eating to concentrate on swallowing
  • HOB elevated
  • aspiration precautions
  • mouth care before meals (stimulate saliva flow)
  • position food in visual field (if necessary)
  • mechanical soft diet better than liquids (thickeners)
  • small bites (on unaffected side of mouth)
  • chew thoroughly
  • sweep mouth after each bite for “pockets”
  • mouth care after meals (clean out pockets w/ gauze)
  • accurate I&O until sufficient intake achieved
  • weekly weights to ensure nutritional status has not been impaired by stroke
29
Q

Cerebral Aneurysm - Subarachnoid Hemorrhage

A

dilation of wall of cerebral artery usually at arterial junction (berry aneurysm)

80% occur in circle of willis

aneurysm ruptures and bleeds into subarachnoid space

can be d/t trauma

sx occur when aneurysm enlarges and exerts pressure on brain, or when ruptures

30
Q

Predisposing Factors that Cause Rupture of Aneurysms

A
  • valsalva maneuver
  • sexual intercourse
  • physical exertion

*if rupture occurred during activity, pt may be reluctant to do that activity again

31
Q

Hemorrhagic Stroke: Sx

A

Prior to rupture:

  • severe HA
  • photophobia (look at shape of pupils, may be oval)
  • intermittent nausea

After rupture:

  • severe HA
  • unequal pupils
  • dysconjugate gaze
  • seizures
  • nuchal rigidity (b/c bleeding is going into CSF and causing rigidness and neck pain)
  • hemiparesis
  • loss of consciousness
  • increased ICP
32
Q

Hemorrhagic Stroke: Dx Tests

A
  • lumbar puncture (blood in CSF = hemorrhage in brain)
  • cerebral angiogram
  • CT scan
33
Q

Hemorrhagic Stroke: Tx

A

craniotomy to clip or coil aneurysm before rupture

meds:

  • osmotic diuretics (Mannitol): to help decrease ICP
  • anti-HTN

goal: prevent further increase in ICP and subsequent rupture

34
Q

Craniotomy: Post-op

A
  • immediate, strict bed rest
  • prevent valsalva maneuver
  • prevent anything that will increase ICP
  • check swallowing
  • HOB elevated
  • quiet, dim, non-stimulating environment
  • constant monitoring
  • keep BP lower (to prevent risk of re-bleed)
  • vasoactive meds: Ca channel blockers (vasodilators to ensure to perfusion to brain and help decrease vasospasms which will cause rebleeding)
  • frequent checks on pt
35
Q

Aneurysm: Complications

A

rebleed
hydrocephalus (which may require ventricular shunt)
vasospasm

Critical Care (14 decks)

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