CVA Flashcards
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
B) The patient’s usual blood pressure (BP) is 170/94 mm Hg.
Stroke aka
CVA/Cerebrovascular Accident/ Brain attack
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) Computed tomography (CT) scan
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
B) Explain that the aspirin is ordered to decrease the risk of stroke.
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) risk for aspiration related to inability to protect airway
What are the 2 different types of strokes?
Ischemia (inadequate blood flow to the brain)
Hemorrhage (bleed in brain)
What is the acronym for remembering strokes?
FAST
face
arms
speech
tongue/time
Stroke is a medical
emergency
When someone is having a stroke, always
Call 911 (so pt can get through faster and directly to CT scans)
Immediate tx decreases neurologic deficit and lowers permanent damage
Stroke results in
brain cell death
Most effective way to decrease burden of stroke is
prevention and teaching
reduce morbidity and mortality
Non-modifiable Risk Factors
age (2x each decade after 55)
gender (more common in men, more women die)
AA and ???????
Hereditary 1st degree
Stroke is more common in what gender?
men
but women die more form them
What is the single most common preventative modifiable risk factor?
HTN
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
d) 62 y/o AA male with HTN who is 25 lbs. overweight***
Modifiable Risk Factors for CVA
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
TIA means
Transient Ischemic Attack
Ischemic Types of CVA
THROMBOTIC
EMBOLIC
Hemorrhagic Types of CVA
Intracerebral
Subarachnoid
TIA
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
Pathophysiology of Stroke
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
TIA tx medication
aspirin XL
-GI upset a/e
Ischemic Stroke
inadequate blood flow to the brain from partial or complete occlusion of an artery
(Thrombotic or Embolic)
Ischemic: Thrombotic Stroke
- **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
The extent of the stroke depends on the
onset
Size of damaged area
presence of lateral circulation
What is the most common cause of thrombotic strokes? (60%)
DM and HTN
preceded by a TIA
Ischemic: Embolic Stroke
Embolus dislodges & occludes a cerebral artery resulting in infarction & edema
Embolic stroke originates mostly in
endocardial layer of the heart
Embolic strokes have a hx of
a-fib
valve replacements
MI
atrial septal defects
least common in long bone fx
Embolic stroke pts need a
anticoagulant
(stroke occurs due to stopping for a surgery)
Embolic pts
sudden onset
conscious
c/o HA
symptoms could be tied to the clot breaking up and flowing through
Is the recurrence of thrombotic and embolic stroke common?
yes, unless the underlying cause is tx
Embolic stroke prognosis
is related to how much brain tissue is deprived of O2
Hemorrhagic Stroke
caused by bleeding into the brain tissue, ventricles or subarachnoid space
Hemorrhagic stroke pts have what type of recovery
severe and long
deficits
Hemorrhagic stroke causes
HTN
aneurysm (artery wall weakens and ruptures)
intracranial neoplasm (abnormal growth)
Arterial venous malformation
occur during activity
In hemorrhagic stroke, 50% of death occurs within
48 hours
poor prognosis
Intracranial Hemorrhage
bleeding within the brain caused by rupture of a vessel (vasoganglia)
-sudden onset within 48 hours
- progresses minutes to hours with ongoing bleeding
Intracranial hemorrhage prognosis
poor with a 30-day mortality of 40-80%
Intracranial Hemorrhage S/S
decrease of LOC
HA
N/V
HTN
varies depending on amount, local, and duration
Most common cause of Intracranial hemorrhage
HTN
during activity
Subarachnoid Hemorrhage
Intracranial bleeding into cerebrospinal fluid-filled space between arachnoid and pia mater
Subarachnoid Hemorrhage is caused commonly by
cerebral aneurysm rupture
- Circle of Willis
increase risk with age and higher in women
Which stroke is known as the silent killer?
