CVA/Aneurysm Flashcards
4 different types of CVA’s
ischemic
hemorrhagic
TIA
Aneurysm
when dx CVA
determine whether its a true CVA
determine if its ischemic or hemorrhagic
*CT of head w/o contrast - GOLD STANDARD
cardiac workups - syncope related?
single most modifiable risk factor for CVA
HTN
Prevention interventions for CVA’s
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)
Pharmacologic interventions for CVA’s
focus on TIA’s - prevent from full out stroke
anti-platelets
ASA/Plavix/Coumadin
with a TIA pt. WILL have an ischemic stroke, t or f
true, its just a matter of when
what do we want to tell our pt. on Coumadin/blood thinners
freq blood test (INR)
pt. safety - falls (avoid injury)
what dx test will pt. receive if presenting with TIA
Doppler scan of carotid arteries
if occlusion of carotid artery(s) what are 2 options for trt
carotid endarterectomy(CEA)"rotorooter" of carotid artery transluminal angioplasty w/stenting
a brief hospital stay is required with CEA/stenting procedure. t or f
true
what happens in a carotid endarterectomy (CEA)
general anesthesia - incision - rid of plaque/open lumen
problems r/t CEA carotid endarterectomy
BP drops (used to having to be elevated) - VS frequently risk for ischemic stroke - neuro checks q15/sev. hrs.
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.
CT Scan - Ischemic - Hemorrhagic
if CT scan confirms ischemic stroke what will be done
tPA (tissue plasminogen activator) - protein=clot buster
when is tPA administered
within 3 hrs. of stroke - very good prognosis
if time is unknown not a candidate for tPA
is tPA given for pt w/hemorrhagic stroke
no - never
contraindications w/tPA
ANY BLEED (head trauma, GI bleed, recent surgery)
risks for tPA
hemorrhagic stroke
how is tPA administered
IV - bolus then continuous PLAN AHEAD (Foley/2 additional iv sites - additional sticks bleed profusely)
nurse mgmt. while admin. tPA
manage VS and neurologic status
mgmt. of acute ischemic stroke phase
monitor elevated BP fluid balance nutritional needs monitor for hyperglycemia/hyperthermia (ice packs) seizure precautions (prophylactic care)
mgmt. for aneurysm
clipping (saccular aneurysm cutting off blood flow)
wrapping- synthetic material reinforces wall
coiling - catheter through femoral artery
IICP is more common in pt. w/hemorrhagic stroke, t or f
true
interventions for hemorrhagic stroke
Calcium channel blocker (nimodipine)
prepare for OR
to assess severity of a stroke use
NHISS - Health Stroke Scale (the higher the number the more likely long term disability effects)
right vs. left sided infarct presentation
right-sided damage - see left sided sequela (more impulsive/safety concern)
left-sided damage - see rt. sided sequela (more aware = depression - more cautious)
most obvious sign of stroke
motor deficit
akinesia - loss of skilled voluntary movements
swallowing deficit
when pt. receives thickened fluids/food for the 1st time do this
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
don’t feed anyone without a gag reflex, t or f
true
communication with stroke
aphasia - dominant hemisphere of brain is effected
dysphasia - difficulty understanding or using language (partial disruption/loss)
dysarthria - trouble pronouncing words
care of pt w/communication issues r/t stroke
ask yes or no questions
take your time - don’t rush them
care of pt w/impaired urinary issues
establish good i/o and toileting routine/schedule
usually come back with time (Foley initially)
long term goal of stroke pt.
decrease the amount of long term disability
