CVA Flashcards
Modifiable factors
•Those factors that can be eliminated or controlled e.g. diet, smoking, activity level
•Non-modifiable factors
- Risk factors that cannot be changed
- Age - with each decade beyond age 55 years.
- Race - African American CVA compared to other groups
- Gender - men have greater risk than women
- Heredity - family history risk for CVA
Sudden, brief episode of neurologic impairment caused by a temporary interruption in cerebral blood flow
Transient Ischemic Attack
Pathology of TIA
Blood vessels occluded by spasms, fragments of plaque, or blood clots
Causes: atherosclerosis, arteriosclerosis, cardiac disease, diabetes
TIAs are a warning that a cerebrovascular accident (CVA) can occur in the near future;
40% of people who experience a TIA will have stroke;
Nearly ½ of these strokes will occur within the first few days after a TIA.
S/S of TIA
•sudden onset, usually lasting 10-20 minutes, but no longer than an hour.
•numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body;
ptosis (drooping eyelid), drooping mouth (uneven smile)
•dizziness
•momentary confusion or trouble understanding simple statements
•sudden trouble speaking (speech difficult 2nd to muscle weak)
•sudden problems with walking or balance.
•tinnitus
•sudden visual disturbances
•. dysphagia,
Medical treatment of TIA
- Depends on the location of the narrowed vessel and the degree of narrowing
- Acetylsalicylic acid (aspirin), ticlopidine hydrochloride (Ticlid), extended-release dipyridamole (Aggrenox), or clopidogrel bisulfate (Plavix) decrease platelet clumping
- Warfarin (Coumadin) and heparin
An abrupt impairment of brain function resulting in a set of neurologic signs and symptoms that are caused by impaired blood flow to the brain and last more than 24 hours (less than 24 hrs = possibleTIA)
Stroke (CVA)
Blood vessel in brain ruptures and bleeding into the
brain cccurs.
Hemorrhagic stroke
occurs when a blood vessel on the surface of the brain ruptures and bleeds into the space between the brain and the skull.
Subarachnoid hemorrhage (SAH)
occurs when a blood vessel bleeds into the tissue deep within the brain.
Intracerebral hemorrhage (ICH)
Obstruction of a blood vessel by atherosclerotic plaque, blood clot, or a combination of the two, or by other debris released into vessel that impedes blood flow to an area of the brain
Ischemic stroke
Afib is
- a leading risk factor for stroke
- more common in people over age 60
- often asymptomatic, making it difficult for people to know that they have it
It’s is Important to note about Afib
• Afib can be successfully managed with the help of a
healthcare professional.
• About 15 percent of all people who have strokes also have
Afib.
• Knowing about and properly managing your Afib can prevent
you from having a stroke.
• Up to 80 percent of strokes in people with Afib can be
prevented.
Hemorrhagic stroke s/s
- Occurs suddenly; may include severe headache described as “the worst headache of my life”, dizziness, nausea, vomiting usually followed by a rapid loss of consciousness
- If the ruptured aneurysm produces a slow leak, a stiff neck, headache, visual disturbances, intermittent nausea develop, latent loss of consciousness
- Other symptoms: seizures
•Embolic (clot) stroke s/s
- Appear without warning
- One or more of the following signs and symptoms:
- one-sided weakness
- numbness
- visual problems
- confusion and memory lapses
- headache
- dysphagia
- language problems
•A defect in the use of language; speech, reading, writing, or word comprehension
Aphasia
•The inability to speak clearly
Dysarthria
Difficulty swallowing
Dysphasia
•The partial inability to initiate coordinated voluntary motor acts
Dyspraxia
•Defined as paralysis of one side of the body
•Perceptual disturbances
affect ability to safely move in
environment
Hemiplegia
•Unable to feel touch, pain, or temperature in affected body parts
Sensory impairment
Unilateral neglect
Do not recognize one side of the body as belonging to them
Perceptual problem: involves loss of one side of field of vision
•Homonymous hemianopsia
- Neurogenic bladder
- Flaccid bladder
- Bowel incontinence
Elimination disturbances
Complications with stroke
• Constipation, dehydration, contractures, urinary tract
infections, thrombophlebitis, decubitus ulcers, and
pneumonia
• Sensory losses put patient at risk for traumatic and thermal
injuries
• Swallowing difficulties place patient at risk for pulmonary
complications, such as choking and aspiration pneumonia
Prognosis of stroke
- Prognosis for TIA or stroke increasingly hopeful
- Critical variables for recovery:
- patient’s condition before the stroke,
- time between stroke and diagnosis, treatment and support in acute phase (usually the first 48 hours),
- severity of patient’s symptoms, and
- access to rehabilitative therapy
- Long-term recovery may depend on the care received immediately after the stroke
- Most recovery takes place in the first 3-6 months, but progress often continues long after that
Acute phase of stroke medical treatment
- Begins with the onset of signs and symptoms and continues until vital signs, particularly blood pressure and neurologic condition, stabilize
- This phase usually lasts 24 to 48 hours
- Many medical management interventions are directed at minimizing complications and deterioration of the patient’s condition after a stroke
- Major focus areas
- Hypertension
- Oxygenation
- Hyperthermia
- Hyperglycemia
Drug therapy
Tissue plasminogen activator (rt-PA, alteplase, Activase)
Given to dissolve clots in acute ischemic strokes
Mannitol (diuretic, potent)
Reduction of intracranial pressure
Nimotop (calcium channel blocker)
Relaxes (dilates) blood vessels andimprovesblood flow to prevent brain damage resulting from an aneurysm
Phenytoin (Dilantin) and phenobarbital for seizures
Acetylsalicylic acid (aspirin), ticlopidine hydrochloride (Ticlid), Aggrenox, and clopidogrel (Plavix
