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kol- Med Surg 320 Spring > CVA/Stroke > Flashcards

CVA/Stroke Flashcards

1
Q

TEMPORARY neurological dysfunction resulting from a BRIEF interruption in cerebral blood flow

A

TIA

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2
Q

biggest Warning sign for possible future ischemic stroke

A

TIA

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3
Q

How long do TIA sxs last? What are they (generally)?

A

resolve within 30-60 minutes –> may last for 24 hours.

—->Visual, Sensory/Perception, Speech, Mobility

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4
Q

What happens to vision with TIA?

A

Blurred vision
Double vision (Diplopia)
Tunnel vision
Loss of visual field, one or both eyes (Hemianopsia)

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5
Q

Loss of visual field, one or both eyes

A

Hemianopsia

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6
Q

Sensory Perception Symptoms of TIA

A

Numbness
Feeling of spinning
Dizziness

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7
Q

Speech sxs of TIA

A

aphasia and dysarthria

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8
Q

difficulty understanding, reading, writing, speaking

–> not understanding what others say, saying wrong word, using made up words

A

Aphasia

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9
Q
  • speech disorder caused by muscle weakness

- -> Slurred/mumbled speech, speaking softly, sounding robotic, talking too fast

A

Dysarthria

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10
Q

mobility sxs in TIA

A 
Weakness
Lack of muscle control and coordination (Ataxia)
Gait
Balance
Mobility
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11
Q

Lack of muscle control and coordination

A

ataxia

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12
Q

Causes of TIA

A
  • Carotid Stenosis
  • Hardening and narrowing of the artery
  • Atherosclerotic plaque buildup
  • Atrial fibrillation –>throws clots
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13
Q

What is ABCD assessment tool?

A

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
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14
Q

What increases risk for stroke? (2 key things)

A

One sided weakness increases stroke risk

Longer duration = Greater risk for stroke

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15
Q

Interruption in perfusion to the brain that results in cellular death.

A

Cerebral Vascular Accident/Stroke

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16
Q

2 main categories of strokes

A
  1. Ischemic

2. Hemorrhagic

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17
Q

2 main kinds of Ischemic strokes

A

Thrombus

Embolus

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18
Q

This kind of stroke is Caused by an occlusion or blockage of the cerebral or carotid artery

A

Ischemic

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19
Q

This kind of stroke is caused when a clot forms IN PLACE

A

Thrombotic Ischemic

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20
Q

Onset of thrombotic stroke

A

slow- over minutes to hours

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21
Q

What is normal culprit of thrombotic ischemic stroke?

A

atherosclerosis clot in carotid

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22
Q

Which is more common, thrombotic or embolic?

A

thrombotic

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23
Q

This kind of stroke is caused a clot that is DISLODGED

A

Embolic Ischemic

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24
Q

Onset of embolic ischemic stroke?

A

sudden

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25
Q

Which kind of stroke can lead to hemorrhagic stroke? how?

A

embolic ischemic

clot goes to small vessels in brain, causes increase pressure on smell vessel –> rupture!

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26
Q

Common causes of embolic stroke?

A

Atrial fibrillation, mural thrombi, endocarditis, atherosclerotic plaque breakage

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27
Q

This kind of stroke is caused by bleeding in the brain tissue or subarachnoid space when vessel integrity is interrupted

A

Hemorrhagic

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28
Q

What are the 2 kinds of hemorrhagic strokes

A
  1. Intracerebral Hemorrhage

2. Subarachnoid Hemorrhage

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29
Q

This kind of stroke is BLEEDING into BRAIN TISSUE

A
  1. Intracerebral Hemorrhage (ICH)
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30
Q

Onset and cause of Intracerebral Hemorrhage (ICH)

A
  • sudden onset
  • often secondary to HTN
  • Vessel wall rupture > Edema >Irritation > Displacement> Increased ICP
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31
Q

This kind of stroke is caused by bleeding into subarachnoid space b/w pia mater and arachnoid layers of the meninges

A

Subarachnoid Hemorrhage (SAH)

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32
Q

Onset and causes of Subarachnoid Hemorrhage (SAH)

A
  • sudden onset
  • secondary to aneurysm or AV malformation
  • more common than intracerebral
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33
Q

What is common after Subarachnoid Hemorrhage (SAH)?

A

Vasospasms of cerebral arteries common after SAH, causing further damage

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34
Q

What is an AV malformation?