SAH
S/S of Subarachnoid Hemorrhage
N/V
seizures
stiff neck
Complications for Hemorrhagic Stroke
neuro and systemic
Cerebral Vasospasm - narrow of blood vessels
Hyponatremia
MI
Infarction
ARDS
Cerebral Vasospasm needs administration of
Nimodipine
Ca Channel Blocker
S/S of Stroke = motor function
Hemiplegia
Hemiparesis
Ataxia
elimination urinary and bowel problems
Hemiplegia
paralysis in one side of the body
Hemiparesis
partial weakness in one side of the body
Ataxia
lack control of voluntary movements
S/S of Stroke = communication
Dysarthria
Dysphasia
Aphasia
Dysarthria
difficulty articulating
Dysphasia
difficulty speaking
Aphasia
expressive (unable to) and receptive (unable to receive the language), global, dysphagia (aspiration possible)
If the pt has a stroke on the left side of their brain, what side of the body?
right side hemiplegia
S/S of Stroke = cognitive impairment
memory loss
low attention span
poor reasoning
altered judgement
S/S of Stroke = psychological
loss of self-control
depression
emotional lability
Emotional lability
Unable to control feelings
Laugh at funerals and cry at wedding
Speech Pathologist is the first to be called to help with pts after
stroke
due to motor deficits communication and eating
Spatial-Perceptual Alterations
Homonymous hemianopsia
Loss of peripheral vison -severity
Agnosia
Apraxia
Homonymous hemianopsia
blind in one side of the body
Agnosia
inability to recognize and object by sight, touch
Apraxia
– inability to learn abilities on command
What dx tests are done for strokes
CT - confirm
MRI
- size and location, differentiate between ischemic and hemorrhagic
EEG
After a CT scan, why does a pt need to go for an MRI?
determine where the bleeding is
Management for Ischemic Stroke
Thrombolytic Therapy within 3 hours of S/S
- TPA
How do you determine the time of onset of a stroke?
when they were last seen normal
FAST
TPA (Tissue Plasminogen Activator) is used for what types of strokes?
Ischemic
TPA (Tissue Plasminogen Activator)
Breaks up clots
blood test coagulation
no contrast CT
TPA contraindications
recent GI bleed in the past 3 months
Mjr surgery in last 14 days
recent stroke
head trauma within last 3 months
The single most important point of pt’s hx is the _______ of stoke onset s/s
Time
TPA is given through
IV with 3-4 hours of s/s
What should the nurse do to the pt who is going to receive TPA?
Platelet count
prep pt
2 Large bore IVs 18 g
Safety fall bundle
bed alarm
Foley
Post-TPA monitor
BP critical for 24 hours
transfer to ICU then neuro floor
Management of stroke surgeries
Carotid endarterectomy
Carotid stenting
Aneurysm clipping, coiling
Resection of arteriovenous malformation (AVM)
Carotid Endarterectomy
prevent impending cerebral infarction
The plaque is removed and stitched closed
Stenting
opens up the artery and is permanently placed to hold the artery open and improve the flow of the blood
Coiling
coil placed in an aneurysm
prevent blood circulating back into and reduce the risk of rupture
Preventative Care of Stroke
healthy lifestyle
management risk factors with
diet, weight control, exercise, take meds
BP management
Prevention drug therapy for stroke
Warfarin for a-fib
Aspirin as anticoagulant = 1st
statins - cholesterol
Antihypertensives
Nursing Interventions and MonitoringAcute for CVA
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
Acute nursing Interventions regarding pt and family needs
clear an understandable explanations
Goals of pt and family after CVA
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
How to help a pt achieve self-care
personal hygiene
start with affected side when dressing
morale
clothing larger than normal
Attain Bladder control
retraining
avoid distension
schedule
avoid indwelling catheter
upright posture and standing position
Achieve Communication after CVA
speech therapist
Treat like an adult
moral support
consistent schedule, routines, and repetition
speak slowly and attention
In stroke what is the order of importance?
Circulation (perfusion and intracranial capacity)
Airway (aspiration, swallowing)
Breathing (mobility, communication)
low self-esteem
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
d) Teach the pt that emotional outbursts are common after a stroke
-Emotional lability
