CVA Management Flashcards
Supportive Care of Ischemic Stroke
- Maintain airway
- Control Fever
- Assess for arrhythmia
- Maintain blood pressure to maintain cerebral perfusion
- Maintain Blood Glucose of 140-180
- Prevent hospital related complications
- Initiate secondary prevention strategies to prevent recurrent stroke
Ways to maintain airway in Ischemic Stroke
Rationale?
Supplemental Oxygen
Ventilator Support
Prevent Hypoxia. Prevent Recurrent Stroke. Prevent Aspiration.
Ways to control fever in Ischemic Stroke
Rationale?
TTM
Anti-Pyretics
Prevent worse outcomes
Monitor for arrhythmias in Ischemic Stroke
Rationale?
MI
AF
Most common with ischemic stroke
Identify arrhythmias that can potentiate a CVA
Blood Pressure Management in Ischemic Stroke
Rationale?
Avoid treatment unless SBP >220 or DBP >120
Maintain CPP
Drug of choice for Hypertension in Ischemic Stroke
- Labetalol
- Hydralazine
- Nicardipine
- Nitroprusside (Last Resort)
When should you avoid thrombolytics in Ischemic Stroke
SBP >185 and DBP>110
Blood Glucose Management in Ischemic Stroke
Normal Saline
Intravenous or Subcutaneous Regular Insulin
Maintain target range of 140-180
Most commmon complication of Ischemic Stroke Management
- Aspiration Pneumonia
- CAUTI
- CLABSI
Medical Management of Acute Ischemic Stroke
- Thrombolytics
- Anticoagolants
- Antiplatelets
Risk Factors for Ischemic Stroke
- Hypertension
- Diabeties Mellitus
- Dyslipidemia
- Smoking
- Alcoholism
- Obesity
- Sedentary Lifestyle
Reccomendations for Hypertension
Maintain SBP of <140 and DBP <90
Diuretics, ACEi
Reccomendations for Diabeties Mellitus
- Maintain SBP of <130 and DBP <80
- Maintain GLU <126 or A1C <7%
ACEi, ARBs, Hypoglycemics, Insulin
Reccomendations for Lipids
- Maintain LDL <100 for Low Risk
- Maintain LDL <70 for High Risk
Statins, Niacin, Gemfibrozil
Reccomendations for Cigarette Smoking
- Smoking Cessation
- Nicotine cessation products
- Counseling
Reccomendations for Alcoholism
- Decrease Alcohol intake
- Provide formal alcohol cessation programs
- Reccomend <2 drinks per day
Reccomendations for Obesity
- Goal BMI of 18.5-24.9
- <35 waist for women
- <40 waist for men
- Weight Reduction programs
Reccomendations for Sedentary Lifestyle
30 minutes of moderate-high intensity exercise
Reccomendations for CAD, Dysrhythmia, CHF, and valvular disease
Treat diease and the underlying etiology
Thrombolytics
Rationale?
Alteplase (rt-PA)
0.9 mg/kg (MD: 90 mg)
10% Bolus with 1H infusion
Restore CBF, Reduce Ischemia, Limit Neurological Disability
Anticoagulants
IV Heparin
Not reccomended after rt-PA administration
Antiplatelets
- ASA
- Ticlopidine
- Clopidogrel
- Dipyridamole
Reccomendations for ASA after Ischemic Stroke
- 162-324 within 48h
- Not an alternative to rt-PA
- Abciximab is not reccomended
Surgical Interventions for Ischemic Stroke
- Craniectomy
- Carotid Endarterectomy
- EC-IC bypass through the STA to the MCA
- Rehabilitation
EC-IC bypass is not reccomended
Nursing Management of Intracranial Hemorrhage (ICH)
- Assessment and Monitoring
- Implementation and Titration of Protocols
- Safety and Prevention of Complications related to Immobilization
- Early Rehabilitation and Recovery
ICH Assessment and Monitoring
- Comprehensive Neurological Assessment
- Vital Signs
- GCS
- ECG
- ICP level
Complications related to Immobilization in ICH
- Hypoxemia
- Hypoglycemia
- Hyperglycemia
- Increased ICP
- Paresis
- Paresthesia
- Paralysis
- Gastrointestinal Bleeding
- Hypertension
- Reperfusion Injury
- Electrolyte Imbalances
- Dysrhythmias
- DVT
- PE
- ATC Therapy effects
- Thrombolytic Therapy effects
Early Rehabilitation and Recovery
Begin rehab as early as possible
Nursing Diagnoses
IS/ICH
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
Performance Measures for ICH
- Baseline NIHSS
- Coagulopathy Reversal
- VTE Prophylaxis
- Admission Unit
- Dysphagia Screening within 24h
- Passed Dysphagia Screening Test before initial intake
- Long-Term Blood Pressure Treatment
- Assessment for Rehab
- Avoidance of corticosteroid use
Performance Measure: Coagulopathy Reversal
INR >1.4 and recieved vitamin K within 90 minutes
Performance Measure: VTE Prophylaxis
Lower limb pneumatic compression on Day One
Performance Measure: Dysphagia Screening
Completed within 24 hours of admission
Performance Measure: Long-Term B/P Control
BP <130/80 by discharge
Putaminal Hemorrhage
Hematoma into the putamen of the basal ganglia
Thalamic Hemorrhage
Hematoma into the thalamic region
Pontine Hemorrhage
Hematoma into the pons
Cerebellar Hemorrhage
Hematoma into the cerebellum
Diagnostics for ICH
Noncontrast CT
CT Angiography
MRI
Blood Pressure Management in ICH
150-220 SBP with no contraindications
Surgical Intervention in ICH
Hematoma Evacuation
Decompression Craniectomy with or without Hematoma evacuation