CVA Flashcards
Two types of stroke
Ischemic and hemorrhagic
Risk factors of stroke
75-85, African Americans and Asians, carotid stenosis, cocaine use, OC + smoking, sickle cell disease, chronic migraines, cardiomyopathy, sleep apnea, lupus, RA
Ischemic stroke
vascular occlusion, caused by thrombus or embolus, also cocaine use and migraine
Thrombotic CVA
clot forms within the vessel, caused by carotid artery stenosis or atherosclerotic plaques
Embolic CVA
clot forms in a proximal site then travels to the brain, caused by afib, valvular heart disease, fat emboli from long bone fractures
CVA Symptoms
Numbness or weakness of face, arm, leg; confusion, alteration in mental status, trouble speaking or understanding speech, dysphagia, diplopia, loss of peripheral vision, homonymous hemianopia, sudden, severe headache, ataxia, cognitive impairment, emotional outbursts/ lability
Hemiplegia
1 sided paralysis
Hemiparesis
1 sided weakness
Dysphasia
impaired speech
Aphasia
inability to express self (expressive) or understand others (receptive)
homonymous hemianopia
loss of 1/2 of visual field
ataxia
unsteady gait, staggering gait, trouble walking, loss of balance or coordination, dizziness
Signs of a stroke
balance, eyes, face, arm, speech, time
Expressive Aphasia
left frontal lobe (Broca), short phrase speech, omit words, trouble finding the correct words, understand speech of others but cannot adequately express themselves, often aware of difficulties, can become frustrated
Receptive aphasia
left temporal lobe (Wernicke), difficulty understanding written and spoken language, difficulty following directions, unaware of speech issues
TIA
temporary neurlogic ischemia, symptoms last less than 60 mins, sudden loss of motor, sensory or visual function, brain imaging shows no ischemia (but not multiples), often serves as a warning sign of impending stroke (15%)
Diagnostic studies for Ischemic CVA
CT scan w/o IV contrast, 12 lead ekg, echo/ tee, carotid US, MRI/MRA, cerebral angiography, illicit drug use test
Ischemic CVA Prevention
no smoking, exercise (30-40 mins, 3-4x week), healthy weight, healthy, low fat diet, modest alcohol consumption, control BP, daily low dose aspirin (only for 1st)
General treatment of ischemic CVA
anticoagulants, antiplatelets, ace inhibitors, diuretics, statins
Immediate treatment for CVA
t-PA (or heparin/ enoxaparin)
Invasive treatment for ischemic CVA
mechanical embolectomy (Penumbra device, trevo, merci retriever), carotid endarterectomy
ischemic stroke nursing care
thorough neuro assessment… (Slide 26)
Hemorrhagic CVA
bleeding into brain tissue or subarachnoid space
Hemorrhagic CVA causes
cerebral aneurysm (dilation), AVM (tangling of the veins)
AVM
tangling of the arteries/veins, congenital, leads to dilation of cerebral a/v that rupture, most common cause of hcva in younger patients, most common cause is HTN
hCVA
similar to iCVA plus- n/v, possible seizure development, sudden change in consciousness or sudden loss, severe headache, nuchal rigidity, visual disturbances, tinnitus, dizziness, increased ICP, coma and/or death may occur
hCVA Diagnosis
CT scan, MRI, Cerebral angiography
hCVA treatment
number one goal is minimize and prevention
bleeding- bedrest, correct INR, DTI reversals
treat seizures, prevent DVTs, analgesics, control fever and BP
hCVA surgical management
Craniotomy, aneurysm clipping
hCVA endovascular treatment
coils- occludes blood flow to treat aneurysm, admin of thrombolytic
complications of hCVA
cerebral hypoxia, vasospasm, ICP, HTN (slides 35 and 36 for how to treat)
CVA nursing care
thorough and frequent neuro checks is key (slide 37)
Post stroke care
assistance with ADLs, adaptive devices, ST,PT,OT, swallowing eval, visual retraining, supportive services, home health care, family support
Pt with swallowing issues
upright position, no straws, dysphagia diet, ST and swallowing eval, thickened liquids
