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Module 4 (MedSurg 2) > CVA > Flashcards

CVA Flashcards

1
Q

Which stroke risk factor for a 48-yr-old male patient in the clinic is most important for the
nurse to address?
A) The patient works at a desk and relaxes by watching television
B) The patient’s usual blood pressure (BP) is 170/94 mm Hg.
C) The patient is 25 lbs above the ideal weight.
D) The patient drinks a glass of red wine with dinner daily

A

B) The patient’s usual blood pressure (BP) is 170/94 mm Hg.

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2
Q

Stroke aka

A

CVA/Cerebrovascular Accident/ Brain attack

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3
Q

A pt with L-sided weakness that started 60 mins ago is admitted to the ED & tests are ordered.
Which test is done 1st?

A) Computed tomography (CT) scan
B) Chest radiograph (chest x-ray)
C) Complete blood count (CBC)
D) 12-Lead electrocardiogra
(ECG)

A

A) Computed tomography (CT) scan

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4
Q

A pt with history of TIA states,”I don’t need the aspirin today, I don’t have fever”. Which action should the RN take?

A) Document that the aspirin was refused by the patient.
B) Explain that the aspirin is ordered to decrease the risk of stroke.
C) Tell the patient that the aspirin is used to prevent a fever.
D) Call the health care provider to clarify the medication

A

B) Explain that the aspirin is ordered to decrease the risk of stroke.

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5
Q

A pt w/ stroke has progressively increasing weakness and decreasing LOC. Which pt problem has the highest priority?

A) risk for aspiration related to inability to protect airway
B) Disturbed sensory perception related to brain injury
C) Risk for impaired skin integrity related to immobility
D) Impaired physical mobility related to weakness

A

A) risk for aspiration related to inability to protect airway

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6
Q

What are the 2 different types of strokes?

A

Ischemia (inadequate blood flow to the brain)
Hemorrhage (bleed in brain)

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7
Q

What is the acronym for remembering strokes?

A

FAST
face
arms
speech
tongue/time

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8
Q

Stroke is a medical

A

emergency

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9
Q

When someone is having a stroke, always

A

Call 911 (so pt can get through faster and directly to CT scans)
Immediate tx decreases neurologic deficit and lowers permanent damage

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10
Q

Stroke results in

A

brain cell death

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11
Q

Most effective way to decrease burden of stroke is

A

prevention and teaching
reduce morbidity and mortality

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12
Q

Non-modifiable Risk Factors

A

age (2x each decade after 55)
gender (more common in men, more women die)
AA and ???????
Hereditary 1st degree

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13
Q

Stroke is more common in what gender?

A

men
but women die more form them

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14
Q

What is the single most common preventative modifiable risk factor?

A

HTN

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15
Q

As one of your clinical assignments, you are assisting an RN with health screening at a health fair. Which individuals is at the greatest risk for experiencing a stroke?
a) 46 y/o white female with HTN and oral contraceptive use for 10 years
b) 58 y/o white male salesman who has a total cholesterol level of 285
c) 42 y/0 AA female with DM who has smoked for 30 years
d) 62 y/o AA male with HTN who is 25 lbs. overweight

A

d) 62 y/o AA male with HTN who is 25 lbs. overweight***

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16
Q

Modifiable Risk Factors for CVA

A

Hypertension***
Heart disease (Afib 25%) – need blood thinners
Diabetes 5x higher
Serum high cholesterol – blockage in arteries
Contraseptives
Smoking
Obesity
Sleep apnea – deprived from O2
Metabolic syndrome
Lack of physical exercise
Poor diet
Drug and alcohol abuse

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17
Q

TIA means

A

Transient Ischemic Attack

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18
Q

Ischemic Types of CVA

A

THROMBOTIC
EMBOLIC

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19
Q

Hemorrhagic Types of CVA

A

Intracerebral
Subarachnoid

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20
Q

TIA

A

WARNING SIGN of further cerebrovascular disease
- acute infarction of the brain with symptoms lasting
- no outcome prediction (1/3 another TIA, 1/3 progress to stroke

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21
Q

Pathophysiology of Stroke

A

Circle of Willis provides blood to the anterior and posterior brain through arteries
safety valve
Stroke occurs due to an artery block preventing O2 and nutrients

