CVA Flashcards
There are 2 main classifications of stroke.
1.
2.
Name each. Explain what each is?
- Ischemic Stroke
(blood clot or blockage of blood to brain tissue) - Hemorhhagic (burst or bleeding blood vessel in the brain)
Which one of the two types of strokes would be d/t a rupture blood vessel in the brain, causing bleeding in the brain?
Haemorrhagic Stroke
Define Transient Ischemic Attack
AKA, TIA.
Intermittent lack of blood flow to the brain d/t small temporary blockage
How long would a patient who is suffering from a TIA show signs of a stroke?
1-2 hours
Are TIA’s an increased risk of a person then suffering from a major stroke?
Yes
What are the Non- Modifiable risk factors for CVA?
Age, sex, ethnicity
What are the modifiable risk factors for CVA?
Atherosclerosis HTN A Fib Obesit Hyperlipidemia Obesity Smoking Diabetes
Explain how the follow are risk factors for CVA..
- HTN
- Hyperlipidemia/Obesity
- Smoking
- Diabetes
- Atrial Fibrillation
- HTN = sets the stage for atherosclerosis (vessel then has impeded blood flow)
- Contributes to atherosclerosis
- Reduces amount of 02 in the blood causing the heart to work harder AND increases atherosclerosis and vasconstriction of the artery
- Hyperglycemia = damages endothelium of vessels (thickening)
- A FIb, abnormal rhythm of the heart can causes blood to pool, which can lead to a blood clot forming
What are the Signs of a stroke?
- F/A/L
- Brain
- Eyes
- Stomach
- Body
- Legs
- Face, arm, leg (on one side) will be numb or weak
- Confusion, trouble talking or understanding speech, diziness, loss of balance, bad headache
- Trouble seeing in one or both eyes
- Throwing up
- Feel tired
- Trouble walking
The following acrynoynm is used to assess if a CVA is occuring.
Explain what each letter means.
FAST
F. Face (drooping on one side?)
A. Arms (unable to raise one arm)
S. Speech (say a simple phrase… do they have slurring or strange speech?)
T. Time (call 911 stat, time = brain!)
If the CVA is in the left hemisphere, what side of the body would symptoms present?
The right side
A Patient suffering from a stroke has motor loss. Define the following terms.
- Hemiparesis
- Hemiplegia
- Ataxia
- Dysphagia
- Weakness
- Paralysis
- Unsteady gait
- Difficulty swallowing
A patient suffering from a stroke has communication loss. Define the following terms
- Dysarthia
- Dysphasia
- Aphasia
- Apraxia
- Problems with speeh
- Problems with swallowing
- Problems with receptive or expressive
- Inability to perform learned tasks
A person undergoing a CVA has perceptual changes. Explain this
Visual- perceptual dysnfuncations are due to disturbances of the primary sensory pathways between the eye and visual cortex
A person undergoing a CVA has sensory loss. Explain what 2 proccess this involves.
- Touch impairment
2. Difficulty interpreting stimuli
When you are assessing a patient who has a CVA, what are 3 things you assess for?
- Airway
- Cardiovascular status
- Gross neurological losses
What is a CT differentiating between in regards to stroke?
Ischemic vs. Hemmorhagic
A patient undergoing a Ischemic Stroke could recieve thrmbolytic therapy if they meet the proper critera. What would thrombolytic therapy include (what drug?)
TPA
Tissue Plasminogen Activator
What does TPA (tissue plasminogen activator) do?
Dissolves the blood clot that is blocking blood flow to the brain
What criteria is there for a patient undergoing an ischemic CVA to meet before being able to have TPA therapy? (7)
- Time
- BP
- Ischemic stroke only
- Not on Warfarin
- Blood Glucose
- Not post surgery / trauma / bleeding
- Patients weight needed for dosing
The criteria for Tissue Plasminogen Activator therapy involves. Explain what the ranges should be.
- Time
- BP
- Can it be a TIA or hemmorhagic stroke?
- Not on Warfarin (INR less than what?)
- Blood glucose
- What about bleeding/trauma/surgery?
- What about the patients weight?
1.
When a patient presents to the ER having a CVA, what would be the process of assessing the patient’?
- What happened? Why are you here? LOTARP
- VITALS
- Neuro Assessment
- Carotid bruit, Weight, Temp, Glucose
In the neuro assessment, what signs are you looking for?
F
A
S
T
Why would you take a patients weight if they are prsenting with a stroke?
If they need TPA, weight based dosing
Why would you assess for carotid bruit?
Assess for blood flow to the brain
- What is the purpose of the Glasgow coma scale?
- When is it used?
- What would a declining glasgow coma scale mean?
- To assess the LOC (gauge the patients brain injury)
- Used when a patients LOC presents to be altered, or there is a suspicion for brain injury
- A decline in the patients LOC or brain injury occurring
The lower the score of a glasgow coma scale.. good or bad?
The lower the score, the more impairment there is.
What diagnostic testing would be done to a patient who is presenting with signs of a CVA? (5)
Keep in mind some of the testing (2) relate to meeting the criteria for a patient to have TPA therapy.
- CT scan
- Possible MRI?
- Coagulation (blood work)
- ECG (looking for AFIB?)
- Blood glucose levels
What is a carotid ultrasound looking at?
The blood supply to the brain. Looking to assess for blocked or narrow carotid arteries
What is a cerebral angiography looking for?
To see how blood is flowing through the brain
The care planning for a patient with CVA involves priorities. Explain what they are.
- Return blood flow to the brain
- Apply O2 (reduce 02 demands)
- Patient is NPO (risk d/t dysphagia)
- Assess if patient has potentinal to have TPA therapy?
What is the nursing care (salience nursing care) that can be provided?
- O2
- Rest
- IV (since NPO)
- TPA eligibility
- Patient may become agitated d/t not follow understanding what is occurring. try to calm the patient down, if you can have family around to try and help with this, do it!
After a person has had a stroke, often times the patient then faces struggles such as impaired mobility, self-care deficits, impaired swallowing and communication, urinary incontienece, disturbed thought process.
Why is it important a nurse knows this?
So that when caring a patient, you are able to understand the importance of knowing their challenges, as well as how this affects family members.
What are some potential complications that be can be associated with strokes?
- Aspiration
- DVT
- Pressure Ulcers
- Malnutrition
- Contractures
- UR / UTI
- Depression
What are ways that strokes can be prevented?
- prevent clot in patient with AF
- prevent DVT
- prevent atherosclerosis
What is the pharmacology involved in preventing strokes? (4)
- Lipid-lowering agent
- Anti-hypertensives
- Anti-platelets
- Anti- Coagulants
