CVA/Aneurysm Flashcards

1
Q

4 different types of CVA’s

A

ischemic
hemorrhagic
TIA
Aneurysm

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2
Q

when dx CVA

A

determine whether its a true CVA
determine if its ischemic or hemorrhagic
*CT of head w/o contrast - GOLD STANDARD
cardiac workups - syncope related?

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3
Q

single most modifiable risk factor for CVA

A

HTN

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4
Q

Prevention interventions for CVA’s

A

HTN management - blood pressure screenings
take meds daily (beta blockers)
smoking cessation
diabetes control
ongoing medical mgmt.
cholesterol (r/t ischemic stroke - plaque build-up)

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5
Q

Pharmacologic interventions for CVA’s

A

focus on TIA’s - prevent from full out stroke
anti-platelets
ASA/Plavix/Coumadin

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6
Q

with a TIA pt. WILL have an ischemic stroke, t or f

A

true, its just a matter of when

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7
Q

what do we want to tell our pt. on Coumadin/blood thinners

A

freq blood test (INR)

pt. safety - falls (avoid injury)

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8
Q

what dx test will pt. receive if presenting with TIA

A

Doppler scan of carotid arteries

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9
Q

if occlusion of carotid artery(s) what are 2 options for trt

A
carotid endarterectomy(CEA)"rotorooter" of carotid artery
transluminal angioplasty w/stenting
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10
Q

a brief hospital stay is required with CEA/stenting procedure. t or f

A

true

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11
Q

what happens in a carotid endarterectomy (CEA)

A

general anesthesia - incision - rid of plaque/open lumen

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12
Q

problems r/t CEA carotid endarterectomy

A
BP drops (used to having to be elevated) - VS frequently 
risk for ischemic stroke - neuro checks q15/sev. hrs.
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13
Q

Thomas Jefferson is admitted to the ED after his coworker noticed Mr. Jefferson begin experiencing unilateral weakness when trying to pour his coffee. He is brought to JHN by EMT. Once arriving in the ED, the first priority for Mr. Jefferson is to have a _____ to determine if he is having a ____stroke or a _____stroke.

A

CT Scan - Ischemic - Hemorrhagic

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14
Q

if CT scan confirms ischemic stroke what will be done

A

tPA (tissue plasminogen activator) - protein=clot buster

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15
Q

when is tPA administered

A

within 3 hrs. of stroke - very good prognosis

if time is unknown not a candidate for tPA

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16
Q

is tPA given for pt w/hemorrhagic stroke

A

no - never

17
Q

contraindications w/tPA

A

ANY BLEED (head trauma, GI bleed, recent surgery)

18
Q

risks for tPA

A

hemorrhagic stroke

19
Q

how is tPA administered

A
IV - bolus then continuous
PLAN AHEAD  (Foley/2 additional iv sites - additional sticks bleed profusely)
20
Q

nurse mgmt. while admin. tPA

A

manage VS and neurologic status

21
Q

mgmt. of acute ischemic stroke phase

A
monitor elevated BP
fluid balance
nutritional needs
monitor for hyperglycemia/hyperthermia (ice packs)
seizure precautions (prophylactic care)
22
Q

mgmt. for aneurysm

A

clipping (saccular aneurysm cutting off blood flow)
wrapping- synthetic material reinforces wall
coiling - catheter through femoral artery

23
Q

IICP is more common in pt. w/hemorrhagic stroke, t or f

24
Q

interventions for hemorrhagic stroke

A

Calcium channel blocker (nimodipine)

prepare for OR

25
Q

to assess severity of a stroke use

A

NHISS - Health Stroke Scale (the higher the number the more likely long term disability effects)

26
Q

right vs. left sided infarct presentation

A

right-sided damage - see left sided sequela (more impulsive/safety concern)
left-sided damage - see rt. sided sequela (more aware = depression - more cautious)

27
Q

most obvious sign of stroke

A

motor deficit
akinesia - loss of skilled voluntary movements
swallowing deficit

28
Q

when pt. receives thickened fluids/food for the 1st time do this

A

assess gag reflex - worried for aspiration
sit pt. up - maintain for 30 min. after eating
take small bites
ensure food isn’t stuck in pockets of mouth
provide oral care

29
Q

don’t feed anyone without a gag reflex, t or f

30
Q

communication with stroke

A

aphasia - dominant hemisphere of brain is effected
dysphasia - difficulty understanding or using language (partial disruption/loss)
dysarthria - trouble pronouncing words

31
Q

care of pt w/communication issues r/t stroke

A

ask yes or no questions

take your time - don’t rush them

32
Q

care of pt w/impaired urinary issues

A

establish good i/o and toileting routine/schedule

usually come back with time (Foley initially)

33
Q

long term goal of stroke pt.

A

decrease the amount of long term disability