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2.0 Adult Nursing Exam 4 > CVA Ischemic > Flashcards

CVA Ischemic Flashcards

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1
Q

What is the most common type of stroke?

A

Ischemic

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2
Q

Why are ischemic strokes more common than hemorrhagic?

A

High cholesterol patients who are uncompliant are super common

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3
Q

Why do we call strokes brain attack?

A

To make it sound more urgent

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4
Q

You notice your new admit has hx of stroke. What do you need to assess for or ask?

A

Ask about any deficits they have due to the stroke

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5
Q

What do we need to get “on board early” in to help with a stroke and minimize damage?

A

Thrombolytics in order to break up the clot

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6
Q

What is the treatment window that begins after the onset of stroke?

A

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.

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7
Q

When there’s a clot causing an ischemic clot, what does the decrease in blood flow result in patho wise?

A

Anaerobic activity, acidosis, and then cell death which is permanent

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8
Q

What is the brain being deprived of if there’s a stroke? Two things

A

Blood

Glucose

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9
Q

T/F

You can bring back dead brain tissue

A

False. If it’s dead, its gone.

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10
Q

T/F

You can race to try to prevent brain tissue from dying.

A

True - you can try to inhibit as much brain tissue from dying as possible.

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11
Q

You push calcium gluconate. Your patient goes stiff and then stars slurring speech. What do you do?

A

Calcium can make you seize up - so push it slow.

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12
Q

What do the vessels do when the stroke causes continued loss of function: vasodilation or vasoconstriction?

A

Vasoconstriction - which makes it worse and causes more damage.

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13
Q

What is the acute goal of care for a stroke patient?

A

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.

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14
Q

What do clinical symptoms of strokes depend on?

A

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.

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15
Q

What is collateral blood flow?

A

The amount of blood able to flow despite the clot

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16
Q

Which patients have less collateral and higher cholesterol?

A

Older patients - high cholesterol

Diabetes patients -less collateral

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17
Q

What nature of vessels do patients have that are noncompliant with cholesterol and diabetes regiment?

A

Brittle vessels which is an aneurysm breaking risk

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18
Q

What clinical symptoms will you see with a stroke patient? (for ischemic and hemorrhagic)

A 
Slurred words 
 Movement deficits 
 Sensory loss 
 Perceptual disturbances 
 Depression 
 Personality changes

But this all depends on the location

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19
Q

Patient has hx of stroke. What do you need to assess respiratory wise?

A

Assess airway patency - they lose that protective mechanism in a stroke and you may have to intubate them

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20
Q

What is a TIA?

A

Warning sign that a big stroke is coming

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21
Q

TIA symptoms

A

Headache
Confusion
Very temporary. Less than 1 hour.

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22
Q

What diagnostic do TIA’s show up on?

A

None

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23
Q

How do they determine if a stroke is ischemic or hemorrhagic?

A

CT w/o contrast

but most of the time they can do an MRI combo too

24
Q

What age group is at increased risk for stroke?

A

Those above 55

25
Q

What gender is at increased risk of stroke?

A

Men

26
Q

What race has increased risk of stroke?

A

African american

27
Q

What do we use as secondary prevention in a. fib patients who stroke or TIA

A

anticoagulation; coumadin, warfarin

28
Q

What some platelet inhibiting meds patients will be on following an ischmic stroke or TIA?

A 
Aspirin
Plavix (clopidogrel)
29
Q

Why do we put patients on statins following an ischemic stroke or TIA?

A

Statins benefit cholesterol levels - but it requires compliance

30
Q

Why are patients who have history of A fib. at risk for ischemic stroke?

A

The blood stasis causing them to throw a clot to the brain

31
Q

What meds do we do for secondary prevention following a stroke or TIA?

A

Anticoagulation w a. fib
Platelet inhibitors
Statins
Antihypertensives

32
Q

Why do we give antihypertensives following an ischemic stroke?

A

Decrease pressure on the vessels and decrease risk of stroke and aneurysm

33
Q

What surgeries will they do following a TIA or ischemic stroke? (2)

A

Carotid endarterectomy

Carotid stenting

34
Q

What thrombolytic therapy will they use for an ischemic stroke?

A

t-PA

- stimulates fibrinolysis by converting plasminogen to plasmin

35
Q

In order to do t-PA stroke intervention, what is the window?

A

Needs to be within 3 hours of onset of the stroke which is based off the last known well.

36
Q

Why is the window for thrombolytic t-PA 3 hours?

A

After 3 hours, if we allow blood to flow again it can increase edema and hemorrhage risk

37
Q

Your a new grad. Can you give t-PA?

A

Probably not. You have to be certified.

38
Q

What is a big complaint of a stroke?

A

Worst headache of their lives

39
Q

What are contraindications of doing the t-PA for an ischemic stroke?

A

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)

40
Q

What medication will you avoid after doing t-PA therapy ?

A

Avoid anticoagulants for 24 hours

41
Q

What endovascular treatment options are

available for an ischemic stroke?

A

Intra-arterial thrombolysis to break it up and mechanically suction out the clot
Guided by angiogram

42
Q

When breaking up a clot, what are we putting the patient at risk for?

A

Hemorrhage
Microclots spreading
- explains why we need a specialist

43
Q

What is the main theme of your job as the nurse during the acute phase of the stroke?

A 
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
44
Q

After the acute phase, what do you focus on?

A

Impairment of function and rehab. Hone in on these

  • mental status
  • sensation/perception changes
  • motor control
  • can they swallow
  • nutrition
  • bowel and bladder
  • adls
45
Q

Quality of life is closely related to ______ _____.

A

Functional status

- if they can be independent, then thats indicative of their ability to function

46
Q

Why do we need to know the baseline of the patient before the stroke when trying to consider after care and needs?

A

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.

47
Q

When family is asking questions about stroke outcomes and long term effects, what do you do?

A

Be honest without diagnosing the patient. Tell them the possibilities so they have realistic understanding.

48
Q

What do the outcomes of stroke depend on?

A

Age
NIH
LOC at time of admission

49
Q

Your patient is having a stroke. Can you do the NIH score?

A

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.

50
Q

How can we prevent shoulder pain related to slumping?

A

Pillows

51
Q

You have patients who are giving up on ADLS. What do you do?

A

Continue to be encouraging

52
Q

Why is it important we pay attention to skin integrity with a stroke patient?

A

They may not be able to move or they may not have control of bowel and bladder so we need to monitor the sites.

53
Q

Why is communication improvement important for the nurse to help out with?

A

A patient may not be able to communicate and it can become frustrating

54
Q

How can we improve though process to a stroke patinet

A

We may have to re-orient them

55
Q

How can bladder and bowel control be attained?

A

OT and PT

56
Q

After the acute phase, and trying to establish if the patient can swallow, who does it?

A

Eval with speech most likely

57
Q

Why is it important to consider the nutrition and hydration of the patient after the acute phase of the stroke?

A

They may need a specific diet like thickened , puree, etc.

2.0 Adult Nursing Exam 4 (8 decks)

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