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Neuro Rehab 2 > CVA - 1b Dx, Clinical Presentation, Med Management > Flashcards

CVA - 1b Dx, Clinical Presentation, Med Management Flashcards

1
Q

why is a-fib a risk factor for strokes

A

inc risk of forming clots -> can dislodge and travel to brain -> ischemic stroke d/t embolic stroke

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2
Q

what are 5 predictors of strokes and what do they all have in common

A

afib
HTN
hyperlipidemia
DM
AVN

all vascular in nature

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3
Q

TIA vs CVA

A

TIA - temporary sx that will resolve w/i 24hrs
- “mini stroke”
- can be treated w dec likelihood of deficits

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4
Q

according to literature on health inequities, what has led to best outcomes s/p CVA

A

go somewhere w specialized stroke unit
- not always available

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5
Q

what are the 4 main characteristics of ischemic strokes that are different from hemorrhagic

A

more common
treated w tPa (clot busters)
clot - thrombus or embolus
dec O2 perfusion

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6
Q

describe the use of tPa in ischemic strokes

A

clot busters - break down the blood clot to help restore blood flow
- get w/i certain window of opportunity from onset of sx for optimal efficacy (w/i few hours)

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7
Q

what role does dec O2 perfusion play in ischemic strokes

A

can be secondary to or the cause of the stroke

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8
Q

what are 6 reasons for dec O2 perfusion that can lead to an ischemic stroke

A

low BP
pulm cause
MI
blood loss (abdominal surgery, trauma)
sickle cell anemia
vasospasms

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9
Q

what are vasospasms and when are they seen

A

blood vessels are spasming and constricting -> dec blood flow
- d/t raynauds, SAH

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10
Q

how can ischemic strokes transition to hemorrhagic strokes over time

A

similar path of swelling and edema
- > transition to hemorrhagic

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11
Q

what are the 2 types of hemorrhagic strokes

A

intracranial hemorrhage (ICH)
subarachnoid hemorrhage (SAH)

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12
Q

what are the 5 main characteristics of hemorrhagic strokes that are different from ischemic strokes

A

inc mortality rate
inc risk of midline shift
inc edema
inc risk of hydrocephalus
inc risk for brainstem herniation

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13
Q

why is there an inc mortality rate associated w hemorrhagic strokes

A

bleeding into brain -> inc fluid in brain -> inc fluid needs space -> pushes brain matter over -> midline shift d/t edema

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14
Q

why is there an inc risk of hydrocephalus associated w hemorrhagic strokes

A

inc fluid in ventricles bc of blood -> putting a lot of pressure on brain

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15
Q

what specific type of hemorrhagic stroke is hydrocephalus commonly seen in

A

SAH

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16
Q

how is hydrocephalus commonly treated

A

w EVD (extra-ventricular drain)
- tube placed in ventricle to drain fluid and dec pressure

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17
Q

why is back pain associated w hydrocephalus secondary to hemorrhagic strokes

A

blood more dense than CSF, then travels down SC and hangs out in base of SB
- blood is irritable to SC and toxic to neural tissue -> irritates nerves -> LBP and leg pain

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18
Q

how is LBP and leg pain d/t hydrocephalus secondary to hemorrhagic strokes managed

A

transient - give them gabapentin (meds for nerve pain)
- blood eventually get resorbed

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19
Q

what is the clinical significance of working w someone who is being treated for hydrocephalus

A

pay attention to ICP (<125)
- drain has to be clamped before movement, then not getting CSF movement out and can see issues w ICP

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20
Q

what do clinical features of a stroke depend on (2)

A

location and severity of stroke

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21
Q

why is your impairment exam of someone w CVA important even if you already know where they had the stroke

A

everyone’s neuroanatomy is different and might present differently
- depending on variations in circulation and collateral flow anatomy

22
Q

what are 8 general features of a CVA and why

A

impaired motor control
sensory deficits
*inc DTRs
*altered ms tone
*path reflexes
secondary weakness, impaired ROM, dec balance

UMNL

23
Q

what is critically important in a dx of a CVA

A

TIME = brain
rapid dx and intervention

24
Q

what scan is more commonly utilized when dx a CVA in an ED

A

CT scan

25
Q

pros and cons of a CT scan as a CVA diagnostic tool in the ED

A

pros:
- quickly show if hemorrhagic or ischemic (quicker than MRIs)
- more readily available than MRIs in ED
- easier to monitor person during CT than an MRI

cons: less specificity/sensitivity than MRIs
- might not show brain abnormalities right away
- could miss stroke if not timed well
- hard time detecting smaller arteries

26
Q

use of MRI after stroke dx

A

person w stroke will always get an MRI to assess extent of neurologic damage in a completed stroke
- question will be when

