CVA/Stroke Flashcards
TEMPORARY neurological dysfunction resulting from a BRIEF interruption in cerebral blood flow
TIA
biggest Warning sign for possible future ischemic stroke
TIA
How long do TIA sxs last? What are they (generally)?
resolve within 30-60 minutes –> may last for 24 hours.
—->Visual, Sensory/Perception, Speech, Mobility
What happens to vision with TIA?
Blurred vision
Double vision (Diplopia)
Tunnel vision
Loss of visual field, one or both eyes (Hemianopsia)
Loss of visual field, one or both eyes
Hemianopsia
Sensory Perception Symptoms of TIA
Numbness
Feeling of spinning
Dizziness
Speech sxs of TIA
aphasia and dysarthria
difficulty understanding, reading, writing, speaking
–> not understanding what others say, saying wrong word, using made up words
Aphasia
- speech disorder caused by muscle weakness
- -> Slurred/mumbled speech, speaking softly, sounding robotic, talking too fast
Dysarthria
mobility sxs in TIA
Weakness Lack of muscle control and coordination (Ataxia) Gait Balance Mobility
Lack of muscle control and coordination
ataxia
Causes of TIA
- Carotid Stenosis
- Hardening and narrowing of the artery
- Atherosclerotic plaque buildup
- Atrial fibrillation –>throws clots
What is ABCD assessment tool?
tool to assess risk of TIA becoming stroke in future
- Age >60 years
- Blood pressure>140/90
- Clinical TIA features -One sided weakness increases stroke risk
- Duration of symptoms–> Longer duration = Greater risk for stroke
What increases risk for stroke? (2 key things)
One sided weakness increases stroke risk
Longer duration = Greater risk for stroke
Interruption in perfusion to the brain that results in cellular death.
Cerebral Vascular Accident/Stroke
2 main categories of strokes
- Ischemic
2. Hemorrhagic
2 main kinds of Ischemic strokes
Thrombus
Embolus
This kind of stroke is Caused by an occlusion or blockage of the cerebral or carotid artery
Ischemic
This kind of stroke is caused when a clot forms IN PLACE
Thrombotic Ischemic
Onset of thrombotic stroke
slow- over minutes to hours
What is normal culprit of thrombotic ischemic stroke?
atherosclerosis clot in carotid
Which is more common, thrombotic or embolic?
thrombotic
This kind of stroke is caused a clot that is DISLODGED
Embolic Ischemic
Onset of embolic ischemic stroke?
sudden
Which kind of stroke can lead to hemorrhagic stroke? how?
embolic ischemic
clot goes to small vessels in brain, causes increase pressure on smell vessel –> rupture!
Common causes of embolic stroke?
Atrial fibrillation, mural thrombi, endocarditis, atherosclerotic plaque breakage
This kind of stroke is caused by bleeding in the brain tissue or subarachnoid space when vessel integrity is interrupted
Hemorrhagic
What are the 2 kinds of hemorrhagic strokes
- Intracerebral Hemorrhage
2. Subarachnoid Hemorrhage
This kind of stroke is BLEEDING into BRAIN TISSUE
- Intracerebral Hemorrhage (ICH)
Onset and cause of Intracerebral Hemorrhage (ICH)
- sudden onset
- often secondary to HTN
- Vessel wall rupture > Edema >Irritation > Displacement> Increased ICP
This kind of stroke is caused by bleeding into subarachnoid space b/w pia mater and arachnoid layers of the meninges
Subarachnoid Hemorrhage (SAH)
Onset and causes of Subarachnoid Hemorrhage (SAH)
- sudden onset
- secondary to aneurysm or AV malformation
- more common than intracerebral
What is common after Subarachnoid Hemorrhage (SAH)?
Vasospasms of cerebral arteries common after SAH, causing further damage
What is an AV malformation?
an abnormal angled tangle of blood vessels without a wall without capillary network , which disrupts normal blood flow and oxygen circulation
What is an aneurysm
weakened ballooning spot
Risk factors for stroke
Tobacco, Alcohol, and Substance abuse Obesity Hypertension Diabetes Elevated Cholesterol Oral contraceptives Genetics Age Race American Indian and Alaskan Native Gender Higher incidence in females
–all the usual things
Paralysis on one side of body
Hemiplegia
Weakness on one side of body
Hemiparesis
Diminished muscle tone
hypotonia
Paralysis due to hypotonia
Flaccid paralysis
Excessive muscle tone
hypertonia
Inability to use object correctly
agnosia
Inability to perform a previously learned skills (Motor or speech)
apraxia
Righ hemisphere damage results in….
=Left Sided Hemiplegia/Hemiparesis
- Visual and Spatial Awareness changes
- Sense of Body Position (Proprioception)
- –>Unilateral Neglect
- Disorientation
- Personality Changes
- Impulsive
- Poor Judgement (i.e. big picture)
- Patient usually unaware of deficits
left or right- patient unaware of defecits?
