CVA Flashcards
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1
Q
2 types Cerebral Vascular Accident CVA
A
ischemic, hemorrhagic
2
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2 types of Ischemic Strokes
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thrombotic, emobolic
3
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Ischemic Stroke: definition
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abnormal perfusion of brain tissue
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cerebrum: definition
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highest level of brain function, voluntary functions and info from sense organs
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cerebrum divided into 2 hemispheres/lobes
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left and right hemispheres
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4 lobes of cerebrum
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frontal, parietal, temporal, occipital
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frontal lobe function
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thinking, planning, s-t memory, Broca area
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parietal lobe function
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touch, taste, temp sensations, spatial balance
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occipital lobe function
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processes visual info
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temporal lobe function
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visual and emotional memories, sounds
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atrial fibrillation
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erratic heart beat so blood pools in atria and clot may develop
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atrial fibrillation caused by
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low serum potassium
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TIA/CVA prevention: 3
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K+, Vit C and no HTN
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fibrillation definition
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irregular contractions of muscle fibers of heart, K+ must be ample to prevent
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Vit C role
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strengthens arteries
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dominant hemisphere typically
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side of brain opposite dominant hand (left for most people)
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Left Hemisphere and CVA
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controls language, 2 speech centers
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2 speech centers Left Hemisphere
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Broca and Wernicke
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Broca role
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speech production
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Wernicke role
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speech comprehension
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Right Hemisphere and CVA
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perceptual and spatial relationships, balance, walking
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Right and Left Hemisphere communicate via
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corpus collosum
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CVA definition
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sudden loss of brain function from a disruption of blood supply to a part of the brain
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ischemic stroke
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oxygen rich blood flow to brain is restricted by blood clot or other blockage (plaque)
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TIA- transient ischemic attack defintion
temporary episode of neurological dysfunction caused by decreased blood flow
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locations of CVA clots: 2 most common
middle cerebral artery, internal carotid artery
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ischemic stroke medications
anticoagulants
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anticoagulants for CVA
aspirin, tPA
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anticoagulants risk
bleeding so don't treat hemorrhagic stroke
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thrombus definition
narrowing or clot blockage of artery supplying oxygenated blood to brain
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embolus definition
clot travels from another location (heart)
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thrombotic ischemic stroke cause
atherosclerosis so does not develop quickly
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risk factors
55+, history of TIAs
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thrombus can become
embolism
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thrombotic clot location
develops in artery and stays there, blocks that area
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thrombus action
narrows or blocks artery that supplies brain
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embolic ischemic stroke cause
clot breaks off from somewhere else usually heart and cuts off blood supply to brain
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emobolic stroke timing
sudden onset vs gradual for thrombotic
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TIAs history with embolic stroke?
no vs yes for thrombotic stroke
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embolus source for embolic stroke
any artery between heart and brain, carotid, vertebral or heart itself
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embolotic stroke and artrial fibrillation
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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Hemorrhagic stroke age
younger vs older for ischemic
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Hemorrhagic stroke cause
breakage or blowout of cerebral artery, aneurysm
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aneurysm
weakening of artery wall, HTN/athersclerosis
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CVA warning signs: 4 physical
numb, weak, paralysis, imbalance, coordination,
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CVA warning signs: 3 mental
dizzy, vision changes, aphasia
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TIA length
up to 1 hour
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contra lateral paralysis
TIA/stroke on left side of brain affects right side of body
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embolus, thrombus and aneurysm can cause TIA or CVA?
both
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"Time = Brain"
rapid intervention is crucial in treatment of acute ischemic stroke
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Cincinnati Stroke Scale
FAST
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cincy stroke scale F
facial droop, ask pt. to smile and show teeth, symmetrical is normal, droop is positive
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cincy stroke scale A
arm drift, pt. extend arms out palms up, close eyes, arm drift is positive
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cincy stroke scale S
slurred speech test, you can't teach a dog new tricks slurred positive
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cincy stroke scale T
timing, call 911 at ANY sign of stroke
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aphasia definition
partial or total loss of ability to communicate through language
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expressive aphasia
difficulty converting thoughts into language
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receptive aphasia
difficulty understanding verbal or written language
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pt. with right sided weakness, assess
assess for aphasia b/c left hemisphere affected
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pt. left sided body unilateral neglect example
head turned away from left side, ignores stimuli from on left side, unaware left sided weakness
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pt. left sided body unilateral neglect affect which hemisphere?
right
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rtPA timing risk
cranial bleed if not given within 4.5 hours of onset of symptoms
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rtPA timing risk
administer within 60 minutes of arriving in ED, "Door to Needle"
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not eligible for rtPA/thrombolytics
pt. bleeding risk, head trauma or stroke in past 3 months, hemorrhagic stroke suspected
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rtPA/thrombolytics and platelets
do not administer if platelet count less than 100,000
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rtPA/thrombolytics and BP
do not administer if BP > 180 or >110
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NIH Stroke Scale
FLEAS
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NIH F
face, show teeth, symmetric?
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NIH L
LOC, commands?
