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CVA Flashcards

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1
Q

2 types Cerebral Vascular Accident CVA

A

ischemic, hemorrhagic

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2
Q

2 types of Ischemic Strokes

A

thrombotic, emobolic

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3
Q

Ischemic Stroke: definition

A

abnormal perfusion of brain tissue

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4
Q

cerebrum: definition

A

highest level of brain function, voluntary functions and info from sense organs

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5
Q

cerebrum divided into 2 hemispheres/lobes

A

left and right hemispheres

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6
Q

4 lobes of cerebrum

A

frontal, parietal, temporal, occipital

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7
Q

frontal lobe function

A

thinking, planning, s-t memory, Broca area

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8
Q

parietal lobe function

A

touch, taste, temp sensations, spatial balance

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9
Q

occipital lobe function

A

processes visual info

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10
Q

temporal lobe function

A

visual and emotional memories, sounds

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11
Q

atrial fibrillation

A

erratic heart beat so blood pools in atria and clot may develop

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12
Q

atrial fibrillation caused by

A

low serum potassium

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13
Q

TIA/CVA prevention: 3

A

K+, Vit C and no HTN

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14
Q

fibrillation definition

A

irregular contractions of muscle fibers of heart, K+ must be ample to prevent

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15
Q

Vit C role

A

strengthens arteries

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16
Q

dominant hemisphere typically

A

side of brain opposite dominant hand (left for most people)

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17
Q

Left Hemisphere and CVA

A

controls language, 2 speech centers

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18
Q

2 speech centers Left Hemisphere

A

Broca and Wernicke

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19
Q

Broca role

A

speech production

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20
Q

Wernicke role

A

speech comprehension

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21
Q

Right Hemisphere and CVA

A

perceptual and spatial relationships, balance, walking

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22
Q

Right and Left Hemisphere communicate via

A

corpus collosum

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23
Q

CVA definition

A

sudden loss of brain function from a disruption of blood supply to a part of the brain

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24
Q

ischemic stroke

A

oxygen rich blood flow to brain is restricted by blood clot or other blockage (plaque)

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25
Q

TIA- transient ischemic attack defintion

A

temporary episode of neurological dysfunction caused by decreased blood flow

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26
Q

locations of CVA clots: 2 most common

A

middle cerebral artery, internal carotid artery

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27
Q

ischemic stroke medications

A

anticoagulants

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28
Q

anticoagulants for CVA

A

aspirin, tPA

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29
Q

anticoagulants risk

A

bleeding so don’t treat hemorrhagic stroke

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30
Q

thrombus definition

A

narrowing or clot blockage of artery supplying oxygenated blood to brain

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31
Q

embolus definition

A

clot travels from another location (heart)

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32
Q

thrombotic ischemic stroke cause

A

atherosclerosis so does not develop quickly

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33
Q

risk factors

A

55+, history of TIAs

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34
Q

thrombus can become

A

embolism

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35
Q

thrombotic clot location

A

develops in artery and stays there, blocks that area

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36
Q

thrombus action

A

narrows or blocks artery that supplies brain

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37
Q

embolic ischemic stroke cause

A

clot breaks off from somewhere else usually heart and cuts off blood supply to brain

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38
Q

emobolic stroke timing

A

sudden onset vs gradual for thrombotic

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39
Q

TIAs history with embolic stroke?

A

no vs yes for thrombotic stroke

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40
Q

embolus source for embolic stroke

A

any artery between heart and brain, carotid, vertebral or heart itself

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41
Q

embolotic stroke and artrial fibrillation

A

left atria quivering so not pumping blood efficiently to left ventricle. blood pools in left atria and thrombus can form. part of thrombus breaks off and gets pumped into left ventricle up to aorta and carotid then brain

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42
Q

Hemorrhagic stroke age

A

younger vs older for ischemic

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43
Q

Hemorrhagic stroke cause

A

breakage or blowout of cerebral artery, aneurysm

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44
Q

aneurysm

A

weakening of artery wall, HTN/athersclerosis

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45
Q

CVA warning signs: 4 physical

A

numb, weak, paralysis, imbalance, coordination,

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46
Q

CVA warning signs: 3 mental

A

dizzy, vision changes, aphasia

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47
Q

TIA length

A

up to 1 hour

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48
Q

contra lateral paralysis

A

TIA/stroke on left side of brain affects right side of body

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49
Q

embolus, thrombus and aneurysm can cause TIA or CVA?

