CVA

Question 1

the three things that cause someone to have a CVA

Answer 1

thrombus, embolism, hemorrhage

Question 2

when is it called an ischemic stroke

Answer 2

when its caused by a thrombus or embolism

Question 3

CVA

Answer 3

Is a sudden circulatory impairment of one or more blood vessels that supply the brain.
Can result in destruction of brain cells (Infarction).
Caused by sudden or gradual interruption of blood supply to the brain following a thrombus, embolism, or hemorrhage.

Question 4

risk factors for CVA

Answer 4

Hypertension, atherosclerosis, arteriosclerosis, Diabetes
Cardiac disease like valvular disease, chronic atrial fibrillation, myocardial infarction.
Obesity, smoking, inactivity, stress and taking oral contraceptives.

Question 5

statistics for COPD

Answer 5

Third most common cause of death in US.
Most common cause of permanent neurological disability in adults.
Affects men more than women. Incidence increases with age.
Stroke rate 50% higher in African American men and 130% higher in African American women than Caucasian.
Death rate has decreased since the 1970s because of improved health habits.

Question 6

classification of an ischemic stroke

Answer 6

Ischemic Stroke:
a. Thrombus caused by atherosclerosis,
arteritis, or hypercoaguability of the
blood.
b. Embolism caused by atrial fibrillation,
valvular disease, and endocarditis.

Question 7

classification of an hemorrhagic stroke

Answer 7

Hemorrhagic Stroke:
a. Hypertensive intracerebral hemorrhage
into brain tissue from rupture of small
blood vessel.
b. Ruptured aneurysm or arteriovenous malformation.
c. Hypocoaguability of blood from blood dyscrasias.

Question 8

pathophysiology of CVA’s

Answer 8

Any condition that alters brain perfusion can lead to cerebral hypoxia.
Prolonged hypoxia leads to infarction and permanent damage.
Cerebral edema accompanies hypoxia and worsens initial deficits.
Symptoms vary based on location and extent of injury.

Question 9

stages of thrombotic CVA

Answer 9

transient ischemic attack (TIAS)
Stroke in evolution
Completed Stroke

Question 10

Transient ischemic attack (TIAS)

Answer 10

Transient  ischemic  attack  (TIAs)
	a.  Warning sign of impending CVA.
	b.  Brief period of neurological deficit 
	      lasting to no more than 24 hours.
	c.  Complete recovery  of symptoms.

Question 11

stroke in evolution

Answer 11

a. Progressive development of stroke

symptoms over a period of hours to days.

Question 12

completed stroke

Answer 12

Neurological deficit remains unchanged

for 2 to 3 day period.

Question 13

common side effects of a CVA involving the right side of the brain

Answer 13

Hemiplegia or hemiparesis on left side of body.
Spatial-perceptual deficits.
May not recognize hemiplegic part and has neglect or ignores it.
Quick, impulsive behavior so safety risk.
Performance memory deficits. Left visual field deficits.
Indifference to disability.

Question 14

CVA involving the left side of the brain

Answer 14

Paralysis or hemiparesis of right side of body.
Speech-language deficits if left brain dominant. Wernicke’s and Broca’s area on left hemisphere so can have aphasia.
Behavior style- slow, cautious
Memory deficits with language.
Right visual field deficits.
Distress and depression r/t disability.

Question 15

other problems from CVA’s

Answer 15

Dysphagia
Agnosia
Apraxia
Dysarthia
Hemianopsia

Question 16

agnosia

Answer 16

—Inability to recognize sensory input.

Question 17

apraxia

Answer 17

—Inability to carry out previously learned motor skills with no weakness or sensory, cognitive, or coordination impairment.

Question 18

dysarthia

Answer 18

—Slurred speech because of motor impairment.

Bowel and bladder incontinence.

Question 19

Hemianopsia

Answer 19

—Loss of vision toward hemiplegic side.

Question 20

stroke in the brainstem

Answer 20

Coordination problems.
Problems with swallowing, eye movement, and sometimes paralysis.
Some changes in levels of consciousness.

Question 21

stroke in the cerebellum

Answer 21

Problems with coordination, balance and eye movement.

Question 22

diagnostics tests for CVA

Answer 22

CT Scan which is highly sensitive to blood. Need to do it quickly to r/o hemorrhagic CVA.
MRI to look at extent of ischemic stroke.
Carotid ultrasound.
Cerebral angiography.
Transcranial doppler imaging
EEG
Cardiovascular workup like ECG, Echocardiogram and telemetry

Question 23

medical management of CVA

Answer 23

Goal—maintain cerebral circulation to prevent ischemia of cerebral tissue.
B/P in an acute stroke is lowered slowly since thought to be a protective mechanism in an ischemic stroke.
Initially may be patient on bed rest with head of bed down for adequate circulation. HOB is elevated if the patient has a large ischemic stroke or hemorrhagic infarct to decrease ICP from edema.

Question 24

medical management of CVA continued

Answer 24

IV fluids to maintain circulatory volume and adequate B/P. May be restricted if large amount of cerebral edema is present.
Patients with ischemic strokes may be given anticoagulants, vasodilators, and thrombolytics to prevent further damage. Antihypertensives are used if indicated. Remaining care consists of support of vital functions and prompt rehabilitation.
Patients with hemorrhagic strokes are on complete bedrest with meticulous monitoring. May need surgery to stop bleed.
New Solitaire procedure to evacuate thrombus

Question 25

new therapies used for patients with strokes

Answer 25

Constraint-induced movement therapy (CIMT)- emphasizes use of disabled limb by constraining unaffected limb. Force patient to try to use disabled limb. Encourages Brain Plasticity which makes it possible for another part of the brain to take up the functions of the injured p[art of the brain.
Neuroprotection by preventing secondary brain injury by decreasing inflammation and blocking toxic chemicals created by dying brain cells.
Implantation of neural stem cells to see if they can replace cells that have died.

Question 26

nursing care for a patient with CVA

Answer 26

Assessment of history of symptoms, co-existing health problems, subjective symptoms, focal deficits, generalized objective symptoms, communication deficits, perceptual deficits, mental status changes, sensory & motor deficits, potential nutritional problems, bowel & bladder alterations, symptoms of ICP.

Question 27

how long should someone be positioned on their effected side after a CVA

Answer 27

20-30 minutes . NO MORE