CVA's Flashcards
how much % of CO is cerebral perfusion
20%
what is the real name for mini stroke
ischemic attack
what is reason for TIA
focal cerebral ischemia without infarction
1/3 of ppl who have a TIA will…
have a stroke
stroke S&S from a TIA last ….
for less than 1 hour
types of ischemic CVA
thrombotic (most common) and embolic
warning sign for ischemic CVA
TIA
are ischemic CVAs more common in men or women
more common in men
thrombotic ischemia onset, age, and major cause
onset: during sleep
median age is old
major cause: atherosclerosis
where is the source of most emboli
left atrial appendage
embolic CVA onset, recurrence, and major cause
onset: suddenly during physical activity
recurrence: common
major cause: emboli from the heart
most common cause of embolic CVA
a-fib
hemorrhagic CVA types
intracerebral
subarachnoid
big sign of hemorrhagic CVA
bad headache
are hemorrhagic CVAs more common in men or women
more common in women
what percent of ppl die after a HCVA
40-80%
what % of deaths from HCVA’s happen within the next 48 hours
50%
intracerebral HCVA onset and major cause
onset: activity
major cause: HTN
subarachnoid hemorrhage (SAH) onset and major cuase
onset: activity, head trauma
major cause: ruptured aneurysm
which type of HCVA has a younger median age
subarachnoid
which one is usually worse, subarachnoid or intracerebral HCVA
intracerebral
where is the bleeding occurring in a SAH
in the meninges
S&S of SAH
- severe HA
- nuchal rigidity
- brudzinski’s sign
- kernig’s sign
cushings triad
signs of IICP
- HTN with widened pulse pressure
- bradycardia
- irregular respirations
S&S of IICP
- decreased LOC and responsiveness
- fixed, dilated pupils
- cushings triad
- projectile vomiting
- hiccups
male and female “more likely’s” for CVAs
men: more likely to get a CVA
women: more likely to die from a CVA
what ethnicity is less likely to get a CVA
caucasian
major thing S&S for CVA
motor S&S affect contralateral side d/t corticospinal tract that crosses over medulla
left hemisphere CVA S&S
- right hemiplegia
- imp. speech and language
- imp. R/L discrimination
- imp. math comprehension
- awareness of problems, depressed
right hemisphere CVA S&S
- left hemiplegia
- spatial-perceptual deficits
- imp. judgement
- imp. time concept
- denies problems, impulsive
hemiparasthesia
sensation loss on one side
hemiparesis
weakness on one side
hemiplegia
no movement on one side
hypo/hyperreflexia
reflexes diminished or exaggerated
dysarthria
lack of muscular control for speech
dysphagia
lack of muscular control for swallowing
language deficit
expressive aphasia
- damage to brocas area
- non-fluent
communication deficit
- receptive aphasia
- Wernickes area
- fluent but doesnt know what you are saying
- dont know they arent making sense
global aphasia
- damage to both areas
- non-fluent
anomia
unable to name an object even though they know what it is
apraxia
unable to do a previously learned action
agnosia
unable to recognize familiar objects
prosopagnosia
unable to recognize faces of people they know
how does left CVA affect intellect
impaired memory
how does right CVA affect intellect
impaired judgement, impulsivity
spatial/perceptual deficits caused by a CVA
- parietal damage- denial of illness
- difficulty judging space/distance
- unilateral neglect
- homonymous hemianopsia
- apraxia
- agnosia
homonymous hemianopsia
loss of half of visual field form both eyes
- teach to scan the room
elimination probs from CVA
atonic bladder (spastic)
constipation
prehospital stroke teaching
BE FASTT
balance
eye/vision
face droop
arms weakness
speech slurred
tongue/time (4 hour window to get help)
initial acute care
ABC
CAB (if unresponsive- CPR first)
STAT CT or MRI
position head midline
HOB 30 degrees
remove dentures
give O2 if needed
NPO untul swallow study
IV access with NS
initiate seizure precautions
gold standard for DX test for CVA
non-contrast CT scan because you can see blood to rule out a HCVA
MRI is used to…
confirm ischemic CVA
cerebral angiography risk
worsening hemorrhage or loosening a clot
transcranial doppler (TCD) is used to…
assess blood flow in the head
lumbar puncture results indicate…
if blood is drawn from CSF: likely HCVA
done if SAH is suspected but CT inconclusive
25% of CVA pts within the first 24-28 hours post CVA…
get worse
two important VS to monitor post CVA
BP and glucose
if ischemic CVA, administer t-PA within…?
3-4.5 hours of onset
before administering t-PA to an ischemic CVA pt…
insert NGT, foley, and multiple IV’s
after administering t-PA to an ischemic CVA pt…
wait 24 hours before another anticoag. or antiplatelets are given
contraindications for t-PA
- active internal bleeding
- history of intracranial hemorrhage
- intracrainal or intraspinal surgery within 2 months
- structural or vascular malformations
- ischemic stroke within past 3 months
- severe uncontrolled HTN
- significant close-head or facial trauma within past 3 months
- prior tx within past 6 months for streptokinase
maintain what BP for ischemic CVA pts who did NOT get t-PA
only treat if SBP>220 or DBP>120
maintain what BP for ischemic CVA pts who DID get t-PA
- maintain <185/110 in first 24hrs
- <185/105 after first 24hrs
two good meds to use for HTN
labetalol and nicardipine (BB and CCB)
for ischemic stroke pt with hyperlipidemia …
insulin drip
pts with ischemic stroke and SIADH what can you NOT give them
D5W
if ICVA pt is dehydrated…
give albumin, crystalloids for hemodilution
ICVA pt has cerebral edema, give what med?
mannitol and lasix to pull water from head and into vessels then excreted
to manage ICP in ICVA pt…
- elevate head, midline, no hip flexion
- prevent fever
- control pain
- prevent seizures
- prevent constipation
what antiplatelets are given to prevent future clots
- ASA 81-325mg
- ticlodipine, clopidogrel, diprydamole
what anticoagulants are given for clot prevention
rivaroxaban, dabigatran, apixaban
what does MERCI stand for
mechanical embolus removal in cerebral ischemia
- used for future clot prevention
t-PA okay for HCVA pts?
NOOOOOO
what to keep Bp for HCVA pts
SBP<160
what to treat cerebral vasospasms with for HCVA
nimodipine
- not given as normal CCB for BP but only for vasospasms
- give Q4h for days
2 methods of surgical tx for ruptured aneurysm in HCVA
clipping or coiling
clipping tx
uses a metal clip to clip off aneurysm from blood vessel
coiling
placing coiled piece of wire inside aneurysm to reduce the amount of blood flowing inside
stroke rehab initial focus
musculoskeletal function and incorporate psychosocial needs
key to discharge planning
level of independence in performing ADL’s
3 core TJC measures taken for ALL CVA pts
VTE prophy (enoxaparin, fondaparinux)
stroke education (EMS, meds, risk factors)
assess for rehab
why are anticoagulants taken after a CVA
to prevent A-fib
4 surgical therapies for CVA prevention
- LAA occlusion (watchman)
- carotid endartectomy
- transluminal angioplasty
- stenting
carotid endartectomy has a risk of damaging what nerve and causing what
recurrent nerve and causing hoarsness
patho of parkinsons
depigmentation of substantianigra of the basal ganglia and loss of neurons
- depletion of dopamine
motor S&S of parkinsons
tremors (at rest, pill rolling)
rigidity
akinesia
