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Clinical One > CVA Management > Flashcards

CVA Management Flashcards

1
Q

Supportive Care of Ischemic Stroke

A
  1. Maintain airway
  2. Control Fever
  3. Assess for arrhythmia
  4. Maintain blood pressure to maintain cerebral perfusion
  5. Maintain Blood Glucose of 140-180
  6. Prevent hospital related complications
  7. Initiate secondary prevention strategies to prevent recurrent stroke
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2
Q

Ways to maintain airway in Ischemic Stroke

Rationale?

A

Supplemental Oxygen
Ventilator Support

Prevent Hypoxia. Prevent Recurrent Stroke. Prevent Aspiration.

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3
Q

Ways to control fever in Ischemic Stroke

Rationale?

A

TTM
Anti-Pyretics

Prevent worse outcomes

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4
Q

Monitor for arrhythmias in Ischemic Stroke

Rationale?

A

MI
AF
Most common with ischemic stroke

Identify arrhythmias that can potentiate a CVA

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5
Q

Blood Pressure Management in Ischemic Stroke

Rationale?

A

Avoid treatment unless SBP >220 or DBP >120

Maintain CPP

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6
Q

Drug of choice for Hypertension in Ischemic Stroke

A
  1. Labetalol
  2. Hydralazine
  3. Nicardipine
  4. Nitroprusside (Last Resort)
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7
Q

When should you avoid thrombolytics in Ischemic Stroke

A

SBP >185 and DBP>110

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8
Q

Blood Glucose Management in Ischemic Stroke

A

Normal Saline
Intravenous or Subcutaneous Regular Insulin
Maintain target range of 140-180

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9
Q

Most commmon complication of Ischemic Stroke Management

A
  1. Aspiration Pneumonia
  2. CAUTI
  3. CLABSI
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10
Q

Medical Management of Acute Ischemic Stroke

A
  1. Thrombolytics
  2. Anticoagolants
  3. Antiplatelets
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11
Q

Risk Factors for Ischemic Stroke

A
  1. Hypertension
  2. Diabeties Mellitus
  3. Dyslipidemia
  4. Smoking
  5. Alcoholism
  6. Obesity
  7. Sedentary Lifestyle
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12
Q

Reccomendations for Hypertension

A

Maintain SBP of <140 and DBP <90

Diuretics, ACEi

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13
Q

Reccomendations for Diabeties Mellitus

A
  1. Maintain SBP of <130 and DBP <80
  2. Maintain GLU <126 or A1C <7%

ACEi, ARBs, Hypoglycemics, Insulin

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14
Q

Reccomendations for Lipids

A
  1. Maintain LDL <100 for Low Risk
  2. Maintain LDL <70 for High Risk

Statins, Niacin, Gemfibrozil

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15
Q

Reccomendations for Cigarette Smoking

A
  1. Smoking Cessation
  2. Nicotine cessation products
  3. Counseling
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16
Q

Reccomendations for Alcoholism

A
  1. Decrease Alcohol intake
  2. Provide formal alcohol cessation programs
  3. Reccomend <2 drinks per day
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17
Q

Reccomendations for Obesity

A
  1. Goal BMI of 18.5-24.9
  2. <35 waist for women
  3. <40 waist for men
  4. Weight Reduction programs
18
Q

Reccomendations for Sedentary Lifestyle

A

30 minutes of moderate-high intensity exercise

19
Q

Reccomendations for CAD, Dysrhythmia, CHF, and valvular disease

A

Treat diease and the underlying etiology

20
Q

Thrombolytics

Rationale?

A

Alteplase (rt-PA)
0.9 mg/kg (MD: 90 mg)
10% Bolus with 1H infusion

Restore CBF, Reduce Ischemia, Limit Neurological Disability

21
Q

Anticoagulants

A

IV Heparin

Not reccomended after rt-PA administration

22
Q

Antiplatelets

A
  1. ASA
  2. Ticlopidine
  3. Clopidogrel
  4. Dipyridamole
23
Q

Reccomendations for ASA after Ischemic Stroke

A
  1. 162-324 within 48h
  2. Not an alternative to rt-PA
  3. Abciximab is not reccomended
24
Q

Surgical Interventions for Ischemic Stroke

A
  1. Craniectomy
  2. Carotid Endarterectomy
  3. EC-IC bypass through the STA to the MCA
  4. Rehabilitation

EC-IC bypass is not reccomended

25
Q

Nursing Management of Intracranial Hemorrhage (ICH)

A
  1. Assessment and Monitoring
  2. Implementation and Titration of Protocols
  3. Safety and Prevention of Complications related to Immobilization
  4. Early Rehabilitation and Recovery
26
Q

ICH Assessment and Monitoring

A
  1. Comprehensive Neurological Assessment
  2. Vital Signs
  3. GCS
  4. ECG
  5. ICP level
27
Q

Complications related to Immobilization in ICH

A
  1. Hypoxemia
  2. Hypoglycemia
  3. Hyperglycemia
  4. Increased ICP
  5. Paresis
  6. Paresthesia
  7. Paralysis
  8. Gastrointestinal Bleeding
  9. Hypertension
  10. Reperfusion Injury
  11. Electrolyte Imbalances
  12. Dysrhythmias
  13. DVT
  14. PE
  15. ATC Therapy effects
  16. Thrombolytic Therapy effects
28
Q

Early Rehabilitation and Recovery

A

Begin rehab as early as possible

29
Q

Nursing Diagnoses

IS/ICH

A

Ineffective airway clearance
Ineffective breathing pattern
Risk of aspiration
Altered Cerebral Tissue Perfusion
Risk of Infection
Impaired Verbal Communication
Impaired Physical Mobility
Risk for DVT/PE
Nutrition Deficit
Altered Urinary Elimination
Altered Role Performance
Unilateral Neglect
Disuse Syndrome

30
Q

Performance Measures for ICH

A
  1. Baseline NIHSS
  2. Coagulopathy Reversal
  3. VTE Prophylaxis
  4. Admission Unit
  5. Dysphagia Screening within 24h
  6. Passed Dysphagia Screening Test before initial intake
  7. Long-Term Blood Pressure Treatment
  8. Assessment for Rehab
  9. Avoidance of corticosteroid use
31
Q

Performance Measure: Coagulopathy Reversal

A

INR >1.4 and recieved vitamin K within 90 minutes

32
Q

Performance Measure: VTE Prophylaxis

A

Lower limb pneumatic compression on Day One

33
Q

Performance Measure: Dysphagia Screening

A

Completed within 24 hours of admission

34
Q

Performance Measure: Long-Term B/P Control

A

BP <130/80 by discharge

35
Q

Putaminal Hemorrhage

A

Hematoma into the putamen of the basal ganglia

36
Q

Thalamic Hemorrhage

A

Hematoma into the thalamic region

37
Q

Pontine Hemorrhage

A

Hematoma into the pons

38
Q

Cerebellar Hemorrhage

A

Hematoma into the cerebellum

39
Q

Diagnostics for ICH

A

Noncontrast CT
CT Angiography
MRI

40
Q

Blood Pressure Management in ICH

A

150-220 SBP with no contraindications

41
Q

Surgical Intervention in ICH

A

Hematoma Evacuation
Decompression Craniectomy with or without Hematoma evacuation

Clinical One (8 decks)

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