A

both

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50
Q

“Time = Brain”

A

rapid intervention is crucial in treatment of acute ischemic stroke

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51
Q

Cincinnati Stroke Scale

A

FAST

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52
Q

cincy stroke scale F

A

facial droop, ask pt. to smile and show teeth, symmetrical is normal, droop is positive

53
Q

cincy stroke scale A

A

arm drift, pt. extend arms out palms up, close eyes, arm drift is positive

54
Q

cincy stroke scale S

A

slurred speech test, you can’t teach a dog new tricks slurred positive

55
Q

cincy stroke scale T

A

timing, call 911 at ANY sign of stroke

56
Q

aphasia definition

A

partial or total loss of ability to communicate through language

57
Q

expressive aphasia

A

difficulty converting thoughts into language

58
Q

receptive aphasia

A

difficulty understanding verbal or written language

59
Q

pt. with right sided weakness, assess

A

assess for aphasia b/c left hemisphere affected

60
Q

pt. left sided body unilateral neglect example

A

head turned away from left side, ignores stimuli from on left side, unaware left sided weakness

61
Q

pt. left sided body unilateral neglect affect which hemisphere?

A

right

62
Q

rtPA timing risk

A

cranial bleed if not given within 4.5 hours of onset of symptoms

63
Q

rtPA timing risk

A

administer within 60 minutes of arriving in ED, “Door to Needle”

64
Q

not eligible for rtPA/thrombolytics

A

pt. bleeding risk, head trauma or stroke in past 3 months, hemorrhagic stroke suspected

65
Q

rtPA/thrombolytics and platelets

A

do not administer if platelet count less than 100,000

66
Q

rtPA/thrombolytics and BP

A

do not administer if BP > 180 or >110

67
Q

NIH Stroke Scale

A

FLEAS

68
Q

NIH F

A

face, show teeth, symmetric?

69
Q

NIH L

A

LOC, commands?

70
Q

NIH E

A

eyes

71
Q

NIH A

A

arms/legs movement, coordinate

72
Q

NIH S

A

speech, language

73
Q

NIH score

A

0 no stroke, 21+ severe

74
Q

Glasgow Coma Scale areas: 3

A

eye opening, motor response, verbal response

75
Q

Glasgow Coma Scale score

A

15 max, no stroke

76
Q

CVA motor response observations: 4

A
  1. abnormal flexion/decorticate posturing
  2. abnormal extension/decerebrate posturing
  3. obey commands
  4. localizes/withdraws
77
Q

abnormal flexor response is

A

arms/elbows abducted away from body, hands up against chest, decorticate

78
Q

abnormal extensor response is

A

arms adducted/toward the body, at sides of body

79
Q

paresis is

A

muscle weakness caused by nerve damage or disease, partial paralysis

80
Q

plegia is

A

paralysis, all voluntary movement is lost

81
Q

rtPA route

A

IV, bolus first

82
Q

CVA.TIA and neurologic impact

A

cause neurologic deficit

83
Q

ED the first hour CT? MRI?

A

CT b/c all hospitals have, quick to show ischemic stroke

84
Q

Ischemic Stroke Penumbra is

A

area on periphery of ischemic core, brain tissue not dead yet, gets oxy from adjacent arteries

85
Q

Ischemic Core is

A

area closest to blocked artery, low oxy, low glucose, necrosis

86
Q

metabolic cascade and CVA

A

metabolic cascade unleashed by stroke, goal to prevent stroke cascade

87
Q

blocked cerebral artery leads to

A

brain tissue served by the artery dies, no oxy, no perfusion = tissue death

88
Q

rtPA Recombinant Tissue Plasminogen Activator aka

A

alteplase

89
Q

rtPA timing

A

within 4 1/2 hours onset or do not admin, onset unclear do not give

90
Q

MERCI Mechanical Embolus Removal in Cerebral Ischemia process

A

long wire via catheter in femoral artery up to carotid artery, pull out clot

91
Q

Carotid Endarterectomy CEA treats

A

carotid stenosis

92
Q

CEA location

A

plaque at bifurcation of carotids

93
Q

Carotid Endarterectomy CEA process

A

incision into neck to get to carotid artery and plaque removed

94
Q

Carotid Endarterectomy goal

A

stroke prevention

95
Q

Carotid Endarterectomy patient

A

TIA symptoms or has had a TIA

96
Q

Carotid Endarterectomy Post Op

A
  1. monitor BP b/c want high systolic BP during procedure to get pressure to brain 160-170 systolic
  2. assess neck for swelling
  3. neuro assessment
97
Q

