CVA lecture

Question 1

what is a stroke

Answer 1

“brain attack” - obstruction of cerebral blood flow

two types: ischemic (more common) + hemorrhagic

Question 2

what is a TIA?

Answer 2

“mini stroke”
- brief episode (mins to few hrs)
- stroke like symptoms
- TEMPORARY blockage

symptoms completely resolve

Question 3

what is the treatment for TIA?

Answer 3

OBs admin (24-48 hrs)

dual antiplatelets (short term) = aspirin or plavix
statin = atorvastatin
telemetry
carotid doppler
echocardiogram = clotting, PFO
lifestyle changes
neuro follow up

Question 4

what is an ischemic stroke?

Answer 4

blood vessel blocked + cuts off blood supply (oxygen) = death of brain cells

Question 5

what is an embolic stroke?

Answer 5

type of ischemic stroke

clot or plaque that forms somewhere else in the body + travels to brain (A fibrillation)

Question 6

what is a thrombotic stroke?

Answer 6

type of ischemic stroke

clot or blockage forms in the brain (carotid artery stenosis)

Question 7

what is the frontal lobe in charge of?

Answer 7

thinking, speaking, memory + movement

Question 8

what is the parietal lobe in charge of?

Answer 8

language and processing touch and sensory info

Question 9

what is the temporal lobe in charge of?

Answer 9

hearing, learning, processing feelings

Question 10

what is the occipital lobe in charge of?

Answer 10

vision and color perception

Question 11

what is the cerebellum in charge of?

Answer 11

balance and coordination

Question 12

what is the brainstem in charge of?

Answer 12

breathing, heart rate, temperature regulation

Question 13

what is the left side of the brain in charge of?

Answer 13

LOGIC

speaking, writing, math skills, analyzing info, planning, controls right side of body

Question 14

what is the right side of the brain in charge of?

Answer 14

CREATIVITY

Question 15

what is the right side of the brain in charge of?

Answer 15

CREATIVITY

attention span, emotions, problem solving, reasoning (jokes), judgement calls, memory recall, music/art awareness, controls left side of body

Question 16

what happens during left brain injury?

Answer 16

right sided weakness
aphasia (word formation + comprehension)
aware of limits (angry, depressed, frustrated)
trouble understanding written text
writing issues
impaired math skills

INTACT MEMORY

Question 17

what happens during right brain injury?

Answer 17

left side weakness
creative impairment (art/music)
confusing time, date, places
can’t recognize faces or names
loss of depth perception
short attention span/trouble staying on topic
spatial-perceptual deficit
nonverbal interpretation
lack of awareness of deficits
impulsive + poor judgement

Question 18

what are the s/s of a stroke?

Answer 18

one sided weakness
sudden severe weakness
vision changes
HA
aphasia
paresthesias (painless numbness or tingling)
dizziness
difficulty walking

Question 19

what is BE FAST?

Answer 19

B – Balance (loss of balance, headache, confusion, dizziness)
E – Eyes (blurry eyes, loss of vision)
F – Facial (face uneven – sudden weakness or droopiness of the face)
A – Arms (arm is weak. Sudden weakness or numbness in one or both arms/legs)
S – Speech difficulties (Trouble speaking, speech is slurred or garbled)
T – Time (Call 911! The sooner the treatment begins, the better the chances of recovery)

Question 20

how is a stroke diagnosed?

Answer 20

hx and physical
CBC, BMP, cardiac biomarkers, coagulation studies
EKG (dont delay CT or MRI)
CT scan (rule out bleeding)
MRI (determines ischemic zone)

carotid doppler
echocardiogram
cerebral angiography

*Important to differentiate ischemic from hemorrhagic

Question 21

what is code stroke?

Answer 21

ER within 1 hr of symptoms
within 5 min (vitals, EKG)
within 10 mins (see doctor for neuro eval)
within 25 mins (CT scan)
within 45 mins (diagnose)

if met t-PA (admin within 3 hrs)
admit to stroke unit in less than 3 hrs

Question 22

what is the treatment for ischemic strokes?

Answer 22

aggressive intervention to attempt reperfusion (once infarction occurs damage is irreversible)

pharmacologic tx:
t-PA (clot buster) = help reduce damage brain cells + dec symptoms (gold standard), dont give after 3 hrs
dual anti-platelets therapy
statins
anticoagulants
antiepileptic meds

thromboectomy
supplemental oxygen (risk: aspiration pneumonia)
BP control
diabetic control (80-110)
control arrthymias

Question 23

what is a thromboectomy?

Answer 23

physically removing the clot

done after patient has received t-PA and within 6 hours of acute stroke symptoms

Question 24

what is t-PA?

