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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
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!
26
Common causes of embolic stroke?
Atrial fibrillation, mural thrombi, endocarditis, atherosclerotic plaque breakage
27
This kind of stroke is caused by bleeding in the brain tissue or subarachnoid space when vessel integrity is interrupted
Hemorrhagic
28
What are the 2 kinds of hemorrhagic strokes
1. Intracerebral Hemorrhage | 2. Subarachnoid Hemorrhage
29
This kind of stroke is BLEEDING into BRAIN TISSUE
1. Intracerebral Hemorrhage (ICH)
30
Onset and cause of Intracerebral Hemorrhage (ICH)
- sudden onset - often secondary to HTN - Vessel wall rupture > Edema >Irritation > Displacement> Increased ICP
31
This kind of stroke is caused by bleeding into subarachnoid space b/w pia mater and arachnoid layers of the meninges
Subarachnoid Hemorrhage (SAH)
32
Onset and causes of Subarachnoid Hemorrhage (SAH)
- sudden onset - secondary to aneurysm or AV malformation * more common than intracerebral
33
What is common after Subarachnoid Hemorrhage (SAH)?
Vasospasms of cerebral arteries common after SAH, causing further damage
34
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
35
What is an aneurysm
weakened ballooning spot
36
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
37
Paralysis on one side of body
Hemiplegia
38
Weakness on one side of body
Hemiparesis
39
Diminished muscle tone
hypotonia
40
Paralysis due to hypotonia
Flaccid paralysis
41
Excessive muscle tone
hypertonia
42
Inability to use object correctly
agnosia
43
Inability to perform a previously learned skills (Motor or speech)
apraxia
44
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
45
left or right- patient unaware of defecits?
Right hemisphere
46
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
47
Involuntary eye movement
(nystagmus)
48
Eyelid drooping
ptosis
49
when are you most at risk of severe complications after stroke?
1st 72 hours
50
Complications post CVA
1. Increased ICP 2. Vasospasms 3. Bleeding 4. Glucose abnormalities 5. Pneumonia (aspiration, immobility) 6. DVT 7. Seizures 8. Pressure ulcer
51
increased ICP is secondary to
EDEMA
52
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
53
cushings triad is a sign of
increased ICP
54
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
55
how long are vasospasms common after subarachnois hemorrhages?
days 4-14
56
strokes are preventable or not preventable
preventable
57
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
58
Ways to prevent stroke
- antiplatelet meds - lifestyle mod - controlling BP/CBG
59
Diet for stroke prevention
heart healthy, low saturated fat
60
most common risk factor for stroke
HTN
61
Code stroke on unit
``` Rapid Response Establish IV Neuro Assessment *Note onset of time OR last time they were normal Prepare for CT ```
62
Complete Neurological Assessment for stroke
- LOC - Cognition - Mobility (gait, balance, movement) - Sensory perception - Speech - Vision - Sudden, severe headache (SAH symptom) - Glasgow Coma Score
63
When caring for a patient with a change in neurological function, always rule out other causes…..
- Hypoxia - Hypoglycemia - Hyperglycemia
64
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*
65
a systematic assessment tool that provides a quantitative measure of stroke-related neurological impairments
-National Institutes of Health Stroke Scale (NIHSS)
66
What will happen to Hemoglobin A1C post stroke?
will elevate in pt w/ severe stroke = body attempt to increase O2 to counteract hypoxia
67
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
68
What diagnostic test will be used To determine if ischemic vs hemorrhagic , primary way to assess
CT scan **if negative- assumed to be ischemic
69
-Magnetic Resonance Angiography (MRA)
Determine patency of arteries
70
Interventions for stroke are based on
causes and location of event
71
IV Fibrinolytics (TPA- Altaplase) is given for what kind of stroke? time to give it?
ischemic! | -admin w/in 4.5 hours
72
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
73
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
74
Embolectomy
suck the embolism out
75
Embolization/Coiling
wall embolism area off in aneurysm
76
Carotid Artery Angioplasty
Widen narrowed or obstructed vasculature
77
Endovascular Intervention - Intraarterial Thrombolysis - TPA window ____hours - Embolectomy - within ____ hours
6, 8
78
how you dress a stroke patient
>Weak ON, Strong OFF - Dress weak side first - Undress strong side first
79
Mobility for post stroke: patients lean towards ____ side ---->> nurse walk on ____ side
STRONG STRONG
80
approach patient on side ____ deficits
without
81
FAST
Face drooping Arm Weakness Speech Difficulty Time to call
82
CBG will ______ initially after stroke
increase
83
a CBG > ____ is linked with higher mortality/severity/poor outcomes/infarct size prediction, especially for ischemic stroke
108

kol- Med Surg 320 Spring (43 decks)

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