Right hemisphere
Left hemisphere damage results in…
=Right Sided Hemiplegia/Hemiparesis
- Speech & Language
- –>Inability to write (agraphia)
- –>Inability to read (alexia)
- Mathematics
- –>Inability to perform math calcs (acalculia)
- Impaired logic
- Cautious
- Depressed
Involuntary eye movement
(nystagmus)
Eyelid drooping
ptosis
when are you most at risk of severe complications after stroke?
1st 72 hours
Complications post CVA
- Increased ICP
- Vasospasms
- Bleeding
- Glucose abnormalities
- Pneumonia (aspiration, immobility)
- DVT
- Seizures
- Pressure ulcer
increased ICP is secondary to
EDEMA
Signs of ICP
Monitor LOC
Headache?
N/V
Posturing- decerbrate/decorticate - late sign
Seizures
Aphasia
Ataxia
-Changes in sensorimotor status
–> pupillary changes, cranial nerve dysfunction
Cushing triad (late sign)
–>HTN, widening pulse pressure, bradycardia
cushings triad is a sign of
increased ICP
Preventing and Managing ICP
- Elevate HOB
- Reduce noise
- Space care, do not cluster care
- Dim lights
- Hyperoxygenation prior to suctioning
- Prevent hypoxia
- Monitor VS closely
- more stimulation will increace ICP
how long are vasospasms common after subarachnois hemorrhages?
days 4-14
strokes are preventable or not preventable
preventable
ABCS of heart health to prevent stroke
- ASA, if appropriate : do not give w/in 24 hours of TPA
- Blood pressure control
- Cholesterol management
- Smoking cessation
Ways to prevent stroke
- antiplatelet meds
- lifestyle mod
- controlling BP/CBG
Diet for stroke prevention
heart healthy, low saturated fat
most common risk factor for stroke
HTN
Code stroke on unit
Rapid Response Establish IV Neuro Assessment *Note onset of time OR last time they were normal Prepare for CT
Complete Neurological Assessment for stroke
- LOC
- Cognition
- Mobility (gait, balance, movement)
- Sensory perception
- Speech
- Vision
- Sudden, severe headache (SAH symptom)
- Glasgow Coma Score
When caring for a patient with a change in neurological function, always rule out other causes…..
- Hypoxia
- Hypoglycemia
- Hyperglycemia
Focused Cardiac Assessment for stroke + ensure SBP does not exceed _____
- Heart Rhythm
- Valve issues?
- Blood pressure
- Chronic
- Acute–>Acute Hypertensive Response
- ->Ensure SBP does not exceed 180
a systematic assessment tool that provides a quantitative measure of stroke-related neurological impairments
-National Institutes of Health Stroke Scale (NIHSS)
What will happen to Hemoglobin A1C post stroke?
will elevate in pt w/ severe stroke = body attempt to increase O2 to counteract hypoxia
Labs for stroke
- No definitive labs to detect stroke
- Coagulation labs (PT, INR, aPTT)
- Lipids
- BMP
- CBC
- Hemoglobin A1C = will elevate in pt w/ severe stroke = body attempt to increase O2 to counteract hypoxia
What diagnostic test will be used To determine if ischemic vs hemorrhagic , primary way to assess
CT scan
**if negative- assumed to be ischemic
-Magnetic Resonance Angiography (MRA)
Determine patency of arteries
Interventions for stroke are based on
causes and location of event
IV Fibrinolytics (TPA- Altaplase) is given for what kind of stroke?
time to give it?
ischemic!
-admin w/in 4.5 hours
TPA admin exclusions
- > 80 years of age
- Anticoagulant (despite INR)
- Stroke involving over 1/3 of brain tissue supplied by middle cerebral artery
- NIHSS score >25
- Hx Stroke and DM
- Active bleeding
Considerations for post TPA admin
*Monitor for bleeding post TPA administration, no ASA w/in 24 hours, do not remove lines or tubes for 24 hours, monitor BP, angioedema, keep BP <180/110, frequent neuro checks, headache signs
—ischemic stroke can turn into hemorrhagic stroke after TPA admin
Embolectomy
suck the embolism out
Embolization/Coiling
wall embolism area off in aneurysm
Carotid Artery Angioplasty
Widen narrowed or obstructed vasculature
Endovascular Intervention
- Intraarterial Thrombolysis - TPA window ____hours
- Embolectomy - within ____ hours
6, 8
how you dress a stroke patient
> Weak ON, Strong OFF
- Dress weak side first - Undress strong side first
Mobility for post stroke:
patients lean towards ____ side
—-» nurse walk on ____ side
STRONG STRONG
approach patient on side ____ deficits
without
FAST
Face drooping
Arm Weakness
Speech Difficulty
Time to call
CBG will ______ initially after stroke
increase
a CBG > ____ is linked with higher mortality/severity/poor outcomes/infarct size prediction, especially for ischemic stroke
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