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22
Q

TIA tx medication

A

aspirin XL
-GI upset a/e

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23
Q

Ischemic Stroke

A

inadequate blood flow to the brain from partial or complete occlusion of an artery
(Thrombotic or Embolic)

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24
Q

Ischemic: Thrombotic Stroke

A
  • **plague build-up and a clot forms
    Results from thrombosis or narrowing of a blood vessel (blocking artery)
    Occurs from injury to a blood vessel wall and formation of a blood clot
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25
Q

The extent of the stroke depends on the

A

onset
Size of damaged area
presence of lateral circulation

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26
Q

What is the most common cause of thrombotic strokes? (60%)

A

DM and HTN
preceded by a TIA

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27
Q

Ischemic: Embolic Stroke

A

Embolus dislodges & occludes a cerebral artery resulting in infarction & edema

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28
Q

Embolic stroke originates mostly in

A

endocardial layer of the heart

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29
Q

Embolic strokes have a hx of

A

a-fib
valve replacements
MI
atrial septal defects
least common in long bone fx

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30
Q

Embolic stroke pts need a

A

anticoagulant
(stroke occurs due to stopping for a surgery)

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31
Q

Embolic pts

A

sudden onset
conscious
c/o HA
symptoms could be tied to the clot breaking up and flowing through

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32
Q

Is the recurrence of thrombotic and embolic stroke common?

A

yes, unless the underlying cause is tx

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33
Q

Embolic stroke prognosis

A

is related to how much brain tissue is deprived of O2

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34
Q

Hemorrhagic Stroke

A

caused by bleeding into the brain tissue, ventricles or subarachnoid space

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35
Q

Hemorrhagic stroke pts have what type of recovery

A

severe and long
deficits

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36
Q

Hemorrhagic stroke causes

A

HTN
aneurysm (artery wall weakens and ruptures)
intracranial neoplasm (abnormal growth)
Arterial venous malformation
occur during activity

37
Q

In hemorrhagic stroke, 50% of death occurs within

A

48 hours
poor prognosis

38
Q

Intracranial Hemorrhage

A

bleeding within the brain caused by rupture of a vessel (vasoganglia)
-sudden onset within 48 hours
- progresses minutes to hours with ongoing bleeding

39
Q

Intracranial hemorrhage prognosis

A

poor with a 30-day mortality of 40-80%

40
Q

Intracranial Hemorrhage S/S

A

decrease of LOC
HA
N/V
HTN
varies depending on amount, local, and duration

41
Q

Most common cause of Intracranial hemorrhage

A

HTN
during activity

42
Q

Subarachnoid Hemorrhage

A

Intracranial bleeding into cerebrospinal fluid-filled space between arachnoid and pia mater

43
Q

Subarachnoid Hemorrhage is caused commonly by

A

cerebral aneurysm rupture
- Circle of Willis
increase risk with age and higher in women

44
Q

Which stroke is known as the silent killer?

A

SAH

45
Q

S/S of Subarachnoid Hemorrhage

A

N/V
seizures
stiff neck

46
Q

Complications for Hemorrhagic Stroke

A

neuro and systemic
Cerebral Vasospasm - narrow of blood vessels
Hyponatremia
MI
Infarction
ARDS

47
Q

Cerebral Vasospasm needs administration of

A

Nimodipine
Ca Channel Blocker

48
Q

S/S of Stroke = motor function

A

Hemiplegia
Hemiparesis
Ataxia
elimination urinary and bowel problems

49
Q

Hemiplegia

A

paralysis in one side of the body

50
Q

Hemiparesis

A

partial weakness in one side of the body

51
Q

Ataxia

A

lack control of voluntary movements

52
Q

S/S of Stroke = communication

A

Dysarthria
Dysphasia
Aphasia

53
Q

Dysarthria

A

difficulty articulating

54
Q

Dysphasia

A

difficulty speaking

55
Q

Aphasia

A

expressive (unable to) and receptive (unable to receive the language), global, dysphagia (aspiration possible)

56
Q

If the pt has a stroke on the left side of their brain, what side of the body?