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NIH E
eyes
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NIH A
arms/legs movement, coordinate
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NIH S
speech, language
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NIH score
0 no stroke, 21+ severe
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Glasgow Coma Scale areas: 3
eye opening, motor response, verbal response
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Glasgow Coma Scale score
15 max, no stroke
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CVA motor response observations: 4
1. abnormal flexion/decorticate posturing
2. abnormal extension/decerebrate posturing
3. obey commands
4. localizes/withdraws
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abnormal flexor response is
arms/elbows abducted away from body, hands up against chest, decorticate
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abnormal extensor response is
arms adducted/toward the body, at sides of body
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paresis is
muscle weakness caused by nerve damage or disease, partial paralysis
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plegia is
paralysis, all voluntary movement is lost
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rtPA route
IV, bolus first
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CVA.TIA and neurologic impact
cause neurologic deficit
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ED the first hour CT? MRI?
CT b/c all hospitals have, quick to show ischemic stroke
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Ischemic Stroke Penumbra is
area on periphery of ischemic core, brain tissue not dead yet, gets oxy from adjacent arteries
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Ischemic Core is
area closest to blocked artery, low oxy, low glucose, necrosis
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metabolic cascade and CVA
metabolic cascade unleashed by stroke, goal to prevent stroke cascade
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blocked cerebral artery leads to
brain tissue served by the artery dies, no oxy, no perfusion = tissue death
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rtPA Recombinant Tissue Plasminogen Activator aka
alteplase
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rtPA timing
within 4 1/2 hours onset or do not admin, onset unclear do not give
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MERCI Mechanical Embolus Removal in Cerebral Ischemia process
long wire via catheter in femoral artery up to carotid artery, pull out clot
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Carotid Endarterectomy CEA treats
carotid stenosis
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CEA location
plaque at bifurcation of carotids
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Carotid Endarterectomy CEA process
incision into neck to get to carotid artery and plaque removed
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Carotid Endarterectomy goal
stroke prevention
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Carotid Endarterectomy patient
TIA symptoms or has had a TIA
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Carotid Endarterectomy Post Op
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
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L/R Hemisphere Deficits: common
paralyzed Left side of body if Right Hemisphere
| paralyzed Right side of body if Left Hemisphere
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L/R Hemisphere Deficits: Behavioral Style
R Hemisphere injury - quick, impulsive behavior
| L Hemisphere injury - slow, cautious behavior
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L/R Hemisphere Deficits: Behavioral Style
R Hemisphere injury - quick, impulsive behavior, short attention span
L Hemisphere injury - slow, cautious behavior
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L/R Hemisphere disability awareness
R Hemisphere injury - indifference to disability
| L Hemisphere injury - aware of disability, so depression
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homonymous hemianopsia is
see only half visual field
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homonymous hemianopsia is visual or brain problem?
brain function problem, not eyes themselves
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homonymous hemianopsia pt. sees
only one side, right or left, of the vision world with each eye
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homonymous hemianopsia Left Hemisphere damage
loss of right half of visual world in each eye
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homonymous hemianopsia R Hemisphere damage
loss of left half of visual world in each eye
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amorphosynthesis is
R Hemisphere damage, pt. unaware of somatic sensations from left side of body
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dysarthria is
slurred speech due to muscle weakness
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expressive asphasia from which area?
Broca
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receptive asphasia from which area?
Wernicke
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assess dysphagia/difficulty swallowing
bedside swallow screen
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CVA 3 Nursing Assessments
Neurologic (intracranial pressure, LOC, seizure risk, eyes), Cincinnati Stroke Scale, NIH Stroke Scale
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CVA 3 Priority Labs
CBC (RBC, WBC, Platelets), Serum Glucose, Basic Metabolic Panel (BUN, Creatitine, elec)
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CVA serum glucose
rule out hypo/hyperglycemia, must be measured before admin tPA
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CVA 3 Nursing Interventions
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
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post CVA assessment include
depression
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intracranial pressure prevention
no cough, no sneeze, no defecation
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TIA necrosis?
no
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peripheral pain stimulation, ex:
apply pressure to finger, push down on fingernail hard, if pt. witdraws/pulls finger away = localized pain
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painful stimulation purpose
establish a baseline of neurological status
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2 types of painful stimuli
central and peripheral
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eyes and painful stimuli, when
pt. does not spontaneously open eyes or open after shouting/verbal stimuli, painful stimulus (supraorbital pressure) is done to get a response
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supraorbital pressure purpose
elicit eye response if not done by pt. voluntarily
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painful stimuli responses and cerebral function
mpre purposeful response indication of higher level cerebral function
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pupils and CVA
change in size, shape, accommodation before and after exposure to light can indicate inc intracranial pressure
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VS and CVA
VS can change quickly/unstable with brain injury
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Glasgow Coma Scale purpose
determine conscious state (under 8 = coma)
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pupillary response like unequal or dilated pupils may signal
increase intracranial pressure
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central pain stimulus locations
central part of body supraorbital, sternal rub, trapezius squeeze
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neurological assessment: 6
1. LOC
2. orientation
3. speech
4. facial symmetry
5. motor and sensory function
6. reflexes