L/R Hemisphere Deficits: common

A

paralyzed Left side of body if Right Hemisphere

paralyzed Right side of body if Left Hemisphere

98
Q

L/R Hemisphere Deficits: Behavioral Style

A

R Hemisphere injury - quick, impulsive behavior

L Hemisphere injury - slow, cautious behavior

99
Q

L/R Hemisphere Deficits: Behavioral Style

A

R Hemisphere injury - quick, impulsive behavior, short attention span
L Hemisphere injury - slow, cautious behavior

100
Q

L/R Hemisphere disability awareness

A

R Hemisphere injury - indifference to disability

L Hemisphere injury - aware of disability, so depression

101
Q

homonymous hemianopsia is

A

see only half visual field

102
Q

homonymous hemianopsia is visual or brain problem?

A

brain function problem, not eyes themselves

103
Q

homonymous hemianopsia pt. sees

A

only one side, right or left, of the vision world with each eye

104
Q

homonymous hemianopsia Left Hemisphere damage

A

loss of right half of visual world in each eye

105
Q

homonymous hemianopsia R Hemisphere damage

A

loss of left half of visual world in each eye

106
Q

amorphosynthesis is

A

R Hemisphere damage, pt. unaware of somatic sensations from left side of body

107
Q

dysarthria is

A

slurred speech due to muscle weakness

108
Q

expressive asphasia from which area?

A

Broca

109
Q

receptive asphasia from which area?

A

Wernicke

110
Q

assess dysphagia/difficulty swallowing

A

bedside swallow screen

111
Q

CVA 3 Nursing Assessments

A

Neurologic (intracranial pressure, LOC, seizure risk, eyes), Cincinnati Stroke Scale, NIH Stroke Scale

112
Q

CVA 3 Priority Labs

A

CBC (RBC, WBC, Platelets), Serum Glucose, Basic Metabolic Panel (BUN, Creatitine, elec)

113
Q

CVA serum glucose

A

rule out hypo/hyperglycemia, must be measured before admin tPA

114
Q

CVA 3 Nursing Interventions

A
  1. airway, breathing, circulation
  2. attach Sp02 Pulse Oximeter want >94%
  3. cardiac monitor, HR, heart rhythm
  4. VS esp fever hyperthermia, BP lower not too fast
115
Q

post CVA assessment include

A

depression

116
Q

intracranial pressure prevention

A

no cough, no sneeze, no defecation

117
Q

TIA necrosis?

A

no

118
Q

peripheral pain stimulation, ex:

A

apply pressure to finger, push down on fingernail hard, if pt. witdraws/pulls finger away = localized pain

119
Q

painful stimulation purpose

A

establish a baseline of neurological status

120
Q

2 types of painful stimuli

A

central and peripheral

121
Q

eyes and painful stimuli, when

A

pt. does not spontaneously open eyes or open after shouting/verbal stimuli, painful stimulus (supraorbital pressure) is done to get a response

122
Q

supraorbital pressure purpose

A

elicit eye response if not done by pt. voluntarily

123
Q

painful stimuli responses and cerebral function

A

mpre purposeful response indication of higher level cerebral function

124
Q

pupils and CVA

A

change in size, shape, accommodation before and after exposure to light can indicate inc intracranial pressure

125
Q

VS and CVA

A

VS can change quickly/unstable with brain injury

126
Q

Glasgow Coma Scale purpose

A

determine conscious state (under 8 = coma)

127
Q

pupillary response like unequal or dilated pupils may signal

A

increase intracranial pressure

128
Q

central pain stimulus locations

A

central part of body supraorbital, sternal rub, trapezius squeeze

129
Q

neurological assessment: 6

A
  1. LOC
  2. orientation
  3. speech
  4. facial symmetry
  5. motor and sensory function
  6. reflexes

Nursing 2 (9 decks)

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