CVA Ischemic Flashcards
What is the most common type of stroke?
Ischemic
Why are ischemic strokes more common than hemorrhagic?
High cholesterol patients who are uncompliant are super common
Why do we call strokes brain attack?
To make it sound more urgent
You notice your new admit has hx of stroke. What do you need to assess for or ask?
Ask about any deficits they have due to the stroke
What do we need to get “on board early” in to help with a stroke and minimize damage?
Thrombolytics in order to break up the clot
What is the treatment window that begins after the onset of stroke?
3 hour window after onset of the stroke
- and this doesn’t mean when the patient got care. This means pay attention to the last known well.
When there’s a clot causing an ischemic clot, what does the decrease in blood flow result in patho wise?
Anaerobic activity, acidosis, and then cell death which is permanent
What is the brain being deprived of if there’s a stroke? Two things
Blood
Glucose
T/F
You can bring back dead brain tissue
False. If it’s dead, its gone.
T/F
You can race to try to prevent brain tissue from dying.
True - you can try to inhibit as much brain tissue from dying as possible.
You push calcium gluconate. Your patient goes stiff and then stars slurring speech. What do you do?
Calcium can make you seize up - so push it slow.
What do the vessels do when the stroke causes continued loss of function: vasodilation or vasoconstriction?
Vasoconstriction - which makes it worse and causes more damage.
What is the acute goal of care for a stroke patient?
Race against time to inhibit the amount of brain tissue affected with neuroprotectants of some sort in order to avoid long term effects and secondary injury.
What do clinical symptoms of strokes depend on?
Depends on locations of the vessels as well as the size of the area that isn’t being perfused and if they have collateral to buy time.
What is collateral blood flow?
The amount of blood able to flow despite the clot
Which patients have less collateral and higher cholesterol?
Older patients - high cholesterol
Diabetes patients -less collateral
What nature of vessels do patients have that are noncompliant with cholesterol and diabetes regiment?
Brittle vessels which is an aneurysm breaking risk
What clinical symptoms will you see with a stroke patient? (for ischemic and hemorrhagic)
Slurred words Movement deficits Sensory loss Perceptual disturbances Depression Personality changes
But this all depends on the location
Patient has hx of stroke. What do you need to assess respiratory wise?
Assess airway patency - they lose that protective mechanism in a stroke and you may have to intubate them
What is a TIA?
Warning sign that a big stroke is coming
TIA symptoms
Headache
Confusion
Very temporary. Less than 1 hour.
What diagnostic do TIA’s show up on?
None
How do they determine if a stroke is ischemic or hemorrhagic?
CT w/o contrast
but most of the time they can do an MRI combo too
What age group is at increased risk for stroke?
Those above 55
What gender is at increased risk of stroke?
Men
What race has increased risk of stroke?
African american
What do we use as secondary prevention in a. fib patients who stroke or TIA
anticoagulation; coumadin, warfarin
What some platelet inhibiting meds patients will be on following an ischmic stroke or TIA?
Aspirin Plavix (clopidogrel)
Why do we put patients on statins following an ischemic stroke or TIA?
Statins benefit cholesterol levels - but it requires compliance
Why are patients who have history of A fib. at risk for ischemic stroke?
The blood stasis causing them to throw a clot to the brain
What meds do we do for secondary prevention following a stroke or TIA?
Anticoagulation w a. fib
Platelet inhibitors
Statins
Antihypertensives
Why do we give antihypertensives following an ischemic stroke?
Decrease pressure on the vessels and decrease risk of stroke and aneurysm
What surgeries will they do following a TIA or ischemic stroke? (2)
Carotid endarterectomy
Carotid stenting
What thrombolytic therapy will they use for an ischemic stroke?
t-PA
- stimulates fibrinolysis by converting plasminogen to plasmin
In order to do t-PA stroke intervention, what is the window?
Needs to be within 3 hours of onset of the stroke which is based off the last known well.
Why is the window for thrombolytic t-PA 3 hours?
After 3 hours, if we allow blood to flow again it can increase edema and hemorrhage risk
Your a new grad. Can you give t-PA?
Probably not. You have to be certified.
What is a big complaint of a stroke?
Worst headache of their lives
What are contraindications of doing the t-PA for an ischemic stroke?
Don’t do it if its outside of the 3 hour window
Don’t give if the patient has had anticoagulants within last 24 hours
or has an INR greater than 1.7 (risk for bleeding)
What medication will you avoid after doing t-PA therapy ?
Avoid anticoagulants for 24 hours
What endovascular treatment options are
available for an ischemic stroke?
Intra-arterial thrombolysis to break it up and mechanically suction out the clot
Guided by angiogram
When breaking up a clot, what are we putting the patient at risk for?
Hemorrhage
Microclots spreading
- explains why we need a specialist
What is the main theme of your job as the nurse during the acute phase of the stroke?
Monitor all systems! LOC Cardio - include BP Respiratory Motor - symmetry Pupils - sluggish on opposite side Skin temp - receptors in the brain control temp receptors for thermoregulation I&O - deficit can affect bowel and bladder Bleeding Ability to speak - may need rehab
After the acute phase, what do you focus on?
Impairment of function and rehab. Hone in on these
- mental status
- sensation/perception changes
- motor control
- can they swallow
- nutrition
- bowel and bladder
- adls
Quality of life is closely related to ______ _____.
Functional status
- if they can be independent, then thats indicative of their ability to function
Why do we need to know the baseline of the patient before the stroke when trying to consider after care and needs?
It helps us understand how big of a change the patient is going through due to the stroke. If their baseline was already hindered, then it may not be as traumatic for them.
When family is asking questions about stroke outcomes and long term effects, what do you do?
Be honest without diagnosing the patient. Tell them the possibilities so they have realistic understanding.
What do the outcomes of stroke depend on?
Age
NIH
LOC at time of admission
Your patient is having a stroke. Can you do the NIH score?
You have to be certified - BUT you can be assessing the patient before hand so when someone who can score them knows without having to assess.
How can we prevent shoulder pain related to slumping?
Pillows
You have patients who are giving up on ADLS. What do you do?
Continue to be encouraging
Why is it important we pay attention to skin integrity with a stroke patient?
They may not be able to move or they may not have control of bowel and bladder so we need to monitor the sites.
Why is communication improvement important for the nurse to help out with?
A patient may not be able to communicate and it can become frustrating
How can we improve though process to a stroke patinet
We may have to re-orient them
How can bladder and bowel control be attained?
OT and PT
After the acute phase, and trying to establish if the patient can swallow, who does it?
Eval with speech most likely
Why is it important to consider the nutrition and hydration of the patient after the acute phase of the stroke?
They may need a specific diet like thickened , puree, etc.