Answer 24

**only used ischemic stroke
goal = give within 60 mins
**contraindicated for hemorrhagic stroke or more than 3 hrs

eligibility:
age > 18
pre-stroke status
SBP <185 and DBP <110
not for minor stroke or rapidly resolving symptoms
no prior intracerebral hemorrhage, AVM< aneurysm or tumor
no major surgery past 14 days
no GI or urinary bleeding past 21 days
no stroke or head trauma past 3 months

Question 25

what are the nursing interventions for using t-PA?

Answer 25

check for bleeding
neuro checks
vitals
labs
monitor glucose
prev injury (bedrest)
avoid unnecessary needle sticks, IV sticks, foley insertion
avoid IM insertions
around the clock neuro checks
BP meds for htn

Question 26

what is a hemorrhagic stroke?

Answer 26

when a weakened blood vessel in the brain ruptures - artery bleeds into brain (lack of O2 + nutrients)

pressure build up = irritation + swelling + further brain damage

intracerebral hemorrhage (within brain, HTN)

subarachnoid hemorrhage (b/t brain + meninges in SA space, aneurysm or AVM)

Question 27

what are the s/s of a hemorrhagic stroke?

Answer 27

sudden violent HA - “worse HA of life”

immediate loss of consciousness
seizures
N/V
visual disturbances

Question 28

what is the treatment of a hemorrhagic stroke?

Answer 28

administer O2
goal: prev or minimize re-bleeding, prevent complications
bedrest
fresh frozen plasma + vitamin K if bleeding
antiepileptic seizures
intermittent compression stockings
analgesics for head and neck pain

Question 29

what are the risk factors and causes of stroke?

Answer 29

age, race, htn, hyperlipidemia, diabetes, afib, carotid stenosis, heavy alc use, cardiac disease, tia hx, obesity, sedentary lifestyle, smoking, AV malformation

Question 30

what is the nursing care + assessment for strokes?

Answer 30

monitor ABCs
admin O2
careful hx + focused physical
eye opening/pupil size
neuro checks
seizure precautions
intake/output
any bleeding
BP/permissive htn
aspiration pneumonia

Question 31

what are the ongoing assessments for stroke?

Answer 31

mental status
sensory/perception
swallowing ability
nutritional + hydration risk
skin integrity
activity tolerance
bowel/bladder function (retention or incontinence)

Question 32

what are goals for rehab?

Answer 32

prevent aspiration
improve mobility
relieve pressure
avoid shoulder pain
self-care
relieve discomfort
bowel/bladder continence
communication
prevent joint deformities

Question 33

what are the type of post-stroke disabilities?

Answer 33

paralysis or motor control problems (hemiplegia, hemiparesis, dysphagia)

sensory disturbances (loss of ability to feel touch, pain, temp), paresthesias, urinary incontinence

aphasia (expressive - difficulty expressing, receptive - difficulty understanding, global - most severe)

problems with memory + thinking (short term memory, making plans, learning)

emotional disturbances (fear, anxiety, sadness, frustration, anger, depression)

Question 34

what is the nursing intervention for dysphagia?

Answer 34

Swallow study
Thickened liquids recommended (not thin!)
Mechanical soft diet
Assist with eating
Touch chin to chest
Remove distractions
PATIENCE

Question 35

what is the nursing intervention for aphasia?

Answer 35

Remove distractions
Be patient
Repeat and rephrase
Encourage patient to repeat sounds of the alphabet
Speak clearly and unhurried

Question 36

what is the nursing intervention for receptive aphasia?

Answer 36

Use short phrases and simple details.
Use gestures

Question 37

what is the nursing intervention for expressive aphasia?

Answer 37

Be patient – let them speak and do not try to answer for them
Ask 1 question at a time
Communication board
Ask questions so they only have to give you a short simple response

Question 38

what is the nursing intervention for hemianopsia?

Answer 38

Place objects within intact field of vision
Injury prevention
Approach patient from side of intact field of vision
Instruct/remind patient to turn head in direction of visual loss to compensate for the loss of vision
Ensure driving ability is evaluated
For loss of peripheral vision, place objects in center of patient’s intact visual field
Have patient scan back and forth

Question 39

what are the potential complications for a stroke?

Answer 39

Aspiration pneumonia
Skin breakdown
Urinary tract infections
Complications of immobility
Deconditioning
Swallowing difficulties
Bowel and bladder dysfunction
Inability to perform self-care

Question 40

how to prevent strokes?

Answer 40

managing htn
healthy lifestyle choices (weight loss, minimal drinking, no smoking, exercise)
BP control
Lower cholesterol
Treat atrial fibrillation
Treat sleep apnea
Manage diabetes