A

right side hemiplegia

57
Q

S/S of Stroke = cognitive impairment

A

memory loss
low attention span
poor reasoning
altered judgement

58
Q

S/S of Stroke = psychological

A

loss of self-control
depression
emotional lability

59
Q

Emotional lability

A

Unable to control feelings
Laugh at funerals and cry at wedding

60
Q

Speech Pathologist is the first to be called to help with pts after

A

stroke
due to motor deficits communication and eating

61
Q

Spatial-Perceptual Alterations

A

Homonymous hemianopsia
Loss of peripheral vison -severity
Agnosia
Apraxia

62
Q

Homonymous hemianopsia

A

blind in one side of the body

63
Q

Agnosia

A

inability to recognize and object by sight, touch

64
Q

Apraxia

A

– inability to learn abilities on command

65
Q

What dx tests are done for strokes

A

CT - confirm
MRI
- size and location, differentiate between ischemic and hemorrhagic
EEG

66
Q

After a CT scan, why does a pt need to go for an MRI?

A

determine where the bleeding is

67
Q

Management for Ischemic Stroke

A

Thrombolytic Therapy within 3 hours of S/S
- TPA

68
Q

How do you determine the time of onset of a stroke?

A

when they were last seen normal
FAST

69
Q

TPA (Tissue Plasminogen Activator) is used for what types of strokes?

A

Ischemic

70
Q

TPA (Tissue Plasminogen Activator)

A

Breaks up clots
blood test coagulation
no contrast CT

71
Q

TPA contraindications

A

recent GI bleed in the past 3 months
Mjr surgery in last 14 days
recent stroke
head trauma within last 3 months

72
Q

The single most important point of pt’s hx is the _______ of stoke onset s/s

A

Time

73
Q

TPA is given through

A

IV with 3-4 hours of s/s

74
Q

What should the nurse do to the pt who is going to receive TPA?

A

Platelet count
prep pt
2 Large bore IVs 18 g
Safety fall bundle
bed alarm
Foley

75
Q

Post-TPA monitor

A

BP critical for 24 hours
transfer to ICU then neuro floor

76
Q

Management of stroke surgeries

A

Carotid endarterectomy
Carotid stenting
Aneurysm clipping, coiling
Resection of arteriovenous malformation (AVM)

77
Q

Carotid Endarterectomy

A

prevent impending cerebral infarction
The plaque is removed and stitched closed

78
Q

Stenting

A

opens up the artery and is permanently placed to hold the artery open and improve the flow of the blood

79
Q

Coiling

A

coil placed in an aneurysm
prevent blood circulating back into and reduce the risk of rupture

80
Q

Preventative Care of Stroke

A

healthy lifestyle
management risk factors with
diet, weight control, exercise, take meds
BP management

81
Q

Prevention drug therapy for stroke

A

Warfarin for a-fib
Aspirin as anticoagulant = 1st
statins - cholesterol
Antihypertensives

82
Q

Nursing Interventions and MonitoringAcute for CVA

A

support respirations
neuro exams
cardio system
ROM passive
skin breakdown
constipation and promote normal bladder function (potty training getting up every 2 hours and after meals)
nutrition

83
Q

Acute nursing Interventions regarding pt and family needs

A

clear an understandable explanations

84
Q

Goals of pt and family after CVA

A

mobility improve
avoid shoulder pain
self-care
communication
restore functioning of family
skin integrity
autonomy through assistive devices
bladder control
thought process increases
Rehab common

85
Q

How to help a pt achieve self-care

A

personal hygiene
start with affected side when dressing
morale
clothing larger than normal

86
Q

Attain Bladder control

A

retraining
avoid distension
schedule
avoid indwelling catheter
upright posture and standing position

87
Q

Achieve Communication after CVA

A

speech therapist
Treat like an adult
moral support
consistent schedule, routines, and repetition
speak slowly and attention

88
Q

In stroke what is the order of importance?

A

Circulation (perfusion and intracranial capacity)
Airway (aspiration, swallowing)
Breathing (mobility, communication)
low self-esteem

89
Q

Pt with a left brain stroke suddenly burst into tears went his family walked in, What information is necessary for the family to know?
a) calm voice to tell them to stop the crying behavior
b) Explain to the family that depression is normal following a stroke
c) Have family members leave the pt alone for a few minutes
d) Teach the pt that emotional outbursts are common after a stroke

A

d) Teach the pt that emotional outbursts are common after a stroke
-Emotional lability

Module 4 (MedSurg 2) (36 decks)

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