CVA

Question 1

Hemorrhageic stroke VS Ischemic Stroke

Answer 1

Hemorrhageic: bleeding in brain tissue itsel or into the subarachnoid space or ventricles

Ischemic Stroke: inadequate blood flow into the brain from partial or complete occlusion of an artery

Question 2

Signs of Ischemic Stroke

Answer 2

• Hemiparesis: sudden weakness or numbness in the face, arm or leg, particularly on one side of the body
• Impaired or loss of speech
• Hemisensory loss: sudden loss of vision, particularly in one eye
• Headache (sudden, severe and unusual headache)
• Dizziness (sudden loss of balance, especially when coupled with the above symptoms)
• Sudden confusion

Question 3

Signs of a hemorrhagic stroke

Answer 3

Similar to those of an ischemic stroke but may additionally have symptoms relating to higher pressure in the brain, such as:

• Sudden severe headache with no apparent cause - “worst headache of one’s life”
• Nausea and vomiting
• Neck stiffness
• Vertigo or syncope
• Seizures
• Irritability, confusion, and possibly unconsciousness
• Most often a sudden onset of symptoms, with progression over minutes to hours because of on-going bleeding.

Question 4

Transient Ischemic Attack

Answer 4

• Similar to an ischemic stroke because it results in the sudden loss of function of a particular part of the body.
• ***compare MI and angina
• TIA is only a temporary interruption of blood flow to a part of your brain.
• Also known as a mini-stroke (lay terminology).
• The difference between a TIA and an ischemic stroke is that the TIA symptoms disappear quickly, usually within 24 hours. Most TIAs resolve within 3 hours.

TIAs are often a warning of a possible impending stroke

Question 5

Subarachnoid vs. Intracerebral

Answer 5

• Subarachnoid hemorrhage bleeding into the subarachnoid space - the area between the arachnoid membrane and the pia mater (between brain & skull)
• Intracerebral hemorrhage bleeding within the brain caused by a rupture of a vessel, flooding the surrounding brain tissue with blood (50% of patients dye)

Question 6

Motor Effect

Answer 6

1. Mobility deficits - loss of voluntary movement, alterations in muscle tone and reflexes; hemiparesis, hemiplegia
2. Respiratory function - alterations in breathing - may lead to gas exchange abnormalities or need for mechanical ventilation
3. Swallowing
4. Dysphagia - chewing and swallowing difficulties
5. Absent gag reflex
6. Difficulties with self-care abilities

Question 7

Communication Effect

Answer 7

1. Aphasia - inability to speak or understand language
2. Broca’s aphasia - understands speech but has difficulty expressing thoughts through speech or writing. The client cannot find the words needed but does know what he or she wants to say.
3. Wernicke’s aphasia - cannot understand spoken and sometimes written words. They can speak but the content is incorrect i.e. words are frequently made-up or do not make sense.
4. Dysarthria - disturbance in the muscular control of speech. Speech can be slowed, slurred or distorted.

Question 8

Affect and Intellectual Function

Answer 8

1. Emotional lability - cry easily or have sudden mood swings, often for no apparent reason
2. Depression is common as stroke survivors recover and as they come to terms with any impairment that doesn’t fully go away.
3. Memory and judgement may be impaired

• Short term memory – got up and can’t remember why.
• patient gets up from wheelchair without having lock wheels

Question 9

Spatial and Perceptual Effect

Answer 9

1. Spatial orientation - difficulties such as judging distances. Objects may look closer or farther away than they really are (may cause spills at the table or falls).
2. Neglect - ignore affected side and do not think that their arm or leg belongs to them which may be worsened by homonymous hemianopia (client may see clearly on one side of the midline but nothing on the other).
3. Agnosia - inability to recognize an object by sight, touch, or hearing (cannot attach meaning to it).
4. Apraxia - may not remember how to start a task, confuse the sequence of steps, or forget how to do tasks they have done may times before

Question 10

Elimination Effect

Answer 10

• Fortunately, most problems with urinary and bowel elimination occur initially and are temporary.
• Initially may experience frequency, urgency and incontinence or constipation (associated with immobility, weak abdominal muscle & dehydration).
• Urinary & bowel problems may also be related to inability to express needs to eliminate.

Question 11

Emergency Management

Answer 11

1. Ensure patent Airway
2. Call a stroke code or the stroke team.
3. Remove dentures. They can chokes
4. Assess O2 saturation.
5. Maintain adequate oxygenation (SaO2 > 92% with O2 2LNP if needed) !!!!!!
6. Establish IV access with N/S
7. Assess & maintain BP (may need CPR)
8. Remove clothing
9. Maintain patient NPO
10. Perform baseline labs (start with CBGM & be ready for more orders from MD)
11. May go for a CT stat
12. Position head midline and elevate head of bed 30° if no symptoms of shock

Question 12

Diagnostic Tests

Answer 12

1. Computed tomography (CT) scan
2. Magnetic resonance imaging (MRI)
3. Carotid ultrasound
4. Doppler carotid ultrasound
5. Carotid angiography
6. PET scans
7. Electroencephalogram (EEG) electrical impulses to the brain

Question 13

Ischemic Treatments

Answer 13

Goal: involves removing the blockage and restoring blood flow to the brain.

• T-PA = tissue plasma activators (clot busters) Called Thrombolytic therapy
• fibrinolytic = break down the clot within 60-90 min.
• hopefully restored perfusion to occlude artery (and therefore tissue)
• problem = bleeding (intracranial or systemic hemorrhage)
• Who is the candidate = must be administered within three hours of onset of clinical signs.
• new research says can be used for 4 ½ hours after symptoms started

Surgical procedures:

• Angioplasty
• Stent
• Carotid endarterectomy

Question 14

Hemmoragic Treatments

Answer 14

**Goal: **preventing further rupture and bleeding. For example, clipping, coiling

• It means the immediate evacuation of the hematomas (anything greater than 3 cm)
• For a subarachnoid bleed we crack open the skull. Remove the bone (keep in freezer till patient better and it can be replaced) and drain the hematoma.
• For the intracerebral bleed that can be more difficult depending on where it is.

Surgical procedures:

Aneurysm – clipped, coiled or wrapping