27
Q

pros and cons of MRIs as a CVA diagnostic tool in the ED

A

pros:
- detect smaller arteries (esp important when assessing above brainstem)
- more accurate in detecting acute stroke than CT
- greater detail provided

cons:
- less accessible in ED
- more contraindications
- can be safety issue - harder to monitor person in MRI

28
Q

what are 4 other dx medical tests to do other than scans

A
  1. blood tests: coag, blood sugar
    - hypoglycemia can present similarly to stroke
  2. angiogram
  3. US (carotid) - looking to identify any plaque formation in arteries
  4. ECG
29
Q

how do CT scans work and how will they show ischemic vs hemorrhagic strokes

A

same principles as XRs
- fluid filled cavities don’t absorb as much so will show up as more black
- blood is more dense and shows up whiter

hemorrhagic strokes - show up bright white
ischemic strokes - darker than normal brain (less dense)

30
Q

what is the best best imaging tool to use to see the full extent of a stroke

A

MRIs w diffusion/perfusion and contrast

31
Q

how do MRI scans work and how will they show ischemic vs hemorrhagic strokes

A

magnetic field

ischemic strokes = white

hemorrhagic strokes will show up white, but not as localized or dense as on CT
- see it running thru the area

32
Q

what is the gold standard screening tool used by trained ED MDs and RNs for stroke dx

A

NIHSS
- national institutes of health stroke scale

33
Q

what is the NIHSS

A

gold standard

initial and serial exam of impairments
can link neuroanatomy to sx and what part of brain impacted by stroke
- quantifies severity of stroke and nature of deficits

34
Q

when is the NIHSS conducted

A

anyone suspected of stroke
done in intervals
- baseline
- 2hrs post
- 24hrs post
- 1-2wks later

35
Q

what are the results of NIHSS helpful w

A

acute management
prognostic outcomes and dc
- <6 good outcome, low disability
- >/=16 high mortality rate, and inc disability

36
Q

what is the goal of medical management of an ischemic stroke

A

restore blood flow to ischemic tissue that is receiving enough blood to survive, but not to function (penumbra)

37
Q

what is the ischemic core

A

dead neurologic tissue
- necrotic in nature
- won’t regain function

38
Q

what is the penumbra

A

ischemic tissue around the core that is still viable
- not full function bc not full O2 perfusion
- want to restore O2 asap so can regain function of penumbra

39
Q

what types of medical management interventions are utilized w ischemic stroke

A

pharmacological management
surgical removal of clot
- corkscrew, suction
manage treatable risk factors (ie cardiac dz)

40
Q

what ischemic strokes is surgical medical management appropriate for

A

large vessel occlusions

41
Q

what pharmacological intervention is utilized w ischemic strokes

A

tPa

42
Q

what is tPa and what are characteristics of using this as management of an ischemic stroke

A

tissue plasminogen activator
- effective if given w/i 3hr of onset
- inc risk of hemorrhagic transformation -> needs to be monitored closely

43
Q

what is the goal of medical management of hemorrhagic strokes

A

dec the high ICP and edema

44
Q

what are medical management interventions to dec ICP in hemorrhagic strokes

A

craniotomy or surgical decompression
VP shunt/drain

45
Q

what role does neurosurgery have in the management of hemorrhagic strokes

A

coil or clamp the aneurysm/AVM

46
Q

what are other medical interventions (that are nonsurgical) for hemorrhagic strokes

A

manage ICP w HOB elevation
meds
vit K infusions - promote clotting

47
Q

where is the most common place for an aneurysm

A

ant communicating a.

48
Q

what is the goal of medical management for a TIA

A

prevent a stroke

49
Q

what are medical interventions utilized in managing a TIA

A

treat risk factors to dec risk of future strokes
- HTN, hyperlipid, DM, afib
- ASA, anticoag, BP meds, statins, antispasmodics

lifestyle modification
- nutrition, exercise, stress

50
Q

what are medical interventions for strokes in general when managed acutely (8)

A
  1. prevent re-bleed, manage ICP
  2. CO, BP, cerebral perfusion, respiration
  3. sz prevention
  4. bowel and bladder function
  5. skin integ
  6. DVT prevention
  7. infection control
  8. nutrition, electrolyte balance
51
Q

ICP level is a greater concern in which type of stroke and why

A

hemorrhagic
watch for midline shift or herniation

52
Q

why are anti-sz meds often prescribed for pts after a stroke

A

stroke or brain injury in risk of pt having a sz d/t pressure and edema from strokes/TBIs result in abnormal cell mechanisms
- high risk of sz

Neuro Rehab 2 (48 decks)

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