A

an abnormal angled tangle of blood vessels without a wall without capillary network , which disrupts normal blood flow and oxygen circulation

35
Q

What is an aneurysm

A

weakened ballooning spot

36
Q

Risk factors for stroke

A 
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

37
Q

Paralysis on one side of body

A

Hemiplegia

38
Q

Weakness on one side of body

A

Hemiparesis

39
Q

Diminished muscle tone

A

hypotonia

40
Q

Paralysis due to hypotonia

A

Flaccid paralysis

41
Q

Excessive muscle tone

A

hypertonia

42
Q

Inability to use object correctly

A

agnosia

43
Q

Inability to perform a previously learned skills (Motor or speech)

A

apraxia

44
Q

Righ hemisphere damage results in….

A

=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
45
Q

left or right- patient unaware of defecits?

A

Right hemisphere

46
Q

Left hemisphere damage results in…

A

=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
47
Q

Involuntary eye movement

A

(nystagmus)

48
Q

Eyelid drooping

A

ptosis

49
Q

when are you most at risk of severe complications after stroke?

A

1st 72 hours

50
Q

Complications post CVA

A
  1. Increased ICP
  2. Vasospasms
  3. Bleeding
  4. Glucose abnormalities
  5. Pneumonia (aspiration, immobility)
  6. DVT
  7. Seizures
  8. Pressure ulcer
51
Q

increased ICP is secondary to

A

EDEMA

52
Q

Signs of ICP

A

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

53
Q

cushings triad is a sign of

A

increased ICP

54
Q

Preventing and Managing ICP

A
  • 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
55
Q

how long are vasospasms common after subarachnois hemorrhages?

A

days 4-14

56
Q

strokes are preventable or not preventable

A

preventable

57
Q

ABCS of heart health to prevent stroke

A
  • ASA, if appropriate : do not give w/in 24 hours of TPA
  • Blood pressure control
  • Cholesterol management
  • Smoking cessation
58
Q

Ways to prevent stroke

A
  • antiplatelet meds
  • lifestyle mod
  • controlling BP/CBG
59
Q

Diet for stroke prevention

A

heart healthy, low saturated fat

60
Q

most common risk factor for stroke

A

HTN

61
Q

Code stroke on unit

A 
Rapid Response
	Establish IV 
	Neuro Assessment
	*Note onset of time OR last time they were normal 
	Prepare for CT
62
Q

Complete Neurological Assessment for stroke

A
  • LOC
  • Cognition
  • Mobility (gait, balance, movement)
  • Sensory perception
  • Speech
  • Vision
  • Sudden, severe headache (SAH symptom)
  • Glasgow Coma Score
63
Q

When caring for a patient with a change in neurological function, always rule out other causes…..

A
  • Hypoxia
    • Hypoglycemia
    • Hyperglycemia
64
Q

Focused Cardiac Assessment for stroke + ensure SBP does not exceed _____

A
  • Heart Rhythm
  • Valve issues?
  • Blood pressure
    • Chronic
    • Acute–>Acute Hypertensive Response
    • ->Ensure SBP does not exceed 180
65
Q

a systematic assessment tool that provides a quantitative measure of stroke-related neurological impairments

A

-National Institutes of Health Stroke Scale (NIHSS)

66
Q

What will happen to Hemoglobin A1C post stroke?

A

will elevate in pt w/ severe stroke = body attempt to increase O2 to counteract hypoxia

67
Q

Labs for stroke

A
  • 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
68
Q

What diagnostic test will be used To determine if ischemic vs hemorrhagic , primary way to assess

A

CT scan

**if negative- assumed to be ischemic

69
Q

-Magnetic Resonance Angiography (MRA)

A

Determine patency of arteries

70
Q

Interventions for stroke are based on

A

causes and location of event

71
Q

IV Fibrinolytics (TPA- Altaplase) is given for what kind of stroke?

time to give it?

A

ischemic!

-admin w/in 4.5 hours

72
Q

TPA admin exclusions

A
  • > 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
73
Q

Considerations for post TPA admin

A

*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

74
Q

Embolectomy

A

suck the embolism out

75
Q

Embolization/Coiling

A

wall embolism area off in aneurysm

76
Q

Carotid Artery Angioplasty

A

Widen narrowed or obstructed vasculature

77
Q

Endovascular Intervention

  • Intraarterial Thrombolysis - TPA window ____hours
  • Embolectomy - within ____ hours
A

6, 8

78
Q

how you dress a stroke patient

A

> Weak ON, Strong OFF

- Dress weak side first
- Undress strong side first
79
Q

Mobility for post stroke:

patients lean towards ____ side
—-» nurse walk on ____ side

A

STRONG STRONG

80
Q

approach patient on side ____ deficits

A

without

81
Q

FAST

A

Face drooping
Arm Weakness
Speech Difficulty
Time to call

82
Q

CBG will ______ initially after stroke

A

increase

83
Q

a CBG > ____ is linked with higher mortality/severity/poor outcomes/infarct size prediction, especially for ischemic stroke

A

108

kol- Med Surg 320 Spring (43 decks)

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